Gateway Therapies
Brisbane occupational therapy, speech therapy, autism therapies and NDIS services for all ages

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Featuring articles from our principal Occupational Therapist, Dr Nicole Grant, members of the therapy team, and guest posts from members of our community.  

Posts tagged therapy
What's Best - Handwriting or Typing?

A few years ago, I conducted an Ergonomic Workstation Assessment for an adult who was employed in an administrative role. This particular employee had the task of completing a large number of forms by hand and she was experiencing symptoms that her GP thought might be early signs of Carpal Tunnel Syndrome. This recent assessment again got me thinking about writing.

Computers and other electronic devices are being used more frequently to communicate - either in real time or to convey a story or recount an experience. It appears as though typing has become the preferred method of communicating over writing and even at times over speaking. I wonder if this is the reason why there is an increasing number of both kids and adults who struggle with writing - either by writing poorly or by developing pain in their hands and wrists during this task?

It's important with any skill to practice often. Use it or you lose it - basically. My approach with working with kids is to firstly correct their pencil grasp, and then practice, practice, practice. Work on letter formation, letter height, width and word spacing. With adults who are reporting pain or other symptoms e.g tingling in the hands, I encourage them to continue writing, but to alternate written tasks with other activities. I encourage all clients, both young and old, to perform hand stretches before commencing writing tasks - just like a footy player would stretch his muscles before running onto the field.

I would love some feedback on this post. Which is more important - handwriting or keyboard skills? Do you experience hand or wrist pain if writing? What about your kids?

Please note, if you experience pain, numbness or tingling when writing or typing, and it does not go away, seek medical attention.

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The importance of building rapport in therapy

As the end of the school year draws to a close, I find that my school age clients get a little bit impatient, frustrated and less cooperative. I think it's a combination of fatigue, burn out, and anticipation of the holidays and Christmas.

One particular client, a boy with Cerebral Palsy, flatly refused to cooperate one day. Knowing that he was likely to be a little difficult, I had prepared activities that I thought would be fun. I only had a few things with me as I was seeing this boy in his home. When he showed no interest in any of the tasks I had on offer, I knew I had to try harder, as there was no alternative. In my therapy room I have a huge range of resources, but on home and school visits I am limited.

"I don't want you in my house", said the boy. "I'm the boss here" he added.

I told him that he wasn't and that we were there to work, that his father would be disappointed if we did nothing, and that it was to help him to use his arm better. "You need to practice using both your left and right hands to play the Wii!" His favourite thing to do.

"I don't want to", he said when I offered him different games. He had not even looked at them.

Complete resistence.

I needed him to understand that I wasn't going anywhere.

"I like you", I said. "I want to be here, and I would really like you to play this game with me".

Well those first three little words made the biggest different. The boy looked at the game I had in front of us, looked up in to my eyes and said "OK". For the rest of the session he was involved, he participated, and he worked hard. I was so proud of him and so thrilled that our therapy session was productive.

I think there are so many messages here in this story. It's important to show consideration and care for other people. It's nice to be told nice things, and it's nice to be nice. I meant what I said, and I think that's important too.

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How occupational therapy helps children with autism

Article originally posted as a Guest Post, Authored by Dr Nicole Grant at Baby Hits and Tips.

Occupational Therapists are highly underrated allied health professionals. Being one, I can say that with some authority. Seriously though, having just returned from a conference attended by about 750 of us, I can definitely say that they are an amazing bunch of people. The thing is, if you haven’t needed one, chances are you don’t know what an OT is, and how much you are missing out on!

OT’s are university qualified health professionals who are specifically interested in helping people to independently undertake those activities that matter to them most. For children, this quite often means helping them to play. We look at all of those things that can impact on a child’s ability to play – like physical injuries, intellectual impairment or developmental delay. We find out what kids love to do, need to do, and want to do, and help them to do it. This may include giving them special equipment or tools, modifying their environment to better support them, or engaging them in therapy aimed at improving their ability to play.

Children with autism can benefit from Occupational Therapy in many different ways. We can help to develop fine motor skills (handwriting, using cutlery, stacking blocks) as well as improve social skills (turn taking, joint attention, making friends). We can help establish alternate methods of communication where speech is limited (PECS, Makaton signing) or provide strategies to help overcome sensory dysfunction(such as hypersensitivity to noises and smells).  OT’s can also help with self-care skills such as toileting and dressing.

Many OT’s will undergo ongoing professional development or seek further education to become specialized in different fields. To work with children on the autism spectrum, you will usually find that your therapist has undergone specific training in interventions tailored towards helping children with autism.

If you are a parent of a child with autism, there are questions that you should always ask your therapist, before deciding if they are the right person for you. The following questions are adapted from the Early Intervention for Children With Autism Spectrum Disorders: “Guidelines for Good Practice”  (Roberts & Prior, 2012).

Questions to ask your OT

  • What are the specific aims of the program or service you offer?
  • Are there any medical or physical risks?
  • What assessments are carried out prior to the intervention?
  • What is the evidence base for this intervention? (i.e. what proof is there that this works?)
  • What evaluation methods have been used to assess the outcome of intervention? (i.e. how good are the studies that have tested this treatment option?)
  • Do you make money out of the intervention you are promoting?
  • What is known about the long-term effects of this treatment?
  •  How much does it cost?
  •  How much time will be involved?

At Gateway Therapies, we specialise in helping children with autism. Contact us now on 3398 9367 to make an appointment. 

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Should my child get a diagnosis?

A post from Director, Nicole.....

I often receive requests to assess for delays with development or dysfunction in the areas of sensory processing, fine and gross motor development, attention/ concentration and other areas of function. One of the questions I am frequently asked by parents, particularly when obvious issues become apparent, is - what do you think it is? Many parents are aware of neurodevelopmental disorders like those on the autism spectrum, and I often get asked about ADHD and sensory processing disorder.

I will always refer to a paediatrician for diagnosis, but can assist with the process by providing a report outlining my observations and recommendations.

Parents often feel reassured when they at least have a little more information as a result of an initial assessment, particularly as my focus is always on providing information and strategies to assist - regardless of whether or not a name is given to the challenges identified.

Once specific issues are identified, the treatment options or interventions used tend to be the same, regardless of what the diagnosis is, or will be. The problem here is that without a diagnosis, parents can have limited access to Occupational Therapy services. Government funding is available in Australia for children with special needs via such schemes as Helping Children with Autism and the Enhanced Primary Care Scheme. However, a diagnosis is required. Parents who wish to pursue intervention with a private allied health professional, and do not have a diagnosis, may be able to claim some of the expenses from their private health fund, or self-fund the fees.

Occupational Therapy services are available to the community via community services and more specifically to school age children through the Department of Education and Training. Waiting lists are often lengthy, which can affect access to early intervention services, however it's worth contacting your local department to check.

My concern with seeking a specific diagnosis or giving a name to the difficulties a child is experiencing, is that some children just do not meet all the criteria to be given a diagnosis. This doesn't mean they are any less in need of assistance. Many children can benefit from Occupational Therapy services, to develop skills to help them with their school work, social interaction, and self care. Click on the links or email me for more information.

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Low Muscle Tone and Poor Attention - A Case Study

A young boy, 4 years of age, was brought to me for assessment about 9 years ago. He had not been diagnosed with any particular disorder, but was easily distracted and found it difficult to pay attention to the task at hand. He had been seeing a Speech Therapist for some time due to a slight delay in his speech development and he dribbled.

The boy's mum was mostly concerned that he would not be able to concentrate in class when he started prep next year. She wondered what she could do to help him at home, in readiness for school.

I gave the child some activities to complete and observed that he fidgeted in his chair, and was easily distracted, and yes - had difficulty paying attention. One of the first things I noticed was that when needing to apply force or pressure, e.g to mould playdough, he would move to position himself over the table to use all his strength, rather than relying on his hand strength alone. When I asked him to throw a ring or ball, he needed to use two hands to get any sort of distance. Throughout the assessment I asked the boy to complete desk-based tasks that assessed things like posture, attention, and fine-motor skills, and more active tasks that assessed his balance, coordination and proprioception.

During the assessment, the 4-year-old managed to respond to multi-step directions, and complete age appropriate puzzles and games. I found that when he began to lose focus and become distracted, his posture also changed and he would recruit compensatory muscle groups to move or exert force on an object. I asked this child if he ever got tired in the neck, back, arms or legs when sitting for a long time. He thought for a second then answered "Yes. Sometimes my elbows hurt." His mum hadn't heard this before and wasn't sure what he meant by this.

By the end of the assessment, it had become apparent that the attention difficulties experienced by this boy were more likely due to low tone, than because of any cognitive or intellectual dysfunction.

Low tone or hypotonia is explained well in Wikipedia:

"Hypotonia is a disorder that causes low muscle tone (the amount of tension or resistance to movement in a muscle), often involving reduced muscle strength. Hypotonia is not a specific medical disorder, but a potential manifestation of many different diseases and disorders that affect motor nerve control by the brain or muscle strength".

I recommended that the child engage in physical activities that promote muscle strength, balance and coordination, like climbing, running, and bike riding. He was already taking swimming lessons and going to structured gym classes, so he was already on his way.

With regards to desk-based work, I suggested that the boy be given a seat and chair that was appropriate for his size and that enabled him to sit with his feet flat on the floor and his back well supported. When performing desk-based tasks, it was probable that the child would become easily fatigued and possibly develop joint or muscle pain. He needed to be given the opportunity to stretch and change postures frequently.

With these strategies in place, and ongoing review of his progress and awareness of his needs, the 4-year-old boy should have no difficulty keeping up with his peers on commencing prep.

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10 ways to help your child to sit still

I often wish I could bottle the energy the children in my life seem to have in abundance. They don’t walk, they bounce. They don’t sit, they wriggle. Boundless energy, which is wonderful really. Except when you need them to stay still.

Most kids struggle to sit in one position. From the time they can first hold their little bodies’ upright, sitting still is hard work.

Being an active child is brilliant and should be encouraged, however sometimes sitting is necessary. Kids need to sit still at meal times, to get their hair cut, when at the dentist, in church, and one of the most challenging scenarios – at school.

It’s important for children to learn to sit still. Some activities are best undertaken in this position. It’s also good manners, and socially appropriate in many situations.

Here are a few tips and tricks to help your child to sit still:

1.    Give them a reason. Kids love to know why they need to do as they are asked. “Because I said so”, is not helpful. Instead, tell them the truth. “It’s good manners to sit at the table when our guests are still eating”, or “your handwriting will be neater if you keep still at your desk”.

2.    Set the rules. If sitting is expected at meal times, or when you have guests, include it in your family rules. Kids are visual learners. If these are written (or depicted as images for pre-readers), put them somewhere prominent to remind your little ones of what is expected.

3.    Model expected behaviour. Children imitate. If you are not sitting, why should they?

4.    Don’t expect too much. Kids generally can’t sit for as long as adults. Let them stand up to stretch their legs after 15 – 20 minutes. Let them shake their wriggles out before resuming the task at hand. It’s a skill that needs to be practiced.

5.    Make them comfortable. If your child can swing their legs, they will. If their feet can’t touch the floor, put a footrest (e.g. upturned box) under their feet to support them. Using a chair with a back support, rather than a stool is best.

6.    Make it fun. Kids struggle to sit still even more so when they are bored. Give them something to keep their hands and minds busy. If they’re not eating, then books, small (fidget) toys, or a game might hold their attention longer. If they are practicing handwriting or math’s tasks, can they use textured paper, or a coloured pen?

7.    Minimise distractions. Kids need to learn to work despite distractions, but too many can be a problem. Sit kids facing away from windows and other children. Limit (don’t eliminate) background noise, and avoid interruptions. Giving kids their own space for desk-based work is best, whether this be a corner of the kitchen bench or their own desk.

8.    Check their tone. Kids with low muscle tone can fatigue easily because they have to work harder to maintain one position. They can start to fidget and seek distractions after a while. Consider seeing an occupational therapist for an assessment if you think your child may have low tone.

9.    Consider extra support. Some children (particularly those with sensory processing issues) benefit from sensory feedback by way of a weighted lap pad or move n sit cushion. Always discuss these options with a qualified therapist first.

10. Don’t sit! Maybe sitting isn’t essential. Homework can be done with your child standing at the kitchen bench. Sometimes changing posture is actually stimulating. Does it matter if they are standing at the movie cinema? If their head is not blocking the line of vision of the viewers behind, does it really matter? Think creatively and be flexible.

Children with developmental delays, cognitive or physical impairment may continue to experience difficulty with sitting. Ongoing assistance from a therapist may be required to overcome some of these challenges.

If you have any concerns about your child’s seated posture, fine motor skills, or ability to concentrate or attend, further assessment by a paediatrician and/ or an occupational therapist should be considered.

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