Tag Archives: physical therapy

At Great Strides We Make Everyday Lives Better

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At Great Strides We Make Everyday Lives Better
By Christina Swanson

Parenting a child with special needs requires meeting a host of challenges with positive determination, patience and unwavering persistence as the child grows and needs change. Eyes and hearts are opened as family members learn gratitude for everyday things and how simple hygiene and basic tasks, which are normally learned with ease and taken for granted, can be a difficult and pain-staking exercise for a disabled child and a time-intensive ritual for the child’s professional therapists, parents or caregiver.

A big part of Great Stride’s focus is to work as a team with the child, parents and/or caregiver, and teacher outside the classroom to help them learn the skills to be more independent which, in turn, increases the child’s confidence and potential to adapt and learn other skills while freeing-up the parent to meet the other many requirements of their day.

Recently, two Great Strides professional therapists extended their caring reach to teach a student/patient specific tasks by adapting equipment and creating specialized exercises that truly goes above and beyond their duties and speaks volumes to their dedication. Conquering something as seemingly simple as getting in and out of mom’s car and being able to clean oneself after using the toilet, has been a true victory for the child and family alike.

The Bidet Adaption Challenge

Young Brandon Belzer is a Great Strides outpatient who receives both occupational and physical therapy within a close collaborative team approach where his mom, Kimberly Belzer, is highly involved.   When Kimberly got the idea to install a bidet on her toilet to relieve her having to be with Brandon every time he used the bathroom, his therapists went to work at teaching Brandon about the many  hand and arm movements  needed for him to turn the small knob that operated this bidet so he could be self-sufficient.

But Brandon didn’t seem to have the strength or ability to understand the proper way to make the knob turn which set in motion another innovative Great Strides success story thanks to the creative construction of Great Strides Executive Director, Dr. Jon Edenfield, OTD, OTR/L, Brandon’s occupational therapist, Hilda Harrison, and an innovative installation at Brandon’s home by Hilda’s husband, Wayne Powell, who is an engineer.  This team looked into ways of adapting the equipment to the skill level of what Brandon could do. In looking for additional products that could change the bidet to have an easy button for Brandon to push instead of turning a knob, there was nothing available on the market. So, Edenfield, Harrison and Powell set to designing adaptive equipment from available parts and combining them together into a final “adaptive” product that’s not available in a store or even yet invented.

Using regular water lines, a lawn sprinkler valve, a low voltage power supply, and a Big Red button type switch, the bidet was adapted, allowing it to bypass the knob operation.  This adaptation resulted in a major functional outcome for Brandon who now independently operates his bidet every day using the Big Red switch.  Both Kimberly and Brandon are thrilled!

 

“As special needs parents, we are always trying to make our kids as independent as possible and have them be less vulnerable and dependent on others to perform everyday function which, of course, helps them grow and makes it a lot easier for us as parents,” explained Kimberly. “Now Brandon can go to the bathroom independent without me having to constantly get up and help him. The people at Great Strides are truly amazing in their caring because they know it is really about helping the children. It is a blessing to me that Great Strides is a true partner in helping our children become functional.”
The Entering/Leaving Car Challenge

Another easy to take for granted ability is to be able to get in and out of a car unaided. If you think about it, it’s kind of a complicated motion involving crouching forward, lifting the initial leg, ducking the head, etc.

Brandon’s physical therapist, John Kirkland, initiated a simulated car therapy based on observational gait analysis and Brandon’s known history of visual impairment, increased extensor tone, rigid adherence to routine, aversion to novel tasks and limited verbal and comprehension abilities. It appeared the inability of Brandon to transfer from the parking lot or driveway into his mom’s SUV keyed upon his inability to step up and translate his center of mass forward while in a crouch stance.  Kirkland determined that a small portion of this task was challenging for Brandon. However, this part task was essential due to the relatively low head clearance and high floorboard relative to the ground in mom’s SUV.  There were also concerns with his ability to pivot into his car seat once he steps into the car.

Kirkland used the principles of over-training, part task training, meaningful rewards, and verbal and tactile cueing with Brandon. He did this by creating a simulated physical situation where he hung a piece of cardboard horizontally from the clinic ceiling to replicate the car ceiling, used a step-up bench that approximated the height of the floorboard of the car and an object on the seat that required him to pivot in order to sit down.  The cardboard was painted to match the color of mom’s car and several other objects were used to simulate the bench seat of the car.

Then everything was set for Brandon to practice stepping up under a low ceiling with the bandwidth of reward, cueing, and assistance appropriately withdrawn.

The key was Brandon’s ability to generalize the task to his mom’s car, which he successfully accomplished after only two to three trials.  A total success and the cost of the project was a nominal $6.00 but helping make mom’s life easier is – PRICELESS!

 

 

 

 

 

 

 

Another Great Strides Advantage

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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.

 

                                               

 

 

 

Fletchers PPEC Success Story—Prymus Buckholtz

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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.