All posts by kelly

Helping Children be Better People

Helping Children be Better People is Promoted by Relationship Between Pak’s Karate Academy of Mandarin and Great Strides Rehabilitation

By Christina Swanson

Chelsea loves practicing the high block, Cole likes saying “Kiai” (kee-yah) and Will takes a shine to kicking. Sounds like a typical elementary-school-aged kids’ response to beginning karate classes except these are children with special needs and the classes are just one way their rehabilitative school goes beyond the norm in expanding their daily learning process.

Great Strides Rehabilitation has been providing speech, physical and occupational therapy services for Northeast Florida for more than a decade with their main clinic, school and outpatient therapy support. Although they are located in Mandarin as part of the Jacksonville Pediatric Enrichment Center, their therapists also help children with disabilities at schools and medically fragile day care centers. Also located within this large Mandarin business complex on San Jose Boulevard is Pak’s Karate Academy of Mandarin, a mainstay in this area for 31 years.

Dr. Jon Edenfield, OTD, OTR/L, founder and executive director of Great Strides, wants his students to engage in a variety of leisure activities to help with their motor and social skills in a fun way. “Many special needs children have a hard time participating in sports teams or other typical activities such as riding a bike, and when they do, it can be a negative experience causing them to become self-conscious of their own behaviors which can lead to poor self-esteem,” said Edenfield.

When the students walk to the play ground each school day, they actually pass the Pak’s Academy building. One day about six months ago, when one of Pak’s owners, Master Christopher Tersak, saw the children, he approached the therapists with the group and struck up the idea of having the kids participate in some basic karate classes at no charge.

Edenfield already knew the benefits of karate for special needs children, especially those in the autism spectrum, in developing better balance, motor coordination, focus on a task, and improved eye contact and social skills. Tersak saw this as an opportunity to give back to the community and fulfill their core mission to extend the benefits of karate to all people, especially those with challenges and behavior issues.

“It’s all about form, discipline and focus rather than the physically aspect of fighting,” said Tersak. “Behavior is a huge part of advancing in karate…how they stand in line, address their instructors and interact with other students.”

“It’s inspiring to see how the instruction builds confidence to speak and perform in front of people which is one of life’s greatest fears even in adults,” explained Tersak. You see when the little ones first come here they are still holding onto mom’s leg; after three months they are standing in front of 300 people performing for their first belt.”

Working with the Great Strides’ students also challenges and grows Pak’s teachers to become more patient and understanding in their instruction methods. They are starting to receive feedback from the kids’ therapists and parents that the classes are showing a positive impact on the students’ everyday lives. “That is our payment because that is why we do it,” said Tersak.

Pak’s Academy is known for being family oriented where about 20 percent of the parents join their kids after they witness how beneficial learning the discipline of karate can be. “The greatest thing is to watch a father practicing moves with his child,” said Tersak. “We are in the business of developing community leaders in school and life, not just black belts. “ (The Pak’s Karate Academy of Mandarin — named after the grand master founder who has 150 schools world-wide and independently owned — was bought by two brothers who learned and have taught there for 20 years, Master Christopher and Master Nicholas Tersak, along with wife Angela Tersak.)

Recently, Edenfield attended his students’ first ceremony at Pak’s Academy, watching six to eight year olds pay strict attention to instructions and beam with pride after breaking their first boards. “It’s obvious the children are really into it and their behavior and focus improvements are extending into other crucial communication areas as shared by their parents,” said Edenfield.

For more information about Pak’s of Mandarin call 262-8200 or go to; to reach Great Strides Rehab call 886-3228 or visit

Prescribed Pediatric Extended Care

Jumpstart Pediatrics

By Christina Swanson

I spoke with Joni Hughes who is recent owner of a new PPEC in town “Jumpstart Pediatrics”. PPEC stands for Prescribed Pediatric Extended Care and is a daycare option for medically fragile children who would not be appropriate for typical daycare due to medical issues. In the past, parents working or in school often kept medically fragile children home with round the clock nursing care. Therapy was provided in outpatient locations or through Early Steps around the parent’s schedule.   Now more parents are learning about PPECs as an option for their child, and there are many more PPEC choices in Jacksonville. PPECs are staffed by skilled nurses who medically care for the children. Therapy is provided “in house” and includes PT, OT and ST as well as vision and hospital homebound schooling options. This cuts down on multiple additional appointments for the parents during the week and often fits their school/ work schedule better. Transportation is provided if needed, with buses or vans picking up the children in the morning and transporting them home. Medical personnel accompany the children on the bus rides to ensure their safety. Great Strides began staffing therapists at PPECs about 10 years ago, and has steadily grown with these companies. Joni responded to several questions about her experiences in this medical business.

What is your background medically?

“30 years of nursing, 20 of that in pediatrics, and most in critical care or home health. I have been involved in PPECs for 15 years.”


How did you decide to open a PPEC?

“I decided to open one because I wanted to produce a program that had more supportive services for the parents and more developmental and academic services for children. “I wanted a program that would offer children a variety of developmental options. People tend to forget that children who are medically complex can progress and should be offered the maximum amount of developmental opportunities available.”  


How long has Jumpstart been open and how many children can it serve?

 “It’s been open since December of 2016 and we are can service 50 children here in the center. We are growing very quickly and we happy with how the community has received the center and services we provide.”


What services does GSR provide for your PPEC?

Physical, occupational and speech therapy. When available, Jon has also sent a music therapist regularly which the children love and respond to significantly.”


How long have you been contracting with Jon Edenfield and GSR?

“I’ve worked with Jon for over 10 years providing therapeutic services to children in PPECs.”


What were you specifically wanting to do with Jumpstart to “set it apart?”

“I wanted it to be a bright, airy and kid friendly environment that would stimulate the children’s growth and development as well as provide for their medical needs. I wanted it to be a place where parents felt comfortable leaving their children for the day.”


 What is the mission of your program?

“At JumpStart Pediatrics, we strive to provide compassionate, quality care in a professional, caring and friendly environment. Our goal is to partner with your family to ensure the highest level of physical, developmental and social growth your child can possible attain. We are committed to help make a difference in your child’s overall health and well-being as we also strive to make a difference in the community we serve.”


Tell me about your family, and what you like to do in your spare time.

“I’ve been married for 30 years, have 4 children and 4 beautiful grandchildren. Family is very important to me.

I like spending time with my husband, children and grandchildren, reading, volunteering in the community, and going to the beach.”


Vocational Training

New Company Partnerships Assist in Student Skills

By Christina Swanson

A vocational training program for older Great Stride students is currently being developed with several fine students currently taking part. Actually started last summer during summer camp with our older clients, Great Strides was looking to review clients’ skills, abilities, and interests during performing three types of jobs and their requirements which included:

  •    Car washing,
  •    Baking
  •   Maintenance at Westminster.

The summer program helped guide the outline for our current vocational program as we flesh-out the details. Coordinated by Lauren Cricchio B.S., RBT, GS Associate Lead Therapist, she explains the purpose of the program,

“The program is not just to teach a certain job skill until proficiency has been met but also focuses on a comprehensive package for each individual on what skills are needed to be successful in a community job – self help, social skills, self advocacy, safety and time management.” After those stages have been taught and met the student will work on specific job areas that interest each individual. A win-win for student and partnering companies.

Great Strides appreciates Westminster Woods on Julington Creek, and Mama Fu’s on San Jose having graciously allowed Great Strides to work with them on potential future employment and great on-the-job training for our students.

We are always looking for new opportunities to provide our clients with many different employment choices throughout the community. If a company is interested in partnering with us, they should call the main office at 886-3228.


Great Strides Summer Camp: June 12 – August 4

By Christina Swanson

This year’s summer camp is an eight week program that runs from 9 am – 2 pm weekdays. Children can attend full time or part time (three days). Please note camp will be closed on July 4 due to the holiday.

This program provides 1:1 Applied Behavior Analysis therapy. Therapeutic interventions are incorporated into fun summer activities including: science, cooking, reading, art, music, gardening, and yoga. The older children will be participating in their own program for functional living skills. For additional information, contact Lauren Albert, GS Ed Coord

Summer Activities for Kids with Autism or Sensory Processing Disorders (from Easterseals)

Summer is a chance to play, rest and enjoy a change of pace. The shift in environment and pace can be more challenging for children with autism or other sensory processing disorders. A director of a resource center for autism shares some creative ideas for summer fun for kids on the spectrum or kids who are simply sensory sensitive.

Summer fun starts with embracing exploration with new sensory activities, which may help improve sensory processing while reducing stress. Get outdoors and pay close attention for signs of frustration or overstimulation so you’ll know when to take a break.

Try seasonal foods through cooking activities.

A farmer’s market may overwhelm some kids, but you can always bring summer fruits and vegetables home to try. Prepare them together in your kitchen or try campfire-style, explaining what to do step by step.
Sandboxes make for a wonderful sensory play. If you don’t have one, create your own sensory table or bucket with any large container (i.e. a small plastic pool, a large plastic storage bin) and fill it with sand or water. You can also include some natural elements to discover within it, like flower petals or small toys.

Consider sensory needs with swimwear and sunscreens. But soft fabrics and fragrance-free lotions or sprays. Apply before you leave the house for the day or start a new activity. If your child is sensitive to some of these safety measures, then try alternatives like sun hats, sunglasses or soft, sun-blocking shirts.

Schedule a time to safely swim together in a pool. Borrowing some time at a friend’s pool or scheduling private swimming time at a local pool (much like scheduling a private swim lesson) may help your child ease in and enjoy. Swimming helps with body awareness (if you want to get technical, we call this proprioception) and tactile input.

Build an obstacle course together in your yard or at a familiar playground.

Ride bikes or scooters.

Go to the play-ground and have fun.


CSI PPEC Success Story—Suzie Wright

Suzie Wright is a 3 ½ year-old miracle child whose rate of advancement has been phenomenal. She was a typically developing child until a year ago (5/19/15) when she suffered a traumatic brain injury from a commercial garage door falling on her. CPR was administered and she was rushed to the hospital.

Suzie had a g-tube placed for nutritional needs and a tracheotomy for respiratory support. She also underwent a craniofacial repair in June of 2015. Suzie remained in a vegetative state with little response to outside stimulation for approximately two months.

It was pretty much a miracle that she woke from that vegetative state–doctors were not confident that she would regain consciousness. But one day, Suzie opened her eyes and began interacting with family and medical staff. She waved “hi” on command and was attempting to speak (which she was initially unable to do because of the tracheotomy). As she continued to progress and show signs that she was medically stable, she was released from the hospital in July 2015. At that time, she began attending CSI Special Care (Arlington location) and was evaluated by the Great Strides therapeutic team, in the areas of Physical, Occupational, and Speech therapy.

Upon starting therapy, she was unable to walk and had very little ways of communicating. She was also receiving all her nutrition via her g-tube and was not able to eat by mouth. Her attention span had decreased and she was impulsive with negative behaviors due to the frontal lobe injury.

Great Strides Therapy Successes:

Suzie has now been receiving physical, speech and occupational therapies for about nine months and has come such a long way— she is:

  • walking independently,
  • breathing independently, tracheostomy removed)
  • eating by mouth (passed a swallow study she still has
    the g-tube as a precautionary measure),
  • speaking in sentences and able to carry-on
    conversations with others,
  • potty training (she was previously potty trained before
    her accident),
  • greatly improved attention span so more cooperative in
  • demonstrating less negative behaviors (kicking, hitting)

The Great Strides staff working with Suzie include: Katie Hartman, MOT, OTR/L; Ashley Ziccarelli, M.Ed, SLP-CCC and Adrienne Vickers, DPT.

Suzie’s mom, Miranda, is so grateful to the Great Strides therapy team saying, “All the varied therapies provided to Suzie at CSI PPEC has made her recovery possible.”

She continues: “We are both looking forward to her going to Great Strides Pre-K school in the Fall. I’ve watched Suzie go from a little girl who was in a coma and upon awakening couldn’t walk or talk because of the accident, to relearning these basic skills at an accelerated rate due to exceptional care. This has been hard on everyone with Suzie having four siblings ranging from age nine to two and her being the one next to the baby. My husband and I were told that we should get therapy because of all the heartache with the accident but our therapy has been seeing her excel and proving the original doctors negative prognosis wrong. We are also so excited as Suzie was just granted her wish for the family to go to Disney World which was given by the Make a Wish Foundation.”

Current Therapy Focus:

She is currently working on ascending/descending stairs, jumping, general strengthening, labeling colors, drawing shapes, completing puzzles, learning pronouns, identifying verbs from pictures, and other skills. Suzie is definitely a miracle child and prayers were answered for her family.

The Future is All Smiles:

Based on the progress she has made thus far in such a small amount of time, prognosis is good and her future looks bright. As always, there can be plateaus with progress but she has not had setbacks in the last year so we only see Suzie making gains and continuing to progress to maximize independence.

Her therapeutic team is proud of Suzie’s advancement and look forward to providing her the skills towards continued success.

A Little Bigger—A Lot Better!

Great Strides will be acquiring some additional space located next door to the main office which means more space for more therapeutic learning and play areas for your child.

Fletchers PPEC Success Story—Prymus Buckholtz

Prymus ArticlePrymus is an adorable and friendly four year old boy who began coming to the Fletchers PPEC as a baby. He was diagnosed with spastic quadriplegia meaning that he has weakness and difficulty moving his arms and legs like he wants. In addition, the muscles of his face and mouth which would coordinate speech and oral feeding are also impacted. Prymus is a bright young boy who loves people and loves learning. He is devoted to his parents and has wonderful support from them. He has a high level of cognitive and receptive language skills but has difficulty expressing what he knows verbally or through gestures, signs or pointing.

In the four years that Prymus has been coming to Fletchers, no one is more proud and happy with his progress than his mom. “When Prymus was born and we learned about his condition, we were told by his doctor what he couldn’t do and his limitations,” said Mrs. Buckholtz. “But the therapy team has always looked to the possibilities and the four years they have worked with him at Fletchers, he had made a 360 degree turn around.”

Prymus’ GS Therapy team include: John Kirkland, DPT; Jess Dailey, DPT; Julissa Taveras, OTR/L; Robyn Hershberger, MS-CCC-SLP; and Susannah Doherty, MS-CCC-SLP.

Occupational Therapy Focus:

Prymus is learning daily living activities such as how to take off his socks, grasp a cup to drink independently, or grasp and release objects. He is also learning how to use one part of his body (one arm or hand) while keeping the rest of his body still. Educational activities and pre-writing skills are also addressed to prepare him for school.

Speech Therapy Focus:

Prymus has difficulty completing the very rapid, alternating fine motor movements of the tongue for speech production. He must work hard to produce even voicing to command. His voice is often much easier for him to produce spontaneously, such as shouting or laughing, but he still needed a method to help him communicate while he works on improving coordination and strength in his oral muscles for speech.

Speech therapy also continues to focus on increasing Prymus’s vocabulary and understanding of language, as well as improving his ability to chew and swallow solids, master cup drinking and swallow safely to avoid aspiration.

Additionally, although he can move his arms, he has difficulty with performing tasks such as pointing with a finger, or targeting a small picture target with his hands to select it as a means of communicating. Therefore, usage of pictures or IPAD apps were not able to match the cognitive ability of his language skills.

After consulting with an assistive technology specialist, his speech therapists decided to try an eye gaze communication system that operates by Prymus “choosing” words with his eyes which then “speak” loud for him. He has just received this device for a trial period during which he will learn how to use it and his family will decide if it is right for him.

In addition to the eye gaze communication system, to give Prymus the very best devices to aid him in his growth in the physical therapy area, Great Strides has helped him obtain a specialized walker called the Theraputic Ambulatory Orthotic System or TAOS Walker along with other medical equipment such as braces for his feet/ legs, a wheelchair and a bath chair.

Physical Therapy Focus

This is the first time Great Strides has ordered such specialized equipment like the TAOS for a child. We are excited to be able to provide the TAOS as there are children who have different needs and every walker or device is not always appropriate for every child, parent and physical therapist.

The TAOS has two basic parts, a bracing system and the 4-wheeled base. The bracing system provides side to side and front to back support to the child’s trunk and pelvis.

Along with the TAOS, physical therapists are working diligently on helping Prymus improve a method for locomotion independently in other ways. They also help him with increasing control of his head and neck muscles, and torso so that he can better sit upright without support.

Great Strides is proud to be a part of Prymus’ learning, growth and continuing advancement.

Making Great Strides for Your Child’s Success

Recognizing each family and patient are unique, it is Great Strides’ mission to enhance quality of life through exceptional therapy services in varying areas and locations geared specifically to your child’s needs. Our dedicated interdisciplinary team of more than 65 compassionate and tenured therapists work together to provide comprehensive and coordinated care for children with special needs at Great Strides’ premier pediatric rehabilitation center and the McKay scholarship-approved private school.

In addition to our main clinic and school, located at the Jacksonville Pediatric Enrichment Center in Mandarin, Great Strides provides quality services in numerous locations around Northeast Florida, including public and private schools and at medically fragile day care centers—known as Physician Prescribed Extended Care or PPECs.

PPECs are medical day care centers dedicated to the excellent care of medically fragile infants and children. PPECs are specifically designed to optimize the development of each child’s independence, while helping them reach their full potential. Daily care is provided by trained nurses centers involves clinical interventions, therapy services and educational activities as well as transportation if needed.

There are three PPEC locations where Great Strides provides expert therapeutic care–CSI-Arlington, CSI-Cassat, and Fletchers Tendercare. Each PPEC has a dedicated Great Strides managing therapist as well as nurses, nurses aids and physical, occupational and speech therapists that work as a team to provide the most effective course of intervention for your child. We also utilize the most   technologically advanced equipment that enrich the therapeutic environment by providing
more opportunity for learning growth learning growth and skill advancement for your child.

An example of a recently purchased advancement to aid in the progress of a child with disabilities is also a wonderful success story.

May is Better Hearing and Speech Month

Each May, Better Hearing & Speech Month (BHSM) provides an opportunity to raise awareness about communication disorders and role of ASHA members in providing life-altering treatment. This year is special because it’s the 75th Better Hearing and Speech Month (BHSM) in the United States.

For 2016, the BHSM theme is “Communication Takes Care“ and reflects the important service of health professionals in speech therapy positions.

In honor of the how their important skills benefit patients all year round, the following is a review of current statistics on communication disorders and some of the challenges the modern speech therapist face.

According to the National Institute on Deafness and other Communication Disorders, the number of Americans suffering from speech, voice, language or hearing impairment hovers around 43 million—in that sobering statistic, there are at least 28 million confirmed cases of hearing loss—and the figure that resonates? 10% of these communication disorders are owned by our children; reason enough for SLPs to get up each day and excel at doing what they do—teaching strategies that help patients cope and overcome.

Because a child with a communication disorder is 4 or 5 times more likely than his peers to suffer from significant reading problems, speech and language pathologists are relied upon by the general public to anticipate those hurdles, and, if possible, lift them out of the way; of course, SLPs are there for anyone in need, at any age, unwilling to let communication disorders hamper social lives, careers or G.P.A.

That being said, have you taken stock of your own health lately? How’s your hearing? It may surprise you to know that of those 28 million people we mentioned earlier—the ones with hearing deficits—only a quarter of them seek diagnosis and hearing aids; since this is a “silent treatment” we can’t afford to perpetuate, here’s a shortlist of symptoms we’d like you to consider.

Is Speech and Hearing Month when you decide you need a hearing aid? The answer may be yes, if you identify with any of the following:

  • Have pain or ringing in your ears
  • Frequently ask people to repeat themselves
  • Keep the volume up on audio equipment, others say is too loud
  • Understand people better looking directly at their faces, or by wearing your glasses
  • Lose your place in group conversations
  • Often turn your ear toward a sound to hear it better

If you don’t get around to thinking about these issues this month, but nonetheless like a historical excuse to take charge of your hearing and communicative health, let June inspire you too.

On June 27, 2010, Helen Keller celebrates her 130th birthday. While not a board certified, and rigorously trained speech therapist, her teacher and mentor, Anne Sullivan, who employed SLP skills helping Helen, made a huge difference in the quality of Helen’s life; to come so far a century ago, is so telling of what speech therapists are capable of now.

This May we ask you to celebrate Better Hearing and Speech Month and to keep working your miracles all year long.