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Why Crossing Midline is Important for Development

As babies grow and develop certain milestones are often celebrated, such as rolling, sitting, crawling, and walking. As a pediatric occupational therapist, one of the milestones I always celebrate might not be visible to the untrained eye. Crossing midline, defined as the ability to reach across the body’s invisible midline with your arms or legs to perform tasks on the opposite side of the body, is a required skill for many higher level coordination activities. Blog Crossing Midline Main-Landscape

This skill typically develops around 18 months of age. Oftentimes when children are referred for occupational therapy due to poor fine motor skills, handwriting, or coordination, they are not crossing midline efficiently.

Some ways to observe whether or not your child is crossing midline efficiently include:

  • Watching to see if your child switches hands during drawing tasks. Do they switch from left hand to right hand to avoid their arm crossing over when drawing lines across paper?
  • Evaluating hand dominance: by age 6, children should have developed a hand dominance. Children with poor midline integration may not yet have developed a hand dominance.
  • Tracking an object across midline: this can be observed during reading, as decreased midline integration can lead to poor ocular motor skill development required for scanning.
  • Observing ball skills: children who are not yet crossing midline may have a difficult time crossing their dominant leg over their non-dominant leg to kick a ball forward.
  • Assessing self-care skills: putting on socks, shoes, and belts may be extremely difficult as these are activities that require one hand to cross over to assist the other in the process.

Children who have difficulty crossing midline may not be able to keep up with their peers, which may cause increased frustration during participation at school and in social situations. In addition, crossing midline is a required skill needed in order to complete more challenging bilateral coordination activities, such as cutting with scissors, using a fork and knife to cut food, tying shoe laces, writing out the alphabet, and engaging in sports.

NSPT offers services in Bucktown, Evanston, Highland Park, Lincolnwood, Glenview, Lake Bluff, Des Plaines, Hinsdale and Milwaukee! If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140.

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How Multidisciplinary Treatment Helps Children with Autism

There are many benefits to providing children with Autism a collaboration of different therapies in addition to Applied Behavior Analysis services. blog-autism-main-landscape

  • Occupational therapy (OT) provides children with skills to help regulate themselves. These skills may help decrease inappropriate stims and help provide children with more socially acceptable skills for regulation.
    • OT can provide children with strategies to help with motor skills.
    • OT can have a different perspective on activities of daily living and as such can provide different and alternative interventions to increase independence on self-care activities.
    • OT improves children independent living skills, such as self-care.
  • Speech therapy can help children with functional communication skills. Speech and Language Pathologists (SLPs) can provide additional support to the children to develop communication skills.
    • SLPs may also provide education and the introduction of alternatives to vocal communication in the form of augmentative devices or picture exchange communication system (PECS).
  • Applied Behavior Analysis (ABA) develops personal one-on-one interventions for children to develop functional skills.
    • ABA focuses on helping children with social, academic, and behavioral concerns.
    • ABA will also focus on providing children with skills for functional communication.
  • Physical therapy (PT) can help provide children with additional motor function and can help with children who have low muscle town or balance issues.
    • PT can also help with coordination for children.
  • Collaboration of all therapies can help ensure that the most effective treatment is provided to the child in all settings.

Fusion of all therapies will provide children exposure to different strategies and interventions in different settings to help with day-to-day life.

NSPT offers services in Bucktown, Evanston, Highland Park, Lincolnwood, Glenview, Lake Bluff, Des Plaines, Hinsdale and Milwaukee! 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!

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Understanding Sensory Processing Disorder: Auditory System

“I know there’s nothing wrong with her hearing but I have to call her name 100 times!”

Sound familiar?

Much like the tactile system, discussed in the previous post of this series, the auditory system refers to our ability to take in information, process it, and produce an appropriate response. When a child overreacts to sounds or seems easily distracted by noise that many of us can tune out, she is demonstrating auditory hypersensitivity. This may be due to an improperly functioning stapedius, which is a middle ear muscle that contracts in response to loud noise in order to protect the hair cells of our inner ears. When this muscle is not properly contracting, sounds may seem louder to these children. This understandably puts extra stress on them and causes difficulty filtering out background noises that most of us don’t even notice. On the other hand, you may see a child with a hyposensitive auditory system seeking out loud noises or demonstrating difficulty localizing and distinguishing sounds.

Below are red flags for hypo and hyper sensitivity to noise:Sensory processing disorder auditory system

  • Fear of sounds from hair or hand dryers, vacuums, flushing toilets, etc
  • Overreaction to loud or unexpected sounds (covering ears, crying, running away, aggression)
  • Annoyed or distracted by sounds most of us either don’t notice or become used to such as fans, clocks, refrigerators, outside traffic, etc
  • Becomes upset with others for being too loud (but are often times very loud themselves)
  • Prefers to keep television, radio, or music very loud
  • Dislikes noisy places such as malls, movie theaters, parades, fairs, etc…
  • Enjoys making noise just to make noise
  • Doesn’t respond promptly to name being called
  • Needs you to repeat yourself often or doesn’t seem to understand what you said
  • Unable to recognize where sound is coming from

It’s important to note that terms related to auditory processing are not always defined consistently. While auditory hyper and hypo sensitivities could be considered an auditory processing disorder (since they refer to a dysfunction in the processing of sound), this term is commonly used to describe dysfunction in the brain’s ability to translate sounds. Central auditory processing disorder (CAPD), now commonly referred to as simply auditory processing disorder (APD), is when normal hearing is present, yet the brain has difficulty interpreting what it hears. Symptoms of this condition can look similar to auditory hyper and especially hypo sensitivities in many ways, yet key symptoms include difficulty with interpretation of sounds or language, speech delay, and difficulty learning to read. In this instance, an audiologist will help identify the issue and may refer to a speech and language pathologist for treatment.

However, if you have concerns that your child is exhibiting some of the red flags listed above for hyper and hyposensitivity, it is worth consulting with an occupational therapist to identify helpful supports for your child. There are a variety of sound-based programs out there and an occupational therapist (OT) can help identify if one may be beneficial for your child. Additionally, issues with the auditory system are often accompanied by issues with other sensory systems and a comprehensive plan should be put in place. Your OT may also provide you with useful tips to minimize distractions for activities in which concentration is required, guide you on the use of noise cancelling or minimizing headphones, and offer other suggestions such as repeating back instructions prior to beginning a task.

Click here to learn about the subtypes of Sensory Processing Disorder.

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What Is the Difference Between Occupational and Physical Therapy for Children?

Many of the parents I meet often ask why very few occupational therapist work with infants, or why an occupational therapist (OT) is seeing their child for toe-walking as opposed to a physical therapist (PT). They often wonder why one child who has balance or coordination issues would see a physical therapist while another with similar limitations would see an occupational therapist instead. Some parents think that occupational therapists only work on fine motor skills while physical therapists only work on gross motor skills.  Physical and occupational therapists work in a variety of settings, including hospitals, neonatal intensive care units, skilled nursing homes, outpatient clinics, schools, rehabilitation centers, and doctor’s offices.  Physical therapist and occupational therapist roles differ depending on the setting they work in and the medical diagnoses they work with.

In the outpatient clinic, some of these roles may overlap.  While there are some similarities between PTs and OTs in each setting, there are a few fundamental differences between OTs and PTs in the pediatric setting.

Pediatric Physical Therapy:

In the pediatric outpatient setting, physical therapists are often musculoskeletal and movement specialists. Parents can seek out evaluations when their babies are as young as 1 month old. Physical therapists have in-depth knowledge about human musculoskeletal, neuromuscular, integumentary, and cardiovascular systems. Based on our background in stages of development and biomechanics, we help children with mobility difficulties; whether they are behind on their gross motor milestones, recovering from injury/surgery, or not keeping up with other children.

Through all kinds of hands-on or play techniques, pediatric physical therapist work with children on the following:

  • Gross motor skills
  • Strength
  • Endurance
  • Balance and coordination
  • Motor control and motor planning
  • Body awareness
  • Pain relief
  • Flexibility
  • Gait mechanics
  • Orthotics training
  • Wound care

Our focus is for children to be as mobile and as independent as possible, while training their caregivers on all aspects of a child’s physical development. This includes anything that may affect a child’s quality of movement, posture, alignment, and safety.

Pediatric Occupational Therapy

Outpatient pediatric occupational therapists are trained to improve the quality of children’s participation in their daily functional tasks.  A child’s job is to play and take part in activities at school and at home. These include important endeavors such as paying attention in class, hand writing, dressing, feeding and grooming themselves, and being able to engage in age-appropriate games. Occupational therapists are also trained to help children organize and interpret information from the environment so that they can just be kids. This may include taste aversions that limit their food intake, or texture aversions that affect their clothing tolerance, or sound aversions that affect their mood.

OTs work with children on the following skills:

  • Sensory integration
  • Cognitive endurance
  • Fine motor skills
  • Hand function
  • Visual-spatial awareness
  • Hand-eye coordination
  • Attention
  • Social skills
  • Body awareness

Occupational therapists often educate parents and teachers on the best techniques to ensure children participate in learning, self-care, and play tasks.

Why do some children need both disciplines and some only need one?

So many factors can affect a child’s ability to participate in her daily life. A child may be experiencing frequent falls or may have trouble jumping due to a number of reasons.  No matter the diagnosis or underlying medical condition, any child who is having a hard time keeping up with his peers can benefit from a comprehensive evaluation by a pediatric specialist.