Autism spectrum disorder (ASD) is a developmental disability that can cause significant social, communication and behavioral challenges. People with ASD may communicate, interact, behave, and learn in ways that are different from most other people. The learning, thinking, and problem-solving abilities of people with ASD can range - as can the level of assistance one may need in their daily lives.
Signs and symptoms of ASD begin during early childhood and typically last throughout a person’s life. Signs/symptoms can include not pointing at objects to show interest, having trouble relating to others or not having an interest in other people at all, avoiding eye contact, difficulty understanding other people’s feelings or talking about and expressing their own feelings, preferring not to be held or cuddled, appearing to be unaware when people talk to them, but respond to other sounds, repeating or echoing words or phrases said to them, having trouble adapting when a routine changes, and losing skills they once had.
There is currently no cure for ASD. However, receiving intervention services early significantly impacts a child’s development. Occupational therapy services can help a child with ASD improve their fine motor, visual motor and self-help skills as well as sensory processing for optimal functioning in daily tasks.
For more information on Autism, please see:
“Cerebral” means brain and “palsy” refers to muscle weakness and poor muscle control. Cerebral Palsy is a problem with movement and posture that makes certain activities difficult. Cerebral palsy involves at least one limb as well as the trunk. It can be accompanied by speech and language delays, seizure disorders, cognitive deficits, and vision or hearing issues.
Cerebral Palsy occurs most often due to prematurity, low birth weight, maternal infection, decreased oxygen during birth, or severe jaundice. Overall, 70% of cerebral palsy is due to a prenatal cause, 20% occurs during birth, and 10% occurs after birth due to a brain infection or head injury. Further, ten thousand children are diagnosed with cerebral palsy every year which means that 2 out of every 1,000 children will develop cerebral palsy.
It is not a disease. It is not progressive and it is not contagious. This means that the brain will not get worse. The signs and symptoms usually improve with treatment. Therapy plays a major role in the lives of children with cerebral palsy. Treatment has immediate and life-long effects and can be cost effective (Olney & Wright, 1994).
Children who receive the right therapy early on often have better outcomes. Treatment of children is specialized. Decisions about the many medical interventions that children with cerebral palsy need such as orthopedic surgery, botox, spasticity management, bracing, and assistive devices are often influenced by the child’s physical therapist. Good therapy not only helps the child, but also has a positive influence on the child’s family, school, community (King et al, 1998).
Other helpful references for information on Cerebral Palsy include: Kid's Health, National Institute of Neurological Disorders and Stroke and United Cerebral Palsy.
All children develop differently. Two children who are born on the same day may achieve a gross motor skill such as rolling, sitting, crawling, or walking months apart. A developmental delay refers to a child not reaching their developmental milestones at or around the expected times.
Delays can be in a number of different areas: gross motor (crawling, walking), fine motor (holding their bottle, picking up cheerios), speech (making sounds or understanding when they are spoken to), social, and cognitive.
Developmental delays may be caused by complications during pregnancy or birth, due to genetic reasons, due to hearing loss or excessive ear infections, and sometimes the reason is unknown. Premature babies born weighing less than 1500 grams or 3 ½ pounds have been found to be two times more likely to have developmental delays.
Parents are often the first ones to notice that their child is not doing what their friend’s children or their older siblings were doing at a certain age. They then often bring it to the attention of their pediatrician. Some pediatricians will take a “wait and see approach” and others will recommend that the child get a developmental evaluation or screening. This can be performed by a developmental pediatrician or by a therapy team of physical and occupational therapists, speech therapists, educators, and psychologists.
Treatment is physical and/or occupational therapy with a therapist who specializes in pediatric therapy.
Other helpful references for information on Developmental Delays include: Developmental Delay Resources, Zero to Three, My Child Without Limits, National Dissemination Center for Children with Disabilities, and Centers for Disease Control and Prevention.
Other helpful references for information on Developmental Delays include: Developmental Delay Resources, Zero to Three, National Dissemination Center for Children with Disabilities, and Centers for Disease Control and Prevention.
Down Syndrome is a genetic condition caused by an extra chromosome, number 21. It is sometimes called Trisomy 21. This extra genetic material causes delays, from mild to severe, physically and mentally.
Approximately 1 in 800 babies are born with Down Syndrome. This number rises with the age of the mother. In a mother who is thirty-five, 1 in 350 babies are born with Down Syndrome. A mother whose age is forty, the baby has a 1 in 100 chance of being born with Down.
Some physical characteristics typically seen in children with Down Syndrome are: flat facial profile, upward eye slant, small ears, decreased creases in the palm of the hand, white spots on the iris in the eye, small hands and feet, and protruding tongue.
Hypotonia or low muscle tone is normally seen with Down Syndrome. This interferes with sucking for feeding as well as gross and fine motor development. Babies and/or children with Down Syndrome are often said to be “floppy”. Delays in speech, self-care skills, and cognition are often seen as well.
About half of children born with Down Syndrome have a congenital heart defect. They have increased risk of pulmonary hypertension. Half also have difficulties with hearing or vision (cataracts, glaucoma). Also, thyroid disease and gastrointestinal problems and upper neck abnormalities (instability of the upper cervical spine) often plague those born with Down Syndrome.
Dyspraxia is a condition that affects a child’s ability to coordinate movement in order to successfully follow through with a task. In other words, the child’s body is unable to do what the child’s brain tells it to do. This results in clumsy, disorganized movements and difficulty learning new skills. Dyspraxia also includes ideation or the ability to come up with the plan in order to successfully complete a task or movement. Or in other words, dyspraxia is an impairment in the movement preparation process. This makes lots of everyday activities for children with dyspraxia difficult.
Symptoms of children with dyspraxia can include clumsy, bumps into things often, cannot jump or skip, does not show right or left hand dominance, cannot grasp a pencil to draw, difficulty with fasteners, has poor hand-eye coordination, struggles with sports, difficulty planning tasks, and can have difficulty with fine motor skills, and school bag and desk are often messy.
Occupational therapists treat children with dyspraxia. By incorporating a variety of traditional and non-traditional (i.e., sensory integration, reflex integration, auditory interventions) treatment approaches, occupational therapy has been successful with addressing children’s dyspraxia and assisting them with improving their overall skill set for optimal functioning in all environments.
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Toe walking is when a child walks on their tippy toes. When toddlers first learn to walk they may come up onto to tip toes as they play around with weight bearing through their feet. However, consistent toe walking is NOT normal at any age. There are many reasons why a toddler/child may toe walk and seeing a physical therapist knowledgeable in toe walking assessment and treatment is highly recommended.
Areas we assess in children who toe walk:
- Muscle strength
- Foot bone alignment
- Gross motor skills
- Flexibility/Range of motion
- Vestibular system
- Visual System
- Proprioception System
There are many areas that may contribute to toe walking. Treatment will be determined by the findings during the assessment.
Treatments may include:
- Muscle strengthening
- Sensory Integration
- Visual-vestibular training
Muscle tone is the resting state of your muscles. “Low” muscle tone means that the amount of tension or resistance to movement in a muscle is lower than normal. The resting length of a low tone muscle is a bit longer than a typical muscle resulting in fibers not overlapping at an optimal length. There are also fewer places where the fibers can attach and generate a pull on the muscle. This causes the muscles to go through a greater range of motion to produce a movement. The response time of the muscle is also usually delayed. Both the greater range of motion of the muscle and delayed response time increases the energy needed to do functional tasks. All this extra energy causes a decrease in the child’s endurance.
Common difficulties often (but not always) experienced by those with low muscle tone:
- Fatigues quickly
- Poor posture
- Increased flexibility, increasing susceptibility to injuries
- Poor persistence to gross motor tasks
- Lack appropriate body awareness feedback
- Avoids chewy foods
- Preference to engage in sedentary activities
Improving strength and endurance is important. Because it is difficult to move, many of these kids don’t move as much as their peers do. This results in weaker muscles and poor endurance. Improving core strength is very important with these kids. Since it is harder to move and activate their muscles they need more practice to do gross and fine motor tasks.
Physical and occupational therapy can help children with low muscle tone become stronger, improve endurance, and improve functional skills.
Other helpful references for information on low muscle tone:
Rett Syndrome is a developmental and not degenerative disorder usually picked up in early childhood.
It is caused by a mutation on the X-chromosome called MECP2. Girls (as this disease is primarily seen in girls) can have up to 200 mutations on this gene. The mutation causes absence of the protein in the gene needed to regulate the functions of the brain.
Typically, the child begins developing normally until 6-18 months old at which point their motor skills stop progressing, then regression begins. Signs and symptoms may include:
- Apraxia: inability or reduced ability to perform motor movements including speech and eye gaze
- Breathing problems: breath holding, irregular breathing
- Floppy arms and legs
- Atypical hand movements such as hand wringing or mouthing of the hands. Usually, they no longer use their hands for fine motor skills such as grasping, reaching etc.
- Decreased head growth
- Increased drooling
- Shaky or stiff gait or inability to walk or crawl
- Decreased sleep or change in sleeping patterns
- Decreased social engagement such as decreased eye contact; Rett’s syndrome can be confused with autism. It is now on the autism spectrum
- Constipation and gastroesphageal reflux
- Decreased ability to communicate or no longer speaking
Girls can have a mild to severe form of the disorder depending on how many and where the mutations of MECP2 exist. There is a blood test to diagnose it. Sometimes Rett Syndrome can also be misdiagnosed as Angelman’s Syndrome, Cerebral Palsy, Disorder Autism, or Mental Retardation.
Sensory Processing Disorder (SPD) is the inability to use information received through the senses in order to function optimally in daily life. People rely on information from 8 sensory systems including auditory, visual, olfactory, gustatory, tactile, vestibular, proprioception and interception to function smoothly. If one or more of the senses are not taking in information efficiently, a person can be overly sensitive to stimuli that other people are not or require more stimuli to react appropriately. Like many conditions, the symptoms of sensory processing disorder exist on a spectrum and vary depending on which sensory system (or systems) is impacted.
Some common symptoms of SPD can include clothing feeling scratchy or itchy, lights being too bright, sounds being too loud, being afraid to play on the swings, or difficulty touching or eating certain textures. Alternatively, symptoms of SPD can also present as difficulty sitting still, always “on the go,” a thrill seeker or risk taker, slow to respond to noises, or unaware when their face is messy or their nose is running. Finally, others with sensory processing disorder may be uncoordinated, bump into things or not recognize personal space, be unaware of where their body is in space, be hard to engage in conversation or play, “act out” in a disruptive way, or have trouble figuring out how to negotiate obstacles in their environment.
People can present with a mixture of symptoms and symptoms can vary throughout the day based on environmental stimuli and in different situations.
Occupational therapists commonly see and treat children with sensory processing disorder. Because SPD can be a primary contributor to poor motor and visual processing skills, treatment depends on a child's individual needs and involves helping the child do better at activities that are hard for them.
Treatment for sensory processing dysfunction is called sensory integration and is provided by an occupational therapist who is knowledgeable and skilled in the area. The goal of sensory integration is to challenge a child in a fun, playful way so they can learn to respond appropriately and function more optimally at home, in school and in the community. The sensory systems that are not processing information efficiently are targeted with the use of a variety of specialty equipment, modalities and techniques fostering appropriate adaptive responses for improved function. Additional treatment protocols such as The Listening Program, Integrated Listening Systems (iLs), Wilbarger’s Brushing/Joint Compression protocol, and astronaut training may be incorporated into the treatment plan.
Many children have symptoms like those described from time to time. But therapists consider a diagnosis of sensory processing disorder when the symptoms become severe enough to affect normal functioning and disrupt everyday life.
For more information on Sensory Processing Disorder, please see:
Spina Bifida occurs when a child is born with an opening in their spine. This is called a neural tube defect. The severity depends on the form of spina bifida. Spina Bifida Occulta is when there is a small opening in the spine, however, most of the time, the spinal cord is not damaged. Normally it is covered by muscle and skin. An extra tuft of hair or a small dimple may mark the area.
Other forms of Spina Bifida include Meningocele is when the meninges, membranes that covers the spinal cord and the brain, protrudes through the opening in the spine, but the nerves do not. Myelomeningocele is when a sac containing nerves and the spinal cord protrudes through the opening in the back. In this case, babies exhibit muscle weakness or paralysis as well as decreased sensation due to the damage to the nerves and spinal cord. The higher in the spine that the opening occurs, the more muscles are affected and are paralyzed. Additionally, 90% of children born with myelomengiocele also develop hydrocephalus or excessive fluid in the brain.
The cause of Spina Bifida is still not completely known. It is has been associated with a lack of folic acid during pregnancy. Further, high fever or exposure to high temperatures during the first few months of pregnancy has been linked to Spina Bifida. Factors increasing the risk that a fetus develops Spina Bifida include obesity, diabetes, and a relative with Spina Bifida.
Complications of Spina Bifida are many. Children with Spina Bifida can have difficulties with their bowel and bladder as the muscles to these areas may be damaged. Learning problems are associated with Spina Bifida as well. Latex allergies and allergies to associated foods are often seen in children with Spina Bifida. Scoliosis, tendonitis, and obesity are also complications noted with this disease. Skin breakdowns due to lack of sensation can also occur. Orthopedic deformities such as club feet, muscle contractures, and hip dislocations are associated with the condition.
Treatment depends on the degree of complications, but common approaches include:
- Children with Spina Bifida need early rehabilitation services consisting of physical, occupational, and speech therapy services. They should be evaluated by an educator as well for possible learning deficits.
- Bracing (orthotics and/or long leg braces) and equipment such as walkers, crutches, and wheelchairs are important in the treatment of Spina Bifida.
- Myelomengiocele will require surgery to close the area. Additionally, in cases with excessive fluid in the brain, a shunt may need to be placed in the infant's brain to drain the fluid a short time after birth.
- Follow up treatment by a good team of doctors including pediatric orthopedists, pediatric neurologists, pediatric physiatrists, urologists, and GI doctors is required.
Other helpful references for information on Spina Bifidas include: Spina Bifida Resource Network, Kid's Health, National Institute of Neurological Disorders and Stroke, Physical Therapy for Children (Campbell, Vander Linden, Palisano, W.B. Saunders Company, 2000), and Clinical Pediatric Physical Therapy (Ratliffe, Mosby, 1998).
Traumatic Brain Injury or TBI is one of the leading causes of acquired disability and death in infants and children. 475,000 TBI’s occur in children 0-14 every year. They cause about 2,700 deaths per year. A TBI is an injury to the brain caused by the head being hit by something such as in a fall or car accident. It can also be caused by shaking an infant very hard (such as in shaken baby syndrome). TBI’s changes how a child moves, acts, thinks and learns. The symptoms can be very different depending on the location of the injury to the brain and how severe the injury was. The physical changes that can be seen are related to the child’s ability to speak, see, and hear. They can experience severe headaches or seizures. Paralysis may be present or increased spasticity of one or more limbs. Fine and gross motor skills such as writing or walking may be affected. Cognitive changes are often present as well. Short and long term memory may be decreased as well as the ability to concentration. Speech and the ability to read may be altered. Judgment and planning skills are often affected by the injury to the brain. Physical therapists work with children who have had a brain injury to return them to age appropriate gross motor skills. If the injury occurs prior to the development of many of their gross motor skills, pediatric physical therapists work to help the young child achieve the gross motor skills appropriate for their age. Increased tone or spasticity can interfere with gait and balance. Balance and gait training is often a large part of the treatment plan.
Congenital muscular torticollis (CMT) is found at birth and is defined as a twisted neck in which the head is tilted to one side while the chin is turned to the other side. It is caused by damage to or shortening of the Sterno-cleido-mastoid muscle(SCM). Sometimes there is hematoma, a lump, in the muscle that will eventually go away as the muscle heals and lengthens. Some babies may develop plagiocephaly, or a flattening of the skull on one side. This needs further assessment by the physical therapist. The most common causes of CMT are in utero positioning, lack of space in utero, or a traumatic birth.
Symptoms of torticollis include:
- Baby holds their head to one side
- Head tilt is noticeable
- A lump or swelling exists in the SCM muscle
- Shoulder is higher on one side
- Flattening on one side of the head
Physical therapy is the primary treatment for a baby with torticollis. Treatment involves stretching the shortened muscle while strengthening all of the muscles of the neck and the core, as well as facilitating normal gross motor development. The therapist works closely with the parents to develop a home program of positioning to facilitate full active range of motion of the neck.
To find out about our approach to assessing Torticollis in infants, please follow this link.