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Old 02-27-2013, 06:06 PM   #1
maamaakrystal
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Physical/Occupational Therapy Questions

My 1 year old has been doing occupational therapy through our county for almost 6 months. He is improving but I'm not convinced it is anything the occupational therapist has really done especially recently. When she first arrives she had oi many great tips as all this was so new (my son has abnormalities ithe areas of the brain that controls motor, speech and vision). How do I know if she is a "good" occupational therapist? I kept asking her if we should also be doing physical therapy and she claims the overlap is so much I only need one right now and now the coordinator tells me they only do one or the other. however, what I read about the different types of therapist, they are different. Our occupational therapist mainly focuses on the adapting and good poster, etc. A little on stretches yet I recently read that kids with cerebral palsy and similar issues need daily stretches to maintain the movement needed for every day life yet no one had mentioned this to me. I live in Virginia.

I'm venting as well as looking for any insight others that have that have been there done that.

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Old 02-27-2013, 06:57 PM   #2
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For very young children PT and OT do overlap quite a bit. If you are concerned about stretches then bring them up. A good therapist will listen to and address your concerns. So much of therapy at that age is subtle and it's hard for parents to pick up on. Ask her to explain what's she's doing as she does it and why.
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Old 02-27-2013, 07:41 PM   #3
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Re: Physical/Occupational Therapy Questions

I think you are right, it is subtle. I've been reading this physical therapy book for kids with cerebral palsy and similar conditions. I've learned a lot of new things. I've been disappointed that my ot has giving me very little info on why she tells us to do certain things and that she's not mentioned the importance of daily stretches for such kids. I've also recently started taking my little guy to My Gym classes and it seems to do more for him then anything and he has a great time.
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Old 02-27-2013, 07:51 PM   #4
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Re: Physical/Occupational Therapy Questions

If you are not thrilled, don't be afraid to switch. I put up with a crappy OT for way too long, and was kicking myself later.
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Old 02-27-2013, 08:11 PM   #5
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Re: Physical/Occupational Therapy Questions

I just don't have a basis of comparison to determine if she's crappy or I have unrealistic expectations.

It doesn't help that my son doesn't like her to touch him and often fusses until the very moment she goes out the door. Everyone else in his life is pretty passive and I often take a whole week to introduce new things to him because he is so resistant to new things so I'm not convinced he would like another therapist any better.
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Old 02-27-2013, 08:43 PM   #6
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Re: Physical/Occupational Therapy Questions

Does she have physical delays or is she just at risk? If at risk I think I would get an eval and listen closely to the suggestions. For an at risk situation this might be enough until her motor skills start to lag.

If she is actually delayed I would be insistent on a physical therapist and even appeal if necessary. PT exercises use core strengthening exercises. Working on not just crawling but crawling correctly, sitting correctly, correct gait, pulling to stand and/or furniture cruising (depending upon the delay, obviously not all children will be on the same page of development) stretching muscles, evaluating which muscles were hypotonic vs hypertonic. DS's Pt at that age was also screening for possible structurally abnormalities and handing out better specialists recommendations then ds's ped (because lets face it most peds are only mediocre at handling children with advanced needs). Also she is at a key age where she needs to be transitioning over to standing therapy if she is not yet bearing weight.

DS's OT is not very good with equipment at all and if your daughter is going to need equipment (and this is the age where equipment needs start to accumulate) you will definitely need a PT. To put it in perspective at 12 months DS's PT had started working on finding a stander, at 15 months finally received stander and DS was also referred to Shriner's Hospital, at 18 months first wheelchair and first AFOs were ordered all equipment was received before his 2nd birthday. Now some kids with less delays skip the whole stander and wheelchair and go straight into either a gait trainer or walker.

Also the other issue I find alarming is if she does need stretches why isn't OT giving you homework and showing you the stretches? If she needs stretches once or twice a week stretching session isn't going to cut it. She should be showing you how to do it and inquiring how it went at the next session. Therapies primary purpose is for evaluation, help pushing the child to the next level and showing the parent what needs to be worked on so they don't regress and hopeful progress in between therapy sessions.

Also it may be a littler early but if her adaptive needs look like they are going to be long term it might be a good idea to start gathering recommendations for rehab doctors and finding out what the wait time is and what age they like to start seeing patients. I regret waiting as long as I did to get one lined up (we didn't use one until ds was 4yo). Evaluation of adaptive needs, procuring equipment and securing spaces in difficult to navigate programs is their specialty. The PT is kind of like the first person that you start the process with but the rehab doc and staff can take a turtle paced DME procurement process and rocket it through as quickly as possible. Seriously I have called for equipment needs per PT recommendations and had appointments either the same day or within a week's time because Rehab staff is just lightening quick with paperwork and cutting through all the impossible crap to get straight to where everything needs to go.

Last edited by mekat; 02-27-2013 at 08:48 PM.
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Old 02-27-2013, 08:59 PM   #7
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Re: Physical/Occupational Therapy Questions

Yes, now that I am reading mekat's post, and remembering back...DS's PT had him in AFOs by 9 months. We did OT, PT twice a week, and speech, starting at 3 months. I would talk to your case manager about adding PT.

If you have medicaid or private insurance, your pediatrician can write for private PT in addition to the EI you currently receive too. For awhile after our PT left EI, we saw her outpatient at a local clinic and medicaid covered it.

If your son is touch sensitive, have you done brushing? Compression vests? Weighted vests?

We definitely had homework from each therapist every week. DS spent a ton of time on the ball working on core strength to sit, and lots of games working to stand. Our PT was very agressive, but our developmental ped said he would never walk when he was 4 months old, and our PT was bound and determined to prove the doc wrong. He finally took his first steps at 18 months, and now at 3 you'd have no idea there were massive problems.
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Old 02-27-2013, 09:00 PM   #8
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Re: Physical/Occupational Therapy Questions

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Originally Posted by maamaakrystal View Post
Everyone else in his life is pretty passive and I often take a whole week to introduce new things to him because he is so resistant to new things so I'm not convinced he would like another therapist any better.
It has been my experience kids hate stretching and physical exercises. My son loves his private PT but he hates physical therapy with her. Physical therapy is hard work and kids just don't always get why it is important; all they care about is being comfortable and playing. I make sure ds always has special books, songs and/or toys just for therapy so he is motivated to work even when he doesn't want to. I wish I could tell you it gets easier but it doesn't the older they get the harder it gets to find something to motivate them.
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Old 02-28-2013, 07:50 AM   #9
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Re: Physical/Occupational Therapy Questions

My DS is in OT and I went through this concern about whether the OT was doing enough or really helping. I also had no real basis for evaluating this either, but looking at my little boy I just had a gut feeling there was more. Not to say that he hadn't improved at all, but it seemed that compared to what other moms said about their kids in OT something was not quite right. We switched OTs (we are private... the county won't help us) at the beginning of this year and I've already seen some great progress in DS.
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Old 02-28-2013, 04:35 PM   #10
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Re: Physical/Occupational Therapy Questions

Thanks so much for the perspectives.

After 2 weeks of not seeing our ot (she went on vacation). I feel we had a good session today. She brought us a great swing he uses on his belly and moves with his feet. She gave me tips on how to get him to lean forward to standing. We also worked on drinking and eating (he hasn't gained weight in 3 months, I just found out last week). He will not drink anything except my milk straight from me. I wonder if I just need to be more pro-active with having pre-prepared issues/questions as I did today. Still no actual assignments but we should keep busy with working on the tips on convincing him to drink and enjoying the swing.

She also was told some of my concerns by the coordinator. She said we could look into pt replacing ot as well as speech therapy. she also said she could bring a pt and speech therapist to an upcoming appointment. She also told me about her 30 years if experience in mulidicipinary therapy including a specialty in cerebral palsy and expertise in eating issues. So, I feel conflicted. I trust her in so many ways and fear loosing her at the same time I've been feeling something missing. Ugh!
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