Wednesday, September 24, 2014

It's Lego time

One of my special children, Udoh has ADHD. Last week during one of our therapy sessions, I found out that he had only simple large no-theme lego bricks.

He could use it to make cars, houses and other shapes and was really bored with this activity...and really too big for this size of lego. He needed another set of small sized lego with a theme to encourage more complex pretend play. 

Bricks are one of my favourite toys for fine motor drills, concept development, pretend play. As such, it was another opportunity to go lego hunting and window shopping. 

I entered the themed lego place and I was really impressed with the wide range of sizes and themed legos. After describing to the lego- crazy attendant what complex skills I needed Udoh to develop and what cognitive stage he was in; that is, I wanted him to learn to construct castles, houses, transit 2d to 3d concepts (spatial relation), to increase his concentration and attention and really improve hand function (complex) and also encourage pretend play and mid level between difficult and easy.

I finally settled on a car race/car repair themed Lego very smallest size. He was really excited, his expression of surprise was priceless. 

Okay he didn't look this excited...

At first I was scared it would be too difficult for him when he started tinkering with it but it's not as hard as I thought it would be. I am trying to teach him to use to use the miniature tool set (spanner, screw driver, hammer screws, nails crow bar) and he is so willing to be taught. Although the picture step by step manual is really really challenging for him.

The amazing thing is that Udoh actually sat quietly for 30 minutes!!!

Image courtesy:,,,,                     ,,,              

Sunday, September 21, 2014

Watch that Splint

I promise this is an interesting topic...

After the Hip Ankle Foot Orthosis (HAFO) was made for Dewunmi who had severe Hemiplegia caused by Cerebral palsy, his mom was so excited but Dewunmi did not like this extra load and inconvenience. He was cranky all through the fittings. 

"Madam I need you to wear him at least 8 hours daily and we have to be consistent because the more he wears it, the better to prevent gradual joint stiffening."

She replied, "Don’t worry, trust me he will wear it even to sleep."

"Ahh!!! No o! Madam this is not a night splint and it could be very uncomfortable, 8 hours is very ok for his age."

After a month, we noticed sores on Dewunmi’s caudal region, I immediately knew that she had ignored my instructions. The HAFO had caused uneven pressure on the caudal bony prominence which had resulted in the development of the sore.

This is why I decided to write a short post on splinting.

Splints and orthosis are temporary devices in neurology used to correct or ensure proper anatomical positioning and sometimes movement and also prevent joint stiffening and subsequent deformity especially for spastic children. It also helps to reduce risk of injury, improve mobility performance and stabilize the joint.

How do Orthosis or splints work?
They work by applying forces to the body. By encompassing parts of the body and preventing movements, muscles and joints can be stretched. Many muscles cross two joints (for example, the calf muscles cross both the ankle and knee). 

To exert stretching effect, either both joints must be held by the device or activities that stretch the joint (passive and active exercises) not in the device should be encouraged. 

Splints and orthosis can also provide stability to help some children stand and walk. 

This is the bio-mechanical explanation of how the device works. 

Materials used include high temperature thermoplast, neoprene and even lycra garments etc.

The following considerations must be properly adhered especially at first fitting and through out the day:

1. Ensure that the splints are well contoured.

2. Always maintain Anti-deformity position (proper body alignment)

3. Snugly position and tighten straps to allow blood flow or veinous return (not too tight, not too      loose).

4. If the splints are too tight or inappropriately placed, circulation is compromised.

5. If a child cannot monitor the status of the affected area, Parents should be instructed to examine the body part for evidence of muscle strain, swelling, redness or sores between straps or muscles around the region.

6. Allow motion out of the splint at periodic interval (parents should learn some passive exercises to perform at these intervals).

7. Avoid or minimize bony prominence.

Foreign Pre-formed Splints
A lot of parents prefer the foreign splints because of the materials and its aesthetic beauty but they have the challenges of “one-size fits no one”  and as such, still have to be custom-fitted by a really experienced Occupational Therapist or Physiotherapist and Orthotist.

Lastly, Orthosis are never an answer in themselves but in many cases they are an extension of the therapist’s arm while away from hands-on active treatment.

The usual trend is this, when a splint, orthosis or an assistive device is made for a child, the parents are usually excited and are consistent within the next few months or weeks, after then, they start faltering, becoming inconsistent with some even totally stopping. 

I understand this because I also see this trend in myself (with abstinence from junk food) but for the device to do what it’s made to do, there has to be consistency and proper adherence to the rules.

Image courtesy:,

Thursday, September 18, 2014

Therapist Thursdays: Gbenga

What is your name?
 Ajayi Olugbenga and I work with Autism Associates

Why did you choose to become a therapist? 
I chose to be a therapist because of the passion I have for people with disability and because of my drive to make impact in lives.

Area of interest, why?
Areas of interest are behavior and speech

Pros of being a therapist / things you like about your vocation?
The best thing about this vocation is the impact making.

Things you dislike about your vocation?
I dislike the aspect of knowing the disability i.e. autism is a life long disability & the aspect of regression in improvement.

Your happiest and saddest moments in therapy?
My happiest moment has always been when a non verbal child starts to verbalize and when the child is improving behaviorally.
Saddest moment is when despite effort input, the child is not responding to prompts or instructions.

Challenges practicing in Nigeria and or in your location?
Inappropriate materials to work with and a favourable therapy environment.

Favourite therapy material, why?
Blowing drills materials.- it enhance speech.
jig saw puzzle.- aside helps build up attention and reasoning skill.

What you wish parents knew about therapy?
I wish parents know that the work is not only for the therapist, their involvement helps a lot in generalizing skills and in turn makes improvement go faster.

Thanks a lot for your time.
You're welcome.

Images courtesy: Gbenga,

Sunday, September 7, 2014

Evaluating and assessing your child

Evaluation and Assessment for Effective Therapy

The goal of Evaluation is to create the child's Occupational Profile

This involves understanding the child’s diagnosis, the child’s strength and challenges related to the contexts and occupations (age appropriate meaningful activities of interest or importance to the child) in which they participate in. 

The parents, siblings, other professionals such as teachers,doctors, psychologists etc are integral to the evaluation process. The child’s occupational profile should also include his likes and dislikes, temperament, peer and family relationship, learning history and school program information.

Evaluation information maybe gathered through standardized and non standardized assessments.
Some popular standardized neurological based assessments include:

Pediatric Evaluation of Disability Inventory (PEDI;Haley,Coster et al.,1992) which assesses child’s functional skill ability and caregivers capability.

The School Function Assessment (SFA;Coster et al.,1998) evaluates the child capabilities in school settings, how appropriate and assistive devices to be added for optimal learning and social skills to take place.

Peabody Developmental Motor Scales (Folio & Fewell, 1983) evaluates age developmental milestones (fine and gross motor skills)

Assessment for sensory dysfunction include Sensory integration and praxis (SIPT; Ayres 1989) of which is the gold standard for all other sensory tests.

Sensory Profile (Dunn.1998) which helps to understand a child sensory needs and processing and modulation abilities.

Toddler and infant Motor Evaluation is used for Assessment of reflexes, postural control, muscle tone (TIME; Miller& Roid, 1994).

Nonstandardized Assessment/Clinical Observation

Neuromusculoskeletal Evaluation: Clinical observation of muscle tone, joint range of motion, automatic balance responses, posture, gait and physical strength.

Play Skills Evaluation: Informal evaluation of play interactions may be set up during the assessment. This is used to observe functional use of motor skills in play, and play occupations such as independent initiation, use of toys, symbolic play, creativity and imagination, and enjoyment of play. There are a limited number of occupational therapy play assessment tools, and those are largely designed for administration in the child's functional environment of home or school.

Oral Motor feeding Evaluation: This may include the assessment of the oral structures, oral-motor control (suck, swallow, chew), behavioral responses during feeding, parent/child interaction, self-feeding skills.

Although standardized assessments increase the reliability of the evaluator’s judgement,it maybe difficult for non-verbal or kids who have significant motor impairments and /or behavioural challenges. Therefore, keen observations of children performing occupations in relaxed and natural settings provide valuable information.

The Final phase of evaluation involves the synthesis of information gathered from Standardized and Non-standardized assessments done and information gotten from the other team members (doctors,psychologists,teachers etc).

Images courtesy of

Thursday, September 4, 2014

Therapist Thursdays 2: Femi

This week, Sensory Care presents to you another Therapist who is changing the world one special child at a time.

What is your name?
My name is Samuel Oluwafemi Oluwawunmi, but most of my friends call me Fesho (nickname)

Why did you choose to become a therapist? 
Well, my decision to work with individuals with special needs as a therapist is a long story but suffice to say that my decision was a response to a call to serve. I had never in my wildest dreams considered this profession, not until 2006 after reading Ben Carson’s “Gifted Hands” and PROVIDENCE further confirmed that I was called as an Educator to make learning easier for individuals with special needs.

Area of interest, why?
My area of interest is definitely teaching, because I specialized in Education.

Pros of being a therapist / things you like about your vocation?
Working with these children though tough [as it requires a lot of patience both with the children and their parents] has also given me joy. For me, seeing a child learning skills he or she has never known before and also seeing their parents express satisfaction knowing that their child is able to learn is very fulfilling.

Things you dislike about your vocation?
I am so sorry to let you know that there is nothing in my vocation that I don’t love. I don’t think I would have been fulfilled doing anything else other than this.

Your happiest and saddest moments in therapy?
My happiest moment is always when I finally discover a child’s learning style or his or her most rewarding reinforcement. Because the moment you discover this, then there is no skill you cannot teach the child in any therapy session. 
The moment I don’t like is when there’s no continuity at home by parents and siblings, even after they have been taught on how to work with the child and what works well with him or her.

Challenges practicing in Nigeria and or in your location?
 My greatest challenges from 2006 up until February 2014 when I left Nigeria were with parents continuing from where the therapist stopped. Most of them don’t even show interest and the few who do are too busy to put it into practice because they believe the therapist should fix it. 
Another challenge is with some schools who have not accepted to modify instructions, materials and assessments to suit our ASD learners.  Even though I must commend some schools that are hospitable to our ASD kids, I have serious issues understanding why so many other schools have not followed suit. 
Talking about modifying instructions and all, for example, tell me what is wrong when a teacher asks a child with ASD to define “a tree” and the child runs outside the class to touch a tree? Or if the child due to difficulties with fine motor cannot quickly write 1-20 on a paper but can recite offhand and identify 1-20 without any help? 
Believe me, our schools need to step up and understand that knowledge expressed verbally, by writing, by gestures, or by demonstration are acceptable as knowledge
That is the difference between a 21st century teacher/school and the 19th or 20th century schools.

The only challenge I am experiencing at the moment in the center I work in SA is with parents. The center basically provides everything without any charges yet, we have to practically beg some people to come in for their appointment or bring in recorded result. 
This center is using one of the best programs for children with ASD, the Rethink Autism which is based on ABA principles but they are not availing themselves of this great opportunity to help their kids.

Favourite therapy material, why?
My favorite therapy materials are visual materials. Reason being that for people with Autism Spectrum Disorder [ASD] and some other related disorders, the preferred mode of learning is VISUAL over VERBAL. 

Also if you are also talking about methods, techniques or approaches of teaching, I like the DTT (Discrete Trial Teaching) because as a teacher, an educational therapist /facilitator working with a child with SEN (esp. Autism) at home or in school environment, it makes instruction very clear to the child I am teaching.  DTT involves 8 simple steps, which are:

GET THE CHILD’S ATTENTION, i.e. make sure the child is looking at you

GIVE AN INSTRUCTION OR ASK A QUESTION. Your instruction or question MUST be clear, simple and short.
 E.g. Say “point to the chair” not, “Femi, can you please point to the chair.” (Please as in the case of “point to the chair” make sure no other furniture is present except the chair you want him to identify)

PROMPT/HELP/ASSIST. i.e. quickly provide assistance to help the child respond correctly to your instruction. (This is what is called the errorless way of teaching, because we know our children with ASD have the tendency to repeat errors, so it is important to prevent errors whenever possible).

REINFORCE/REWARD. i.e. give the child something he/she likes IMMEDIATELY after he/she responds (even though it’s by your help) to make them more likely to respond again independently.

FADE YOUR PROMPT/HELP. i.e. gradually provide less & less assistance each time you instruct him until the child responds independently on his own.

REINFORCE INDEPENDENT RESPONSES. i.e as the child responds with less help from you, show more enthusiasm and give him a bigger and better reward.

INTRODUCE DISTRACTOR TRIAL. i.e. once the child is responding correctly without any help at all, then introduce something else. For example, you can put a bag as a distractor and repeat the instruction “point to the chair”. A distractor must at first be something from a different category / class.

GENERALIZE. Practice your instructions in different settings, in different colors, different shapes and by different people in order to generalize the skill.

What you wish parents knew about therapy?
First and foremost, I would like parents to know that they are their child’s best therapist. If they can come to this understanding, then this will propel them to learn and understand what the OT [occupational therapist], Speech therapist, teacher etc are doing so as to use the same method/principle at home with the child. By this, everybody will be on the same page and the child’s progress will know no bounds.

Secondly, parents in getting a therapist to work with their child, above just looking for cheaper therapists, should seek for therapists who have a passion for children and upgrading their skills. They will know a therapist who has the passion to upgrade by the amount of workshops, conferences and trainings locally or internationally attended. 

Thanks a lot for your time.
You're welcome.

Images courtesy: Femi