W-Sitting

Have you ever noticed your child sitting with both legs out to the side in a w-sitting position? This may not be the ideal play position for your child to maximize strength gains and promote normal development through major gross motor milestones.

So why is this position not ideal? *This position places your child’s hips in maximal internal rotation range of motion causing increased risk of hip problems such as hip dysplasia. On the other hand, this position also stretches out the muscles of hip external rotation causing hip weakness and limited ability to keep the legs in a neutral alignment. Think of a game of of tug of war, both sides of the rope need the same amount of strength to keep the rope in one place, however if one side is weak then the other team will likely win. This weakness and increased range of motion can increase the risk of walking with feet turned inward in pigeon toed position. *Additionally, your child may be using the w-sit position children to maintain a stable posture by locking their hips and lower spine into place, however this limits their ability to perform trunk rotation and use their core muscles properly. Limited trunk range of motion can limit the ability to perform coordinated movements such as cross midline. Furthermore, weak core muscles can limit a child’s ability to balance at an age appropriate level as they do not have the supporting muscles to maintain their posture. How do we fix this posture? It is important to correct this posture as early as possible before it becomes a habit. Try finding a common phrase such as “fix your legs” followed by repositioning your child’s legs into a more ideal position. The more consistent you are with correcting this posture, the more your child will decide to use more choose more preferred playing postures without need for cueing. Ideal floor playing positions include: Tailor sit (Criss-cross applesauce): this posture allows your core and postural muscles to work properly allowing for greater trunk rotation

Side sitting: this posture allows for strengthening on one side of the core with integration of bilateral coordination as one leg is in internal rotation and the other leg is in external rotation allowing for better transitions into and out of this position. Just make sure that your child is sitting like this to both sides!

Prone positioning: having your child play on their stomach can improve back and core strength as well as allow for weightbearing through their arms

Any of these positions allow your child to be in a more optimal position to improve their strength, core stability, bilateral coordination, and hip mobility required to perform motor milestones with less risk of injury or gait abnormality! Morgan Hamlett PT, DPT

The Ugly Side of Therapy...Insurance

Pediatric therapy is a specialized service that has astronomical benefits for children to assist them not only in achieving their highest level of independence at their current age, but also prepares them for their future. There are many numerous positive things we can discuss regarding therapy. However, I would like to discuss the only ugly side today. And that is dealing with insurance. Here is the first reality: Insurance is a necessary evil for most people to be able to afford therapy. With this reality, it means no matter how frustrating it is for the parent or the provider, it is not going away. We must all learn the best ways in which to navigate the insurance system and what roles we each play with the child's best interest at heart. Here is the second truth: Insurance never guarantees payment. Yep, you hear that right. We can verify your insurance and be told you have coverage, however, they always add the disclaimer that "this information is not a guarantee of payment." Great. So what does that mean? It means that each and every policy has different coverage terms. There may be some exclusions on policies for services that are developmentally related (which is ironic when you think about the services we are providing for DEVELOPING children). Some policies may require a pre-authorization by their team, which may or may not be disclosed to your provider when they verify your insurance (again, remember their tag line "this information is not a guarantee of payment"). Third truth: Any phone call to insurance is not going to be short. That goes for all of us; providers and parents. We get your frustration. Our minimum wait time is 45 minutes per phone call. And that is to deal with one child's claims. Now look at the fact that we have over 200 active clients. You can imagine the amount of time we spend on the phone with insurance! So, get comfy and grab a snack to settle in when making your call. Next truth: We are all the child's advocate. As a parent you may have to spend time (sometimes lots of time!) on the phone with your insurance company. The reality is is that you are the policy holder and the relationship regarding your plan is between you and your insurance carrier. As a provider we have very little ability to have them make exceptions or changes to your policy. This is where you will be your child's advocate and spend the time with your provider. We understand that this can be very frustrating, however, this is the role you will play with your insurance provider. Final truth: We are not the bad guys, we are on the same side. As providers we often become the "bad guy" in an insurance situation. If insurance denies your child's claims we will contact your insurance provider to try to understand why and make any corrections or adjustment that we can to get your claim paid. Trust us, we would much rather collect the money from the insurance company than you. However, there may come a point that we cannot fight the claim anymore. At that point, we will need to collect payment for the services we have already provided to your child. This is that financial responsibility part we have in our paperwork. We understand that this is frustrating, but we as a company still need to be paid. Think of it like this, would you eat at a restaurant and then refuse to pay the bill at the end after you have already eaten your food? Most likely not. We are a business in the same way and have already paid that therapist that delivered an amazing service to your child. We understand navigating the waters of insurance can be as varying as the sea; calm on some days and worked up into a frenzy on others. The best part is that we are all on this journey together to provide the best care and opportunities to children.

The Importance of Therapy in the Summer

As we approach the end of another school year, we are closer to the Summer time. Right around this time every year I am asked the same question: "Can we take a break from therapy for the Summer?". The answer is always a resounding "NO!". And why you may ask? Let me share with you the reasons that stopping therapy for the Summer should never be an option. 1. Regression: Regression is the loss of skills that one has already learned or mastered. When a child that has not met and consistently demonstrated the mastery of their goals, they are showing that there are still performance areas that are not up the the developmental age level as expected. Without the consistency and frequency of therapy, their skills that are not mastered will begin to regress. Once therapy is resumed the therapist will need to go back to working on skills that they had already started to make improvements on. This most always ends in frustration for the kiddo. 2. Inconsistency of Schedules: Many children thrive on consistency and predictability. When the Summer arrives they are already lacking a major portion of their routine. Taking therapy out of the picture as well will result in increased frustration and dysregulation. Children can have decreased ability to handle disappointment, have increased outbursts, and a harder time calming down once upset. Routines are very important. Therapy is part of their routine. That shouldn't change. 3. Therapy is not school: Therapy plan of cares are designed with the frequency and duration that the medical professional has deemed are required for your child to meet their goals. Consistency is key to this. It must happen weekly and at the correct frequency. Each child will progress at different rates towards their goals, which is why we have individualized treatment plans. On the flip side, each grade for school has a specific cirriculum for each grade that is set to be completed in 10 months. When the school year is over, the idea is that the goals that were set in the cirriculum have been achieved. They give them a break between the grades as their is a definitive break between goals. Therapy goals are developmentally driven and do not have an end until your child reaches their highest level of independence. 4. Resuming will be HARD: Because children thrive on routines, getting back into the routine of therapy and school come the start of a new school year will be HARD!! For all of you. Therapy is not something that you want to have your child resist coming to because there is so much change happening all at the same time. Hopefully this was helpful information! Work with your therapy provider to help work around vacations and camps so your child can benefit from all the things! Happy almost Summer and cheers to a fun summer of therapy!

What is a Phonological Process?

When a child learns to speak, they often attempt to simplify adult speech into an easier speech pattern. These patterns are referred to as a phonological process. These processes typically occur in the early stages of speech and language development and typically disappear by a certain age. However, when these patterns remain in a child's speech past a certain age, they may need speech therapy to eliminate these speech errors. Examples of Phonological Processes: 1. Final Consonant Deletion: This is the process where a child will leave off the final consonant sound in words. For example, a child might say "ca" instead of "cat" or "do" instead of "dog". This process should be eliminated by the time a child is 3 years old. 2. Cluster Reduction: This is the process where a child attempts to simplify consonant clusters by producing a single consonant. For example, a child might say "pay" instead of "play" or "top" instead of "stop". This process should be eliminated by the time a child is 5 years old. 3. Stopping: This is the process where a child replaces a fricative (/s, z, f, v/) or for a stop consonant (/t, d, b, p/). For example, a child might say "tun" instead of "sun" or "do" instead of "zoo". This process should be eliminated by the time a child is 3 for /s/ and /f/ sounds and 4 for /z, v/ sound 4. Fronting: This is the process where a child replaces a sound that is supposed to be said in the back of the mouth for a sound said in the front of the mouth. For example, a child might say "do" instead of "go" or "tat" for "cat". This process should be eliminated by the time a child is 4 years old. An evaluation by a Speech Language Pathologist may be necessary to assist with diagnosing and treating these phonological processes. By Lindsay Edmonds, CCC, SLP

Facilitating Language in the Home

One of the biggest questions I get as a speech therapist working with younger kids is, “How can I help my child at home?” As a therapist, I almost always have the child take the lead. Follow them around the house and see what they are engaging in. For example, if your child goes to the fridge and points to the fridge you can work on labeling what they are doing or what they want i.e. open, close, milk, juice. We want to make sure we are keeping the phrases short and concise. If a child is currently using one word phrases i.e. “open”. We can say “open” and then slowly expand from there i.e. “open door, open please”. If they are not using any words we can work on giving them options. For example if they go to the fridge and you know they want something to drink we can give them two options, “milk” or “juice”. Say the child points to the milk but does not vocalize it then we would repeat “milk” and then hand them the milk. We want to give the child an opportunity to label if they can, but we don’t want them to get to the point of frustration. Children are like sponges and the more models they are getting in the home, then they will eventually start to use what they are learning independently. Another big question I get as a speech therapist is what toys should I buy for my child? Children are able to play with just about anything in the home! For example you can give them magnets on the fridge and work on language as they play with them. You can work on labeling what the magnets are pictures of (i.e. animals, letters, colors, etc) and work on labeling the actions (i.e. put on, take off, get, give me, etc.) If you chose to buy additional toys for your child, I would focus on toys that do not make sounds or take the batteries out of the toys. By doing this it helps to facilitate a child’s imagination. It will also help children to vocalize more sounds during play i.e. animals sounds: moo, qwack, bah, environmental sounds: vroom, beep, etc.) Christine DeCicco MS CCC-SLP

What is AAC?

By Andrea Esinhart, CCC, SLP Augmentative and Alternative Communication (AAC) is all the ways a person can communicate besides talking. Augmentative means to add to a person’s speech. Alternative means to be used instead of talking. Some people use AAC for a short period of time. Some people use AAC throughout their life. Did you know that everyone uses AAC? Facial expressions, gestures, body language, texting, emails, writing, and social media are just to name a few. There are many types of AAC systems. Options include no-tech (gestures, eye gaze, body language), low-tech (communication boards, switches, fixed devices, picture exchange), and high-tech (speech-generating devices). Speech-generating devices may include an app on an iPad, tablet, iPhone, or apple watch to communicate. There are many individualized options. Many people use the Total Communication Approach (all communication methods available to them) by combining no-tech, low-tech, and high-tech options. Speech-Language Pathologists help find the right AAC system and help people learn how to use AAC to communicate. Occupational Therapists help people access their technology on the AAC system in regards to vision, eye gaze, mounting, and other technologies for access. Multidisciplinary collaboration important in order to assess the person’s functional skills, preferences, environment, and activities of daily living across different settings. Common questions about AAC - Is my child too young for AAC? – No. Research shows that AAC helps people of all ages. You can use AAC early. There are no thinking skills, test scores, or other milestones needed to be reached before AAC can be introduced. Presume competence (believe your child has the potential to use AAC). - Will AAC stop my child from talking? – No. Research shows that AAC improves verbal output. Many children will verbally imitate the AAC device. Robust AAC systems promote reading and writing development as well.

Occupational Therapy at AKT

Occupational Therapy at AKT begins with the belief that each child that we serve is unique and deserves unique services. This belief is set across all that we do and all that we strive to be. Services begin with a thorough evaluation of each child. The assessment tools are choosen to ensure that the proper areas of concern are being evaluated as well as any possible additional performance areas that may be affecting the child. This can include residual reflexes, fine motor coordination, dexterity, visual motor coordination, sensory processing, ADL skills, visual perception, social skills, cognition, and bilateral coordination. Following the completion of testing, therapists will spend time with the caregiver present to collect information regarding history and present abilities. They will spend time reviewing test results and impressions with the caregiver while providing them with their recommendations for treatment.

Once the evaluation is complete, services can be scheduled. Treatment sessions will look different for each session. This can include the treatment approaches as well as the therapist providing them. AKT strongly believes that children benefit from seeing a variety of therapists. There are several reasons for this. The first is that every therapist has a different set of specialties. By having each therapist provide treatment to a child we can ensure that each expert is assessing the child thru their specialists eyes. Another great reason for utilizing different therapists is to ensure that there is carryover for new skills and not just performed for one therapist alone.

Throughout the course of treatment, therapists will communicate and educate the following with our AKT families: 1. Progress towards goals 2. Work/exercises/activities to be performed at home 3. Discharge planning from services once goals have been mastered Although discharge time can be sad for both our kiddos, therapists, and families, it is such an exciting time to celebrate all the hard work that our kiddos have put in to achieve their maximum potential. It is such a magical time to celebrate! We hate see our kiddos leave us but we love when they visit just to say hi!