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Is My Child Clumsy or Could it be Developmental Coordination Disorder?

I have to admit, I’m not the most coordinated person.  You may have noticed the same about yourself or your child.  

The big question parents often ask me is whether their child is on the clumsy end or is there another explanation for it.  

The biggest question to ask yourself is whether your child’s clumsiness is impacting their everyday life.  Is it making them a wallflower on the playground?  Is it making it difficult to make it through a meal without spilling or dropping something?  Is the child tripping frequently or bumping into things?  

Partially because clumsiness has been the butt of so many jokes in media, its often not taken seriously.  The truth is that clumsiness doesn’t naturally improve and can have a really big impact on a child’s confidence and self-esteem.  

Plus, therapy can help!  So if there’s a big problem impacting a child’s everyday life that is making them feel bad and we have the power to improve it, we can’t overlook it!  

Let’s take a look at 2 different people with Developmental Coordination Disorder (DCD), how it impacts their lives, and then we can talk more about how to know when to seek help.

Meet Jane

Jane is a very warm and friendly seven-year-old girl diagnosed with developmental coordination disorder and dyspraxia. She has never had success with academic, gross motor or fine motor activities, and prefers to talk her way out of challenges. Talking she is good at, but only with adults. She has struggled to make and keep friends. 

Jane started a PT program at Kid PT and after two months of participating in a program working on her visual-motor and rhythmic movement skills, her mom reported that not only was she moving better, but she was having so much more success socially.. Mom said, “I can imagine that if you can’t keep up with the kids on the playground, that’s going to affect your confidence playing with the other kids.”

Mom’s observation was so true and impacts so many children everyday. Our innate sense of rhythm runs in the background of everything we do. It affects how we interact with others and how we multitask emptying a backpack at school while saying hello to a friend while smiling and remembering everything you need for the day. The consistent and reliable rhythm of our brain and body supports all of these seemingly mundane tasks that can be overwhelming if you have to think about them every step of the way!

Meet the Professor

I had the opportunity to meet a brilliant 55-year-old professor a few years ago who had struggled with his body his entire life. As an adult, he received the diagnosis of Developmental Coordination Disorder. 

He talked about years of trauma that occurred in gym class throughout his school years and how writing and driving were still next to impossible for him. This man, a PhD and professor, was trying to make healthy changes in his life to manage his overall health. He knew exercise was important, but could never access it because of his lack of coordination. He found swimming to be his personal answer, but wanted additional help to make swimming more successful.

During his evaluation, I identified many sensory and motor deficits that were greatly impacting all of his movement skills.   His vestibular function (inner ear) was impaired, particularly the vestibular ocular reflex, which keeps vision steady as we move through space. His vision was working too hard trying to make up for vestibular impairments, so his balance was decreased at night when vision couldn’t be relied on as much.

He also had postural asymmetries that he was likely relying on for years that were causing musculoskeletal issues, in addition to affecting body awareness.His movement system had never gone on autopilot. He had limited ability to use his hands and feet simultaneously, especially when he couldn’t rely on vision for feedback.

“For the first time in 55 years I think I found someone who actually understands my coordination issues. I have spent a lot of time and money getting nowhere.” Together, we had found the reasons behind his symptoms, and were able to move forward with building a stronger foundation.

Understanding the building blocks of development of the movement system for an adult, who has only experienced failure with the practice, practice, practice approach, can change one’s perspective dramatically.

 Instead of blaming yourself for not trying harder, you can own your challenges, empower your strengths, and begin to move forward. Awareness of his challenges didn’t change his body immediately, but it did change his perception of himself.

What is Developmental Coordination Disorder?

Children with Developmental Coordination Disorder (DCD) are not simply clumsy. DCD is a motor skills disorder that affects approximately five to six percent of all school-aged children. DCD has been described in many ways over the years, including dyspraxia, minimal brain dysfunction, and clumsy child syndrome. The medical community has chosen to use the term DCD as the preferred diagnostic term. DCD occurs when a delay in the development of motor skills, or difficulty coordinating movements, results in a child being unable to perform common everyday tasks. They often have difficulty keeping up with their peers during gross motor play, have frequent falls, and have a hard time doing daily skills, such as zipping and tying shoe laces.

The biggest challenge is often with learning a new movement-based skill, which is a challenge that is experienced throughout childhood. These children are often labeled as lazy (read more about how NOT lazy these kids are here!). They’re often told that if they would just try harder they could do it. In the past, it was often assumed that children would outgrow these challenges, but research has demonstrated that children with coordination problems do not simply outgrow these problems. In fact, these children are at greater risk for being sedentary and less healthy as adults than their peers. These children are also at greater risk for mental health problems. We cannot risk overlooking the struggles of these children. There is too much at risk for their futures!

Children with DCD are constant victims of imperfect practice. These children blend in with their peers well and are often not even diagnosed. Goal-oriented methods help with the practice component, but this is not enough. Life will constantly present new skills, so this creates a constant challenge, especially throughout childhood. In addition to working towards specific skills, we can work on developing a child’s building blocks of movement in order to also “teach the child how to fish.” Building the foundations of movement, rather than just teaching gross or fine motor splinter skills, improves the child’s learning abilities and decreases their reliance on others.

Children with DCD often have low tone, as well. Due to the low tone, it is generally assumed that these children are flexible everywhere. However, when you look closely at their core, the opposite is often discovered. Children with low tone typically don’t develop sufficient three-dimensional control in their core. Without the development of core control, asymmetries often remain and limit the development of core control. Often parents will tell us their kids will just randomly fall out of their seats in school (learn more about why here!).

Children with coordination disorders can vary in their vestibular responses. The vestibular system can be underactive, limiting the child’s ability to develop a strong sense of where they are in space, or the vestibular system can be oversensitive, leading to fear of movement. Low tone and hypermobility can lead to less information going from the joints and muscles (proprioception) and traveling to the brain to tell us where we are in space. Commonly, the visual system will work hard to make up for less teammates in the balance team.

Many children with coordination disorders will have difficulty getting their bodies stacked up with good alignment in order to turn their power on. These kids will often hold their bodies in an alignment that feeds into chest breathing, with their chest shifted up and their back appearing to be arched. This position and breathing pattern feeds into the child’s fight-or-flight system, or sympathetic nervous system, and gives them less ability to use their calming parasympathetic nervous system.

Children with coordination disorders struggle to put all of the pieces of their movement skills and sensory feedback together to be able to combine it with timing, sequencing, and multitasking. Being able to do this is demanded from a student, even in kindergarten! Because of this, beginning school is often the turning point for parents to seek out extra help for their child.

We move through daily life without consciously thinking about how we are moving our bodies. We can walk while daydreaming without bumping into a street sign, and we can sit in a chair without falling off while reading and writing. This may sound natural for many of us, but children with postural deficits use excessive energy, attention, and focus to fulfill all of the expectations they face each day. When our gears are synchronized, movement is automatic and children can focus on higher level skills, whether it is moving through the classroom without bumping into things or learning algebra. Filling in or strengthening these missing building blocks to develop a child’s sensory-motor system can build automaticity in order to multitask and to free the child up for higher cognitive skills. That’s where we can help!

Children with coordination disorders are often called lazy and told they’re not meeting their potential. People assume things will get better as the child gets older and that these are delays that will “catch up.” In the meantime, the child struggles with their self-worth, self-esteem, and mental health. As we said before, research supports that children do not grow out of these struggles, and that children with coordination challenges are typically more sedentary adults with increased risk of cardiovascular and mental health problems. 

Supporting a child’s ability to learn the skills they need in daily life is important, but we cannot fall into the work harder and try harder pit, without also working towards long-lasting change. We can help these children fill in those missing and weakened foundational skills. There are so many ways we can help these children meet their personal potential and protect their mental health, all at the same time. They are working so hard, day in and day out- let’s acknowledge that, support their efforts, and improve their building blocks so that they are building their houses with the strongest foundation as can be.

Top 10 Tips for Parents of Children with DCD

  1. Martial arts and swimming are individual sports that help improve body awareness, sensory processing, and balance. They are sensory rich and can be modified for individual differences.
  2. Explore movement in fun, social, and noncompetitive ways, such as hiking, yoga, and creative movement.
  3. Identify postural imbalances that may be limiting the development of core strength and learn ways to improve postural symmetry..
  4. Provide supports for sitting if the child has difficulty sitting upright, such as a yoga wedge or a towel roll.
  5. Encourage the development of timing using music and movement opportunities.
  6. Adapt the environment for success. Some adaptations include picture schedules, written lists, and typing instead of writing.
  7. Practice listening, looking, and moving at the same time. Play walking and looking games, such as “I spy,” while going for a walk.
  8. Model the use of feedback during play. For example, if you throw a ball and it lands short of the basketball hoop, say “I threw it too soft.” Discuss what you could do differently, try it and discuss whether it was successful. Bring awareness to this process.
  9. Backward chaining is a way to learn how to complete a task by working backwards from completion. The child first does the last step to complete the task. Next, they would try the last two steps. The child can build this until they are independent with the entire task.
  10. Team up with a PT or OT specialist to work on the foundations of movement so that practice is more effective and successful!

Getting Help

If you see your child is working harder than other kids to get through their daily activities, don’t wait to look for help. You also don’t need an official diagnosis to get help. Reach out to us at KidPT and come in for a Discovery Visit. We will listen to your concerns, do a screening of your child and their movement skills, and help you make a plan. We’re here for you!

References

  1. Zwicker JG, Suto M, Harris SR, Vlasakova N, Missiuna C. Developmental coordination disorder is more than a motor problem: children describe the impact of daily struggles on their quality of life. Brit J Occup Ther. 2017:030802261773504. 10.1177/0308022617735046.
  2. Sugden, D A, Chambers, M, & Utley, A. Leeds Consensus Statement 2006.
  3. Cousins M, Smyth MM. Developmental coordination impairments in adulthood. Hum Move Sci. 2003;22(4):433–459. doi: 10.1016/j.humov.2003.09.003.
  4. Wilmut K, Du W, Barnett AL. Navigating through apertures: perceptual judgements and actions of children with developmental coordination disorder. Dev Sci. 2017:20(6). doi: 10.1111/desc.12462.
  5. Missiuna C, Moll S, King G, Stewart D, Macdonald K. Life experiences of young adults who have coordination difficulties. Can J Occup Ther. 2008;75(3):157–166. doi: 10.1177/000841740807500307.
  6. Fitzpatrick DA, Watkinson EJ. The lived experience of physical awkwardness: adults’ retrospective views. Adapt Phys Act Q. 2003;20(3):279–297. doi: 10.1123/apaq.20.3.279.
  7. Lingam R, Jongmans MJ, Ellis M, Hunt LP, Golding J, Emond A. Mental health difficulties in children with developmental coordination disorder. Pediatrics. 2012;129: E882–91.
  8. Hill EL, Brown D. Mood impairments in adults previously diagnosed with developmental coordination disorder. J Ment Health. 2013;22:334–40.
  9. Harrowell I, Hollén L, Lingam R, Emond A. Mental health outcomes of developmental coordination disorder in late adolescence. Dev Med Child Neurol. 2017;59(9):973‐979. doi:10.1111/dmcn.13469.
  10. Cairney J, Hay J, Veldhuizen S, et al. Trajectories of cardiorespiratory fitness in children with and without developmental coordination disorder: a longitudinal analysis. Brit J Sport Med. 2011;45:1196-1201. 406/mojsm.2018.02.00054.
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Watch Your Back: It’s Scoliosis Awareness Month

Hi all! We know June for being the last month of school and the month where summer fun begins, BUT did you know June is also Scoliosis Awareness Month? Yes! June is the month where we highlight Scoliosis, a diagnosis that affects so many kiddos (and adultos☺️) across the world. So, for Scoliosis Awareness Month, we wanted to bring you all some information about Scoliosis, what it is, and how Physical Therapy can help! 

What Is Scoliosis?

Scoliosis is a diagnosis that involves a curvature of the spine, the bones that run along the middle of your back. If a child is affected with scoliosis, as they grow, their spine will begin to curve in either the cervical, thoracic, or lumbar spinal regions, aka the neck, upper back and lower back regions. Changes in the spine’s natural anatomy create imbalances in the body that may cause your child’s shoulders, shoulder blades, hips, or ribs to look unlevel or uneven. It may also cause their spine to appear curved when bending forward, may affect their overall mobility, and may create back pain later in life if left untreated. If a child’s scoliosis is very severe, it can also affect the shape and growth of their internal organs, like the lungs or the heart. 

Scoliosis Types

There are four different types of scoliosis: idiopathic, neuromuscular, congenital and degenerative. Degenerative scoliosis is often diagnosed above the age of 65 due to normal wear and tear on the spine and surrounding joints. Congenital scoliosis occurs as a result of spinal or rib deformities present at birth. Neuromuscular scoliosis can occur when a child has a neuromuscular condition, like cerebral palsy or muscular dystrophy. With Neuromuscular scoliosis, as the child grows, their muscles pull on their bones as they move and continue to participate in developmentally appropriate activities. When a child has a neuromuscular condition, they might not be moving with similar movement patterns or frequency to a child that is developing typically. This means that their muscles are not pulling the same way on their bones as a typically developing child’s muscles are, and this can cause their bones to grow abnormally, creating a potential for scoliosis. 

Most Common Form of Scoliosis

Adolescent Idiopathic Scoliosis is the most common form. It can be a confusing diagnosis for families to receive because it is often unknown as to why the spinal scoliosis is occurring in the first place. Medically, doctors will often recommend either a “watch and see” approach, monitoring the spinal curvature to see if it is progressing or staying the same. If a scoliotic curve is on the more severe side, or continues to worsen with time, doctors will often recommend bracing to try to prevent the curve from continuing to worsen or will recommend surgery to correct the curvature. Doctors will usually also recommend Physical Therapy, and that’s where we come in! BUT, you don’t need to wait- starting Physical Therapy at the first signs of scoliosis can prevent it from progressing in the first place!

Tips for Parents

What are some signs that you should ask your child’s pediatrician or a physical therapist about scoliosis?  Take a look at your child from behind without a shirt on.  Look at your child’s shoulders, shoulder blades, and hips.  Compare the left and right sides looking for one side higher than the other.  If you see any asymmetries between the two sides of the body, that is a sign to have it looked into by a medical professional.

How PT Can Help Your Child

In PT, we will work with you and your child as a team to help decrease any soft tissue and muscular tightness that may be pulling on your child’s spine while they are growing. We will also work with your child to improve their core strength so that as they continue to grow and improve their mobility, their body can better support itself to control and maintain their new, more-symmetrical posture. If they are having trouble holding a more symmetrical, stable posture while sitting at their desk in school, a physical therapist can also help improve your child’s postural endurance and offer solutions to help improve their sitting posture so that they can sit while supporting their body in class.

Putting It All Together

We understand that scoliosis can be a very scary diagnosis, especially when your doctor starts describing the ways it may affect them and about your treatment options. Through treating kiddos with mild to severe scoliosis, we have found that acting quickly and starting PT as soon as your child receives a diagnosis of scoliosis is the most effective way to help prevent future progression of their spinal curve. We are here to support you through the decision making process and to help provide therapy that will work to improve your child’s body through movement in a way that is friendly and fun! 

Call Us -We are here for your family ☎️

If your child has just been diagnosed with scoliosis, or is being watched for scoliosis and you would like to be more proactive with their care, reach out to us with questions and to schedule a free Discovery Visit so that we can see if physical therapy here at KidPT is the right match for you and your child. 

References: https://www.btetechnologies.com/therapyspark/4-types-of-scoliosis-and-their-interventions/

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Father’s Day Monkey Business!

Happy Father’s Day to all of our amazing Kid PT Dads!

Dads know just how to bring a laugh and a giggle to the moment.

Check out these ideas to bring some movement fun to celebrate how much your kiddo loves you on Father’s Day!

First, hold each other’s hands. Can you lift one foot and hold it? Try taking turns closing your eyes and see if you can still both keep your balance. Add in singing a song together like the ABCs and see if you can balance all the way to Z.

Next, have Dad get into the Downward Dog position! How many times can the child crawl under, run around to the start, and climb under again! Let’s really challenge Dad with this one!

Finally, its time to fly! There are many fun ways to do this, from piggyback rides to holding the child and zooming around the house. My favorite way is for Dad to lie on his back his his hands and feet up. Dad puts his feet on the child’s belly, holds the child’s hands, and lifts them up! This is so much fun, just be careful. Be sure there is nothing nearby the child can fall on and only go as high as you can control.

What other movement adventures can you have today?

Did you go on a bike ride together, go on a hike or walk to the park?

Have a Happy Father’s Day!!!

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Outdoor Backyard Gross Motor Fun!

The kids are getting out of school, the weather is getting VERY warm, and many families are looking for things to do! Many people are starting to think about backyard barbecues and other fun, family friendly activities as we picture our summers! Don’t forget to include some gross motor fun into your next backyard barbecue extravaganza. These activities below are sure to keep your kids moving and having a blast!

Sack Races

Sack races are so much fun and allow kids to jump, jump, jump to the finish line in a way that engages their competitive side and gets all of their energy going! Jumping with your legs together is a great way to work on coordination and strength while getting a little bit of that extra energy OUT! If you think this would be a fun idea, you can buy sacks for outdoor racing here:

Movement Circle

Have all the children stand in a big circle, where they can all see each other! In a movement circle you can play fun games like “Pass the move” where every child does one move and then everyone repeats the move. These moves can be linked together to form a whole mini dance to keep kids moving and grooving in a funky way! In the circle, they can also move along to kids music specifically created for movement, like “Simon Says”, “The Hokey Pokey”, and “Animal Action”. Look for children’s movement songs on YouTube, Spotify, or other music Apps. There is also a whole YouTube channel of children’s movement songs through GoNoodle too, if your child loves silly characters! Here are a few links to some fun ones: 

Simon Says

Hokey Pokey Freeze

Animal action: https://www.youtube.com/watch?v=30ePPeUbwSs

The Floor Is Lava Dance

GoNoodle’s YouTube Channel

Building an Obstacle Course

For this one, have each child choose one item they want to put in their obstacle course (so that no one is touching the same items). Have them make up a specific rule for how to use their part of the obstacle course and have each child explain that rule to their friends. By the end of all the explanations and the building process, they will have created a full obstacle course as a team! This will help them use their creativity and collaboration skills before each of them jumps into action to move through their creation, helping them to work on strength and coordination too!

Hopscotch

This old classic is great for working on jumping and hopping, and makes kids switch feet on every step, so it is also great for coordination. It can be set up with simple sidewalk chalk on a driveway or blacktop at the park. Jumping between numbers can be made even more fun and tricky if you ask the children to skip certain numbers, say their top ten favorite animals with every jump, or come up with their own wacky pattern for jumping through the squares.

Have fun out there everybody, keep moving, and enjoy the start to your SUMMER! Let us know @Kidpt on Instagram and @KidPTNJ on facebook or by emailing us at info@kidpt.com to tell us how these outdoor games worked out and if you want more fun ideas for how to keep your kids moving this summer! 

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Spring Exercises: Garden Edition

There is so much nature and wonder to experience in a garden.  Here in the KidPT garden, we invite your kids to participate in shoveling the soil, transferring dirt with a wheelbarrow, jumping over the rows of vegetables, imagining they are earthworms tilling the soil, shading the garden as nearby trees, and invading the garden as clever rabbits. 

Shovel the Dirt

  1. Have your child stand on a pillow with a pile of cotton balls (or any small item) on the right and an empty bucket to the left
  2. Use a small beach shovel or kitchen spatula or tongs and have your child squat to pick up the balls and then transfer them into the bucket one at a time. 
  3. Then switch and place the cotton balls on the left and the bucket on the right

Wheelbarrow

Have your child assume the wheelbarrow position by pushing up through their hands on the ground and have a sibling or friend hold them at their knees. The child on the ground will walk forward on their hands while the other child follows them supporting their lower body in the air. Then have them switch roles. If the child’s back is arched (aka the stomach is dipping downwards towards the floor and is lower than the chest and ankles), make it easier by holding them closer to their trunk until they can keep their back straight. Too easy? Hold the child further from the trunk and as close to the ankles as they will tolerate.

Jump Over the Rows of Vegetables

Line up pillows or rolled up towels on the ground and have your child jump over them. Have them name the row of vegetables that they are jumping over as they jump. Switch it up by having them jump sideways and backwards too.

Earth Worm

Start in a standing position and have your child slowly lower their hands down to the ground in front of their feet. Then walk their hands forward as far as they can with their feet planted on the ground. Then walk their feet up towards their hands. Repeat as they squirm their way across the room. 

Tree Pose

Have your child stand on one leg and rest their other leg’s foot on their inner thigh. Once they gain their balance in this position, have them wave their arms in the wind just like a tree. Who can make a tree with the largest branches? Too hard? Instead, have your child place one foot on a step that is in front of them.

Rabbit Under the Fence

Set up the imaginary fence by extending a long piece of tape or string from one kitchen table leg to another ( or any stable surface) at about a foot height off the ground. Then have the kids take time to army crawl under the imaginary fence to the garden. 

What are your family’s favorite garden activities and plants to grow? 

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Arthritis Month: Is it growing pains or is it something more?

Juvenile Idiopathic Arthritis 

May is Arthritis month! Why are we talking about Arthritis? Well, it’s not a diagnosis that only affects adults, it affects kids too. Juvenile Idiopathic Arthritis is a diagnosis that affects kids of many ages, both young kids and older teens too. Unfortunately, Juvenile Idiopathic Arthritis (JIA) is sometimes passed off as “growing pains” by some medical professionals when a child complains of joint pain. This is seen to happen more frequently with older children or young teens complaining of joint pain because at this time in their lives, they are going through large periods of growth and physical development. Sometimes it is just growing pains, but sometimes it might not be! We wanted to give parents and therapists a guide so that you can recognize when signs and symptoms of JIA might be present and know who to seek out for help if you think your child might be showing some signs and symptoms of JIA.

What is Juvenile Idiopathic Arthritis?

JIA (also known as Juvenile Rheumatoid Arthritis), causes joint stiffness and joint swelling, also known as inflammation. JIA affects one or more joints for at least 6 weeks or more in children who are 16 years old or younger. JIA is different from Adult Rheumatoid Arthritis, because symptoms can decrease or go away completely as they get older BUT it can affect how a child’s bones develop as they grow. 

What causes Juvenile Idiopathic Arthritis?

JIA is an autoimmune disease. An autoimmune disease can occur when the body’s immune system becomes overactive and begins to attack its own healthy tissue. In JIA, the primary tissues that are affected are bone and cartilage around the child’s joints. When this begins to happen, it can happen chronically or episodically. If a child’s JIA symptoms are chronic, they have them most to all of the time where as if they are episodic, they may go through flare ups where their symptoms get worse and then have periods where they have no symptoms at all. 

What symptoms do children with JIA have?

Children with JIA primarily have symptoms related to their joints like swelling, stiffness, and pain. The joints that are most commonly affected are the knees, hands, feet, ankles, shoulders, and elbows, but the spine and hips can also be involved. Pain and swelling are often at their worst in the morning or after a nap. Children can also have decreased appetite, poor weight gain, slow growth, eye inflammation, and fatigue. In systemic JIA, children can also present with a high fever, rashing, and swollen lymph nodes. The tricky thing is that some of these symptoms can seem like other illnesses or health conditions so it is important to make sure your child is seen by their primary doctor and a rheumatologist for appropriate diagnosis.

Do kids with JIA benefit from Physical Therapy?

Yes, They absolutely do! Physical Therapy is essential for kids with JIA to help preserve joint function and to help strengthen the body to better support the joints. When a child has JIA, strengthening has to be done carefully so to not overstress the joints, and PTs have the expertise to help guide you and your child away from activities and sports that may be harmful for your child’s joints and toward more helpful activities. In acute phases of JIA, when your child is exhibiting a flare up of their symptoms, PT helps to maintain their joint range of motion, prevents muscles from getting too weak, and helps protect their bones from getting weak too. When your child is not experiencing a flare up of pain and stiffness, PT will help improve your child’s gross motor skills, especially ones that may have been limited due to their pain and decreased range of motion, so that they play and move with more freedom and confidence. If a child has a more chronic form of JIA, physical therapy will also help to achieve new mobility goals while making sure to keep their pain levels low and to prevent increased swelling.  

If your child has a diagnosis of JIA or if you think there is a possibility they may have JIA, talk to your child’s primary care doctor about whether or not they believe JIA is a possibility and what your next steps should be. If your child is experiencing joint pain, they may benefit from physical therapy for all the reasons discussed above and more. Our therapists at KidPT can help give you more information and can take a look at your child to see if physical therapy would be an appropriate next step to help their body grow and develop in the healthiest way possible!

If you want to learn more about the different types of JIA, the process for diagnosis for JIA, and more, click to read the article below:

https://www.hopkinsmedicine.org/health/conditions-and-diseases/arthritis/juvenile-idiopathic-arthritis

References:

  1. https://www.hopkinsmedicine.org/health/conditions-and-diseases/arthritis/juvenile-idiopathic-arthritis
  2. Rhodes, V. J. (1991). Physical therapy management of patients with juvenile rheumatoid arthritis. Physical Therapy, 71(12), 910–919. https://doi.org/10.1093/ptj/71.12.910 
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Mother’s Day Musings

Happy Mother’s day to all our moms. Today we celebrate the unmatched and superhuman strength of mothers. Motherhood comes in many forms from biological to adoptive to a grandparent caregiver to legal guardian to working mom to stay at home mom to single mom to military mom and so much more.

Every mother is different and has their own strengths and weaknesses, but we want to applaud you and encourage you for all you do. 

Raising a child is the most vulnerable, life-giving, exhausting, and worry-filled adventure we can go on. From the extreme highs to the devastating lows, it can feel indescribable. But our legacies are the children we love and support so that they can live a life of joy and meaning. 

On this Mother’s Day we are celebrating a few of the many strengths of moms. Today is a day to just honor and acknowledge who you are day in and out. No need for tips, tricks, or advice today as you are enough, mom. 

Emotional Strength

You deserve to be applauded for the emotional weight you carry in your home. It can be hard to be the emotional reservoir for an entire family. It can seem that you are always worrying about something as a mom whether it’s managing their schedule, academics, nutrition, health care, transportation, sleep, etc. Sometimes the constant thoughts and the emotional weight can take a toll on you and all you can do is just sit on the couch in mental exhaustion. This is no sign of weakness when you consider the strength and endurance it requires to constantly carry and nurture your family’s needs. 

Physical strength

The physical strength needed to be a mother is nothing short of extraordinary. From the physical expense of carrying a child in the womb and the physical changes that your body undergoes while nurturing your baby’s life to the physical demands of carrying, bathing, cleaning, feeding your child and managing your household. Sleep often becomes a long lost friend from sleepless nights caring for your infant to catching up on “me time” or other tasks while the kids are in bed. There is nothing like the physical strength of a mother to overcome these hurdles in order to provide for the needs of herself and her family.

Resilience 

Every day comes with its own journey, victories and disappointments. Parenting is a marathon and it may feel hard to see the progress of your parenting each day. Despite this, you push on and do your best to remain hopeful and engaged. It may seem the values you are trying to teach your children are not taking root and that your efforts are ineffective. But how sweet it tastes when you are awarded little glimpses of your children practicing strategies that you have been intentionally trying to instill in them, whether it’s noticing their kindness in how they treat others or signs of their developing bravery, emotional intelligence, and self regulation. You are resilient and your children will learn to be resilient through your example. Don’t underestimate the moments when you help them conquer their fears and how you make them feel heard and understood when they are struggling. It’s all too common for mothers to look around and convince themselves that everyone else is doing life better and that other mothers always do the right thing. It’s normal to have these feelings and doubts and to perceive that your world is in chaos. It is hard to figure out which route or philosophy to take with parenting and it is easy to feel overwhelmed. Despite this negative self talk, things are going better than you imagine and your kids are thriving from your strength and resilience. 

From our families to yours, we hope this Mother’s Day you feel seen, affirmed, and loved.

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Top Tips for the Sensory Savvy Parent

Savvy parents know that every child has their own sensory preferences and things they avoid. Whether it is picky eating, not liking the seams in socks, or having a hard time sitting still because the child’s body has the wiggles, every child has their own sensory world. Every adult has their sensory preferences too, but we learn to manage our needs by taking walks when we need to wake up a bit, chewing gum to stay focussed, or shaking our foot while listening to a speech.

Every child will have their own personal sensory profile, but when is it time to get help. When sensory preferences are impacting daily life, that’s a good time to seek help from an occupational therapist or a physical therapist.

Below we’re going to introduce the difference sensory systems and give you some tips to start figuring out what sensory strategies will help your child.

Proprioceptive System

Kids who seek out rough play, jumping and/or crashing, or our kids who like to lie down on the ground a lot may need more input to this system.  It helps us to sense movement and organizes our bodies to help with coordination, body awareness and spatial awareness.

TRY activities that involve:

Vestibular System

Kids who appear to seek constant movement, are risk takers and like to be upside down may need more input to this system.  Some kids may look more sedentary or lethargic and may also need some vestibular activation! This is another movement sense, it is related to our head position in space, and gives our bodies information about balance and is closely related to our visual system. 

TRY activities that involve: 

Tactile Input

Kids who are constantly touching and fidgeting may need more input in this area.  Kids who are extra sensitive to seams or clothing, or avoid getting messy might be on the opposite side of  tactile processing.  It refers to our sense of touch, and can impact all areas of function from eating to walking to feeling the  nuances of toys and materials during self-care and play.

TRY activities that involve: 

Auditory Input

Kids who are constantly humming, yelling, and making other noises, they may need more auditory input than other children. Kids who zone out, seem to ignore you, or struggle to shift from one listening to another listening cue/instruction (or for example, respond to their name). 

TRY activities that involve: 

Visual Input

Kids who require more visual input may look closely at objects. They may seek out moving or spinning objects. They may have difficulty focusing on information presented visually.   On the other end, lights might be too bright or the child may struggle to adjust to lighting changes, or become overwhelmed incertain lighting, like fluorescents. 

TRY activities that involve: 

Olfactory and Oral Sensory Systems

Kids seeking out input to these systems may lick or smell objects like crayons or toys. Chewing also provides proprioceptive input, so kids may bite or chew on objects (think pencils or shirt collars).  May be averse to tastes or smell, picky eaters tend to be sensitive in this area. 

Links to some of our favorite sensory products:

Need some more help finding sensory savvy solutions for your child! Reach out to us at info@kidpt.com and schedule a FREE Discovery Visit with one of our therapists to learn more.

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Autistic Voices: In Their Own Words

When learning about any topic, you can only learn so much from studying the academic literature. For example, if I want to understand Italy I can only learn so much from a textbook. In order to truly better understand Italy, It is vital that I actually go to Italy and experience first hand the climate, the weather, the people, the food, and the culture in varied settings and at different times of the year. Some things can’t be taught, they need to be experienced.

Why don’t we also do this with people with special needs and specifically autistic individuals? 

We may learn the physiology, the outward signs and symptoms, and theories on how to address and “treat” autistic people, but we will never truly understand autism by only relying on an outsider’s perspective. It is vital to listen to autistic voices in order to better understand, support them, and create an inclusive environment.

As autism is a spectrum and no two autistic people are the same, it is important to experience the perspective of a variety of people; from those who are non-verbal to those who have more asperger-like symptoms, those who have more physical limitations to those with more cognitive impairments,  and from the young to the old. With that in mind, we will be discussing two books: “Fall Down 7 Times and Get up 8” by Naoki Higashida and  “Look Me in the Eye: My life with Asperger’s” by John Elder Robison. 

Naoki Higashida wrote the book “The Reason I jump” at age 13 which has been translated from Japanese to over 30 languages. Through his works he has provided the world with the inner voice of a nonverbal child and now adult with severe autism. “Fall Down 7 Times, and Get Up 8” is an incredible book in which he shares wise insight, in depth descriptions of his thought processes, and also clever, creative writing. Naoki has a refreshing and enlightened outlook on life and his autistic diagnosis. He covers topics ranging from inexpressible gratitude for his family to the thought processes he uses to register what the sound of rain means to empathizing with his grandfather’s dementia. Despite the obstacles he faces as a nonverbal autistic individual, Naoki is determined to live with purpose and self love.   

John Elder Robison is an autistic man born in the late 1950’s who was undiagnosed until much later in life. His book is a captivating memoir of his extraordinary life as he makes it to the big time in the music industry, the corporate world, and then owning his own car service and dealership company while finding his niche in the world as a neurodiverse individual. He discusses the challenges of not knowing why he was different from other people and repeatedly claims that his childhood and early adulthood would have benefitted from a knowledge of his diagnosis. 

3 Takeaways from Both Books:

Autistics prefer to be alone: Debunked

Although it is a common trend for those with autism to isolate, that is more of a response to frustration than a desire to be alone. We all have experienced the pain of not fitting in and feeling uncomfortable in our skin and how all we wanted to do in that moment was run away. Those with autism, in self-preservation can do the same. The heart-breaking reality is that neurotypical people often grow out of this phase as they have more social tools available to them, while those on the autism spectrum, if not properly socialized and made welcome in a community, can find themselves isolated. Communication is a tool most people take for granted and underestimate. At the deepest levels of who we are, we crave to be known and to know others. It really is what life is about and autistic people are no exception. Communication is what makes that possible. John Elder says that he can’t speak for other autistics, but that he never wanted to be alone. He explains that due to repeated failure with attempts to connect with people, autistics are at risk to turn inwards and withdraw from others. Naoki describes wordlessness as a “soul crushing condition” and the loneliness is agony. But this loneliness can be interrupted as he goes on to explain that “if there is a single person who understands what it’s like for us, that’s solace enough to give us hope.” Naoki describes that just being in the presence of his family brings him comfort. He describes, “and from my face and reactions you wouldn’t know that I’m enjoying myself, but just watching my family being a family brings me great pleasure.”

Autistics want acceptance 

Naoki believes that he has his positive outlook on his autism because his parents were neither in denial of his autism or limited his potential because of it. They allowed him to dream, make choices, and respected his feelings. They treated him with the expectation that he was capable of more and provided him with relevant resources. They loved, dreamed with, and accepted him. It is natural to want the best for someone with autism and try to help them or even fix them. Naoki and John Elder agree that the deeper need is not to be fixed, it is to be loved and accepted for who they are, as they are. Naoki said, ““Love and only love makes whole the heart of those made desperate by loneliness.” Naoki’s advice is simple. Do as his parents did: “please lend us that support as we strive to live in society.” 

Autism is a communication disorder

Although someone with severe autism may not be able to show typical outward signs of understanding, it does not mean that they do not listen or have an inner voice that wants to communicate. Autism “may look like a severe cognitive impairment” but “it is a sensory processing and communicative impairment.” The old adage, don’t judge a book by its cover, is an important lesson to remember when spending time with someone with autism. Naoki gives us a sober insight that, “we are listening to everyone around us, & we hear you, you know.” He describes how demoralizing it can be when people speak about him as though he is not in the room. Everyone deserves to be treated with respect and dignity. 

Likewise, John Elder provides insight into why interactions and conversations with neurotypical people can be challenging and why his responses and actions can often be misinterpreted as socially inappropriate. He has a gifted way of describing his logical thought process which contributes to his difficulty reading social cues, engaging in small talk, and interpreting the intention behind the words of others. He explains that sometimes people have less compassion for him because there is no outward sign of his conversational handicap, but instead see him as arrogant or psychologically unstable. He suggests that with a deeper and broader understanding of the autism spectrum, the general public will be able to create a better and more inclusive environment for the neurodiverse.

To those of you reading this who communicate often with someone with autism, I want to encourage you. Yes, this is difficult, yes we will make mistakes, and yes, at times our frustration can get the best of us. But we need to remember that even if we don’t say or do the right thing all the time, the important thing is we love, respect, and accept autistic people for who they are. 

Referenced below are the books covered and others like it. 

References:

“Fall Down 7 Times, and Get Up 8.” Naoki Higashida, KA Yoshida, and David Mitchell

“Look Me in the Eye: My Life with Aspergers.” John Elder Robeson’s Book, 

Further Reading: 

“The Reason I Jump.” Naoki Higashida, David Mitchell, and Keiko Yoshida

“Carly’s Voice: Breaking through Autism.” Arthur and Carly Fleischmann

“How Can I talk if My Lips Don’t Move? Inside My Autistic Mind.” Tito Rajarshi Mukhopadhyay

“Born on a Blue Day: Inside the Extraordinary Mind of an Autistic Savant.” Daniel Tammer

“Pretending to be Normal: Living with Asperger’s Syndrome.” Liane Holliday Willey

“Thinking in Pictures.” Temple Grandin

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What Does Movement Have to Do with Autism?

What does movement have to do with Autism, you ask? In short, EVERYTHING! Movement is the way we interact with our environment, one of the ways we make sense of all the information around us, and the way we turn our will into action! Even something that seems so based in the brain, like writing or typing our thoughts down, involves movement to actually get those thoughts onto paper or into a computer. 

But what if the wiring in your brain telling your body to move a certain way wasn’t communicating that information effectively?

Or what if the information you were getting from your environment, like the sights or feelings around you were coming in as too bright, too sharp, or not clear enough?

What if you couldn’t necessarily tell where your body was in relation to your environment or where your legs and arms were while walking around?

It would be so much harder for you to get around without knocking into things, to react to your environment in the safest way, move the way you wanted, and keep your stress level down while doing all of these things, right?!

These are just some of the small or large mountains that a person with Autism needs to climb on a daily basis to feel like their normal selves and to engage with our crazy world. Movement can be overwhelming and difficult to coordinate or extra movements may be necessary to feel where their bodies are in space. With the many lenses we can look through from a therapy perspective, we often land on the tie between Autism and movement and want to discuss the connection and why children with Autism may be inclined to move more and to move in their own individual way.

Movement to meet sensory needs: 

  • Often, neurotypical people take the ordered processing of environmental sensory input for granted. There are many ways that valuable information from the environment can be altered as the brain and body perceive it. It can not be perceived enough or perceived too intensely by the body and the brain. Below we are going to talk about multiple sensory systems that can be affected and how that may cause changes in movement.
  • Our vestibular system senses movement and contributes to our sense of balance. When someone does not perceive vestibular input strongly enough, they may partake in a lot of extra rocking or spinning movements. This may help them get a better sense of where their body is and how gravity is affecting them, so they don’t just feel like they are floating when they move.
  • Our proprioceptive system tells us where our joints and limbs are, like how bent your knee is when you are going to climb a stair or that your arms are resting by your sides when sitting on the couch. If this system is not giving enough information, it may take extra effort OR over reliance on another system, like the visual system, for someone to know where their legs are while climbing the stairs, while balancing, and while walking, to name a few examples. Not perceiving enough proprioceptive input can make someone confused about where their body is at all times. To help decrease their confusion, they may seek and need extra deep pressure input from their environment. This can come in the form of pressing on things, like desks, walls, unsteadiness during movement, looking for tight squeezes and hugs, and enjoying weighted items like weighted blankets.

Movement that is Difficult to Coordinate:

  • Neurotypical people often take the ability to produce clear, coordinated movement for granted too. For some people, kicking a ball is not as simple as the brain saying “okay kick” and then their leg executing that action. Sometimes the signals get misconstrued and there is extra movement of body parts, body parts do things together when they aren’t supposed to, or balance suddenly becomes more difficult. Some people have to think about what their standing leg is doing separate from what their kicking leg is doing, separate from what their upper body is doing. And oh yeah don’t forget about coordinating the movements of your eyeballs so you can see too! It’s not always as easy as one, two, three, and sometimes can feel like one, two, three, four, five, six, seven, eight, and so on!
  • Movement can become especially tricky to coordinate when the sensory information from the environment is perceived in a disordered way too. For example, you dodge a ball flying your way based on the fact that you see or hear that ball. You walk forward to get your cup of water from a table and know how far to walk, where the table is, how far to reach your arm, how wide the cup is, and how heavy the cup is once you pick it up. Now, Imagine if you couldn’t get your eyes to work together to see the ball coming your way… you might not move out of the way in time! OR imagine if you couldn’t feel how heavy the cup of water was and it was heavier than it felt to you… you might drop the cup! Putting all of these things together takes a lot of extra energy and effort and all the errors in perception often lead to errors in the execution of movement, even if the mover is trying their very best to do the right thing.
  • Not moving or moving slowly requires even more precise control of your movement! Many autistic children move fast and the observer may think that child has great movement control. Learn more about how that may not be true here.

Now add extra distractions of daily life to the Mix!

  • Another piece to the puzzle is the trickiness of dual tasking! Again, a neurotypical individual often takes dual tasking for granted. Dual tasking is what happens when someone walks and talks at the same time, or eats and watches a television show with ease. It gives us our ability to put one of the things we are doing on autopilot while focusing on something that takes a little bit more brain power.
  • When someone with Autism is trying to coordinate their movements as described above, it may take a decent amount of brain power. But then, a lot of the things in their environment demand a lot of attention, like the people around them or the sights, smells, sounds, and etc. So all of the thought energy that is needed to go toward their movement gets divided between movement and other things. This can create even more difficulty coordinating movement and may lead to overall disordered movement patterns as your child or adult moves through their everyday life. 

These are just some of the big reasons why movement can be tricky and discoordinated in autistic children and how it can impact os many areas of daily life, from getting dressed in the morning to social interaction. We know this is A LOT of information to take in, but this connection is an important one to make because when movement is hard, it makes coping with everyday life hard and stressful! If you feel like coordinating movement or movement with other daily tasks is sometimes tricky for your child, call (908) 543-4390 or visit our website at www.kidpt.com to schedule a FREE Discovery Visit today!

Extra reads:

Autism in motion
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