Implications for Occupational Therapy and Speech and Language Therapy with Earlier Diagnosis of Autism

New Research:
A study recently published in the American Journal of Psychiatry, found differences in white matter tract development in the  brains of Autistic children as young as 6 months of age.  This study was an international collaborative effort following hundreds of babies over several years. Not only did MRIs reveal this disparity in the white matter, but they also revealed larger head circumference. 

What does this mean? Well for starters they may now be able to diagnose Autism much earlier leading to earlier intervention. Also, the MRI scans may be able to tell us what part of the child’s brain is being affected so that therapy can be tailored accordingly. 

Previously physicians had to rely solely on clinical exam and behavioral reports in order to diagnose Autism. Now we may have data for a more definitive diagnosis leading to better outcomes. 

As for the cause of Autism and a cure? Well, that’s still up in the air. But, researchers feel as though they are getting closer. 

To learn more read a summary of the article, “UW Work Helps Pinpoint Autism Indicator in Infants’ Brains,” via the Seattle Times. 

To read the entire article from the American Journal of Psychiatry, follow this link: 

As a therapist, what would these early indicators mean for your practice? 


Barbara Hypes responds to blog with therapy thoughts and suggestions

We posted a clinical case study a few weeks ago and had some great responses. We wanted to share one comment from our distinguished faculty member; Barbara Hypes

Alyssa Posts:
DEAR ERI COMMUNITY: Hello! I am a pediatric physical therapist (Early Intervention) currently struggling with a little girl (19 months old); significant hypotonia, NO head control, dislocating joints (elbows, shoulders, hips and knees), joint contractures in lower extremities, minimal movement, can roll to her side, no other gross developmental milestones met, bright girl, tracking, babbling and responding to her name and to simple verbal requests with vision and limited upper extremity movements in a supine position or supported in her xpanda chair. Has seen multiple specialists on the east coast and all are scratching their heads. MD has been ruled out, SMA ruled out. Is feeding via g-tube but has nice oral motor munching patterns and drinks from a straw. Thoughts on activities for promoting more head control or muscle activation. Cannot stress this enough, NO head control at this point. Have used a Hensinger, Miami J, and DMO suit to supplement supported sitting activities.

Thanks for any input.

[caption id="attachment_837" align="alignright" width="113" caption="Barbara Hypes"][/caption]

The biggest mistake I observe is that people try to promote head lifting without attending to shoulder girdle stability and alignment in the shoulders and neck. In therapy I would attend to alignment and promote activity in the upper trunk and shoulder girdles. In regards to head lifting, I encourage therapist and parents to think about “making the child’s head weigh less”. When the head is supported there is no “traction” or pulling, instead the weight of the head is partially supported by the adult helping the child activate what they can without being overwhelmed by the mass of the inactive head. This can lead to active assisted recruiting and the therapist needs to observe what responses the child can elicit and build on his/her control by tweaking the provided support.
I also support the idea of bracing and am encouraged to discover how open you are to adaptive equipment. But, this won’t necessarily lead to control and might lead to greater compensations so my overall goal is MAXIMUM FUNCTION WITH MINIMAL PATHOLOGY THROUGHOUT LIFE.
I too would strongly encourage parents to continue to pursue a diagnosis. Have mitochondrial issues been explored? Genetic testing?

We are pleased to offer Barbara’s Courses: Improving Function in Pediatrics using the Therapy Ball


Plateau in Therapy No Longer Ends Medicare Coverage

Medicare coverage for therapy for people with chronic health problems and disabilities will no longer end when they don’t “progress”, as long as a doctor deems it medically necessary. 

A class-action lawsuit brought by the Center for Medicare Advocacy and Vermont Legal Aid on behalf of four Medicare patients and five national organizations brought this issue to light and was settled in January, 2013. 

This ruling covers Medicare patients with chronic health problems and disabilities like Parkinson’s or Alzheimer’s disease, stroke, MS, and SCI etc. who are home-bound or in a nursing home. The hope is that it will delay costly nursing home admissions by enabling seniors to live longer in their own homes. In nursing homes, the duration of therapy is still limited to up to 100 days per “benefit period”, and they still have to spend at least three days as an inpatient in a hospital. 

The Medicare limits before the exceptions were $1900 for each of the therapies (PT, OT and SLP). Beneficiaries also often lose Medicare coverage for outpatient therapy when they hit this payment limit. But under the exceptions process Congress continued for another year, the health care provider can put an additional code on the claim that indicates further treatment above the $1900 limit is medically necessary. After $3700, the provider can submit more documentation to request another exception for 20 more sessions. 

Therapists: we’d love to hear your reaction to this new ruling. Tell us about some of your patients and how this will help them maintain their function!


New Continuing Education Course for Therapists on Movement Based Learning Needs a Title – Help!

We are excited to share that June Smith, supervisor of OT services at Cardinal Cushing Centers and occupational therapist at South Shore Therapies, is coming on board to teach a new workshop this fall. Some of you may have attended her “Integrating Movement-Based Learning into the Classroom and Therapy” breakout session during 2012’s Therapies in the School. Thanks to your helpful feedback, we learned that there is great interest in participating in a two-day workshop on this topic. Her new course will focus on an expansive variety of movement-based techniques, and the evidence supporting use of these techniques, to help children enhance gross and fine motor skills in the classroom and in therapy. Some of the many techniques you will be able to immediately apply in your practice setting include Brain Gym, Bal-A-Vis, and Occular-Motor and Listening strategies. 

We are working with June on developing the course now, and we need your help in deciding on a good title for this new workshop. We would be grateful for any ideas you may have for the title of this new course, as well as any techniques you are eager to learn. We look forward to hearing from you! 

Vote for one of these titles or suggest your own: 

  • Learning Moves that make a difference- An Evidence-based Approach .
  • Brain Moves
  • Therapeutic Learning Connection
  • Integrating Movement-Based Learning into the Classroom and Therapy 

Please post your thoughts and suggestions below 
Thank you 


Songs to Enhance Social Skills

Posting from Distinguished Faculty
John Pagano:

It is important for all preschool and kindergarten children, and elementary classes that include children with special needs, to provide frequent music and movement breaks. The movement breaks  take five minutes or less and children are taught to resume working after the activity. The rules are “don’t touch any body, don’t touch anything, and get back to school work after the break or we won’t do it tomorrow (but will try again the next day).

Social skills are enhanced by playing songs like “Help” by the Beatles or “Respect” by Aretha Franklin, letting children dance, then asking them to draw a picture with a caption describing how they show respect or areas in which they need help.

John Pagano presents his course:
Effective Ways to Manage Behavior and Increase Functional Outcomes in Autism and Sensory Processing Disorders
April 26-27, 2013 – Puyallup, WA
September 20-21, 2013 – Orland Park, IL
October 18-19, 2013 – Cedar Knolls, NJ 
November 8-9, 2013 – Hollywood, FL