Help needed from pediatric PT’s and OT’s! Positioning for a complex 13 month old.

DEAR ERI COMMUNITY:

Posting from Megan:

Hi folks!
I am hoping to start a brainstorm thread for a really complicated kid I have picked up.
He 13 month old boy, one of triplets – his identical brother did not survive and there was twin-to-twin transfusion resulting in my guy losing most of his frontal lobe. He is a very involved kid. The biggest concern at this point is that he needs to be held – practically all the time, even asleep – because if he is not held in a tight “clamshell” he goes into extreme extensor tone and screams and cries. He can tolerate his belly on a rigged up cushion from an OT for about 30 seconds. I have been brainstorming a list of things to try with him but would love any ideas.
His positioning when he is comfortable is sitting on mom’s leg, hips and knees flexed, spine kyphotic except cervical spine hyper extended (strangely he has pretty good head control) but this cervical posture is concerning in the long term. He hates any pressure on the back of his head that would bring his spine into better alignment.
Basically the family is looking for something that will hold him in his comfortable position without their hands.
My thoughts to try:
Theratogs
Full seating/positioning eval with a very skilled vendor
Stander? He would need AFOs
He is getting started with Perkins (MA school for the blind)- maybe they could build him a chair that would work??
Togrite to hold him in the clamshell on his side on floor (OT gave them a gait belt to try for this, didn’t work)
Nada chair?
They have a clamshell seat thing – maybe was some kind of stadium seat – which has been a little bit useful inside a baby hammock – but he still extends out of it. Thought about drilling holes in it for belt at key points of pelvis to keep him in it.

Any other thoughts and suggestions, things you’ve tried or found helpful for a very involved kid like this would be fantastic! Thank you! 

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Whats on the horizon for stroke rehab?

Researchers at Ohio State Wexner Medical Center may have found a way to help prep a stroke victim’s brain prior to physical therapy to aid a more complete recovery. A non-invasive transcranial magnetic stimulation, or TMS,  prepares a stroke patient’s brain for physical therapy by sending low-frequency magnetic pulses painlessly through a victim’s scalp to suppress activity in the healthy part of the motor cortex. This allows the injured side to make use of more energy during physical therapy, which immediately follows the TMS.

Please click here for the full article found in the Washington Post

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Richard Clendaniel – Vestibular Expert, Publishes Paper in the Journal of Neurologic Physical Therapy

Richard Clendaniel, PT, PhD Richard Clendaniel, PT, PhD[/caption]

Richard Clendaniel, PhD, PT, vestibular expert and instructor for Education Resources publishes a paper in the Journal of Neurologic Physical Therapy (34:2): 111-116, 2010 

Summary: 
The efficacy of both habituation and adaptation exercise interventions in the treatment of unilateral vestibular hypofunction has been demonstrated in several prior studies. The purpose of this paper, by Richard Clendaniel, was to describe the preliminary results of a study that compared the effects of these two different exercise approaches on outcomes related to vestibular function. 

Seven participants with unilateral vestibular hypofunction completed a 6-week exercise intervention after randomized assignment to either habituation (H) exercises, or gaze-stability (GS) adaptation exercises. The following measures were taken pre-treatment and post-treatment: Dizziness Handicap Inventory (DHI) to measure the symptom impact, motion sensitivity quotient (MSQ) to assess sensitivity to head movements, and the dynamic visual acuity test (DVA) as a measure of gaze-stability during head movements.

Gaze-stability and habituation exercises have previously been shown to decrease symptoms of dizziness and increase function in individuals with vestibular disorders. The preliminary results of this study indicate that both exercise interventions lead to a reduction in the self-report measure of the impact of symptoms on the ability to function, a decrease in the sensitivity to movements, and an improvement in the ability to see clearly during head movements. The author states: “Continued investigation will be needed to determine if these results will hold, to determine if there are different effects of the two interventions, and to determine the mechanisms of improved visual acuity.”

The actual mechanisms underlying the improved dynamic visual acuity test (DVA) for either intervention are not known. Analysis of the eye movements during the DVA test both pre- and post-intervention may help elucidate these mechanisms but were considered beyond the scope of this paper.

Dr. Clendaniel, recently appointed to the Medical Advisory Board for VEDA; Vestibular Disorders Association, teaches a number of Vestibular Rehab courses for Education Resources including the new Cervicogenic Dizziness online course:

Vestibular Rehabilitation: Evaluation and Management of Individuals with Dizziness and Balance Disorders

Vestibular Rehabilitation: Advanced

Online Course:Vestibular Rehabilitation: Cervicogenic Dizziness

Clinicians: What has been your experience treating patients with unilateral vestibular hypofunction? Do you utilize habituation exercises, gaze-stability adaptation exercises or both? Will this research change what you do clinically?

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Vestibular Rehab Series Now Available Online from Education Resources Inc.

Vestibular RehabilitationEducation Resources, a leading provider of evidence-based continuing education, is thrilled to announce the launch of its new vestibular rehabilitation online course series.

The first offering in the series,

Vestibular Rehabilitation: Cervicogenic Dizziness 

 

 

is recorded live from international vestibular expert Dr. Richard Clendaniel’s highly acclaimed Evaluation and Management of Individuals with Dizziness and Balance Disorders course, and is now available. 

This 5 hour course will focus on the assessment and treatment of one cause of vertigo, cervicogenic dizziness, and how to distinguish it from central vestibular deficits.  Through lecture, case studies, demonstrations and extensive directed lab practice, participants will enhance their skills in vestibular rehabilitation. It is recommended for individuals who have experience with or who have previously taken a two day course in vestibular rehabilitation. 

$159 for 5 CEU hours 

Education Resources online courses are the next best thing to attending live:

  • Engaging CEU’s on demand
  • Learn at your convenience – access the courses for a full year
  • Advance your skills
  • Expand your knowledge
  • Learn from leading experts

Please Visit our FAQ Page to Learn More

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Therapies in the School Speaker Highlight – Cathy Stern

 

As the annual Therapies in the School Conference draws near we would like to highlight one of the dynamic speakers and the session she is presenting:

Dr. Cathy D. Stern OD, FCDO, FCOVD, FNORA  is known for “treating the visual side of learning”. She provides developmental, behavioral and neuro-optometric rehabilitation in private practice and as a consultant at the Massachusetts Hospital School. Dr,. Stern is She received her Doctor of Optometry degree from the Pennsylvania College of Optometry in 1980. She is a developmental and behavioral optometrist with specialized training in learning-related vision problems, vision rehabilitation, computer vision syndrome and sports vision strength training.

She has extensive experience working with children and adults with learning problems, add/adhd, non-verbal learning disability, cerebral palsy, autism and the multiply challenged. She also is involved with vision rehabilitation following head trauma and stroke. Dr. Stern has presented workshops and seminars for physicians, teachers, psychologists, occupational, physical, speech therapists and other professionals who work with special populations.

She is a Fellow in the College of Optometrists in Vision Development (FCOVD) and the College of Syntonic Optometry (FCSO). She is also trained in Neuro-Optometric Rehabilitation. Dr. Stern is State Director of the College of Optometrists in Vision Development, Vice President of the College of Syntonic Optometry and Massachusetts Keyperson for the American Optometric Association Sports Vision Section. The Massachusetts Society of Optometrists recently recognized her as a leader in vision therapy.

Presenting:

Visual Thinking: A New Paradigm to Maximize Success with School-Based Therapies
Visual Thinking involves seeing clearly and processing visual information in the brain for accurate motor action. We will demonstrate techniques to help a student better use visual thinking for reading, writing, math, attention, memory and sports.

Cathy is presenting this session with Donna McCrorey OTR/L an Occupational Therapist at the Massachusetts Hospital School for over twelve years where she specializes in the care of children with multiple disabilities including: cerebral palsy, muscular dystrophy, spina bifida, head injuries and other rare genetic conditions. 

Please click here for more information, to download a brochure or to register

 

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