Tag Archives: behavior

Partnering with Nemour’s Continence Clinic

Partnering with Nemour’s Continence Clinic:

Potty Training BOOTCAMP

Great Strides has partnered with the Nemours’ Continence Clinic to offer families a whole child approach to successful toilet training. Sometimes toileting delays are caused by medical issues, while other times they can be caused by environmental or behavioral issues. With the partnership between Nemours Continence Clinic and Great Strides Rehabilitation, your child will benefit by having all aspects of the root cause of the toileting delay being addressed.

Since the Spring of 2017, Nemours has been referring children for applied behavior analysis (ABA) with Great Strides during evaluations after testing and ruling out physical or medical conditions that could be affecting a child’s ability to learn toilet training.  Great Strides has been working with families in this area since it first began offering ABA therapy in 2007. Of course, families are welcome to contact Great Strides directly to do an evaluation.

If a child’s incontinence has a medical component, Great Strides will refer the family to Nemours to correct the medical condition first.

As explained by Nemours, a child isn’t a small adult, especially when it comes to pediatric urology — when it comes to conditions affecting the kidneys, ureter, bladder, urethra, penis and testes – because their reproductive system and urinary tracts are still growing and developing. Testing for pediatric urology problems can include urinary and fecal incontinence, urinary frequency and urgency, recurring urinary tract infection (UTI), failure to toilet train and chronic constipation.  Some children with disabilities may refuse to participate in scheduled toilet training programs or have an aversion to sitting on the toilet, while others may be successfully trained for urination but have to have wear pull-ups for fecal elimination.

“Once a child’s pediatrician and Nemours’ specialist have reviewed the medical aspect of the child’s incontinence, and if there are still issues, because these professionals are not trained in behavior analysis, the family would be referred to us,” explained Candy Hurst, BCBA, Director of Applied  Behavior Analysis.

How Does ABA Help with Toilet Training?

Applied Behavior Analysis is the science of how the environment affects a person’s learning and behavior. Toilet training, for some kids, needs to be specifically designed with
environmental modifications to increase the opportunity for success.

Such modifications may include: increasing comfort in the bathroom, schedule of trips to the bathroom, caregiver responses to successes on the toilet and accidents. Once the child begins to experience success with toileting, the family caregivers then have something to reinforce, thus increasing the likelihood that the child will continue to have success. This schedule of reinforcement is a vital component of toilet training. The bottom line is answering: What are the issues to address and how are we going to address them?

Presently, there are seven children onboard with the “potty training boot camp” program. “There are many different things that can improve a family’s quality of life and one of the biggest things is toilet training,” said Hurst.  “We encourage parents to reach out and get their child trained and out of pull-ups because even if a child is a teenager, there still is hope.”

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“The Great Strides program truly works!  Regardless of age, behavior issues, medical history, or diagnosis, this model is tailored made for your child. At the age of 3, my daughter (ASD and non-verbal) still wore pulls-ups and showed zero interest in the potty.  Witnessing my frustration, our ABA therapists recommended their “Potty Training Boot Camp”.  Admittedly, I was skeptical but committed to the process.  In a matter of days, she caught on to the program. Now at 8 years old, my daughter has remained fully potty-trained (without regression).”

~ Laura H.

 

Another Great Strides Advantage

Dr. Rebecca Kilgore, PT, DPT, BCaBA – both a licensed physical therapist and board
certified assistance behavior analyst – and why that’s EXCEPTIONAL  
By Christina Swanson

As a child grows and learns reaching typical milestones, it’s easy to take everyday things for granted, like putting on closed-toed shoes or interacting with peers playing a simple game. Unless you’re the parent of a child on the autism spectrum or other special need. Then something as simple as walking on the grass can be difficult for a child with sensory aversion as the grass can feel to them like spiders crawling on their ankles.

Imagine the heart-felt joy for family members to watch their child with disabilities play an organized sport, albeit on a reduced scale, knowing it meant overcoming so many challenges and learning enough social, verbal, physical and gross motor skills to be part of a team. At Great Strides Rehabilitation Clinic and School in Mandarin, such an accomplishment came true for many of their 13 to 17 year-old-students in large part to the unique talents and skill sets of Dr. Rebecca Kilgore, PT, DPT, BCaBA, who is both a licensed physical therapist and board certified assistance behavior analyst.

So how is this unique and why is having both specialties an advantage to such children and their parents? Whether physical, speech, or occupational, a therapist’s studies and internships are on a set course that differs from a certified behaviorist’s path. Yet many children with special needs, require help in all of these disciplines to reach developmental targets. Let’s say a patient has behavior issues and throws a ball at the physical therapist rather than doing a particular exercise with it. Because the physical therapist deals with body improvements, they would not be trained in how to redirect this aggression. With both disciplines needed for the child to improve, it’s more efficient and targeted to have one person be able to immediately teach what’s needed. Also, the act of physical therapy itself is not usually fun since stretching areas can hurt, so a physical therapist who is also behavioral certified can help the child stay motivated to finish the session.

Kilgore has learned through her own experience that combining athletics with behavior therapy is a winning combination toward helping kids with special needs advance. She also focuses on teaching parents how to better set up their environments to help develop their children as they grow.  “This additional degree has allowed me to work with parents on behaviors they would like to decrease to feel comfortable taking their kids into the community, while improving understanding of how exercise tolerance or even severe physical disabilities can be overcome or functionally assisted so their child can participate in everyday activities,” explained Kilgore.

When Kilgore, along with other Great Stride specialists, set up and prepared students for an “in-house” soccer team two years ago, it was truly a huge triumph in every discipline from social skills (sharing the ball, winning/loosing, congratulating and cheering on peers), to teaching step-by-step motor imitation and physical skills down to the very act of how to kick the ball. They worked on attention span and remaining engaged as well as their physical capacity for the game.

“I believe if a child can’t physically keep up with their friends or kids their age, then they are left behind which makes developing social skills nearly impossible,” said Kilgore. “Typically, when kids are difficult to manage, parents keep them home and limit their exposure to other kids, which, of course, impacts both physical and social capacities. Athletics is a great way to tackle and overcome all of this.”

The kids wore neon green jerseys that they designed themselves with their nicknames printed on the back. Many had therapy to get them to wear the jersey, sneakers and kick the ball on grass. So when the parents got to see their child play as a team for the first time it was a monumental achievement that gave them hope in their child’s potential.

“I am most passionate about how physical capabilities affects behavior and how behavior effects physical capabilities,” said Kilgore. When she joined Great Strides in 2011 as a behavioral instructor with a bachelor’s in psychology, she soon became a Board Certified assistance Behavior Analyst (BCaBA) lead running classrooms and teaching other assistants while going to college full time toward earning her behavior analyst certification. During her doctorial studies, which she completed in May 2017 from Nova Southeastern University in Tampa, Fla., Kilgore evaluated and treated patients with various orthopedic and developmental/neurological conditions as well as postsurgical and medically fragile oncology patients, incorporating a range of therapy mediums including aquatic therapy and youth sports.

With Great Strides known for its innovative approaches, from karate classes to vocational opportunities with local businesses, Kilgore is excited about presently creating a Physical Ed program for the Great Strides’ school that combines physical and behavioral therapy as basic PE goals for the school’s kids ages five through 21. “All kids with disabilities, especially those with autism, need to experience social contact where they learn how to relate to their peers and vice-versa,” said Kilgore. “Through PE, these kids will get stronger, coordinated and learn the steps they are missing to be able to interact with other kids on the playground.”

If Kilgore sounds passionate about helping children with disabilities learn the skills needed to have a productive life and make their parents happy as they improve, well, yes, it’s her life purpose. And she doesn’t back down. That’s because she knows what it’s like to overcome a handicap herself. And that the seemingly impossible can happen when you have someone helping who refuses to give up—which for Kilgore was her dad who instilled in her that the things in life that are worth doing aren’t usually easy.

As a youngster, her arm was so badly broken from a horse-riding accident that doctors wanted to amputate.   Her dad refused and after the casts were removed and much PT, doctors said she’d never extend her elbow. But her dad had other plans, enrolled her in softball and worked on her swing and throw for a year with her ultimately becoming a good softball player.

 “This experience taught me that just because something bad happens it doesn’t have to define you; and just because someone says you have to do something one way to get better, if it’s not working, try something else,” explained Kilgore. “My kids at Great Strides inspire me everyday to be creative. You can’t work from a preplanned list of exercises with these kiddos because they need more than that. And their families also need more than that.”

“So many kids out there that seem to be discouraged because people only see the different outward behaviors rather than look for the good in these children,” said Kilgore. “I want to work with getting them past that, teach them the skills to have a better life and participate in society and be happy.” If you’d like to have Dr. Kilgore work with your child, contact Great Strides at (904) 886-3228 or info@greatstridesrehab.com.

 

                                               

 

 

 

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