When Hands are not Enough!

Updated on October 12, 2013
Jeannine Moyer
Jeannine Moyer

As Physical Therapists for teli (The Early Learning Institute), Physical Therapists, Mary Welage and Jeannine Moyer, have seen hundreds of infants and toddlers with special needs.  Jeannine has worked for teli for 14 years.  Mary Welage, PT, has worked for teli for over 6 years.

Mary has worked in Early Intervention for 12 years, school age children for 12 and out patient therapy services for three.  Through Early Intervention, children are referred due to a variety of conditions including prematurity, Torticollis, Down Syndrome, Cerebral Palsy, Spina Bifida (Myelomeningocele), Autism, limb deformities, Hypotonicity, and genetic disorders, among others.

Early Intervention services for children from birth to 3 years of age are provided in the child’s natural environment, most often consisting of their home, daycare, or grandparent’s home.  Seeing how the children function in their most comfortable surroundings gives therapists an accurate picture of how children use their skills in their day to day life.  These observations are used to develop a program that caregivers can more easily adapt into their daily routines.

Teli_Mary Welage copy
Mary Welage

To understand the specific needs of each individual child, physical therapists often assess strength, range of motion, posture, motor ability, and preferences of movement.  Typically, the family or caregivers are the most important source of information.  Parents and other caregivers share their concerns regarding the child’s movements, often giving the therapist clues as to what may be causing a delay.  At times the environment of the home is considered as well.  Other information to consider is the child’s medical history, cognitive function, behaviors, and possible sensory issues.

The therapists then develop a plan of treatment which might be comprised of hands on facilitation of movements, manipulation of the environment to encourage independent movement and/or the use of adaptive equipment to achieve optimal function.  Parents and caregivers are encouraged to actively participate in the session, as well as carry out activities suggested by the therapist during the time between sessions.  Sometimes, however, their hands are not enough.  This is when therapists recommend equipment that can provide support when their hands are not available.

Some types of devices therapists may recommend are orthotics to manage lower extremity positioning which can improve stability in standing and walking, cranial molding helmets for plagiocephaly, specialized seating or garments to provide trunk support, standers when weightbearing is limited, and gait trainers, walkers or crutches for more independent mobility.  Since the therapists see the child’s home, they can take into consideration any space limitations or other challenges to the use of devices and work with the family to aid success.

For instance a child with low muscle tone may present with severely abducted hips which hinders their ability to crawl.  Adaptations through the use of household items, such as elastic wraps, or a specialty item which can be purchased online are suggested and used.  These adaptations help hold the legs together therefore allowing the child to progress in crawling.  Also a child with Spina Bifida (Myelomeningocele) may require bracing for their legs and an adaptive walking device.  The therapist is there to suggest appropriate interventions to best suit the child’s ability as well as taking into consideration their natural living environment.

The goal is to provide families and children with information so that they can make educated decisions to create the best possibility for a child with challenges reach their optimal ability and function.  Many of the children seen in Early Intervention do not require the use of adaptive equipment or may only need an adaptive item for a short time. When a therapist hands cannot provide the support required to help a child be successful then they look to the use of adaptive items and equipment.  Ultimately the child’s independence and family’s ability to see the child function within their home and community is their success story.

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