Welcoming New Respected Clinician, Debra Evans Rogers to our Faculty

 

Debra Evans Rogers[/caption]

We are thrilled to announce that Debra Evans Rogers, PT,PhD,PCS, internationally known and respected clinician and published researcher is joining the Education Resources faculty. She received her bachelor’s degree in PT from the University of Missouri-Columbia; Master’s of Science in Special Education from Old Dominion University in Norfolk, Virginia; and PhD from Rocky Mountain University in Provo, Utah. She is certified as an APTA Board Certified Clinical Specialist in Pediatric Physical Therapy. In addition to completing the NDTA Certificate course in the Treatment and Management of Children with Cerebral Palsy , she completed the Advanced Baby Course in 1998, and has attended other advanced courses. She has served on the NDTA Board of Directors as the Director of Regions and Past President (appointed). She was an adjunct professor for the Masters PT Program at Old Dominion University from 1992-1995.

She  offers a unique perspective combining clinical expertise with pediatric research knowledge. She has assisted students and presented pediatric courses throughout the United States and abroad including Romania, Nicaragua, India, China, and Chile. She is a pediatric physical therapist with over 30 years of clinical experience specializing in assessment, intervention and research in children with neuro-motor involvement. She is trained in pediatric Neuro-developmental Treatment and baby treatment and is an NDTA PT Instructor and CI candidate.   She has worked in private practice both in the home and clinic settings, schools, early intervention, home health, acute care, NICU and outpatient hospital clinics offering insightful information in a variety of physical therapy settings.

Debbie is currently an NDTA PT instructor. She resides in Houston, Texas with her family and works with the University of Texas-Medical Branch ECI Program.

Look out for her new course coming to Texas, Missouri, Illinois and Oregon in 2017:
Pediatric NDT: Treatment Intensive

This course will address utilizing current NDT intervention strategies for the pediatric client aged 0-18 with neuromotor challenges (eg CP, Down Syndrome, TBI and other syndromes). Information presented will address using the ICF for assessment/evaluation while practicing intervention strategies for improvements towards function. Participants will be assisted to improve their observational and direct handling skills with analysis and problem solving using NDT techniques. Both didactic lecture and hands-on labs will be presented throughout this course.

Click here for full details, dates, venues, to download a brochure or to register.
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Why is this year’s Kindergarten class not developmentally “ready”?

GUEST BLOGGER: Kathryn Biel

Disclaimer: This is an opinion piece and the views expressed do not necessarily represent the views of Education Resources, Inc.

This year has been a tough one. Lots of new referrals. I did more new referral evaluations from September to December than I did all of last year. And most of the kids came on program. These kids are hot messes. The majority in kindergarten (although there were a few needy first graders too). As I travel from school to school in my district (five elementary schools), I heard the same thing. This kindergarten class is tough. Needy. Young. Not ready for kindergarten. The parochial school in district (which I also service) had the same complaint. I flippantly joked, “What was in the water six years ago?”

Then, at the Therapies in the School Conference, I had a similar discussion with a therapist from New Hampshire. And then one from Massachusetts. It wasn’t just me. It wasn’t just here. This class is a hot mess.

I guess it’s good for one teacher to know that others are struggling, but it’s not fixing the problem either. And I like to know why. There are some easy answers. Some of our kids didn’t have preschool experience. Some of our kids are from very poor, disadvantaged homes, which we know impacts education and educational-readiness. It seems a disproportionate number of our kids are super young this year, just making the cutoff date (which, in New York, is December 1st, so we have lots of four-year-olds throughout September and October and into November). We’re still following the developmentally inappropriate guidelines of the Common Core Learning Standards.

All of these things make sense, but they don’t really explain the difference between a class two or three years ago and this class. Why is this class so not ready?

I don’t know the answer, but I have a theory. In addition to the factors listed above, there are two main factors that I think are significantly impacting the development and school readiness of our children.

The container lifestyle and mobile technology.

As therapists, we all recognize the detrimental effect the container lifestyle has on early development. Here are my thoughts on this:

  • The constant position in supine and flexion impacts motoric development that is initiated through prone. Lack of prone positioning and extension through prone impacts visual tracking and development, especially convergence and divergence, which is especially used in education in shifting gaze between the board and the desktop.
  • The reticular activating system, responsible for transitioning between sleep and wake and into periods of high alert and attention, is stimulated through cervical extension. Lack of extensor muscle development fosters poor posture in which capital extension is present but true cervical extension is not, thereby inhibiting activity in the RAS. Babies are stuck in flexion, which impacts the sleep-wake cycle.
  • There is more and more retention of primitive reflexes because babies do not move through the developmental sequence to re-wire the brain to integrate these reflexes. This impacts a child’s ability to cross midline (and therefore have a hand dominance), maintain a seated position especially while moving the head, and maintain emotional regulation, particularly in the case of the retained Moro reflex.
  • Use of standing containers facilitate extensor posturing and an on-toe weightbearing pattern, which can cause tight gastrocs and contribute to toe-walking. It also encourages increased capital extension, scapular retraction with elevation, lumbar lordosis, and knee hyperextension. All the compensations PT’s work diligently to break in adults with postural dysfunction. And we’re causing this as soon as the baby is facing gravity.
  • Poor tolerance to prone causes decreased quadruped crawling, which leads to shoulder girdle weakness. This causes poor development of the palmar aches, in addition to impaired fine motor skills.
  • Plagiocephaly which can lead to torticollis, which can impact visual tracking as well as overall posture and ability to maintain one’s positioning in a chair.

There may be more as well.

Now, the second piece: mobile technology and screen time. The explosion of iPads and smartphones and other mobile devices being accessible in most homes took off approximately six to seven years ago. Just as this year’s kindergarten class was being born. The majority of these children have always had screens in front of their faces. The constantly shifting images, the bright colors, the stimulation from the LED screens, the audio input. From birth. How many times have we seen toddlers working their parent’s phones? One year-olds with their own iPads? Babies with a video playing on a phone while the adults enjoy an uninterrupted dinner? Heck, they even make a potty with it’s own tablet.

Here’s my thought: Kids today can’t function without a screen. They can’t listen and process verbal directions without the ever-shifting visual stimulation. There appears to be a significant underdevelopment of audio skills with an over reliance on visual input (and this could be further impacted by impaired eye development as discussed above). We have a whole grade-level of kids who can’t learn from a person because they’re so used to being engaged by a screen.

If I’m right, this is frightening.

Don’t get me wrong—I love my technology. My kids have tablets and iPods and Chromebooks (although they did not have access to this technology until at least the age of seven). I may be slightly addicted to my phone. But I really worry about five and six year-olds who simply cannot follow two and three-step commands.

Here’s how I figured this out. I watched a class doing a GoNoodle Yoga video (one of the Maximo ones). The class looked great. Then, I had the teacher leave the audio on, but turn the picture off. Initially about half the class continued what they were doing, and even completed the next step. The other half of the class immediately stood up (they had been bent over, stretching to one leg), and seemed paralyzed by the fact that the image had disappeared. The teacher gave the instruction to listen and follow along. At the end of the video, every single child was bent over as they had been when the image was turned off. They should have been standing. Not one single child had been able to listen and follow the directions.

I’m not a researcher, and I don’t have data (although I may start collecting some) to support this. These are my theories and hypothesis of why these kids are struggling so. Try the GoNoodle (or similar video) trick and see if your kids can continue on once the image is turned off. What do they do?

What do you think? How are your kindergarteners this year?

~Kathryn Biel, PT, DPT

 

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NEW Online Certification Course – SAEBO UE Orthoses – Improving UE Motor Recovery

Saebo Certification Education Resources

 

Education Resources, Inc. is thrilled to announce a new partnership with Saebo, Inc. offering a new online course to train and certify therapists to use Saebo’s Functional Dynamic Orthoses:

Saebo UE Orthoses – Improving UE Motor Recovery Following Neurological Injury – Online Course

The certification was developed to provide occupational therapists, physical therapists and assistants with practical experience and training to incorporate the latest evidence based treatment approaches for UE neurological rehabilitation to benefit patients. The course will review current research findings related to the treatment of the hemiparetic UE, teach participants to identify which patients with a variety of diagnoses will benefit, teach participants how to correctly fit and adjust the Orthoses (SaeboFlex, SaeboReach, and SaeboStretch), as well as teach participants to establish patient specific treatment plans that can be immediately incorporated into clinical practice.

Participants may earn eight CEU hours while becoming certified.   

“Our partnership with ERI comes at a very exciting time. As we strive to improve the education experience for our therapists, we recognize the importance of adding an online self-study platform. This new format provides the therapists with an opportunity to access the same effective training that is provided at our Live Certification Courses, but with the increased flexibility and ease of completing the course at their own pace, stated Henry Hoffman, Co-Founder of Saebo.”

The course includes video lecture and lab activities that may be done at the therapist’s convenience. Henry Hoffman, MS, OT/L, the inventor and co-founder of Saebo and Shannon L. Scott, OTD, OTR/L, faculty in the Occupational Therapy Program at StonyBrook University teach the course and facilitate the lab component.

Education Resources, Inc. is an approved provider for Live and Distance Learning-Independent courses by the American Occupational Therapy Association (AOTA), and has been a long-time provider of continuing education courses to help therapists improve outcomes for patients with neurological diagnoses.

Please click here to learn more about the course, to download a brochure or to register 

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A Wonderful Endorsement of Mary Massery’s Approach from our Guest Blogger

GUEST BLOGGER: Kathryn Biel

The year was … well, a long time ago. I was a PT student at Boston University, and Larry Cahalan was teaching a cardio-pulm class. I don’t remember which one exactly, but I know it was the semester before my second clinical. He brought in a guest lecturer, Mary Massery, who talked a lot about postural control and breathing, and the relation of the two.

You know it’s a good lecture when almost twenty years later, you remember what you learned. In the short term, on my second clinical the following semester, I was able to take some of the applications and help a very complex medically involved baby (I think he was about a year old). This baby, whose list of diagnoses was long and complex (and he had a brother with the same mysterious condition), didn’t tolerate therapy. He shut down and pretended to sleep, opening his eyes as soon as the door closed. One of the things I noticed is that he was using his accessory muscles to breathe, making it a very rapid and inefficient breathing process. Calling on the discussion from Dr. Massery’s lecture, after discussion with my C.I., I worked on different positioning and handling techniques to facilitate the more effective and efficient diaphragmatic breathing in this client.

I would say that it wasn’t much. But, as the title of Dr. Massery’s course indicates, “If You Can’t Breathe, You Can’t Function.” This child, facing so many challenges simply on the basis of his anatomy, had to learn how to breathe efficiently. The application of Dr. Massery’s teacher gave him that.

I kept in touch with the family for a few years after I graduated. I went to work at a special education school for medically fragile children because of working with this child (and his fabulous family). In one letter (remember when we actually wrote pen and paper letters?), the mother let me know that they still worked on the positioning to facilitate breathing. She said that there hadn’t been one single intervention that had impacted his life as much as that. Now that he was breathing better, he didn’t shut down for therapy, and was more available to work on new skills.

I often wonder how this family is doing today. My client would be in the tail end of his years in the school process. I do know that the lecture from Dr. Massery shaped my career in terms of working with this family, and I particularly enjoy working with the medically-complex, multiply-involved children to this day. I can’t promise that Dr. Massery’s course, “If You Can’t Breathe, You Can’t Function” will change your life the way it did mine, but I have a feeling it will.

P.S.- This past weekend, while cleaning out the basement, I found Dr. Massery’s business card from that lecture. I’ve kept it in my PT stuff all these years because I knew how valuable it was. While other things went into the recycling pile, I think I’m going to hold onto that for a little while longer.

~Kathryn Biel, PT, DPT

Don’t Miss Her Courses:

If you Can’t Breathe, You Can’t Function – Introductory Course Plus TWO days of Intensive LAB
March 10-12, 2017 – Chicago, IL
March 24-26, 2017 – St. Louis, MO
July 27-29, 2017 – Mountainside, NJ
(an option is available to attend a one day introductory course)

 

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How to Wrap-up Your In-Service Presentation

Carol Loria, President ERI:

 

Leaving your colleagues inspired and wanting for more information can be a challenge.

In your final comments, repeat your main points.  Tell your colleagues how they can obtain further and more in-depth information.  If you are so inclined, invite them to observe you treating a patient using this new information or offer to consult on one of their challenging patients.

Don’t forget to share reference materials that colleagues may need to provide evidence and support for this clinical approach.

Good luck! 

Feel free to post any specific questions you may have as you pull together an effective in-service for your colleagues.

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