Home » Blog

Rose Bigsby Honored for Contributions to Neonatal Care

Rose Bigsby Education Resources Rose Bigsby[/caption]

We would like to offer our congratulations to Rosemarie Bigsby, ScD, OTR/L, FAOTA, who has been elected as a recipient of the Pioneer Award for Neonatal Therapy.

Rose, renowned for her knowledge, skill and expertise, has worked as a pediatric occupational therapist and consultant for over 30 years, with over 20 years in the NICU, in the combined roles of therapist, educator and researcher.

The Pioneer Award was created to honor neonatal occupational therapists, physical therapists and speech-language pathologists who contribute tirelessly to establish and advance the specialized field of neonatal therapy. This inaugural presentation of the award reflects decades of largely unrecognized work by those who established the art and science of neonatal therapy.

She is Coordinator of NICU Services for the Brown Center for the Study of Children At Risk, Department of Pediatrics, Women & Infants’ Hospital, Providence, RI and Clinical Associate Professor of Pediatrics, Psychiatry & Human Behavior, The Warren Alpert Medical School of Brown University. She is a Fellow of the American Occupational Therapy Association, a contributor to the AOTA guidelines for NICU Practice, and the author of a number of journal articles and book chapters. She is coauthor of Developmental & Therapeutic Interventions in the NICU a book for NICU therapists, and The Posture & Fine Motor Assessment of Infants, and contributed to the development of the NICU Network Neurobehavioral Scale (NNNS). Her research focuses on motor development, behavioral cues, physiologic regulation and interventions and developing an interdisciplinary approach to initiating and progressing breast and bottle feeding.

Rose received her bachelors of science in occupational therapy and biology at Western Michigan, her masters degree in advanced pediatric practice and occupational therapy education and her doctor of science in therapeutic studies at Boston University.

Bigsby has also been a recipient of the American Occupational Therapy Association’s Service Award and the Service Commendation for her authorship of “Specialized knowledge and skills for occupational therapy practice in the neonatal intensive care unit.” She also is a co-investigator and co-author of a recent report documenting the benefits of single family room model of care for NICU patients that was covered by the New York Times, National Public Radio, Reuters and other new outlets at the national level.

We are honored to offer Rose’s course:

Intervention for the High Risk Infant: Providing Services in the NICU and During the Transition Home

June 4-5, 2015 – Edison, NJ
October 15-16, 2015 – Weymouth, MA

]]>

Treatments for Rocker-Bottom Foot

GUEST BLOGGER: Kathryn Biel

This clinical question was received from Holly:

Is there anything that can be done for a severe rocker bottom foot? Child is 8, spastic diplegia, has heel cord contracture, but has had two heel cord lengthenings. Currently not using AFOs, does have a slight crouch gait (was a toe walker before most recent heel cord lengthening). His foot hits the floor flat, but the mid foot then bottoms out and heel lifts during early stance. Is there any way to stretch gastrocs? I’d obviously love to avoid further surgery.

Rocker bottom foot can occur in a number of situations. It can be a congenital condition in which the navicular is malpositioned at the neck of the talus. This condition is rigid, with the foot in and equinus position with dorsiflexion. It is common in chromosomal abnormalities. Treatment recommendations include early plaster casting in plantar flexion and inversion to stretch ligaments (talonavicular, deltoid, and calcaneal cuboidal) and muscles (triceps surae and peroneous brevis) that are tight. Surgical reconstruction of the foot itself is also used as treatment.

However, rocker bottom foot can occur in cerebral palsy as a secondary impairment that results from spastic plantar flexors. In this condition, during weight bearing, the spastic plantar flexors pull the hindfoot upwards, resulting a weight shift forward to the forefoot. The center of gravity is moved forward as well. Over time, with the weight bearing surface stretches out and then eventually reverses the longitudinal arch, resulting in a rocker bottom appearance. Additionally, the spasticity through the gasctrocs over powers the inverters, which results in a collapse into valgus.

When stretching in PT, it is important to maintain stabilize the subtalar joint (through a firm hold on the calcaneus) so that it does not further collapse into valgus. Stretch should not be applied to the forefoot alone.

Orthotics may be the best bet to stabilize the subtalar joint while resisting plantarflexion. Orthotics that do not stabilize the subtalar joint will contribute to a further valgus deformity. The orthotics must include sufficient support and sculpting to hold the calcaneus stable. A skilled orthotist and close collaboration is key to make sure the hindfoot is stable in weightbearing.

Also, due to lengthening surgeries, the triceps surae is often weak, resulting in the crouched gait. Strengthening may be something to consider. Also, on going tone management (Botox or Baclofen, for example) is important to monitor as it is the spasticity that caused the deformity in the first place.

Does anyone else have ideas for how to non-surgically treat rocker bottom foot in a child with cerebral palsy? I’d love to hear what works for you.

~Kathryn Biel, PT, DPT

]]>

WIN A FREE ONLINE COURSE – Help us to Name a New Advanced Vestibular Online Course

COMING SOON!
NEW Advanced Rehabilitation online courses

We need your help!
ENTER TO WIN A FREE ONLINE COURSE

As our new Cerviocogenic Dizziness online course is proving to be popular
we are excited to add two more sessions to our Advanced Rehabilitation Series, filmed live and taught by internationally respected expert, Dr. Richard Clendaniel:

Advanced BPPV
Special Topics

We are trying to come up with a meaningful title for the new Special Topics 3 hour digital course series that covers these topics:

Post Concussion Syndrome
PPPD (formerly known as Chronic Subjective Dizziness)
Migraines
Fistulas
Canal Dehiscence
Meniere’s Disease

We would value your thoughts and ideas on a title that would attract you to take this course

PLEASE CLICK HERE TO EMAIL ME YOUR TITLE SUGGESTIONS
and in May 2015 we will randomly choose a winner who will receive free access to this new session

Thank you so much for any input as we strive to meet your needs.
Mandy

]]>

AS PEDIATRIC THERAPISTS, HOW ARE WE TREATING CHILDHOOD OBESITY?

GUEST BLOGGER: Kathryn Biel

As a school-based physical therapist, this issue comes up for me every year. Children are referred for physical therapy (and occupational therapy) evaluations because they are obese. Every year, I wrestle with my clinical decision making regarding these children.

The CDC posts some alarming statistics about childhood obesity:

The prevalence of childhood obesity has more than doubled in the past 30 years
In 2012, more than ½ of children and adolescents were overweight or obese
70% of obese children (age 5-17) have at least one risk factor for cardiovascular disease

Children who are obese are at high risk for the following medical conditions: pre-diabetes, cardiovascular disease, and orthopedic or joint problems. Additionally, obese children are at high risk for depression and social difficulties.

In school, we see these children as having difficulty participating in P.E. class and recess with their peers. Getting up and down from the floor can be difficult. Self-care, like shoe tying, can be challenging. Additionally, personal hygiene is often difficult. And this sounds like a silly point, but many obese children have trouble with properly fitting clothing, often leaving either stomachs or rear ends exposed.

Schools are doing their part by reforming school lunches (at the government’s doing). P.E. teachers are encouraging participation in before and after-school running clubs. Posters about healthy eating line the school and cafeteria walls. Schools are trying.

I’ve been documenting Body Mass Index (BMI) in IEP’s for students in which weight may be acting as a barrier to education. This can be a controversial practice. My purpose in doing this is to have data points in which to track a student’s progression. A child who has a BMI above the 99^th percentile and then drops to the 95^th percentile at the following review has shown significant improvement, even if the improvement is not apparent visually. Also, for children with whom weight management is an issue, I try to take measurements at the beginning of the school year, midway through, and right before summer vacation. It does become a delicate balance when taking these measurements and reporting on them to be very mindful of the child’s self-esteem.

In the past, some parents have been hotlined (Child Protective Services has been contacted) because of a child’s obesity and the resultant physical concerns. This is not common practice, and there has been little follow through when it was done.

However, I still struggle with the idea of pulling a child out of academic time to exercise. Firstly, it is not skilled physical therapy (or occupational therapy). Much of the time the issue is not that a child cannot perform a skill (i.e. shoe tying), but that they cannot perform it on their body. Secondly, will one session a week make a difference? Can we justify more therapy because of a lifestyle?

I often feel helpless in these cases. The teachers want PT and OT for these students. Some parents are insistent, while others are not. The meetings are usually uncomfortable.

So, as clinicians in the school environment, how are we handling this epidemic? Are you keeping these children on your caseload?

~Kathryn Biel, PT, DPT

]]>

PT Needing Advice on Autistic Child with Particular Behavioral issue

GUEST BLOGGER: Kathryn Biel.

Jacqueline submitted this clinical question:

I am a physical therapist working with an autistic child who continues to throw toys and other items constantly. He will throw items over, under and thru railings, in his sister’s crib and pack and play. This behavior happens all day in his home and other relatives’ homes. Parents and team members have tried several strategies to prevent this but nothing seems to help. We have tried ignoring the behavior, getting him to pick up the item each time he throws and try to distract him when we know he is about to throw an item. He has been doing this for over a year and now parents are concerned because he is beginning to throw larger toys and he now has a little sister and parents are concerned about her safety. Any suggestions to stop this behavior would greatly be appreciated.

This is a tough one. The behavior is meeting a need for this child. What is it? Is it simply fun and now it became a habit or a routine or is it somehow meeting an underlying issue? If such, then it would need to be replaced with another habit/routine (and finding one that is less harmful may be difficult). How you go about doing this will be challenging.

The other thing that I can think of is to help sculpt the behavior of throwing into a more limited activity. For example, he can throw, but it has to be into a large bucket (like one of those rope-handled beverage buckets). Putting several of this same container throughout the house so he has a place in each room to throw into may eventually channel this behavior. If part of the enjoyment is throwing through things, then how about putting a grate (or slots, like in the crib rails) over the opening to the bucket/container could help carry this behavior over to the buckets, rather than his sister’s crib.

I’m going to turn this question over to the experts out there. What else would you do to help with this behavior? Looking forward to hearing what you have to say!

~Kathryn Biel, PT, DPT

]]>

Rose Bigsby Honored for Contributions to Neonatal Care

Treatments for Rocker-Bottom Foot

WIN A FREE ONLINE COURSE – Help us to Name a New Advanced Vestibular Online Course

AS PEDIATRIC THERAPISTS, HOW ARE WE TREATING CHILDHOOD OBESITY?

PT Needing Advice on Autistic Child with Particular Behavioral issue

Recent Posts

Categories

Archives