Orthotic Assessment

Functional electrical stimulation (FES) uses small electrical signals to stimulate the nerves, causing the muscles to contract and produce a movement. FES can improve muscle mass and strength, spasticity, passive range of motion, upper and lower extremity function, and standing/walking abilities. When placed on multiple muscles that work together in function, the child will motor learn this movement when practiced over time.

his program provides intensive physical and/or occupational therapy consisting of therapy 3 hours a day, 5 days a week for 3 weeks. This provides your child with the opportunity to achieve his/or goals sooner than traditional therapy of twice weekly for 30 minutes.

Research has shown that intensive therapy sessions are more effective at helping the child achieve their same goals as compared to traditional non-intensive therapy (see "additional information" links below).

Our program is individualized to the child and the goals are discussed and determined with the parents and the child.

• Cerebral Palsy
• Developmental Delays
• Post Stroke

The 3-week intensive therapy program allows us ample time to use many of the treatments we are trained in including Theratogs, FES, Kinesiotaping, NDT, Myofascial Release, Whole Body Vibration, Partial Weight Bearing Treadmill Training and sensory integration. However, two components are invaluable to the improvement in function in children with neuromuscular impairments. These components include:
1. The strengthening component. Improving muscle strength and endurance results in improvements in functional skills. Children with neuromuscular disorders have significantly reduced muscle strength. We use the Universal Exercise Unit, which is a system of pulleys and weights supported by a steel frame. Using this unit, specific muscles are isolated, with gravity eliminated, to facilitate even the weakest muscles to contract. The Whole Body Vibration unit and Functional Electric Stimulation also helps strengthen these weak muscles.

2. Functional training component. Children with neuromuscular disorders need to practice a skill or movements many times to learn it. Using the steel frame (spider suspension system), the child can be partially or fully suspended with a system of belts and bungee cords in an upright or seated position. Here, with the impact of gravity decreased, the child can practice many motor skills that they were not able to achieve due to the effects of gravity. In this supported position, the child experiences normalized movements. FES is another way to help train the muscles and the body to learn new tasks.

The family will be provided with a home exercise program, including pictures and/or video of their child performing them. To discuss this program and whether this would benefit your child please call us for an evaluation.

Kinesio Taping is a therapy technique that helps to provide support and stability for muscles and joints without preventing them from moving. It helps to prolong the benefits of a therapy session. It can be worn for several days and is safe and non-invasive. Kinesio tape can help to relieve pain, decrease inflammation, re-educate the neuromuscular system, and promote circulation and healing. The tape is applied specifically for each client based on what their therapy needs are.

Myofascial release is a hands-on technique that requires gentle pressure through the myofascial system to restore motion and decrease pain. Fascia is a specialized system in the body that surrounds and attaches to all structures. It is like a sweater that is woven throughout the body. Any trauma or inflammation can cause this supple fascia to tighten, causing pain and decreasing range of motion. (John Barnes) We use this technique to improve range of motion of the joints as well as to improve postural alignment. Children with cerebral palsy with high muscle tone and/or spasticity who have tightness throughout the body may benefit from this approach. MFR can help improve range of motion of the legs, arms, neck and back and may help avoid surgical intervention.

Neurodevelopmental Treatment (NDT) is a hands-on treatment approach to treat neuromotor deficits, postural disorders and movement disorders. NDT is used by physical therapists, occupational therapists and speech-language pathologists. Through the hands on approach the child is gently guided through a motion, or inhibited to move in an atypical way. The therapist is able to feel the movements the child is demonstrating and then respond to it and facilitate a better way of moving. The movements are continually being assessed and responded to allowing the child to learn the movement with good postural control.

Pediatric Physical & Occupational Therapy, PLLC, uses the WalkAble from Litegait for our partial weight bearing treadmill training program.

This is a device that through a harness, positions the child in partial weight bearing either over a treadmill or over the ground. This decrease in weight bearing decreases the demands on the muscles and thereby allowing more effective and efficient gait. It provides proper posture and eliminates the fear/concerns of falling and allows free movement of the arms and legs. It allows for progression of weight bearing from minimal weight bearing to maximum. Walking over a treadmill at constant rate provides rhythmic input which reinforces a reciprocal pattern of movement. The therapist’s hands are free so they can facilitate appropriate leg placement during walking on the treadmill.

Typically treatments are twice weekly for one half hour to one full hour. The program can run for 8 to 12 weeks. As soon as the goals are achieved gait should then be practiced over ground.

Spider therapy is physical therapy using a piece of equipment called the spider “cage”. It involves attaching several bungee cords from a belt on the child to different levels on the cage. With proper positioning, the child will be suspended and weight bearing will be determined as to where the bungee cords are attached.

This suspension and partial weight bearing allows the child to move independently, strengthen their body as well as learn a variety of movements.

Gravity has a huge effect on children with neuromuscular conditions. It makes it difficult for them to move, resulting in abnormal movement patterns and postures. While suspended in the spider cage, gravity is reduced and movement becomes easier.

The positions the child is placed in while in the cage is based upon the goals to be achieved. They can stand, weight shift, kick a ball, put one foot on bench, practice sit to stand and even jump. Lower level activities such as tall kneel, half kneel, hands and knees can also be accomplished in the cage.

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Spider therapy can:

• Improve postural responses through stimulation of proprioceptors and spatial awareness
• Improve strength and stability
• Improve balance and coordination
• Improve vestibular system
• Be FUN!!!!

....and much more

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The therapists at Pediatric Physical and Occupational Therapy of Hudson Valley, PLLC (PPOT) are all trained with using the spider cage. It is frequently used as part of a 3 week intensive program; however we use it every day, all day. It has become as common place to us as using a therapeutic ball.
Please feel free to visit the office and see the Spider Cage.

TheraTogs™ are a “Velcro-sensitive garment” that applies prolonged, gentle forces to the child’s body to bring about changes in the way that they move. The garment allows the therapist or caregiver to attach straps that “work like external muscles” to improve the child’s posture and alignment of their limbs.
They can be used with a variety of diagnosis such as hypotonia, cerebral palsy, scissoring gait, knee hyperextension, ataxia, sensory disorders, flexible spinal kyphosis.
TheraTogs™ are a great adjunct to a therapy session. The garment can be worn under the child’s clothes throughout the day to help provide muscle or joint stability or sensory input to their whole body.
Our therapists are Certified TheraTogs™ Fitters and can assess your child and fit them with the TheraTogs™ system that will produce the best alignment.

(picture courtesy of TheraTogs™)