Diagnosis—is it essential?

Parents are the first observers of any atypical behavior in their child such as delayed speech, delayed walking, clumsiness, poor feeding, and many more symptoms. In kindergarten or grade school, difficulties are observed in reading and writing abilities. Or simply there is a gut feeling that all is not well with their child. That probably begins their journey with medical examinations, internet searches, and exploring treatment options. 

And they either get puzzled when the child is not provided with a proper diagnosis,  or there is a sigh of relief that there is no diagnosis. Either way, the problem still remains as to why is the child displaying atypical behaviors or struggling in school. 

A qualified physiotherapist, occupational therapist, or a speech therapist would do a detailed assessment of the child in terms of assessing muscle tone, strength, flexibility, motor skills, sensory systems, balance, communication, language, visual-motor skills etc. to detect any deficits that would lead to difficulties that the child is experiencing. Therapy is targeted to reduce these identified difficulties and improve functional abilities. 

Rather than arguing about whether the child is diagnosed or not, getting the symptoms addressed is an option. And earlier the better, since issues can be treated at a better and faster rate until age 7 when the brain is most adaptable to learning.

Peddler in Pediatric Therapy

While working in the sub acute rehabilitation centers in the United States, I had used the peddler for the geriatric population as a means to strengthen the lower extremities. Occupational therapists also used it for upper extremity exercises with the patient in either sitting or standing position. We had separate peddlers for upper and lower extremities for hygiene purposes. (I can still remember when I got yelled at by an occupational therapist because I had taken the UE-marked peddler for LE use, albeit in a rush of time!

Personally, despite the benefits of cycling on a peddler, I viewed it as boring equipment, which I used for my patients on hectic days.  I did not like it much since it needed to be stabilized with weights so that it would not glide while being used. To make it interesting and justify its objectivity, I would tie cuff weights to the patient’s ankles as well as time the minutes of peddling.

Little did I know then, that it would become crucial equipment in my private pediatric practice in India. I purchased peddlers for adult treatments, and ended up using them mostly for children!

During the past 3 years, I came across many preschool children who had difficulty with propelling a tricycle. Not only did they have strength deficits in the lower body, teaching them to pedal at home was a daunting and frustrating task for parents.  All of these children were aged 3 to 5 years with various diagnoses such as autism, sensory processing dysfunction, traumatic brain injury, spastic diplegia and hemiplegia. One child, at the age of 9, was struggling unsuccessfully to pedal his bike through full revolutions. The demands of strength, balance, and coordination of two sides of the body were too overwhelming for these children. Moreover, any effort to pedal caused the bike to move, which further instilled fear in some of the children who were oversensitive to movement. 

That is when I realized that the peddler would be a perfect, stationary solution to start learning alternate and reciprocal movements of the extremities. I had the child sit on a small chair or a regular chair with pillows for support for pedaling with lower extremities. The child would sit cross-legged on the floor or stand while using the peddler with upper extremities.  Doing so, I had to initially help them push, and it did take a number of sessions before the child would be able to propel themselves. Soon I started introducing cuff weights on ankles or arms to provide them with increased proprioceptive input. And most children soon started riding the bike at home.

For children who were still non-ambulatory, the peddler became a useful tool for practicing stepping movements of the lower extremities. The functional changes in strength and balance led to better stance and consequently faster ambulation. For some others, peddling helped correct the in-toeing gait by strengthening the hip external rotators.

The peddler is static, light-weight, easy to move as well as store, and economical to purchase. By practicing on the peddler, I was teaching the children the sensation of alternate-reciprocal movement of the upper / lower extremities that is so crucial for body awareness, bilateral coordination, and facilitating better communication across cerebral hemispheres. Ultimately it led to the skill of cycling that is so essential for any child’s movement, play repertoire, confidence, and self-esteem. 

As a clinician, I learnt another lesson as to how a simple equipment can become valuable in skill attainment for our clients. This is a reminder that we may easily miss out simple strategies already available to us in our quest for sophisticated solutions.

#pedaling #cycling #bilateral coordination #bilateral integration #body awareness #hand cycle

Movement -Part 2

In the previous post, I discussed the two characteristics of movement—goal oriented and variation.

When movement is purposeful rather than aimless running around, new connections in the brain are not being formed and learning does not occur. In other words,  goal-oriented movement that requires some sort of problem-solving is required for the brain to develop, which typically occurs in a growing child.

Example 1.  A baby crawls towards an attractive object or to get into mom’s lap.

Example  2.  A toddler walks, crawls under tables, or climbs up small furniture in order to retrieve a toy.

Example 3. An older child may jump, hop, skip as a part of a game that holds some goal.

Example 3.  An adult bends over, turns around, steps backward, and moves in multiple ways while searching a lost item or cleaning the house. 

Movement of our body segments and our entire body through space in order to fulfill a task also provides  sensory input  to our central nervous system in terms of visual, vestibular, and proprioceptive stimuli.  Optimal sensory input leads to improved alertness, attention, and conduces us to better engage in tasks.

If there is hardly any purpose in movement as displayed by children who are hyperactive, movement is dysfunctional and disruptive. These children do walk, run around, and may seem to be typical  to an average observer. However, they have difficulty sitting in a place, are fidgety, or are always on the go. Engagement in a single task is difficult for them, attention and focus are short-lived for a few seconds to a couple minutes. Hence learning does not occur, but rather there is a narrow repertoire of movements and task abilities.Sitting in a classroom, mingling with other kids, attending a birthday party become very difficult.

In my clinical experience, children who are hyperactive , can’t sit still,  can’t sustain any activity generally calm down when encouraged or enticed into heavy work and purposeful activity.  Sensory Integration has been shown to be beneficial for children with ADHD.

#movement #meaningful movement #learning #goal-oriented #sensory input 

Movement-- Part 1

Movement is an essential component of anything we do in life. Just think how many times do we move throughout the day.  We move in several  ways such as turning and getting out of bed, sit to stand, squatting to pick up an object from the floor, reaching for something across the table, reaching overhead to retrieve an object from a shelf, bending over to open a drawer at a knee level, walking, negotiating steps, etc. We also move our body frequently in subtle ways when we are required to sit in a spot for a long time. It is nothing less than amazing that  we move throughout our  waking hours.

Upright posture, movement, and walking are crucial for many physiological functions such as bone health, blood circulation, and functions of the digestive and urinary tract.

Movement is also important for arousal, balance, and coordination.

 

The  common denominators of every movement are that movement  is purposeful,  goal-oriented, and variegated. 

Every movement holds a purpose. You walk across the kitchen to get a cup of water, walk from one room to another to get a book, and out the door to walk to a neighborhood store. Even on a leisurely walk through the park, you have a goal of walking for a certain fixed time period and in a pre-decided direction. That means purposeful movement is meaningful. 

Movement is variable. We walk, climb, step, squat, bend, reach, turn, and much more throughout the day.

The same movement may have different goals depending on the individual. For example a toddler may roll and get out of the mother’s arms for a toy, an adult may roll to get out of bed.  A child may run to a toy at another end of the room, an adult may run as a part of his exercise routine. Similarly, as a child you have learnt finger movements to play a musical instrument which are later also used to operate a computer keyboard.

Movement makes a child effective for exploration, communication, and learning. Variety of movement is crucial to building neural connections in the brain during the first three years of life. Earlier the child feels successful, he/she  feels  confident about progressing  in any area of life.

I have been always proud to be a movement specialist, since physiotherapists are trained to be experts in movement.

#movement #physical therapist #balance #coordination #meaningful