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Did You Know That Concussions Are a Brain Injury? 

As March is also Brain Injury Awareness Month, we will be discussing concussions. Did you know that concussions are actually mild traumatic brain injuries?

Let’s unpack what actually happens during a concussion. 

First of all, a concussion can result from rapid movement such as whiplash, a direct blow to the head/ face/ neck, or indirectly by a significant blow elsewhere in the body that is transmitted to the head. These forces put stress on the brain cells and can cause microdamage. Whenever there is damage to a part of the body, the body responds with inflammation, changes in blood flow, and changes in tissue chemistry. While this body response can help assist healing, it requires a high demand of energy and also reduces the amount of energy and nutrients that the brain has access to due to changes in blood supply. This places the brain in a vulnerable state as the brain has limited resources to function as it heals. 

Once the brain has experienced a concussion it is more vulnerable to repeated injury. Subsequent concussions often have longer lasting and more severe symptoms, so it is important to avoid environments and activities that could expose the child to a second concussion. Therefore, it is vital to reduce the demands on the brain to allow it to rest and heal and minimize the symptoms. A concussion can impact cognitive, physical, emotional, and proper sleep function. 

Some symptoms of impaired Cognitive function include difficulty concentrating, reduced short term memory, feeling in a fog, and feeling slowed down. Physical symptoms of a concussion include headaches, dizziness, fatigue, nausea, sensitivity to light, balance impairments, ringing in the ears, and blurred vision. Emotional impacts include depression, irritability, and lack of interest in favorite activities. These symptoms impact many aspects of daily life like the ability to complete classroom assignments, withstand environments with bright lights, participate in sports and recreational activities, and complete daily tasks at home. 

This is where Physical Therapists can help. We have expert understanding of the healing process of the body and have the tools to assess and treat the individual child’s impairments. 

Below are Five Common Ways that we as physical therapists get our clients with concussions back to doing the things they love and the activities necessary for success at school and at home. 

Educate On Strategies to Promote Rest and Healing

As mentioned above, there is a high energy demand on the brain after a concussion as it heals and there is less access to energy resources due to inflammation and blood vessel changes. This can last up to several weeks. It is vital to allow mental and physical rest so that the body’s resources can be used to attend to the damaged brain. Ways to promote rest are limiting screen time, schoolwork, and recreational activities. Once a child is ready to return to the classroom, there are strategies to adapt the environment to improve reading tolerance and participation in class with less onset of symptoms by using colored films, tinted eyewear, and incorporating a schedule for physical and mental rest throughout the day. 

Facilitate and Guide The Process to Return to Sports

Return to sport activities should be overseen and directed by an informed clinician in order to provide the right amount of rest vs challenge. The sporting environment has a high risk for a second and more severe concussion that can have lasting effects. Avoiding competitive sports and recreational activities is a good way to reduce the risk of repeated injury. Also, if a child is challenged too quickly, their symptoms may last longer as healing is delayed. On the other hand, it is important to provide the “just right” challenge to the young athlete to avoid unnecessary deconditioning. A physical therapist has the expertise to create a plan of care that provides the appropriate amount of progression to return the athlete to his/ her sport in the safest and most efficient manner possible.

Promote Sensory Integration

The normal function of the brain is interrupted with a concussion. This can impact how the brain interprets and integrates sensory information from the vestibular, auditory, visual, and proprioceptive systems. A typical brain automatically takes in all the information that your senses perceive, organizes it, and then helps you to respond appropriately. This complex process of integrating the sensory information provides the child with body awareness, understanding where they are positioned in space, postural control, regulation skills, depth perception, coordination of the eyes, and so much more all while they are simultaneously breathing, moving, multi-tasking, and processing a changing environment. When the brain connections that integrate the sensory information are delayed or interrupted, it can be disorienting and lead to visual and balance problems and sensitivities to varied sensory stimuli. A physical therapist will assess what sensory systems are impacted and will progress the interventions to return the child to unhindered play.

Address any Musculoskeletal Injuries Associated with the Concussion

Often the forces that cause a concussion also result in injury to the neck, spine, or other areas of the body. Sometimes injury and muscle tightness in the neck can even cause symptoms of headaches or dizziness and will benefit from therapeutic interventions to promote flexibility, stability, and strength to reduce these symptoms. Physical therapists are experts at identifying and treating these injuries alongside the concussion.

Restore Strength and Endurance

Since rest and lack of physical activity after a concussion is so important, most children will need to build back strength and cardiovascular endurance to return to the state they were before the concussion. Physical therapists are experts in exercise prescription and provide a plan of care to restore strength and endurance at a pace that meets the “Rest vs Challenge” criteria mentioned earlier.

This information is intended for educational purposes only. Please seek the advice from the medical team that manages your healthcare to manage your personal medical needs. 

https://www.choosept.com/guide/physical-therapy-guide-concussion

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Top 7 Reasons to Supercharge Your Child’s Physical Therapy with the Spider Cage

There are so many reasons why the Spider Cage is a powerful therapeutic tool to integrate into your child’s physical therapy program. If you worry about your child not having all possible opportunities to develop new movement skills, you should try out the Spider Cage during a trial session at our office to see firsthand what your child can do!

Why is the Spider Cage so powerful? Let’s look at 7 reasons that the Spider Cage gives children access to developing new skills and abilities, by supporting them to increase strength, balance, motor control, endurance and sensory processing, all while having sooooo much fun. Remember, fun is really important when it comes to children- if they’re having fun, then they’re LEARNING! Let’s get into those 7 reasons now.

  1. Exploration of New Skills

The Spider Cage is setup where the child wears a belt and the bungees connect to the belt. There are 8 bungees that can be attached to the belt with 2 on each corner.The child can be sitting, on hands and knees, standing, walking on a treadmill or moving between positions. The bungees in the Spider Cage provide support, but they’re also dynamic, so it is a different experience for a child that has been in a stander or a gait trainer. It is also different than having a parent or therapist helping. The child can try out new skills with just enough assist, but they are initiating the movement and responding to what worked and what didn’t work to learn from the experience.

In the video below, you can see the boy practicing standing up by himself without using his hands, which he can’t do outside of the Spider Cage. Over time the bungees can be lowered or only 4 bungees can be used to build more independence, which can then generalize to outside of the Spider Cage.

2. Confidence Building

Many children with movement delays or disabilities develop a learned helplessness from frequently experiencing things being difficult or impossible. Learned helplessness is when you have learned that you can’t do something, so you stop trying. It is an understandable reaction, but one we have to mindful of when guiding children to develop new skills and abilities. The Spider Cage is a fantastic tool for children to experience that they are capable of doing, with just the right support. This can be basic gross motor skills like sitting, standing and walking, or it can be more advanced skills, like hopping and balancing on dynamic surfaces.

The boy in the video initially needed hands on help to perform this motion. He didn’t try to initiate it on his own and needed help to complete the motion. After several times in the Spider Cage, he learned how to transition from hands and knees to standing with the help of the bungees alone. He was so proud of himself and this transferred to him helping more with transitions off the floor outside of the Spider Cage.

3. Safety to Try Higher Level Balance Skills

Children will limit attempts at new skills if they know their body isn’t going to be able to do it reliably and safely. Knowing they can’t fall, the Spider Cage gives the opportunity to try all sorts of challenging balance tasks without the risk of falling and hurting yourself. This way, the kids can work on those advanced skills, flood their brains with novelty and develop more advanced movement control.

In the video below, she challenges herself to move from standing to half kneel while standing on a bolster that rolls side to side. What a challenging task! This would be a risky thing to try holding maybe a trapeze overhead and would have allowed her to rely mostly on her arms, instead of her hips. Doing this activity in the Spider Cage let her work on a high level of hip and balance control and no rely on her arms for help.

4. Sensational Sensations

As we said before, the Spider Cage is a DYNAMIC place to be! The bungees provide resistance and assist to movement, giving intense proprioceptive/deep pressure input to the children’s bodies. All of the movement is very stimulating to the vestibular system in the inner ear as well. The Spider Cage is a great place to put together the postural system with the eyes, vestibular (inner ear), and proprioceptive (information from joints and muscles) to work on improving body awareness and regulation skills.

In this video you will see a boy doing intense jumping, having a BLAST, and regulating his system to do focussed work afterwards!

5. Hands Free Movement

Children who use crutches or walkers for mobility are always using their hands to help manage the rest of their bodies. The problem is that they then become limited in using their hands for other activities, such as carrying something, and they rely on using their arms to initiate movement, rather than using the pelvis, the cornerstone and powerhouse of our bodies.

In this video you’ll se a boy playing basketball where he typically needs a person to help or his hands on an assistive device to be able to do an activity like this.

6. Speed & Power

The Spider Cage gives the support a child needs to be able to work on moving at increased speeds than they could do outside of the cage. It also lets them work on their power with jumping and leaping. The dynamic assist on the bungees give greater access to new skills while decreasing risk of falls at the same time. This allows motor control, strength and endurance to build to support the use of increased power and speed outside of the cage in the future.

In this video, the boy walks 2mph, when he usually walks at a slow pace with crutches, he’s able to explore increased speed. You can see how proud he is at his acomplishment!

7. Play

Play is how babies and children learn! Play in the Spider Cage gives access to children with a limited play repertoire to develop more advanced play skills. Children can jump, kick a ball, throw a ball, and knock down towers. There are so many games children with limited play skills can try out in the Spider Cage!

In the first video below, the boy initially needed assistance from the therapist to stop on the target. With practice he was doing it all on his own and laughing so hard each time!

In the second video, we used the Spider Cage in a completely different way to make a ninja obstacle course with the bungees! The boy is working on his midrange postural control to move over and under while trying not to touch the bungees.

In the 3rd video the boy is playing t-ball! He has the opportunity to be hands free using the support of the bungees to play the game!

Blast off!!!
The ninja avoids the obstacles at all cost!!!
Baseball time!!!
Every kid deserves to knock over their therapist once in a while!!!

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Arts for All!

Participation in the arts are a way for someone to express themselves. It creates a window into the soul and an escape all in one. Some turn to painting, drawing, music, drama, or dancing to find their sense of self or to relieve stress after a long day, and this is no different for kids and adults with Cerebral Palsy (CP). Taking part in the arts is a wonderful thing for children with CP to do, no matter their level of disability, and here’s why!


Self Expression Without Limits

The arts allow for a place to explore what you are thinking or feeling. Whether you are verbal or non-verbal, participation in an art form is a way to get your feelings out! Society often tries to put us in boxes that may make us feel limited. But when you are creating art, you get to make the rules. Bend the rules to work for you

Adaptability

With the free form nature of many arts programs there are no rules that have to be adjusted to make it work for your body. If your dancing includes, moving your head side to side to make your wheelchair turn to the right and the left, do it! If you need something to secure a paint brush to one of your hands or to your head to paint your beautiful picture, why not! It’s your masterpiece, so the environment can be set up to make creating your art that much easier.

Community OR Solitary Art

Many arts are performed in a group setting for those who love being social, like Drama. You can find your Drama, Dance, or Visual Arts community if that floats your boat. BUT the cool thing about the arts is many forms don’t have to be done in a group, they can be done alone too if you’d prefer to work that way.

Confidence Booster

For many kids and adults, taking part in the creation of something beautiful, or something they made themselves, is a huge confidence booster. When the right adaptations are in place to support each child or adult, either with motor or intellectual considerations, the child can make something by themselves (or with a little bit of teamwork if needed) and feel proud of themselves for doing so!

Types of Art

Visual Arts

  • Visual arts include painting, drawing, sculpture and photography, are likely to be the most common of all arts programs designed for people with disabilities.
  • The visual arts are easily modified. A child’s pointer finger, pencils, and brushes can all be adapted to fit their needs by instructors or parents. The most common forms of modifications are handles and grips on paint brushes, pencils and pens; easels that can be attached to a wheelchair or placed on a table. There are even attachments designed for the head in which the artist can manipulate the brush, just as is used on a pointer for the computer.
  • Photography can also be modified to meet various physical needs. Cameras can be attached to wheelchairs so they can remain stable while a person is shooting a photo. It might require some creative thinking, but if the photographer cannot use their fingers, cameras can be placed in such a way that a student can use their tongue to release the shutter.

Dance

  • When many people think of dance, they picture the ballerina trope, but that’s not all dance is, in fact, there are so many styles of dance! This includes modern, ballet, tap, and jazz. In the past years, dance has become so much more freeform than people think. With the dawn of modern dance and creative movement, movement can be whatever you want! The creation of movement is often left up to the dancer OR to the choreographer
  • Movement can be created in many ways. Students in wheelchairs can be pushed by a fellow dancer while they dance in their chair or other times can push themselves in a pattern as part of the choreography. Students can use their crutches or walkers to move, participate in floor mobility, and show off their specific mobility strengths. Choreographers can play into this as well, creating routines that maximize each dancer’s strengths.
  • As Dance is very aerobic, it also provides an outlet to work on mobility, strength, and develop flexibility. It can help those moving to stay fit and healthy. It can also help children with CP work on coordination and balance!

Drama

  • Theater programs for disabled actors provide opportunities to show off their talent. Often, modifications are made to shows that make the performance accessible to actors with disabilities. There are troupes of performers with disabilities as well as productions who participate in inclusive casting. 
  • Theater is often all about building community and putting yourself out there, and for many regardless of mobility status, gives actors the chance to put on a second skin. When you are acting as another person, you get to leave your own troubles behind and step into that person’s life and mind for a few hours. This can be a great escape for anyone, including children and adults with a disability.

Music

  • Music is another way that children and adults with CP can creatively express themselves and can be a great stress reliever. Music, like the other artistic forms discussed above, can be followed, but it can also be created! A child with CP can participate in a piece of music though percussive instruments, can learn to strum the strings of a guitar, and others too. 
  • Music therapy is a great outlet to explore as it not only allows for creative expression but also works on rhythm and timing, social skills, language, and mobility!

But where is there to go in NJ for my child with CP to participate in the arts? Check out these links to find out more!

Dance:

http://kayelynndance.com/chance-to-dance/

http://www.danceinnovations.org/dipf

http://kayelynndance.com/chance-to-dance/

http://www.danceinnovations.org/dipf

Theater:

https://papermill.org/access-for-all

Art: 

https://www.tasoc.org/

Music:

https://www.theconnectiononline.org/com

https://jamminjenn.com

References:

https://www.cerebralpalsy.org/information/activities/arts

https://www.cerebral-palsy-faq.org/art-exhibit-highlights-skills-of-children-with-cerebral-palsy.html#:~:text=Art%20therapy%20stimulates%20expression%20and,intelligibility%20due%20to%20cerebral%20palsy.

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3 Ways Total Motion Release (TMR) Sparks Change with Children with CP

Children with cerebral palsy (CP) undergo intervention throughout their lives. They often receive physical therapy, occupational therapy, and speech therapy for many years in the home, school and clinic settings. Parents are often presented with lots of opinions as to therapy options, medical interventions like botox and baclofen, bracing options, and surgical procedures, such as selective dorsal rhizotomy and lengthening procedures.

Although it is a lot to navigate, parents, you need to know that you are the experts in your children, there is not doubt about that. Many parents will tell me that they feel like they are left to manage their child’s care in a world that speaks a different language that are all giving different opinions. This is not easy! That’s why when we provide care for our families, our goal is to help you manage the big picture and not only provide your child’s therapy. We’re here to support you, guide you, and connect you with resources every step of the way.

In the therapy world, there are so many different treatment approaches out there and often they are filled with big promises. This can add to the challenge of navigating the best care for your child. We know that you want the best for your child and we want to empower you to trust your gut, combined with learning as much as you can, to find the best match of services for your child.

TMR is a treatment approach that can be powerful for children with CP. Rather than tell you so, or even show you someone else’s child, I invite you to come in for a Discovery Visit at our practice to learn how TMR can help your child. TMR is integrated into our intensive therapy programs as well as our weekly sessions. It is an approach that is easily accessible for you to do at home in between sessions, which is a big piece of why it is so powerful- your repetition at home adds on to changes that are made in therapy sessions, stacking up to powerful changes in your child’s ability to breath, balance and move.

There is a reason families from around the world, from South Korea to Saudi Arabia, to throughout the United States, from NY, Virginia and Texas, have worked with us to learn how to use TMR to help their children breakthrough limits and open up new worlds of possibility.

Whether you’re curious or skeptical, we want to talk to you and share with you the future of pediatric therapy with children with CP and other movement disorders! Email us anytime at info@kidpt.com or call/text us at 908-543-4390.

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