Today I performed treatment techniques on a 7mth old baby boy to help improve his rolling, sitting balance and the transition from prone into 4 point kneel into sitting or crawling and toencourage crawling. I did 4 point kneeling over a cushion and rocking him gently to increase strength and get him used to the feeling of being on all fours. I also praticed the transition from 4 point kneeling in and out of sitting to show him the correct movement pattern and strengthen his truck. The other exercise I did with him was facilitating rolling from prone to supine and supine to prone to improve his efficiency.
The other interesting aspect of this child is that both of his parents were quite young and have learning difficulties. This is a type of family dynamic I have not encountered before and it was really great to see the love that they had for this baby and that they were very enthusiastic about doing exercises for him and ensuring his developmental progress.
I think the treatment went well as I feel I have become more effective and comfortable in my handling of the babies especially. I also explained and demonstrated to his parents the simple exercises that would be most beneficial and gave them handouts with pictures. I am really enjoying being able to be more hands on with the clients now I have a better understanding of physio in developmental paediatrics.
Thursday, October 30, 2008
Week 3: Entry 2
Yesterday I had the challenge of running an exercise group for yr1s i.e. 6yr olds. As it happened there were only 2 people in the group which meant i was able to control it a bit more but i did struggle to keep them on task at times. Their main areas of weakness were decreased muscle strength, poor ball skills and poor motor planning so I designed a 1 hr program based around these.
I think that I chose age appropriate exercise that also provided a challenge and interacted well with the kids. However I can definitely improve for next week by working on strategies to maintain focus as at times they became easily distracted and started playing with other equipment and running all over the place. The other aspect which i will alter slight for next time is adding a bit of variety and fun to strengthening exercises such as sit ups. I have asked the physio for a few ideas and also have been recommended a book to read for some other suggestions. Overall I think the class ran well for my first attempt and it was very nice to recieve positive feedback from the parents and also the physio.
I think that I chose age appropriate exercise that also provided a challenge and interacted well with the kids. However I can definitely improve for next week by working on strategies to maintain focus as at times they became easily distracted and started playing with other equipment and running all over the place. The other aspect which i will alter slight for next time is adding a bit of variety and fun to strengthening exercises such as sit ups. I have asked the physio for a few ideas and also have been recommended a book to read for some other suggestions. Overall I think the class ran well for my first attempt and it was very nice to recieve positive feedback from the parents and also the physio.
Monday, October 27, 2008
Week 3: Entry 1
Today I got the chance to do a home visit with one of the child health nurses who work as part of PAL (play and learn) in SCDC. The little girl we visited was 22mths and born premature, which is why she was referred to SCDC. The main role of the home visits is to check in with parents about any concerns they may have as well as provide toys that the families can borrow for the week. The toys loaned encourage age appropriate developments in play as well as fine and gross motor skills.
The session consisted of making playdough, going through all the steps with the child and then pretend cooking of the playdough on a stove top. We then played with it to make sausages, do cutting and also use it for counting and songs/nursery rhymes. The other toys were then shown to the little girl. These included a dolls house and many accessories, simple puzzles and toys that required colour and picture matching. Parents are explained the benefits of the toys and different types of play such as imitation and their role to facilitate normal development on many levels.
I really enjoyed this experience and think that it is a wonderful service that is provided by the SCDC. The variety of services available through the one centre never ceases to impress me.
The session consisted of making playdough, going through all the steps with the child and then pretend cooking of the playdough on a stove top. We then played with it to make sausages, do cutting and also use it for counting and songs/nursery rhymes. The other toys were then shown to the little girl. These included a dolls house and many accessories, simple puzzles and toys that required colour and picture matching. Parents are explained the benefits of the toys and different types of play such as imitation and their role to facilitate normal development on many levels.
I really enjoyed this experience and think that it is a wonderful service that is provided by the SCDC. The variety of services available through the one centre never ceases to impress me.
Sunday, October 26, 2008
Week 2: Entry 3
Friday was another interesting day with the opporunity to go and treat a patient who was in the PMH day care who has been referred to DSC for services but because she hasn't been picked up yet she is still getting physio for gross motor delay from SCDC. This little girl is 21mths and has lissencephaly which is a neurological disorder that is characterised by a lack of gyri in the brain. As a result she is intellectually and physically disabled and will be for the rest of her life.
Our role as physios was to try and reduce the amount of developmental delay in her gross motor skills be encoraging WB through arms and legs, moving herself into sitting and rolling as well as generally improving strength in her core and extremities.
We treated her in the day care setting which is very beneficial in a number of ways. Firstly it is a very comfortable environment and also when other children see what she is doing they want to do it to. This is a great opportunite for her to watch and learn by copying and also as a motivational tool.
The main exercises I did with her was to facilitated 4 pt kneeling, sitting and pulling to stand. The most challenging part for me was using the best handling and what hand to put where to provide best support as well as allowing the child to work and strengthen their muscles simultaneously.
I really enjoyed this experience of working with an intellectually disabled child and now appreciate how much more difficult it is to make progress mainly due to their lack of motivation and that the changes made are going to be very slow. I feel that my handling skills are improving but definitely need to keep practicing to try and make my movements seamless.
Our role as physios was to try and reduce the amount of developmental delay in her gross motor skills be encoraging WB through arms and legs, moving herself into sitting and rolling as well as generally improving strength in her core and extremities.
We treated her in the day care setting which is very beneficial in a number of ways. Firstly it is a very comfortable environment and also when other children see what she is doing they want to do it to. This is a great opportunite for her to watch and learn by copying and also as a motivational tool.
The main exercises I did with her was to facilitated 4 pt kneeling, sitting and pulling to stand. The most challenging part for me was using the best handling and what hand to put where to provide best support as well as allowing the child to work and strengthen their muscles simultaneously.
I really enjoyed this experience of working with an intellectually disabled child and now appreciate how much more difficult it is to make progress mainly due to their lack of motivation and that the changes made are going to be very slow. I feel that my handling skills are improving but definitely need to keep practicing to try and make my movements seamless.
Wednesday, October 22, 2008
Week 2: Entry 2
The SCDC runs group exercise programs for different age groups and level of gross motor delay. The PT group today was for year 1s so mostly the children are 6yrs old. Only one child turned up today who was a little girl in the middle of our custody battle between her parents. Her family has some serious issues and is closely looked after by a social worker at the centre.
It was very interesting to view a completely different parent to those who usually attended with their children. As soon as they arrived the mum began telling the physio all the good things she was doing for her child and even brought in a brochure of the 'top' ballet classes her daughter had been attending and listing the benefits. She was almost in denial that her daughter had any developmental delay even though it was obvious just in her movement patterns and with speech. Her mother also blamed the supposed delay as something made up by her father. The mother continued this for almost the whole session (1hr) as I played/did exercises with her daughter.
This child is very skinny for her age and lacks a lot of core body strength, has poor motor planning, poor balance and is very hesitant to try activities she doens't think she will succeed in. I ran through a variety of exercises very briefly today as the physio was speaking with mum and also because it was the first group session so a brief initial assessment is required to get an idea of strengths and weaknesses.
I made up a circuit comprising of different activities which frequently varied if the child came up with a new idea. Exercises included marching, jumping, hopping, single leg balance. throwing and catching, star jumps, duck walking and wheelbarrows finished off with a turn on the flying fox as a reward.
I felt that I worked very well with the child and quickly built rapport by allowing her to feel comfortable and safe and doing mainly things she enjoyed but altering them as needed to fit in with my informal assessment. Building a good relationship with this child was of great importance considering her less than optimal home and living situation as well as the fact that her mum said that she gets picked on at school. I think that next time the session would have been more beneficial if we were able to do the weaker activities repeatedly and also test a more advanced level of motor planning. I also forgot do include the assessment of her sit ups, prone extension and hip extension from four point kneeling as well as her abilty to do a jump-clap sequence.
It will be very interesting next week when the dad brings her to see any differences in parenting style and how the child interacts with her father compared to her mother. I found today that towards the end of the session when her mother became more involved she tended to become more distracted and uncooperative. The reasons for this I am not sure of. Stay posted for next weeks installment.
It was very interesting to view a completely different parent to those who usually attended with their children. As soon as they arrived the mum began telling the physio all the good things she was doing for her child and even brought in a brochure of the 'top' ballet classes her daughter had been attending and listing the benefits. She was almost in denial that her daughter had any developmental delay even though it was obvious just in her movement patterns and with speech. Her mother also blamed the supposed delay as something made up by her father. The mother continued this for almost the whole session (1hr) as I played/did exercises with her daughter.
This child is very skinny for her age and lacks a lot of core body strength, has poor motor planning, poor balance and is very hesitant to try activities she doens't think she will succeed in. I ran through a variety of exercises very briefly today as the physio was speaking with mum and also because it was the first group session so a brief initial assessment is required to get an idea of strengths and weaknesses.
I made up a circuit comprising of different activities which frequently varied if the child came up with a new idea. Exercises included marching, jumping, hopping, single leg balance. throwing and catching, star jumps, duck walking and wheelbarrows finished off with a turn on the flying fox as a reward.
I felt that I worked very well with the child and quickly built rapport by allowing her to feel comfortable and safe and doing mainly things she enjoyed but altering them as needed to fit in with my informal assessment. Building a good relationship with this child was of great importance considering her less than optimal home and living situation as well as the fact that her mum said that she gets picked on at school. I think that next time the session would have been more beneficial if we were able to do the weaker activities repeatedly and also test a more advanced level of motor planning. I also forgot do include the assessment of her sit ups, prone extension and hip extension from four point kneeling as well as her abilty to do a jump-clap sequence.
It will be very interesting next week when the dad brings her to see any differences in parenting style and how the child interacts with her father compared to her mother. I found today that towards the end of the session when her mother became more involved she tended to become more distracted and uncooperative. The reasons for this I am not sure of. Stay posted for next weeks installment.
Monday, October 20, 2008
Week 2: Entry 1
Today I was introduced to the concept of global developmental delay in children. This means that not only are their gross motor skills delayed but also are fine motor, speech, language and cognitive skills are delayed to a pretty similar point. If their assessed to have a development age less than 70% of actual age assessed by a Griffiths score then the child is classified with an intellectual disability. This assessment is carried out by a paediatrician, rather than the physio who will mainly assess gross motor skills, commonly using the AIMS score (i.e. Alberta Infant Motor Scale).
I met an 11mth old girl today who was suspected to have a global delay but has not yet been seen by a paediatrician (but is on waitlist). She is recieving treatment currently by both physio and OT with the physio predominantly focusing on lack of strength in upper and lower limbs and a hesitation to WB through her lower limbs. This is evident in supporting the child in pull to stand as she flexes her knees quickly when her feet touch the ground.
The exercises done with a peanut ball and bolster in 4 point kneeling and lying prone over peanut ball and just rocking the baby so that herr limbs are forced to take weight. To sit her up, another challenge, the hip key point was stabilised as she rolled onto her side and she given assistance as required at the opposite shoulder so she had to work her core muscles to move into a sitting position.
At the moment this little girl is at roughly an 8mth gross motor level and is thought to be at roughly this point in all skills. A factor that is contributing to her gross motor delay especially is the reduced motivation to move and play which may also be linked to cognitive delay. The poor motivation means that she is not trying to explore her surroundings and is quite content to just sit and play with whats available as well as being very hesitant and slow to pivot in prone even though she would physically be able to do it.
I met an 11mth old girl today who was suspected to have a global delay but has not yet been seen by a paediatrician (but is on waitlist). She is recieving treatment currently by both physio and OT with the physio predominantly focusing on lack of strength in upper and lower limbs and a hesitation to WB through her lower limbs. This is evident in supporting the child in pull to stand as she flexes her knees quickly when her feet touch the ground.
The exercises done with a peanut ball and bolster in 4 point kneeling and lying prone over peanut ball and just rocking the baby so that herr limbs are forced to take weight. To sit her up, another challenge, the hip key point was stabilised as she rolled onto her side and she given assistance as required at the opposite shoulder so she had to work her core muscles to move into a sitting position.
At the moment this little girl is at roughly an 8mth gross motor level and is thought to be at roughly this point in all skills. A factor that is contributing to her gross motor delay especially is the reduced motivation to move and play which may also be linked to cognitive delay. The poor motivation means that she is not trying to explore her surroundings and is quite content to just sit and play with whats available as well as being very hesitant and slow to pivot in prone even though she would physically be able to do it.
Saturday, October 18, 2008
Week 1: Entry 3
Yesterday was quite a hectic day with a lot of stressed parents and crying babies. The SCDC runs classes for infant massage to promote bonding between parent and child, get the baby uesd to being touched and handled as well as to help relieve any colic pains the baby may have (if they can't pass wind). The Friday session ran for about an hour and a half and involved 8 babies and their parents.
I was not running the class, but helped show parents correct techniques and various strokes by performing the massage on a doll as my supervisor led the class. It was very interesting to compare this sort of group session to those we did in our 224 labs. Babies are very unpredictable. This means that the instructor has to be able to accomodate to and adapt for any babies who are crying, need a feed, only want to play with the toys or need a sleep. As well as adapting the class to this it is also essenstial to teach the massage strokes so that parents can adopt the principle to what best suits their own child.
As it was the first class like that I had attended, I didn't know what they are normally like. However my supervisor said it was one of the worst ever, most probably due to the fact that when babies did become restless or were crying, the parents became quite stressed and anxious which then rubs off to the baby causing them to become more unsettled and a very tense atmosphere. After about 1hr there was only 1 baby of 8 that was still happily being massaged, and 2-3 that weren't crying.
Although the babies were very unsettled and the class didn't run very smoothly, it's most important that the parents come away feeling they have picked up one or two new strokes they can do with their baby. Parents were given a written handout of all the strokes on conclusion which provided a great summary.
Even though I did not have such an active role in the class today it was still a great learning experience that is very relevant to both pre and post natal physio. Although run be a physiotherapist the main aim of these massage classes are to reiterate the importance of handling and connecting with your baby to provide a circle of security in which they feel safe and secure.
I was not running the class, but helped show parents correct techniques and various strokes by performing the massage on a doll as my supervisor led the class. It was very interesting to compare this sort of group session to those we did in our 224 labs. Babies are very unpredictable. This means that the instructor has to be able to accomodate to and adapt for any babies who are crying, need a feed, only want to play with the toys or need a sleep. As well as adapting the class to this it is also essenstial to teach the massage strokes so that parents can adopt the principle to what best suits their own child.
As it was the first class like that I had attended, I didn't know what they are normally like. However my supervisor said it was one of the worst ever, most probably due to the fact that when babies did become restless or were crying, the parents became quite stressed and anxious which then rubs off to the baby causing them to become more unsettled and a very tense atmosphere. After about 1hr there was only 1 baby of 8 that was still happily being massaged, and 2-3 that weren't crying.
Although the babies were very unsettled and the class didn't run very smoothly, it's most important that the parents come away feeling they have picked up one or two new strokes they can do with their baby. Parents were given a written handout of all the strokes on conclusion which provided a great summary.
Even though I did not have such an active role in the class today it was still a great learning experience that is very relevant to both pre and post natal physio. Although run be a physiotherapist the main aim of these massage classes are to reiterate the importance of handling and connecting with your baby to provide a circle of security in which they feel safe and secure.
Thursday, October 16, 2008
Week 1: Entry 2
Today I met an 7 and half month old girl who had been referred for physio because of her flat head, plagiocephally. She had an obvious plagiocephally, with the left posterior aspect of her head flatter and I also noted slight facial asymmetry. Secondary to her plagiocephally, she also had slight gross motor developmental delay.
I was able to have a more active role in her assessment and although was not asking the questions and leading the examination i was able to also assess her strength, tone, ROM and also did an AIMS assessment of her. I think I communicated well with her mother as I felt more comfortable with the examination process and the facts that needed to be established in the history.
I also was more able to clinically reason in regards to her developmental delay as I am aware of what a normal 7-8mth old baby should be able to do and after assessing her propose possible reasons for the delay. In this case her delay was the result of poor muscle strength through trunk and shoulder girdle and poor endurance.
I then prepared the report for the physio on the assessment which had room for improvement. I am now aware of specific ways to document assessment findings and hope that tomorrow I will get another opportunity to practice writing up reports.
I was able to have a more active role in her assessment and although was not asking the questions and leading the examination i was able to also assess her strength, tone, ROM and also did an AIMS assessment of her. I think I communicated well with her mother as I felt more comfortable with the examination process and the facts that needed to be established in the history.
I also was more able to clinically reason in regards to her developmental delay as I am aware of what a normal 7-8mth old baby should be able to do and after assessing her propose possible reasons for the delay. In this case her delay was the result of poor muscle strength through trunk and shoulder girdle and poor endurance.
I then prepared the report for the physio on the assessment which had room for improvement. I am now aware of specific ways to document assessment findings and hope that tomorrow I will get another opportunity to practice writing up reports.
Tuesday, October 14, 2008
Week 1: Entry 1
Today I was able to watch an initial assessment of a 6yr old girl performed by a senior physio.
Although I mainly was observing the developmental paeds assessment I still found it very beneficial. The child was referred by her school teacher who thought she may require physio and/or OT services to facilitate her gross and fine motor development skills.
I observed the various techniques used to assess a childs muscle strength, length, gross motor skills and fine motor skills. I assisted the therapist in some note taking but becuase am unfamiliar with a developmental paediatrics assessment I was unable to do much more than that.
I do feel that as I am being exposed to more children and the families (mainly mums) I am getting more comfortable with my communication skills and better confidently giving information to the parents. I think I am also improving in my communication with the children I am having contact with and learning the most appropriate strategies to build rapport with the child.
The child that was assessed today was not found to require extra physio services although did have deficiencies in coordination, muscle strength (especially core upper body and abdominal muscles) and motor planning. An OT assessment is still required and it is likely that more significant deficits may be found in her fine motor skills.
I think that today went very well and look forward to being able to have a more active role in assessments both subjective and objective.
Although I mainly was observing the developmental paeds assessment I still found it very beneficial. The child was referred by her school teacher who thought she may require physio and/or OT services to facilitate her gross and fine motor development skills.
I observed the various techniques used to assess a childs muscle strength, length, gross motor skills and fine motor skills. I assisted the therapist in some note taking but becuase am unfamiliar with a developmental paediatrics assessment I was unable to do much more than that.
I do feel that as I am being exposed to more children and the families (mainly mums) I am getting more comfortable with my communication skills and better confidently giving information to the parents. I think I am also improving in my communication with the children I am having contact with and learning the most appropriate strategies to build rapport with the child.
The child that was assessed today was not found to require extra physio services although did have deficiencies in coordination, muscle strength (especially core upper body and abdominal muscles) and motor planning. An OT assessment is still required and it is likely that more significant deficits may be found in her fine motor skills.
I think that today went very well and look forward to being able to have a more active role in assessments both subjective and objective.
Saturday, October 11, 2008
Pre-placement entry
I'm really looking forward to this first placement of community paeds. It is an area of physio I am very interested in and can't wait to get an idea about the developmental aspects of paediatrics rather than just the pathologies and conditions we learnt about this semester. I am nervous that I won't know enough and will feel a bit overwhelmed but I often find I learn more when I'm under the pump.
I think my role will be mainly assisting the senior physios with consults and exercise programs and classes as well as being able to listen in on initial assessments and the meetings of the allied health team.
Overall I am very excited about my first placement and can't wait to start put some of my newly developed skills into practice.
I think my role will be mainly assisting the senior physios with consults and exercise programs and classes as well as being able to listen in on initial assessments and the meetings of the allied health team.
Overall I am very excited about my first placement and can't wait to start put some of my newly developed skills into practice.
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