torticollis

What Happens When Torticollis Goes Untreated

As a pediatric physical therapist in the outpatient setting, about 10-25% of my patients are diagnosed with Torticollis. Torticollis is the tightening of one muscle in the neck called the Sternocladeomastoid, or SCM for short. The SCM is the muscle that controls ipsilateral sidebend and contralateral head rotation.  This muscle, located on either side of the neck, works to tuck the chin down.  When one side works independently, it will work to turn the head to the opposite side and tilt the head towards the direction of the muscle. Torticollis is a serious medical condition, and left untreated, can result in many impairments. I will go over some of the most frequent and serious below.

Possible Results of Untreated Torticollis:

  • Plagiocephaly – This is the most common consequence of untreated Torticollis. Plagiocephaly isWhat Happens When Torticollis Goes Untreated the mishapening of the bones on the skull, usually resulting in a large flat spot on one side of the back of the head and facial assymetries. Early diagnosis and conservative treatment can be successful in decreasing the severity of the Plagiocephaly. However, late diagnosis must be treated by a helmet or craniofacial surgery.
  • Cervical spine contractures into the preferred head rotation and sidebend – These contractures can become ossified over time, significantly impacting functional mobility and ability to interact with peers. Once a contracture is ossified, surgery is required to lengthen the muscle, followed by several sessions of physical therapy to regain full cervical spine range of motion.
  • Limited shoulder mobility – Decreased active movement into non-preferred rotation and sidebend can also result in shoulder elevation. This in turn impacts the child’s ability for upper extremity weight-bearing and reaching toward midline with hand.
  • Cervical Scoliosis – Persistent head tilt in the absence of shoulder elevation can result in a lateral shift of the cervical spine, which leads to cervical scoliosis.

If you suspect that your child has Torticollis, please contact one of our physical therapists at North Shore Pediatric Therapy for a free screen.

north shore pediatric therapy physical therapy

NSPT offers services in BucktownEvanstonHighland ParkLincolnwoodGlenview and Des Plaines. If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates today!

4 year old doctor visit checklist

4-Year Doctor Visit Checklist

We continue our series on checklists for yearly Pediatrician check-ups (click here to see the checklists for the 1-year visit, the 2-year visit and the 3-year visit). Pediatricians have a set of developmental red flags, but these only hit the “big-bad-uglies” as we like to call them, including the following: Can you understand everything your child says? Does your child fall excessively? Is he feeding himself? These red flags are very specific, meaning a child who exhibits these red flags would be identified for services, but not very sensitive, meaning many children who would benefit from therapy services are missed. To help bridge the gap between Pediatricians’ red flags and children who need therapy services, I have put together a checklist of things to discuss with your Pediatrician at your child’s 4 year check-up.

At 4 Years Your Child Should Be Able to Do the Following:

Gross Motor Skills4-Year Old Doctor Visit Checklist

  • Places one foot on each stair, while going up and down stairs without handrail use
  • Hops forward on one foot
  • Throws ball at a target 5 feet away
  • Runs and stops without falling to ground

Fine Motor Skills

  • Unbuttons and buttons clothing
  • Cuts paper in near straight line
  • Independent eating with good fork use

Speech Skills

  • 100% intelligible to familiar audience
  • Uses plurals and past tense
  • Correctly uses “he”, “she”, “they”
  • Follows 3-step commands
  • Points to parts of pictures

Take this checklist with you to your 4-year visit. If you have further concerns, schedule a pediatric physical therapy evaluation.

north shore pediatric therapy physical therapy

NSPT offers services in BucktownEvanstonHighland ParkLincolnwoodGlenview and Des Plaines. If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates today!

How to Qualify for Physical Therapy Services at School

North Shore Pediatric Therapy recently hosted our first IEP bootcamp, where our school advocate explained how to get the most out of your child’s IEP and school services. Similarly, children can receive physical therapy services at school. Here is a breakdown of how a child would qualify for physical therapy services in a school system and the differences between physical therapy services in a school and physical therapy services in a private setting.

How is Physical Therapy Included in School Services?

Through the Individuals with Disabilities Education Act (IDEA), public education must be accessible toHow to Get Physical Therapy Services in School all children aged 3-21 years old[i]. Physical therapy is a related service used to help implement IDEA. School-based physical therapy must be aimed towards allowing the child to access his educational environment. Some of the things a school-based physical therapist might assess include travel from one area of the school to another, getting onto and off of the bus, safely navigating the bathroom and cafeteria, getting into and out of classroom chairs, and participation in all classes. They will assess independence, safety, and timeliness of the above areas in determining need for physical therapy services.

The Role of the IEP:

If parents, teachers, or students determine a need in the student accessing the school environment, an IEP referral is made.  This begins the process for school-based services. A physical therapist employed by the school district or contracted through an outside agency will evaluate the child and determine eligibility. In Illinois, the physical therapist is required to obtain a prescription for physical therapy from the child’s physician prior to treatment. However, physical therapy services must be provided at no cost to the family when deemed necessary.

Clinic-Based vs. School-Based Physical Therapy:

Clinic-based physical therapy is aimed at improving quality of movement, return to function, and achieving gross motor milestones in an age-appropriate time frame. Many children who would benefit from physical therapy services, but don’t qualify for school-based services due to the restrictions, attend private clinics for physical therapy services. In these settings, a physical therapist determines need based on standardized assessments, functional assessments, strength and range of motion testing, and compares these scores to age-appropriate norms. Some things that may qualify a child for outpatient physical therapy but not school-based physical therapy include gait abnormalities (including toe-walking and in-toeing), developmental coordination disorder, decreased endurance and overall weakness, hypotonia, foot pain, sports injuries, burns, etc. In Illinois, the physical therapist is required to obtain a prescription for physical therapy from the child’s physician prior to treatment. Physical therapy services in an outpatient setting must be covered through insurance or private pay.

Dependent on your child’s needs, physical therapy services may be required in a school setting, in an outpatient setting, or both. If you have any concerns about your child’s gross motor development or access to services in their school district, please contact the professionals at NSPT.

NSPT offers services in BucktownEvanstonHighland ParkLincolnwoodGlenview and Des Plaines. If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates today!

[i] Fact Sheet. Providing Physical Therapy in Schools Under IDEA 2004. www.pediatricapta.org. 2009. Accessed 07/14/2015.

3 year doctor visit checklist

3-Year Doctor Visit Checklist

We continue our series on checklists for yearly Pediatrician check-ups (click here to see the checklist for the 1-year visit and the 2-year visit).  Pediatricians have a set of developmental red flags, but these only hit the “big-bad-uglys” as we like to call them, including: stutter, go up and down stairs by themselves, or answer and ask “yes or no” questions.  These red flags are very specific, meaning a child who exhibits these red flags would be identified for services, but not very sensitive, meaning many children who would benefit from therapy services are missed. To help bridge the gap between Pediatricians’ red flags and children who need therapy services, I have put together a checklist of things to discuss with your Pediatrician at your child’s 3 year check-up.

At 3 Years, Your Child Should Be Able to Do the Following:

Gross Motor Skills3-Year Doctor Visit Checklist

  • Pedals a tricycle
  • Catches a ball thrown from 5 feet away
  • Jumps forward at least 24 inches, with both feet leaving the ground at the same time
  • Stands on 1 foot for 3 seconds
  • Walks up stairs with 1 foot on each step

Fine Motor Skills

  • Draws circle, horizontal lines, and cross, with demonstration
  • Strings small beads
  • Opens screwed top container
  • Pulls up pants and puts on coat independently

Speech Skills

  • Increases word production to >300 words
  • Combines 3 word phrases
  • Starts to understand differences between opposites
  • Begins to follow 2 –step commands
  • Names colors
  • Demonstrates parallel play

Take this checklist with you to your 3-year visit. If you have further concerns, schedule a pediatric physical therapy evaluation.

north shore pediatric therapy physical therapy

NSPT offers services in BucktownEvanstonHighland ParkLincolnwoodGlenview and Des Plaines. If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates today!

2-Year-Old Checklist

2-Year Doctor Visit Checklist

Building off of last month’s 1 year check-list for Pediatrician check-ups, we bring you a check-list to look at prior to your child’s 2 year old check-up.  Again Pediatricians have a set of developmental red flags, but these only hit the “big-bad-uglys” as we like to call them, including the following questions: does your child get frustrated when trying to talk, can he or she jump or attempt to jump, did your child walk by 18 months. These red flags are very specific, meaning a child who exhibits these red flags would be identified for services, but not very sensitive, meaning many children who would benefit from therapy services are missed. To help bridge the gap between Pediatricians’ red flags and children who need therapy services, I have put together a checklist of things to discuss with your Pediatrician at your child’s 2 year check-up.

2-Year Check-Up Red Flags:

Gross Motor SkillsParent Checklist for 2-Year-Old Well Visit

  • Runs forward 10 feet, without a loss of balance
  • Jumps in place, jumps forward, and jumps down from a step
  • Walks forward, backwards, and sideways independently and without a loss of balance
  • Walks up and down a set of stairs, using a handrail
  • Kicks a ball forward 3 feet

Fine Motor Skills

  • Turns pages of thick page book, 1 at a time
  • Stacks 5 cubes
  • Draws vertical lines given demonstration
  • Takes off button-less clothing and socks independently

Speech Skills

  • Begins saying 2 word phases and 2 word questions
  • Increases vocabulary to saying >50 words and understanding >300 words, with new words added every week
  • Answers “yes or no” questions
  • Points to objects named
  • Speech should be understood at least  50-75% of the time by a familiar listener

Take this checklist with you to your 2-year visit. If you have further concerns, schedule a pediatric physical therapy evaluation.

north shore pediatric therapy physical therapy

NSPT offers services in BucktownEvanstonHighland ParkLincolnwoodGlenview and Des Plaines. If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates today!

a guide to buying baby shoes

A Guide to Buying Baby’s First Shoes

The seemingly exponential growth of the children’s shoe industry can overwhelm the even the most expert buyer. A quick search on Google for “Buying Baby Shoes” reveals over 40,000,000 hits. In this blog I’ve broken down the shoes requirements for each stage of walking to guide the consumer.

A Guide to Buying Baby’s First Shoes:

  • Pre-Walking – Shoes for children in this stage are used for protection from the elements. Due toA Guide to Buying Baby's First Shoes increase of floor time, shoes should be flexible enough to allow for ease of movement in this position. It should be noted that the best footwear for children in this motor phase is no-shoes at all.
  • New Walkers – As a child begins pulling up to stand and taking her first steps, her shoes should change to meet the increased demand. Shoes should continue to remain flexible, allowing for ease of transition between crawling and walking. It is also important that these shoes have some sort of grip associated with them to limit slipping.
  • Expert Walkers – These children use walking as the main, and usually only, means of locomotion. Crawling is no longer functional for them, but may be used in play. As children transition into this phase of walking, their shoe needs change as well. The shoe should have a semi-rigid sole, meaning the sole is made of hard plastic, but it can twist with a moderate amount of effort.

If your child has demonstrates any sort of gait abnormality (single foot turned out, walking on toes, excessive falls) or has not begun walking by 18 months, please come into NSPT for a free physical therapy screen.

north shore pediatric therapy physical therapy

NSPT offers services in BucktownEvanstonHighland ParkLincolnwoodGlenview and Des Plaines. If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates today!

using stairs to assess functional strength

How to Use a Staricase to Assess Functional Strength

We as physical therapist use functional measures of strength to assess strength in a child. Parents can use these same measures to assess whether their child is on track with gross motor skills, or to see if there is an underlying weakness. I have broken down the milestones for stair ascent and descent during the first 4 years of life, along with possible weaknesses and impairments associated with delayed skill.

Functional Strength Assessment Using a Staircase:

  • 18 months – Children should be able to walk up and down 1 set of stairs in home or at the park, How to Use Stairs to Assess Functional Strengthusing one railing or one hand held assistance, and demonstrating any type of form. Children will usually place both feet on each step at this phase. Be aware of children who always lead with the same foot; this may be a sign of opposite side weakness. Delays to this milestone may indicate core weakness, lower extremity weakness, or balance impairments.
  • 2 years – As children continue to practice this skill and strengthening their legs, their stair skills dramatically improve. First children will begin testing their stair skills by carrying objects up or down stairs and taking steps without holding onto the railing or holding a hand. Initially, they will place both feet on each step. By 2½ years old, children will begin using a more mature reciprocal form (one foot on each step), when going up stairs while using one handrail. Delays to reciprocal gait while going up stairs usually indicates weakness in the leg that does not step up.
  • 3 years – A 3-year old should be able to ascend 1 set of stairs demonstrating reciprocal gait, without handrail support. This milestone may be delayed due to short stature, and subsequent shortened tibia length (shin bones) which make it harder to reach the stairs, but will be achieved prior to their 4th birthday. Delays to reciprocal gait without handrail support indicates lower extremity weakness in non-leading leg.
  • <4 years – Prior to their 4th birthday, children should have mastered stairs. This includes walking up a set of stairs using reciprocal stepping, both with and without handrail use, as well as walking down a set of stairs using reciprocal stepping, both with and without handrail use. While handrail use will be dependent on situation, reciprocal gait will be the norm, used regardless. Delays to reciprocal gait while going down stairs may indicate eccentric weakness of quadriceps (inability to control limb with slow descent), impaired single limb balance, or core weakness.

Any child over the age of 4 who is unable to walk up and down 1 set of stairs without support, demonstrating a mature one-foot-one-each –step form, should come into NSPT for a free physical therapy screen to assess leg strength and balance.

NSPT offers services in BucktownEvanstonHighland ParkLincolnwoodGlenview and Des Plaines. If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates today!

12-Month Doctor Visit Checklist

12-Month Doctor Visit Checklist

Developmental check-ups with a Pediatrician throughout your child’s first year of life (at 2, 4, 6, 9, and 12 months) are a perfect place to bring up any concerns you as a parent may have a about your child’s development. While Pediatricians have their own set of developmental red flags, these only hit the “big-12-Month Doctor Visit Checklistbad-uglys” as we like to call them, including the following:

  • Is your child rolling by 6 months?
  • Is your child sitting independently by 8 months?
  • Is your child crawling by 12 months?
  • Is your child walking by 18 months?

These red flags are very specific, meaning  a child who exhibits these red flags would be identified for services, but not very sensitive, meaning many children who would benefit from therapy services are missed. I have seen many children referred to physical therapy for delayed walking skills, who are not standing independently or didn’t roll consistently until 8 months. To help these children who are being missed by the Pediatricians red flags, I have put together a checklist of things to discuss with your Pediatrician at your child’s 12 month check-up.

Checklist for your child’s 12-month doctor visit:

Gross Motor Skills

  • Independently transitions into and out of sitting
  • Rolling independently from back to belly, and belly to back, with ease
  • Crawling on hands and knees with reciprocal form
  • Pulls to stand at stable surface
  • Cruises along furniture

Fine Motor Skills

  • Begins using pincher grasp (thumb and single finger)
  • Transfers objects from one hand to the other
  • Places toys into large container, and takes toys out
  • Begins holding spoon during feeding

Speech Skills

  • At least 1-2 words
  • Babbling with constant – vowel combination, ie. ba-ba, ma-ma, da-da
  • Labeling object with consistent sounds, ie. ball is always “ba”
  • Pays attention to speech around them
  • Follows simple commands, ie. “go get the ball”

Take this checklist with you to your 12-month visit. If you have further concerns, schedule a pediatric physical therapy evaluation.

north shore pediatric therapy physical therapy

NSPT offers services in BucktownEvanstonHighland ParkLincolnwoodGlenview and Des Plaines. If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates today!

Why Isn’t My Child Walking Yet?

As a follow up to last week’s blog, Signs that My Child Will Walk Soon, I present the next topic in my walking series, Why Isn’t My Child Walking?. As first birthdays come around, many anxious parents wonder, “why hasn’t my child taken his first steps?” First off, let me dispel the myth that babies will begin taking their first steps by their first birthday. The normal range for independent walking is 10-18 months, however most children begin walking around 14-15 months. Delayed walking skills may be due to decreased muscle strength, decreased confidence, or impaired balance. Read below for a description of signs of each and tips to help improve them.

 Reasons Your Child May Not Be Walking Yet:

  • Decreased Muscle Strength: Walking is a major milestone for children and requires a lot of lower extremitywhen will my child walk strength. This is why there are so many important precursors to walking, such as cruising and creeping on hands and knees. Children typically spend 1-4 months in each of these precursory milestones in order to build the strength necessary for walking. Encouraging your child to spend time in these gravity dependent positions will help build lower extremity strength.
  • Decreased Confidence: Often times children who have been cruising for significant periods of time without making the transition to independent stepping may have decreased confidence in their walking skills. Employing a towel or blanket that is held as a link between parent and child, can help build their confidence.
  • Impaired Balance: A child who shows difficulty with independent standing may have impaired balance and proprioception. Using heavier shoes that help give feet to the child that let them know where they are in space.
  • Other Medical Reasons: There may be an underlying medical condition preventing your achieving his gross motor milestones in an appropriate time frame If your child is not demonstrating signs that he will walk soon by 12 months of age, please contact your physician or come into North Shore Pediatric Therapy for a free physical therapy screen.

NSPT offers services in BucktownEvanstonHighland ParkLincolnwoodGlenview and Des Plaines. If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates today!

signs my child will walk soon

When Will My Child Start Walking? 5 Signs That Your Child Will Be Walking Soon

All children develop and grow and their own rates. Current research gives a range where typically developing children achieve their gross motor milestones. But when the baby books and Pediatricians tell you that your baby will probably be walking independently somewhere between 10-15 months, with some children even walking at 18 months and still falling within normal ranges, parents want more answers. A great way to see if your child is on the right track is to check for these 5 signs that walking may be in their imminent future.

5 signs your child will be walking soon:

  1. Pull to Stand – When a child begins pulling up into standing using hands or stablesigns my child will walk furniture, he is strengthening his legs to prepare them for walking. The mature form of pulling to stand is to perform through a half-kneeling position.
  2. Cruising – Cruising is defined as walking while holding onto furniture. Cruising allows your child to practice weight shifting and forward progression in a safe environment.
  3. Crawling onto and over Furniture – As a child becomes stronger throughout his core and extremities, you may find him starting to climb onto furniture or crawl over obstacles. These are all signs that your child is developing the muscle strength and balance needed to walk independently.
  4. Walks with Push-Toy/Handheld Assistance – The added stability of walking while holding onto a push-toy or a parent’s hands helps children develop the confidence needed to take those first independent steps. Some children may use this as a crutch, so be sure to provide as little support as needed (2 handheld assistance>1 handheld assistance> holding onto sleeve of shirt>holding blanket between child and parent).
  5. Standing Independently – Children begin to let go of objects while standing when they feel confident and stable. The longer the child is able to stand, the greater his confidence is.  Bonus if the child is able to get into or out-of this position with control by himself.

If your child has not begun demonstrating the above skills by 12 months of age, he may benefit from a physical therapy evaluation.

NSPT offers services in BucktownEvanstonHighland ParkLincolnwoodGlenview and Des Plaines. If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates today!