What is Listening?

In order to understand why your child’s therapist may recommend use of the Therapeutic Listening® program, it is important to first clarify what is meant by “listening”. Sheila Frick provides the following definition:

“Listening is a whole-brain, whole-body experience that connects us to the world outside of ourselves and is the most basic precursor to interaction, speaking, reading, and writing. Listening relates closely to arousal, attention, focus, vigilance, and concentration, and it helps us to modulate and integrate sensation. Listening also plays a part in keeping us oriented in the physical world of space and time. Environmental sounds give us a sense of the three-dimensional space we occupy, and the duration of a sound gives us a sense of the passing of time.”

*Frick, S. M., & Young, S.R. (2009). Listening with the Whole Body: Clinical Concepts and Treatment Guidelines for Therapeutic Listening. Madison: Vital Links.

Listening is largely an unconscious process. Throughout the day, we unknowingly monitor our auditory environment, filtering out ambient or background noise and shifting our attention when a salient sound occurs. For instance, when at the office, we tend to ignore the buzzing sound of the lights or overhead fan. We tune in to the sound of a fire alarm or a co-worker speaking by stopping what we are doing, looking to the source of the sound, and responding as needed. Listening, therefore, plays an important role in survival and allows us to socially reference our world.

How Is Therapeutic Listening® Used In Occupational Therapy Treatment?

Children with sensory processing challenges often have a difficult time with listening skills. Use of Therapeutic Listeningâ coupled with sensory integration treatment may improve the following areas:

• Attention
• Organized behavior
• Self-regulation
• Postural control
• Bilateral coordination
• Praxis (Motor Planning)
• Fine motor control
• Visual-motor integration
• Social skills

Your child’s treating therapist may recommend using Therapeutic Listeningâ as part of his/her treatment plan. The therapist will conduct structured observations and provide a parent questionnaire to gather information necessary to select appropriate music. Once a starting point has been identified, music will be trialed during a therapy session. The following specialized equipment will be used:

• Therapeutic Listeningâ CD or Digital MicroSD Memory Chips with electronically modified music designed to elicit specific physiologic responses.
• Portable CD or Sansa Clip Music player
• Sennheiser HD500A or Pro-50 Headphones with “open ear system” (child can listen to music and hear conversational language around him/her)
• Tune Belt (allows for greater mobility when using a portable CD player)

Your child will use the recommended CD or music chip at home for 30 minutes twice a day over a period of two weeks. New music will be introduced every two weeks. Your child’s therapist may ask you to track changes in your child’s attention, sleep patterns, activity level, behavior, etc.

Therapeutic Listeningâ is a valuable tool that can help children to meet their therapy goals. Consult with your child’s therapist to learn how it may be used as part of the treatment process. For more information on Therapeutic Listeningâ, visit www.vitallinks.net.

Eileen Gordon, M.S., OTR/L

Each group will run for 6 weeks beginning the week of May 21, 2012.

Summer sessions will begin the week of July 9th and will run for 6 weeks!

Exceptional Explorers will begin Friday, July 13th 8:30-10:30 and run for 6 weeks.

The week long BAC Camp is August 20th -24th from 9-12pm.

Click here to fill out our GROUP INTAKE FORM

Age Range: 3-5                                                                            Therapists: Carolyn and Elvira

Day: Wednesday                                                                           Time: 11:00-11:45AM

Stretch and strengthen while learning to manage emotions, fear and attention through yoga’s breathing techniques.  Led by an OT/MSW and a PT, this class makes the therapeutic benefits of yoga fun for kids of all abilities.

I was reading an interesting case report the other day in the Pediatric Physical Therapy Journal www.pedpt.com , Sport Specific Fitness Testing and Intervention for an Adolescent  With Cerebral Palsy: A Case Report.  This case report describes how a physical therapist developed and implemented a fitness-related intervention program that incorporated sport-specific goals of a 16 year old male with spastic diplegia.

The adolescent, who was born at 35 weeks, has a history of:  hospitalizations related to an infection and being placed on a ventilator for several weeks, bilateral heel cord lengthenings (that were repeated) and bilateral hamstring lengthenings.  Prior to the hamstring lengthening, it was reported that the participant had difficulty ambulating without support from walls and furniture.  Approximately 9 months after bilateral hamstring lengthening and physical therapy, the participant was able to ambulate on even and uneven surfaces, ascend/descend stairs, jump forward (somewhat asymmetrically), hop multiple times on his dominant foot, and one time on his non dominant foot.  The participant was reportedly unable to hop or jump previously.  A little over a year after his surgery, the participant joined his high school wrestling team.  A few months after joining the team, the participant expressed interest in improving his wrestling performance, specifically being able to get up and down from the mat more quickly, perform movements more quickly and increase his strength.

A physical therapy examination was performed using tests and measures specific to the fitness demands of wrestling.  These tests were specific to anaerobic fitness (muscle power sprint test), agility (10×5-m sprint test), muscle strength, aerobic power (10-m shuttle run test), and activity measures of gross motor function (Gross Motor Function Measure, GMFM-66).

A fitness related physical therapy program was set up at 2x week, x 10 weeks.  The therapy centered on interval training as to mimic the anaerobic energy requirements used in wrestling.  This intervention was also chosen based off of studies that have shown that children with CP respond to interval training with improvements in strength, agility, and gross motor function.  The participant started with a 5-10 minute warm up, followed by 1-2 cycles of an 8-station interval training program (jumping, therapy ball toss, lateral shuffle, transitions to and from the floor, high knee jog with exaggerated arm swing, modified, oblique sit-ups, squats, and push-ups).  The participant worked up to a 2 minute duration of each activity, as wrestling competition consists of three, 2 minute periods per match.  The interval training was followed by a 5 minute cool down and flexibility exercises (to address the flexibility needed to  wrestle competitively).  The participant also participated in a HEP on the days he was not at therapy.  The participant did not have any muscle or joint pain during the course of the therapy nor did the program appear to negatively affect his quality of movement.p

At the completion of his 10 week interval training session, the participant scored higher on all tests and measures.  Additionally, the participant reported functional gains including getting up from the floor more quickly, riding his bike faster and for longer distances, running faster and jumping higher and faster.  Functional gains were also made in wrestling, including getting up from the mat more quickly, and being more difficult to bring down in matches.  He improved in his ability to perform jumping jacks and push-ups, and he was beginning to be able to jump rope.  Informal observations included that the participant was experimenting more with his movement in therapy such as running and jumping on to crash mats and running and leaping over mats (previously not attempted).  The participant also appeared more motivated to participate in therapy and more confident with his motor skills.  He required decrease extrinsic motivators in therapy and appeared excited about the connection between his therapeutic activities and his personal goals of improving his wrestling performance.

Conclusions:

I was really excited about this article.  It seemed to support the use of fitness-related therapy intervention for addressing sport specific goals of a teen with CP.  Even though this is a case study and lacks the control of a research study, I was happy to see that the participant made functional gains as well as improvements in testing.  Here at the Boston Ability Center, we want to inspire confidence for all of our kids to try new recreational activities as well as improve in their current sport activities.  We have several patients that are working towards the goal of running in a road race.  They are all working hard on their individualized programs which include: treadmill training, interval training, strengthening, and flexibility exercises.  We are so proud of all of our patients’ progress and can’t wait to cheer on our racers in the upcoming months!

Carolyn Graham, MS, PT

Sport-Specific Fitness Testing and Intervention for an Adolescent With Cerebral Palsy: A Case Report, Lisa K. Kenyon, PT, MHS, PCS; Mark D. Sleeper, PT,MS, OCS; Melissa M. Tovin, PT, MA, PhD, Pediatric Physical Therapy, Summer 2010, Volume 22, Number 2

Torticollis describes an abnormal posture of the neck.  This posture in an infant is typically with the head tilted toward the body in one direction and rotated in the opposite direction.  This presentation usually occurs in the first year of life.

Additional symptoms include:

-          One side of the face being larger than the other

-          One eye being larger than the other

-           Favoring of one side to play, roll, or sleep

-           Flattening of the back of the head (especially on one side), otherwise known as  plagiocephaly

Early treatment is important for these infants, including physical therapy.  Physical therapy may include stretching of the neck muscles, strengthening of the neck and trunk muscles, positioning techniques, and facilitation of gross motor skills.  Treatment may also include corrective helmets and/or orthotic collars.

Home Activities

There are many activities you can do at home to help your baby with torticollis.

One of the most important is encouraging tummy time.  Tummy time will help develop your baby’s neck muscles so that he can hold his head up on his own and reduce head flattening.  Some babies do not like being on their bellies.  Some ideas to make your baby more comfortable include rolling up a towel and propping it under his chest,and using tummy time mats or boppy pillows.  As a parent, you want to encourage tummy time as often as possible during the day.

Another important activity is to encourage your baby to look or rotate her head to the opposite direction of her preferred side.  You can use toys with bright colors, toys that make noise, and mirrors to encourage her to turn to one side.  Position your baby so that she is encouraged to look to the right or left, whichever is opposite from her preference.  This can include positioning on the floor or changing table, as well as the way you face her in a swing or bouncy seat.  Babies love to look and listen to their parents and siblings. Talk to your baby and sing songs to encourage your baby to turn her head towards you.

When putting your baby down to sleep at night or for a nap, turn his head to the opposite direction.  He may rotate back to his preferred side at some point, but the more time he spends on the opposite side, the more comfortable he will become.

It is important to encourage your baby to play in various positions.  In addition to tummy time, you also use a Bumbo Seat  . Once your baby can hold his head up, he can sit in a Bumbo seat for short periods.  This will help develop his neck strength as well as reduce the amount of pressure on the back of his head.  The Baby Bjorn is another nice option for your baby to be off the back of his head.  If your baby does not yet have enough head control, he can face in towards you.  If your baby has adequate head control, he can face out and work on turning his head in both directions.  Sidelying is another position for your baby to play in on the floor.  You can prop him up with a towel roll or wedge behind him.  This position will encourage your baby to bring his hands to midline, roll, and alter the pressure distribution on your baby’s head.

Feeding:

If you are bottle or breast feeding make sure that you switch sides at each feeding.  This will encourage your baby to look in both directions.  If your baby is eating solid foods, angle her seat to the right or left, so she will turn in the direction of the food.  Encourage her to pick up finger foods with her right or left hand to encourage turning to the side that is opposite her preference.

Carrying positions:

Alternate the side that you carry your baby on to encourage your baby to turn in both directions.  If you are carrying your baby up at your shoulder, turn his head so he is facing away from his preferred position.  If your baby is older and can be carried on your hip, face him so he is looking out to his opposite side.

Car Seat Positioning:

If your baby tends to tilt his head to one side or rotate to one side when he is in the car seat or if he falls asleep, neck wings can be helpful.  These padded cushions strap onto your baby’s car seat straps.  They help to keep your baby’s head in a more neutral position during car trips.  You can also place hanging toys on your baby’s car seat to encourage him to turn in the opposite direction.

Try these suggestions at home with your baby.  Always consult with your doctor or physical therapist for any further medical advice or questions.

*all pictures of equipment were taken from Toys R Us at http://www.toysrus.com*

Carolyn Graham, MS,PT

This summer in addition to the groups we currently run we are offering some special summer time camps!

‘Exceptional Explorers’ is two hours of therapy, fun and friendship! The groups will run on Fridays for 6 weeks (July 15- August 19) for kids 3-5 yrs and 6-8 yrs. During this two hour group your child will participate in therapeutic activities created by an occupational therapist, physical therapist and speech therapist. Our time together will be filled with gross motor, fine motor and language activities, emphasizing friendship and cooperation. We will also share a snack together so plan to pack a small snack and drink!

Come join us for a week of BAC Summer Fun! BAC Summer Fun is for children age 3-5. Your child will build skills while having fun and making friends! Our therapists will combine gross motor, fine motor and language based activities with facilitated free play, and snack time to ensure the perfect combination of function and fun!

Click HERE to fill out our group intake form!

Payment plans available upon request.

According to A. Jean Ayres, Ph. D., it is the “process of organizing sensory inputs so that the brain produces a useful body response and also useful perceptions, emotions, and thoughts.”

Organization is a key element to this definition. We are exposed to a variety of stimuli from our sensory systems that we respond to unconsciously and quickly. The ability to respond in an organized manner leads to a purposeful action (an adaptive response). When a person is unable to respond in an organized manner we may observe signs of inattention, distractibility, movement that is clumsy, avoidance of specific activities, or emotional upset.

What are the sensory systems that are involved?

We usually think of the five major senses; auditory, visual, tactile, olfactory, and taste.  However, there are two additional sensory inputs that are vital: the vestibular and proprioceptive systems.

The Vestibular system is based in the receptors of the inner ear. Through these receptors the vestibular system responds to movement of the head and body in relation to gravity. This process allows us to receive information regarding the speed and direction of movement which is essential to the development of balance and equilibrium.

The Proprioceptive system receives input from muscles and joints that gives us the sense of our body’s position in space. The vestibular and proprioceptive systems work together to help us move safely in our environments, negotiate around obstacles and know where we are without over-relying on our vision.

For example, when a child is on a playground there are a variety of heights and surfaces to walk on. When shifting from one to another it is necessary to keep balance, remain upright and continue moving forward. If there is any impairment in the vestibular or propiroceptive systems  it  would be more challenging  and could result in the possible avoidance of activities that require a child’s feet to be off the ground, such as climbing up ladders or swinging.  Ultimately the child’s gross motor skills could become delayed.

What do the terms sensory modulation and sensory discrimination mean?

Dr. Ayres speaks of two modes of response to stimuli, “defensive, or protective because it evolved to protect animals from danger and the other known as discriminative. Defensive processes are simple automatic reactions; discriminative processes involve complex refinement in the cerebral hemispheres.”

Modulation: When a child has the ability to modulate the stimuli in his/her environment we observe examples of attention, appropriate level of activity, and an ability to transition between activities. According to Dr. Ayres, “Unusual under-or over-responsiveness to sensation is often called a sensory modulation disorder”. For example, if a child is unable to modulate auditory stimuli a teacher may observe the student put his hands over the ears, or the student will talk out or speak loudly, or become distracted by sounds such as, noises in the hallway outside the classroom or cars driving by. The child is responding “defensively” to the stimuli.

In this situation an occupational therapist consulting to the classroom would provide specific strategies for the child and also make suggestions to modify the environment, which would enhance all the students’ experiences.

Discrimination: A child who discriminates input from the sensory systems can interpret what the sensations mean and use that information in a skillful way.  Dr. Ayres provides a description of tactile discrimination, “When we need to feel the difference between a penny and a dime in our pocket… we rely upon our discriminative mode.” In the classroom a child who has poor tactile discrimination may have difficulty using classroom tools or managing his belongings. He may also not detect when his face is dirty after eating snack. A child with poor vestibular and  proprioceptive discrimination may avoid playing on swings, or hesitate walking down a flight of stairs without stopping and looking at each one.

A child who presented with both of these challenges would be given specific materials and therapeutic activities by an occupational therapist to address his/her challenges.

Recommendations for parents:

Dr. Ayres believed in the essential importance of play for a child’s sensorimotor development.

“Through play the child obtains the sensory input from his body and from gravity that is essential for both motor and emotional development. The sensory input is what makes it “fun”.

• If you have concerns that your child may have sensory-integration difficulties an evaluation by an occupational therapist trained in sensory-integration therapy will define your child’s areas of challenge and make recommendations for treatment.

For additional resources:

• Sensory Integration and the Child by A.Jean Ayres, Ph.D.
• The Out-of- Sync Child by Carol Stock Kranowitz, M.A.
• The Out-of Sync Child has Fun by Carol Stock Kranowitz, M.A.

Elvira Fulchino, MS. OTR/L, MSW, LICSW.

by Cheryl Mallernee

There are a number of games and activities that you can do with your child that will help with oral awareness, strength and coordination.  These activities can be fun and easy to do!

Blowing

• Whistles/partyblowers
• Blow through a straw into water to make bubbles
• Blow bubbles with different sized bubble makers
• Blow cotton balls through a straw – have a cotton ball race!

Sucking

Drink thicker items through a straw

• Yogurt
• Milkshake/Fruit Smoothie
• Pudding (you may want to add milk to make it a little smoother)
• Even regular drinks
• Suck small marshmallows up onto the bottom of a straw and transport them to a bowl/cup nearby (6 inches to a foot away)

Make funny faces

• Puff out your cheeks
• Fish face – suck your cheeks in and wiggle your lips
• Blow kisses
• Smile big (“eeeee”) and then protrude lips (“uuuuuuu”)
• Move tongue around inside and outside of your mouth to be silly (e.g. push in cheeks, stick out, move side to side, move up and down)

Have fun with these games and next time I will have some activities you can do with food!

First, think about posture

In order for a child to be successful in drawing and writing it is necessary to have finger and hand strength as well as postural stability (strength in the trunk and shoulder muscles). It is important for a child to be seated in a chair that is at an appropriate height for the table. When a child has a good sitting posture the feet are flat on the floor and knees are bent at a 90 degree angle.

Next, think about attention

Some children find it challenging to remain seated for tabletop activities. If this is the case, it is helpful before sitting down at the table to have the child be in a “ready” state, in terms of attention and ability to sit for a period of time. It is also helpful when a child is doing homework to take movement breaks such as, get a drink of water, take a brief walk outside, or even do a set of jumping jacks. Using periodic movement breaks helps to facilitate attention.

Activities to facilitate a “ready” to work position:

• Try hand “warm-ups” such as manipulating Play Doh, or clay for several minutes.
• Finger play games such as Itsy, Bitsy Spider, Where is Thumbkin, or thumb wrestling.
• Stretch and move your whole body before sitting down for tabletop activities.
• Help your child create an organized space for homework that is quiet, with limited distractions or interruptions.
• Find out if your child works better with background music.

Activities to promote trunk and shoulder stability:

These activities can be incorporated into your free play time at home.
• Lying in a prone position (on the tummy) while watching t.v. or looking at books.
• Wheelbarrow walking races (holding onto feet or upper thigh for more support)
• Crab walking forward or backwards (on hands and feet )
• Carrying weighted objects, such as helping to water the garden with a hose or a watering can.
• Tug of war
• Swimming
• Yoga animal postures for kids

Activities to promote finger and hand strength:

Many of these fun activities can be placed into a container that your child can select on their own during times of free play. Drawing with your child is also a way to encourage their exploration.

• To help develop the web space (the circle that forms with the index finger and thumb –necessary for holding the pencil correctly) try these activities: popping the bubbles on plastic packing sheets, opening/closing ziplock bags, winding up wind-up toys, spinning tops, using an eye dropper to make pictures with colored water, ripping magazines or wrapping paper to make a collage, rolling pieces of tissue paper to make a picture.

• To help develop the muscles of the thumb, index, and middle fingers (the fingers that grasp the pencil) squirt water from a spray bottle while in the bath, pick up cotton balls with tweezers. Cut Play Doh with a plastic knife or child scissors.

• Create a rice bin with small items such as animals, beads, and wooden letters hidden inside and use tongs to pick up.

• Hide items in Theraputty (varying degrees of resistance) and poke holes with fingers to find them.

• To increase finger strength use a hole punch to make a design. Insert pegs, beads, buttons into clay or putty. Play games:  Lite Brite, Kerplunk, Jumpin’ Monkeys.

Activities to facilitate drawing and writing which require the integration of vision with fine motor skills:

• Dot to Dots (letters and numbers) and Mazes for specific ages.

• Building with Duplos, Legos, or Bristle Blocks all help to develop the integration of vision with fine motor control.

• Draw designs, letters in wet sand, shaving cream, finger paints, or soap foam. Use paintbrushes or popsicle sticks for those children who display tactile sensitivity to messy media.

• Use Wikki Stixx, wet sand, clay, popsicle sticks, or Play Doh to form shapes and letters.

Materials that can be helpful

• Use a slanted or a vertical surface to write on, such as easels or blackboards. This provides the necessary support to the wrist as well as helping to develop muscles in the shoulder. When doing homework use a 2 ½ inch empty binder which will create an appropriate slanted surface to place the paper on.

• For younger children use large, sidewalk chalk, wide pencils, large crayons, wide markers and large brushes when drawing or painting. Tape paper onto an easel or on a wall.

• For the children who are still developing a grasp, triangle shaped pencils (available @ Staples, Therapro) can be helpful. You can also wrap Wikki Stixx around a pencil to provide a tactile cue for the child to position their fingers in a “pinch”.

• Using a Mov-n-sit cushion on a chair can provide a fidgety child with some movement input while remaining seated. Some families also find that using a Tripp Trapp chair (`Stokke company -several are in our waiting room) is a good option as the chair’s seat and foot rest can be adjusted as the child grows.

• Handwriting Without Tears is a handwriting protocol used by our occupational therapists. The protocol includes wooden pieces for forming letters, and books for each level of writer with specific approaches for formation of upper and lower case letters.

By providing these activities for your child at home you can support the development of fine motor skills which form the foundation for handwriting.  Consult your child’s teacher or occupational therapist for more information.
 
Have fun!

Elvira Fulchino, MS. OTR/L, MSW, LICSW

Music therapy is the use of music, in the context of a client-therapist relationship, to work toward specific cognitive, physical, social, communication and emotional goals.

The music is generally played live and is chosen according to the preference of the client and the specific objectives of the session.

Sessions are designed and adapted so as to support, encourage and engage each client in making and responding to music in a way that is appropriate for his or her needs and abilities.

What Happens in a Music Therapy Session?

A session might include any or all of the following

• Structured activities to support acquisition and development of language skills.
• Structured activities to support other academic, physical, social or emotional goals.
• Singing, chanting, playing, clapping and moving to music.
• Free, exploratory musical instrument playing.

How Does Music Therapy Work?

• Music provides a structure;  it organizes our actions and thoughts.
• It provides sensory stimulation;  it is highly motivating and optimizes our attention.
• Music is pleasurable:  it provides a sense of success and enhances mood.
• Music is processed in both hemispheres of the brain;  it stimulates cognitive functioning and facilitates the development of language skills.
• Music is easily adaptable to individual differences in preference and ability.
• Musical competence can be intact even when other competences are lost or poorly developed.

How Does Music Therapy Benefit Children with Special Needs?

Cognitive/Academic • Supports language acquisition • Serves as mnemonic device • Raises awareness of surroundings • Develops attending skills • Provides multi-sensory stimulation • Increases auditory discrimination	Social/Communication • Encourages language use • Allows non-verbal communication • Facilitates social interaction • Creates sense of connection
Physical/Motor • Expands range of motion • Strengthens motor coordination • Improves eye-handcoordination • Enhances oral motor facility	Behavioral • Engages child in focused activity • Reduces agitation and aggression
Emotional •  Validates personal identity  • Boosts self-esteem • Inspires and uplifts

For more Information:

Music Therapy and Autism

Music Therapy and Special Education

Music Therapy and Young Children

Family Friendly Fun

Article by National Autism Assoc

Music Therapy