Here is a great article about tummy time and the importance of it in your baby's daily routine. As a physical therapist, I always educate the parents of my patients to increase their amount of tummy time daily to improve overall strength. Children who do not have as much tummy time may develop slower and demonstrate weaknesses in their shoulder girdle and neck musculature. Please read this article for more information.
http://www.babyzone.com/askanexpert/tummy-time-101If your child is experiencing slow development or has head asymmetries, you should consult your doctor about a referral to a physical therapist. Early treatment can improve your child's prognosis and decrease the amount of treatment time drastically.
Please contact me if you have any questions or concerns about your child's gross motor development.
Leslie Holmes
lholmes@childandfamilydevelopment.com
Children with severe impairments benefit greatly from early intervention, improving their overall health and quality of life. Infants and toddlers with mild to moderate developmental issues may not be identified as easily; this may delay the process to a quicker resolve for underlying developmental delays. When evaluations and treatments begin at an early age, many of these delays can be resolved quickly and children will not be affected in the long term.
Child & Family Development services are clinic based- meaning the child would come to our site for evaluations and treatment. Children benefit from site-based services by working one-on-one with a therapist in a therapeutic setting designed to support new learning techniques and challenge the child’s developmental abilities. Our clinics contain special tools, toys and equipment that allow the therapist to challenge children in a unique environment. Parents and caregivers participate throughout the entire therapeutic process, from the evaluation to the treatment sessions. Parents/caregivers and therapists will collectively discuss activities that can be performed in the home that imitate the activities that are performed during treatment sessions to ensure carryover and promote developmental growth. Guidance and education is provided to ensure continuous progress throughout the child’s daily life- not only during therapy sessions.
For early intervention, timing is everything. Child & Family Development is accepting new referrals! We are scheduling evaluations within a few weeks of the initial call.
An initial evaluation for a baby with torticollis with a physical therapist will most likely include a reflex screen (to make sure all reflexes are present and integrating appropriately), a range of motion assessment of the neck, and overall gross motor movement assessment.
The INFANIB is one of the tests used to assess the reflexes of babies at Child and Family Development. There are 20 reflexes that are demonstrated during the first year of a babies life- most will integrate or disappear throughout the first year of life and some will become the cornerstone of movement; for instance, catching yourself when you fall by throwing your hands out. These reflexes are important to the development of your baby and the physical therapist will be able to guide you through each test and explain why each test is being completed.
I also like to use the Alberta Infant Motor Scale (AIMS) or Peabody Developmental Motor Scales- 2nd edition (PDMS-2) to assess the overall gross motor movements of the baby- depending on the age of the baby. They look at the overall picture of movement:
Skills your child is completing lying on his/her back (these are a few):
- bringing his/her hands to midline
- holding the head in midline
- arm movement, reaching for toys
- chin tuck, neck flexors are active
- hands to knees, hands to feet and feet to mouth
Skills your child is completing lying on his/her stomach (these are a few):
- lifting head asymmetrically/symmetrically
- propped on elbows with head extended
- lifts head and maintains posture
- weight shifting on elbows and reaching for toys
- The physical therapist will also assess the way your baby is moving through space and in positions like sitting and supported standing.
Finally, the physical therapist will assess the range of motion and strength of the neck musculature. Typically the right or left sternocleidomastoid muscle (SCM) will be tight and there will be weakness in the opposite SCM- this muscle and its action are talked about in an earlier blog-"My baby has torticollis...what does that mean?"
- If the right SCM is tight then your baby will tilt his/her head to the right and rotate to the left, predominantly. The tilt component is the harder component to treat and will resolve slower than the rotating component. Sometimes babies only have the tilt component.
- With active rotation to the restricted side and applied ovepressure, as instructed by a physical therapist your baby will start to look to the restricted side more freely. Placing his/her favorite toys on the restricted side constantly when lying on his/her stomach or lying on his/her back will increase active rotation to that side and improved range of motion over time.
- With passive stretches that sidebend through the restriction, as instructed by a physical therapist and varying positioning during feeding and sleeping- the tilt will begin to resolve. Again, the tilt usually takes longer to resolve than the rotation component.
If you suspect your child has torticollis or is holding his/her head tilted to one side please ask your pediatrician for a referral to a pediatric physical therapist. The earlier your baby is evaluated and treatment is started, the better the outcome.
A diagnosis of torticollis means that there is a neck musculature imbalance- the sternocleidomastoid muscle (SCM) is usually the muscle involved. The SCM is the large neck muscle that runs from the mastoid process (close to the ear), all the way down to the sternum. Its function is to rotate and tilt the head. When the SCM is tight on one side it causes the head to tilt in that direction and rotate to the opposite direction. For example, if the right SCM is tight, the child's head will tilt to the right and rotate to the left. Now, there are exceptions to every rule and sometimes a child's head will tilt and rotate to the same side, but for the most part, torticollis follows the previously mentioned pattern. The cause of the musculature imbalance could be related to how the child was positioned in the womb, positioning following birth during sleep or resting, and/or if the child is not getting the necessary amount of "tummy time".
I have had many babies come in for treatment due to their parents ability to pick up on early signs and asking their pediatricians for referrals. Typically, parents begin to notice their child's head is flat on one side or in the back or a slight tilt of the neck/head in photos. The treatment for torticollis is effective- with physical therapy treatment weekly for 6-12 weeks, depending on the severity, and a home exercise program that is implemented daily. Torticollis can resolve quickly and easily.
The first step is to receive a pediatric physical therapy evaluation and a home stretching program for your baby. Please feel free to ask questions if your child has been diagnosed with torticollis. Further treatment ideas and tools are to come in a future blog.
I hear this from parents all of the time... "My child is just a little clumsy" or "My child has a hard time keeping up with their peers in sports, but is a strong kid". These children will sometimes perform very well on the strength section of an evaluation, but score at a very low level on the coordination section. A possible explanation for problems with coordination could be that the child is dyspraxic.
What is dyspraxia? Developmental dyspraxia is a motor learning difficulty that can affect planning of movements and co-ordination as a result of brain messages not being accurately transmitted to the body. There is an underlying neurological issue, but typically, signs will not show up on a CT scan or MRI.
Some characteristics of developmental dyspraxia are:
-Appears messy or accident prone
-Decreased sense of body and what their body can do
-Difficulty with motor planning (figuring out how to make their body perform a task like others)
-Does things in an inefficient way
-May have problems with self image
-May seem "stubborn"
-Emotionally labile/sensitive
-Complains a lot about minor physical problems
-May have slower reactions times (can be mistaken with slow auditory processing)
You may note only a few of these characteristics in your child, but having a physical therapy evaluation could be the first step to improving your child's self image and self worth. Many children who have problems performing gross motor tasks will have a difficult time in physical education in school. In turn, they may become quiet and introverted; feelings as though they don't "belong". While there is no cure for dyspraxia, a trained pediatric physical therapist can assist the child in learning ways to improve their motor planning abilities and becoming more successful with gross motor learning and performance.
October is National Physical Therapy Month! Check out what the President of the American Physical Therapy Association, R. Scott Ward, PT, PhD. has to say about our profession..
http://www.apta.org/AM/Template.cfm?Section=NPTM&Template=/CM/HTMLDisplay.cfm&ContentID=61245
If your child is being seen by a physical therapist, speech therapist, or occupational therapist, chances are they have a home exercise program. Whether your child has a developmental delay or a specific diagnosis, one of the main key ingredients to home exercise programs is core strengthening activities.
Who remembers loving sit ups growing up? Yes, no hands go flying up on that one. A few easy ways to make doing sit ups more fun for your child are: timing them to see how many they can do in 30 seconds and comparing their scores day to day, grabbing a puzzle piece and placing it in the puzzle when they sit up, or giving high fives each time they sit up. Also, using an exercise or yoga ball can also make doing sit ups more fun- once they complete five you could bounce them on the ball. The ball also makes doing sit ups easier- you can control the ball and assist the child in completing one.
It only take 21 days to create a new habit- get started today! Maybe get in there with your child and do 30 sit ups every day... nothing is more motivating to your child than doing something along with their parent!
My favorite part of being a pediatric physical therapist is discharging patients who have met their goals. Recently, I discharged an 18 month old girl who I had been treating for 10 months. Her pediatrician referred her family to our clinic due to a developmental delay- she didn't start rolling until she was 8 months old-after starting physical therapy treatment at our clinic in Charlotte (rolling should start at 5-6 months).
Through the months that followed, her Mom kept sharing with me that she was nervous her child wouldn't walk or would never catch up, but we kept pushing the little girl's limits and she continued to progress. I remember telling the family the child would need a brace for her foot and how it effected the family. After wearing an ankle-foot orthosis (AFO) for 3 months, her foot's alignment had improved giving her better balance and she started taking independent steps. The child's tone and strength improved from all of the "pre-walking" skills she had mastered like rolling, crawling, pulling to stand, and crusing on furniture leading this day. Her Mom called me the day she started walking between chairs in their house- her daughter was now officially a walker!! Our last appointment was last week and she was walking all over the room and through the hallways with no problem. We said our goodbyes and she walked out of the office all by herself.
Even though it is my job and I have experienced children walking for the first time more than one time, it is special with every single time. I find myself tearing up with the family when the children reach motor milestones. What a blessing!
Some interesting new findings concerning a link between genetics and autism. The cause of Autism is still considered a mystery, but this research may help with the search for a cure.
http://www.reuters.com/article/idUSTRE6584E520100609
The first Yoga Moves class at Child and Family Development was a success- a big thank you to everyone who participated! I always feel successful when parents report their children are doing yoga poses at home and showing off their new found skills!
I was really impressed with the way the children held each pose and pushed themselves throughout the entire hour. The format included doing about 4 static poses holding as long as they could and then breaking into a yoga game including soccer toss, windmill, skin the cat, or becoming volcanoes. There was a cool down each day that included stretches followed by envisioning ourselves on the beach making sand castles. :)
Sometimes I forget just how active imaginations are.. it was definitely refreshing for me to be a part of the class! Hope to see you in June for our next physical therapy-based Yoga Moves series! Please contact me if you are interested in reserving a spot.
lholmes@childandfamilydevelopment.com
704.332.4834 ext. 41
As a pediatric physical therapist at Child and Family Development, I am always thinking about kids in motion. Throughout the day, I help children achieve therapy goals related to balance, coordination, core strength, developmental gross motor skills and more.
Coincidentally, this is now my focus outside of the clinic too- but in a very different way! I am honored to be a member of the Junior League of Charlotte. The League is an organization for driven women who want to have an impact on the community of Charlotte. This Spring, the League is hosting the 5th annual event- Kids in Motion!
Kids is Motion is being held at the Symphony Park in Charlotte on Sunday, April 18th from 12-5pm. Admission is $5 and there will be all types of vehicles for children to explore, including a fire engine, ambulance, and police car to name a few. Food, crafts, games and entertainment will also be on hand for the entire family to enjoy.
Please make plans to come experience Kids in Motion! I look forward to seeing you there!
Special Yoga Moves classes being offered the week of Spring Break for just $20 per session!
Yoga Moves is a physical therapy based class that incorporates some basic principles of yoga and Pilates. The movements and positions are adapted to each person's capabilities and skill level.
Leslie Holmes, DPT is a full time physical therapist whose clinical work and holistic therapy approach encompass a variety of diagnoses. She has a special interest in and additional training in yoga and is actively purusing a certification.
Yoga Moves is designed to take premises from yoga and pilates, along with traditional physical therapy perspective of improving motor skills and body strength. It is to be considered adjunct to regular PT intervention.
Individual health and wellness goals may vary, but every person can have improvements in:
Balance
Coordination
Core strength
Flexibility
Modeling others (following directions, copying poses)
Social skills
Home carryover ideas and suggestions will be provided!!
The times for our special classes will be:
Monday, April 5 9-10 AM
Wednesday, April 7 11-12 AM
Thursday, April 8 10-11AM
*Join us for one or for all*
If interested, please contact Leslie Holmes, DPT at 704.332.4834 ext. 41 or lholmes@childandfamilydevelopment.com
February is not only heart month because of Valentine's Day, but it is also considered Heart Awareness Month. Getting plenty of rest, eating healthy, and getting at least 30 minutes of exercise per day will increase your heart health.
It is important for children to get started early with healthy habits for life. Encourage your children to play outdoors, join a recreational team in the community, or play games with the family like hot potato or throw/catch in the backyard.
A great FREE community event being held this month is called Keeping Kids in Motion. They will have some fun and healthy activities including yoga, dance funk, tumbling, relay races, flag football and more. There will also be tips on healthy menu ideas, injury prevention, and fitness. The event will be held February 20th and 27th from 9:30 am to 12 pm. It will be held at Naomi Drenan Recreation Center which is located at 750 Beal St. Charlotte, NC 28211. Should be a great event for families to attend!
The Junior League of Charlotte is a cosponsor of the event which I am a member. Keep those kids in Motion!! Happy Heart Month!
Yoga Moves is a class that will be offered each Thursday in February at 5pm at Child and Family Development- starting February 4th!
Yoga Moves is a physical therapy based class that incorporates some basic principles of yoga and pilates. The movements and poses are adapted to each person's skill level. The goals of the class are to improve control of movements, timing of breathing during exercise, and core strength. Yoga mats will be provided. Get your child signed up today!
For more information, please contact Leslie at Child and Family Development either by phone 704.332.4834 ext. 41 or by email at lholmes@childandfamilydevelopment.com
A new pediatric therapy group is in the works at Child and Family Development for the Spring/Summer 2010. Preparations are being made for a Yoga & Pilates class for children of all ages to gear up- the class will be 60 minutes long and include learning individual and group poses with an interactive staff.
After completing a yoga course over the summer, I got really excited about the idea of holding a class for children. Yoga & Pilates help strengthen the body, improve balance, increase coordination, and flexibility. It teaches children how to control movements, time breathing appropriately, and engage core mucles to optimize their performance in daily life.
Hatha yoga will be used during our classes and it is NOT a religion or based on any religion- this is a common misconception. It is a system of techniques used to reach personal goals specifically related to health and wellness. I have started using these poses and techniques in my regular physical therapy sessions and I find the children I serve begging to do yoga when they walk in my room. A crowd favorite is the cobra pose- lying on the tummy and pushing up with the arms- a nice precursor to doing push ups. There are so many poses that children remember and want to teach their siblings- not only are they gaining strength in weekly physical therapy sessions, but also at home which is the primary goal for any therapist!
In 2010 there will be more information about dates and times of the upcoming Yoga & Pilates class...Happy Holidays!
I have returned to Union Academy- Lower School to provide physical therapy services for the 2009-2010 school year! I am excited about this opportunity and had such a wonderful experience when I provided services there previously. The speech therapists, occupational therapists and resource teachers at Union Academy are extremely accomodating and helpful in finding a space for physical therapy to take place on the school grounds- which can sometimes be a challenge.
School physical therapy pushes creativity sometimes due to limited space, working around the classroom schedule and all the other children wanting to participate and "play" with the therapist. In order to qualify for school physical therapy the child must already be receiving speech therapy. The process to initiate physical therapy starts with a concern about gross motor development brought to the attention of the therapy team by the physical education teacher, classroom teacher or parent. Typically, a physical therapy evaluation follows with a weekly or monthly treatment plan recommended, if needed.
Sometimes getting a jump start with gross motor development can boost their self confidence which may improve performance in and outside the classroom!
Entering elementary school is an exciting time for children- there will be so many new experiences and opportunities in the next few weeks including getting a backpack, meeting new friends, possibly riding a school bus for the first time, and participating in organized physical education. Physical education is the most active part of the day where children run around, play games with peers, and interact with one another. It is important for your child to be prepared physically for this new adventure! Here is a checklist of six gross motor skills that most children entering elementary school can perform:
- Stand on one foot without losing balance for 5 seconds
- Walk on tiptoes 10-15 ft.
- Hop forward on 1 foot 4-6 ft.
- Skip with alternating feet
- Throw a ball overhand
- Use both hands to hold things and play
If you are interested in fine motor and language skills for your rising Kindergartner the full Development Chart is found under the Resources tab on our website: www.childandfamilydevelopment.com
Hi all! My name is Leslie Holmes- I recently returned to the Child and Family Development in July and I am so excited to be working with this experienced multidisciplinary team including physical therapy, occupational therapy, speech therapy as well as psychological and education therapies in Charlotte! Over the past three years I have worked in Charlotte as a pediatric physical therapist in school, home health, and outpatient settings. I look forward to serving you in the future!
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