What's in a swing?

Aaaahhh......swinging.....an essential part of childhood.

Movement is essential for typical development to occur in all children. Most of us have no problem combining all our senses.
For autistic children and other disorder however, it's a mighty challenging task. Processing stimuli from the senses of sight, smell, sound, touch, taste, balance and body is overwhelming. Those suffering from autism will often withdraw to avoid over stimulation, or try to sort out the input from their senses with self-developed soothing mechanisms and repetitive behaviors.
A significant amount of occupational therapy for special needs focuses on sensory integration through specially designed programs. Some of the greatest tools for sensory integration therapy for autism, cerebral palsy and other type disorders are various types of swings.

Swinging can have powerful impact the brain's ability to process and use sensory information. Whether the child is linear swinging on a strap swing, cuddled up in a net swing for proprioceptive input or spinning in a rotating movement, all of these movements can act as a powerful activator on the body's systems.
People with various autism spectrum disorders such as Autism, PDD, ADHD, Asperger's, proprioceptive dysfunction and tactile defensiveness will benefit from using swings as part of their therapy.
Children, who find the smooth, swaying motion soothing, will relax and unwind while using it. However, children who have a vestibular dysfunction will feel uneasy while in the hammock and might initially protest its use.

For them, hammock therapy is more about regaining equilibrium and learning to tolerate vestibular stimuli. The motion of swinging restores balance to the vestibular system provides proprioceptive input (deep pressure) and generally children feel more "in balance".



The soothing motion of swinging soothes, relaxes and increases concentration. Children who have trouble focusing on tasks such as reading or math, might find it easier to concentrate sitting in a hammock chair, their bodies engaged in a soothing motion.

Therapists, parents and teachers can use swings effectively to reinforce any therapy objectives for children and provide sensory diets for special needs children. In addition, swings can act as a strong motivator. Since all kids like to swing (special needs or not), swinging can be used as a reward for positive behavior.

 




When choosing a swing and swing apparatus it is critical to consider safety at all times.


• Adult supervision is always required at all times.
• Be aware of floor wall and head protection
• Make sure the swings are able to support the user(s).
• Children who are seizure prone may require additional precautions.
• Make sure the child has the ability to stop on their own at a moment's notice.
• The child must want to swing on their own. Never force a child to participate

Happy Swinging!


Image courtesy: makemesomethingspecial.co.uk, how-to-make-tips.com, www.novanatural.com,                                  www.dailymail.co.uk, Geoff Robinson, kidsdreamgym.com

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: www.amazon.com, metro.co.uk, www.marchoftherobots.com, www.sodahead.com,                               lego.wikia.com, www.nkayesel.com, lego.brickinstructions.com,                        lego.brickinstructions.com

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:  arthritisbroadcastnetwork.org, www.nopcoclinics.com, www.oandp.org

                            haydentrigg.blogspot.com,  www.wannatowel.com, orthoinfo.aaos.org

                            www.dailymail.co.uk, www.ncmedical.com, www.splints.co.za

Does your child have Attention Deficit/Hyperactive disorder(ADHD)?

What is Attention Deficit Hyperactivity Disorder  (ADHD, ADD)?

Attention deficit hyperactivity disorder (ADHD) is one of the most common childhood disorders and can continue through adolescence and adulthood. Symptoms include difficulty staying focused and paying attention, difficulty controlling behavior, and hyperactivity (over-activity).

ADHD has three subtypes:

1. Predominantly Inattentive Type
   The person finds it very difficult to organize or finish a task. They find it hard to pay attention to details and find it difficult to follow instructions or conversations.

2. Predominantly Hyperactive-Impulsive Type
   The person finds it hard to keep still - they fidget and talk a lot. A smaller child may be continually jumping, running or climbing. They are restless and impulsive - interrupting others, grabbing things and speaking at inappropriate times. They have difficulty waiting their turn and find it hard to listen to directions. A person with this type of ADHD will have more injuries and/or accidents than others.

3. Combined Type
   A person whose symptoms include all those of 1 and 2, and whose symptoms are equally predominant. In other words, all the symptoms in 1 and 2 stand out equally.

What are the general signs of ADHD in children?

Children who have symptoms of inattention may:

• Be easily distracted, miss details, forget things, and frequently switch from one activity to another
• Have difficulty focusing on one thing
• Become bored with a task after only a few minutes, unless they are doing something enjoyable
• Have difficulty focusing attention on organizing and completing a task or learning something new
• Have trouble completing or turning in homework assignments, often losing things (e.g., pencils, toys, assignments) needed to complete tasks or activities
• Not seem to listen when spoken to
• Daydream, become easily confused, and move slowly
• Have difficulty processing information as quickly and accurately as others
• Struggle to follow instructions.

Children who have symptoms of hyperactivity may:

• Fidget and squirm in their seats
• Talk nonstop
• Dash around, touching or playing with anything and everything in sight
• Have trouble sitting still during dinner, school, and story time
• Be constantly in motion
• Have difficulty doing quiet tasks or activities.

Children who have symptoms of impulsivity may:

• Be very impatient
• Blurt out inappropriate comments, show their emotions without restraint, and act without regard for consequences
• Have difficulty waiting for things they want or waiting their turns in games
• Often interrupt conversations or others' activities.

ADHD Can Be Mistaken for Other Problems

Parents and teachers can miss the fact that children with symptoms of inattention have the disorder because they are often quiet and less likely to act out. They may sit quietly, seeming to work, but they are often not paying attention to what they are doing. They may get along well with other children, compared with those with the other subtypes, who tend to have social problems. But children with the inattentive kind of ADHD are not the only ones whose disorders can be missed. For example, adults may think that children with the hyperactive and impulsive subtypes just have emotional or disciplinary problems.

The above signs may be observed in children frequently and usually do not mean the child has ADHD. It is when these signs become significantly more pronounced in one child, compared to other children of the same age, and when his/her behavior undermines his/her school and social life, that the child may have ADHD.

Some children with ADHD also have other illnesses or conditions. For example, they may have one or more of the following:

Autism,Learning disability,Oppositional defiant behaviour and also co-exist with sleep disorder,bed wetting,eating disorder and meltdowns.

Recognizing ADHD symptoms and seeking help early will lead to better outcomes for both affected children and their families.

What causes ADHD?

There is no known cause of ADHD,but possible risk factors include

Genes

Food addictives intake during pregnancies

Mercury exposure during pregnancy.

Interesting link: Possible causes of ADHD (New Zealand's ADHD Online Support Group)

Diagnosing ADHD

This could be done by  Psychologist,Pediatrician,Psychiatrist with input from an Occupational therapist.Also done through observations of the child’s behaviour in his daily routines.

Recent studies by the Food and drug Administation,US,have approved the use of EEG for more accurate diagnosis.

 Interesting links   Diagnostic Criteria for ADHD (ADHD Information Services)

Treatment
Treatment options for ADHD include
Occupational Therapy intervention in which physical,behavioural,social and cognitive goals are drawn up and addressed using therapeutic activities in home and school settings
Psychotherapy
Medications-this should be prescribed by a doctor who is experienced and knowledgeable about ADHD and closely monitored by him.