Early Mobilization in the ICU and in Acute Care – A Family's Perspective

GUEST BLOGGER:

Kathryn Biel

As a PT, it’s not uncommon to spend our days in the hospital. This fall, I got to spend more time in the hospital than I’d planned for. My dad had a stroke. Unfortunately, he was at my house when it happened, so I had the task of bringing him to the hospital. I sprung into PT mode, assessing his mobility, his coordination, his speech, his balance. Of course, I was scared. We all were. What I was thinking about the whole time were about the possible lifetime limitations my dad would face. What would his impairments be? What would he get back?

He was admitted of course, and due to unstable blood pressure, was admitted to the ICU. The next morning, he seemed pretty good. There was some barely noticeable dysmetria in his hand. Occasional dysarthria. His balance was a bit off. I was pleased that his PT was in by 9 am. Ambulation and transfers were assessed, and he was able to get out of bed.

Mid-day, he went south. We still don’t know why. What I do know is that while the nursing documentation stated “no change” (long story there), his PT was able to not only provide documentation, but to speak with the physician on our behalf to explain the gravity of the situation. My dad went from being stand-by assist without assistive device to moderate assistance x 2 with a rolling walker. His speech was virtually unintelligible. His right hand barely worked. The PT knew. The PT understood. The PT got the ball rolling and advocated for transfer to the best rehab in the area.

Just under three months later, my dad’s doing great. He’s not 100%. Like I feared in the ER, he may never be 100%. But I know, those first few days in the ICU and acute care were critical. And I know what a difference early mobility made for him.

So, on behalf of my family, thank you to the therapists who brave the machines, the illness, the crazy families (of which I may or may not be one of) to get in to the ICU and acute care. I know you know what a difference you make. Now I know too.

~Kathryn Biel, PT, DPT

 

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NEW COURSE: Linking Play and Self-Regulation to Mealtime Success and Introducing NEW SPEAKER: Susan Roberts

 

We are thrilled to introduce a new speaker to our faculty:

[caption id="attachment_3035" align="aligncenter" width="251"]Susan Roberts Susan Roberts[/caption]

SUSAN ROBERTS

Susan L. Roberts, author, nutritionist, and award-winning occupational therapist uses innovative, research-based approaches for children and teens with autism spectrum disorders, ADHD, CP, Down’s syndrome and other special needs.  Her child-friendly, positive approach integrates physiology, psychology, and social-emotional aspects of mealtimes to achieve better health and behavioral outcomes.

Susan will be presenting her new course developed for Education Resources:

Linking Play and Self-Regulation to Mealtime Success

This course explores the growing problem of food refusals and nutritional deficiencies from a revolutionary new perspective that addresses self-regulation, socio-cultural, and emotional perspectives while incorporating conventional nutrition, oral-motor skills, sensory processing and behavioral techniques. Medical conditions affected by food refusals include obesity, diabetes, autism spectrum disorders, ADHD, and learning disabilities. Participants bring in case-studies from their own practices, applying Susan’s integrative framework which usesplay, the primary occupation of childhood, as a focal point for assessing client needs and preparing intervention plans. The seminar format provides ample time to discuss a variety of cases. Participants take away useful tools they can apply immediately in everyday practice. These include: structured observations of play and mealtime behaviors to determine developmental readiness; food journals for determining individual nutritional, sensory and food sensitivity issues; writing functional, measureable play and mealtime goals for school-based interventions that align with Common Core academic standards; and strategies for implementing related performance objectives.

April 15-16, 2016 – Los Angeles, CA

June 3-4, 2016 – Danbury, CT

November 4-5, 2016 – Cedar Knolls, NJ

Please click here for full course details, to download a brochure or to register

 

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HAPPY NEW YEAR from us all at Education Resources

As the year is coming to a close, and the office is now a little quieter, after our crazy fall season, we are reminiscing and looking back at yet another exciting year.Education Resources

A year that introduced 7 new leading faculty members to our distinguished line up of dynamic international speakers, bringing our community of therapists more evidence based, dynamic and engaging CEU courses. Courses that provided in-depth material focusing on: Toe Walking, The Neurologic Upper Extremity, Amputee Rehab., Post Concussion Syndrome and TBI,  Adult Dysphagia, NICU Developmental Intervention, or Connective Tissue Mobilization in Pediatrics, adding to and complementing our established well respected course offerings.

We were VERY excited to expand our unique program of online courses, launching 6 new school based courses in February, adding to our highly regarded resources for therapists practicing in the school setting. In June we were very proud to launch our Series of Vestibular Rehab online courses taught by internationally renowned expert Richard Clendaniel.Whether blended with a live course or taken as a stand alone all our online courses are proving to be popular and well received.

Watch this space; we are busy proofing and editing new videos to add to our library in the new year!

Something for EVERY therapist!

Our new blogger series with PT, Kathyrn Biel, was launched and received with great enthusiasm. It is a great venue for any therapist to share clinical problems, challenges, breakthroughs and ideas. Kathryn was able to meet many of you at our Annual Conference in November.

Our sold out annual Schools Conference; Therapies in the School held in November in MA, proved to be one of the best yet! Therapists from all over the country heard the best of the best and came away invigorated on returning to school on Monday morning! We from the Education Resources team certainly enjoyed reconnecting with many therapists returning from previous years and enjoyed meeting so many new participants. Thank you to all for making this year’s conference such an outstanding success.

We have expanded our “in-house” training to offer staff development training to acute care hospitals, rehab and community settings and school districts.

This year also saw some changes in the office.

[caption id="attachment_3016" align="aligncenter" width="300"]The team at Education Resources The team at Education Resources[/caption]

We welcomed a beautiful new baby boy and grandbaby, much to the excitement of all of us! We said a sad farewell to Kathy as she retired to enjoy traveling. We cannot thank her enough for her dedication, passion and the happiest personality. She will be missed!

[caption id="attachment_3017" align="alignleft" width="152"]Denise Mowles Denise Mowles[/caption]

We do extend a warm welcome to Denise, who will be working closely with our faculty members to plan their travel and help them develop their syllabi. She brings a dynamic personality and dedicated spirit to our ERI “family”.

As we move into 2016, we have many new, exciting opportunities to share with you: new speakers, new topics, and new initiatives.

Look for “Infants Born Preterm: Identifying and Addressing Their Special Needs in Early Infancy to Support Development” a new course from Jan McElroy. A new course from new faculty member Roberta Pineda, an NDT course from Gail Ritchie and a mealtime success course from our new speaker: Susan Roberts. Look for Megan Donaldson’s newly developed course: “An Evidence Based Lumbopelvic Examination and Treatment”.

For the first time we are thrilled to add a pre-conference to out Therapies in the School Conference in November; “The Zones of Regulation” with Leah Kuypers. Register early for this one!!

And we are still in December!!

We will continue to develop and customize more great courses for you throughout 2016. As always, please reach out to us with your thoughts and ideas.

Wishing you health and happiness in 2016, from us all at Education Resources.

Don’t forget we are offering our holiday discount:
“Holidays 2015” through Monday January 4th

 

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Light touch and Holding Interventions

Faculty Member: John Pagano

Light touch and holding strategies promote body awareness and social-emotional skills in children and adolescents with behavioral challenges. Deep pressure touch is a more common therapeutic intervention. However, light touch and holding are valuable therapeutic options for promoting attention, body awareness and social-emotional skills.

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Body awareness, stress and somatic pain challenges negatively impact behavior in many children and adolescents with developmental, sensory processing, Post-Traumatic Stress Disorder, internalizing behavioral concerns and other psychiatric disorders.  Attention, body awareness, stress and somatic pain problems can be addressed through the use of light touch and holding strategies.  Light touch and holding strategies are particularly useful for improving and directing functional attention, and provide a valuable option for reducing stress, somatic pain, and social-emotional problems when deep pressure massage is contraindicated.  Particularly for young people experiencing acute pain, edema, taking analgesic medications (e.g., which can decrease pain perception) or taking antidepressant medications (e.g., which can cause light headedness and dizziness) light touch and holding are preferred.

Recent research indicates that positively perceived slow, light touch specifically activates CT afferent fibers connecting to the Insular Cortex that convey social-emotional interactions and our internal sense of self.  FAB Strategies utilizing light touch and holding include: Vibration to the Back, Arms, & Body as well as the Rolling the arm, Back X, Spine crawl, Head crown, and Foot input.  These light touch and holding techniques which are components of FAB Strategies will be described below.

It can be clinically useful to provide extremely irritable children and adolescents who have significant body awareness challenges repeated sensory experiences of the front, back, top and bottom of their bodies. FAB Strategies light touch and holding techniques were developed to provide sensory experiences of the front, back, top and bottom of the body as a foundation for improved body awareness and social-emotional skills.  In addition to the light touch and holding strategies the awareness of the front, back, top and bottom of the bottom is practiced through several FAB Strategies deep pressure touch and mindful movement activities.

Vibration to the Back, Arms, & Body provide light touch input.  Vibration can also be applied to various body parts with eyes open and closed, to increase body awareness by having clients identify each body part as it is touched (e.g., arm, left ankle).  Light touch can also be provided through the Rolling the arm strategy.  The therapist rolls the arm in a palm open, thumb lateral direction providing relaxation.

Trager and me Original

The Back X involves drawing an X across the back with your fist, while the Spine crawlinvolves moving up the spine to give awareness of the back. The Back X and Spine Crawl can be done as part of the X Marks the spot light touch game

XMarkstheSpot

The Head Crown involves 10 second holding on the head, first on both sides then on the front and back of the head.

HoldingHeadTx

Foot input involves massage and holding of the feet to provide improved sensory awareness of the feet as the foundation and bottom of the body.  Foot input can be followed by stretching exercises to help decrease the likelihood of habitual toe walking.  Light touch and holding strategies are a valuable intervention to improve attention, body orientation and social-emotional skills through interpersonal touch.  Light touch and holding can also decrease stress, pain, and provide comfort when more intense massage is contraindicated.

References:

Beider, S., Mahrer, N. E., Gold, J. I. (2007). Pediatric massage therapy: An overview for clinicians. Pediatric Clinics of North America, 54(6), 1025-1041.

Bjornsdotter, M., Loken, L., Olausson, H.., Valbo, A., & Wessberg, J. (2009). Somatotopic organization of gentle touch processing in the posterior insular cortex. The Journal of Neuroscience, 29(29) 9314-9320.

Koester, C. (2012). Movement based learning for children of all abilities. Reno, NV: Movement Based Learning Inc.

McGlone, F., Wessberg, J., & Olausson, H. (2014). Discriminative and affective touch: Sensing and feeling. Neuron, 82(4), 737-755.

Perini, I., & Olausson, H. (2015). Seeking pleasant touch: Neural correlates of behavioral preferences for skin stroking. Frontiers in Behavioral Neuroscience, 9.

John is teaching his course in 2016 with Education Resources:
Effectively Treat Behavior in Children: Traumatic Brain Injury, Autism Spectrum Disorder, Sensory Processing, Cognitive Limitations, PTSD, & Other Challenges

May 13-14, 2016 – Millbrook, NY
October 21-22, 2016 – Washington, DC
November 11-12, 2016 – John City, NY
December 2-3, 2016 – Dallas, TX

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