Close

Archive for category: Kids

by

P is for Prevention

Julie Entwistle, MBA, BHSc (OT), BSc (Health / Gerontology)

In recognition of Brain Injury Awareness month, I thought it would be fitting to start at the very beginning. PREVENTION. Really, it is the best medicine. For now, let’s forget about the symptoms of brain injury and its’ impact on work, home, school, and quality of life. Let’s not talk about how it is assessed and treated. Instead, let’s focus on trying to stop it from happening in the first place.

But even before that, we need to know what we are dealing with. It is well known that brain Injury is the leading cause of death and disability worldwide. In Canada, Traumatic Brain Injury (TBI) is more common than breast cancer, spinal cord injury, HIV/AIDS, and multiple sclerosis (MS) combined. There are approximately 18,000 TBI hospitalizations annually. In the province of Ontario, 25% of the two million people diagnosed with a neurological condition have suffered from a TBI. In 2000-2001 brain injuries accounted for $151.7-million in direct costs to Canadians (1).

By way of distribution, TBI is most common in children (0-19) at 30%, followed by seniors (60+) at 29%. In kids, falls are the most common cause followed by motor vehicle accidents and then sports. In adults, motor vehicle accidents cause the most TBI’s, and in seniors the causes include falls (76%) followed by car accidents (2).

Knowing the causes helps to look at how we can engage in preventative strategies. As an occupational therapist with a background in health promotion, a parent of four, and athlete, here are my thoughts:

Falls

Kids fall all the time, so how can we prevent that? Well, there is a difference between a child falling when walking, running or jumping, versus falling from, say, a shopping cart, off of a playground structure, or from a tree they tried to climb. Falls from bikes, skateboards and scooters are going to happen – and a helmet can mean the difference between a head injury and not. The bottom line is that falls in kids are best prevented by proper adult supervision. Yes, it is that simple.

In seniors, falls take on a different form. They are not from carefree or reckless behavior, but often happen when someone is just trying to go about their day by having a shower, coming down the stairs, or taking a leisurely walk. Seniors need to be attuned to the physical, balance and vision changes they are experiencing as they age, and need to consider the importance of anti-slip mats in the bathroom, removing scatter mats, installing grab bars or railings, and the benefits of a walking stick or cane when outdoors. Seniors need to engage in regular exercise and activity to maintain bone density, mobility and intact balance. They have to be very careful when living with pets or when trying to negotiate places that are cluttered or dark. Awareness of declining abilities is the first key to addressing these properly such that a prevention plan can be developed that will ultimately improve safety and reduce the risks. Note that the services of an occupational therapist can be pivotal in creating this safety plan.

Motor Vehicle Accidents

Like falls, despite our best intentions, these can and do happen. The issue here is trying to minimize the risk and optimize the outcome. Safe drivers are attentive, undistracted, and alert. They travel at safe speeds, approach intersections with caution, stop behind the line, pass when appropriate, and recognize that rushing to get somewhere on time is useless if it means you never get there at all. Safe drivers don’t text or hold a phone to their ear, don’t eat a hamburger and steer with their knees, and don’t drive when tired. If you are one of these drivers you are going to increase your chances of avoiding a collision, and lower your chances of being the cause. Unfortunately, however, not everyone is a safe driver. So, all the rest of us can do is wear our seat belt, buy a car with a good safety rating, make sure everyone in the car is buckled properly, make sure the headrest is at a proper height, put loose belongings in the trunk (I know of a child who got a head injury from a flying jar of pickles that escaped the grocery bag during a collision), and follow the rules for child seats.

Sports

I am an avid athlete and have pretty much played or tried every sport. There are very few sports I dislike and I honestly feel that sports can be the most positive and influential outlet for young people, and one of the most engaging and social outlets for adults. The issue is that sports seem to be becoming more and more competitive, kids and adults are getting bigger and stronger, and the culture of some sports has changed from friendly competition to all-out war. Preventing head injury in sport can include outfitting your kids with proper equipment (many hockey parents spend more on a stick than a helmet), ensuring they are playing at their level, monitoring the coaching influence and team culture to make sure this is appropriate, and my favorite is from the book “The Secrets of Successful Families” and includes that the only job of a parent in organized sport is to “shut up and cheer”. No parent should be on the sidelines encouraging reckless, mean or harmful behavior. The results can be devastating. And if you are concerned about your child’s risk of head injury in sport, know that there are many other sports that reduce the risk but are equally as challenging, competitive, fun and have the same physical, cognitive and developmental benefits.

So, let’s start our recognition of Brain Injury Awareness Month by practicing prevention. It does not have to be easier said than done.

(1) Brain Injury Association of Canada
(2) Canadian Institute of Health Information

by

How To Promote Inclusion to Your Kids

The following from Abilities Magazine discusses great ways to proactively talk to children about disability and inclusion and how to react appropriately should your child ask an inquisitive question about someone they recognize as “different” when in public.

Abilities Magazine:  “Mom, What’s Wrong With That Man?”  Those Awkward Questions and How to Promote Inclusion and Acceptance Among Children

by

Protect Your Noggin!

Last month on the blog we shared with you tips on bicycle safety and the importance of wearing a helmet. ( “Don’t Forget Your Helmet!” ) However, if the helmet isn’t the right fit or is not worn properly, it may defeat the purpose. With so many different styles and types, how do you know which helmet to choose and if the fit is right? The following from the Doctors of BC shows you how to properly fit a helmet and what to look for when making your purchase.

The Doctors of BC:  Bike Helmet Safety

 

by

Turtle Twins (Part 2) – Treating Auditory Processing Disorder

Julie Entwistle, MBA, BHSc (OT), BSc (Health / Gerontology)

In my previous post I explained that auditory processing disorder (APD) is like a game of “Operator” where a message is misinterpreted when travelling between the ears and brain.  This causes problems with communicating in noisy environments, following multi-step instructions, and wrongly hearing words, sounds and sentences.    The good news is that APD can be improved organically and through modifications to the functional environment.

Personally, my daughter was diagnosed in Grade 3 (age 8).  To understand her problems, I read several books on APD and copied some chapters for family.  I disclosed fully to my daughter the results of her testing and explained that sometimes her ears and her brain are hearing different things.  I wanted her to understand that at times, when things people say might seem funny, confusing or strange to her, she might have heard them wrong.  She was encouraged to ask questions about her ADP, and to never be shy about asking people to repeat themselves if needed.

At school, the teacher started wearing an FM unit to help best deliver instructions and teachings to my daughter who wore corresponding headphones.  The teacher and I put tennis balls on the classroom chairs to reduce noise.  My daughter was relocated near the teacher’s desk and away from the busy hall.  The door was closed (reducing background noise) during lectures.  She was allowed to write tests in the quiet resource room.  The teacher was provided a list of other classroom modifications to implement, including ways to breakdown instructions into smaller chunks to improve her retention and follow-through.  I talked to the teacher about the fact that when my daughter was reading in class (when she was supposed to do other things) to tune out classroom noise and / or because she missed the directions.

In sports, we noticed an issue with her playing basketball.  The sound of the balls bouncing on the floor made it difficult for her to hear her coach and the background noise in the gym during practice was a struggle for her.  At Karate, she would look around to see what the other kids were doing as she would miss instructions.  All of her coaches and Sensei’s were advised of her APD and started speaking more directly to her, asked her to repeat instructions, and tried to reduce background noise when possible.

We also made changes at home.  We took extra time to reduce background noise (difficult in a family with four kids), would reduce the number of instructions we gave her at one time, had her repeat these back to us, and developed a “roger that” mantra that she would say to indicate she got her instructions.  Our audiologist recommended Fast Forward, an online game designed to help improve APD.  While research does not conclusively confirm that this is helpful for APD, we decided to give it a try and she found it very helpful.  Ultimately, and for reasons other than just her APD, we moved her to a small school with very low class sizes and she is now thriving.  We still notice her APD at times, but she is very aware of this and is mature enough to understand that if something sounds wrong (i.e. turtle twins) she should politely ask for clarification.

 

by

Turtle Twins (Part 1) – Auditory Processing Disorder

Julie Entwistle, MBA, BHSc (OT), BSc (Health / Gerontology)

In recognition of Speech and Hearing Month, I wanted to tell the story of my personal experience as a mom of a child diagnosed with auditory processing disorder (APD).

APD is best explained using the example of the game “Operator”.  If the first person is the ears, and the last the brain, everyone in between is the channel by which the message travels.  And remember what happens?  By the time the message reaches the “brain” it has been altered.  So, really APD is just that – when a message or sound changes as it travels from the ears to the brain resulting in the brain getting the wrong message.

Signs of APD can include difficulty with: communicating in noisy environments, following multi-step instructions, and wrongly hearing words, sounds and sentences.  As an overlap exists between the signs of APD and other disorders, and this may coexist with other problems, it can be difficult to diagnose.

Being a clinician, I recognized early that my daughter struggled with “hearing”.  Yet at 18 months her hearing test was “fine”.  When she was three I remember telling her that her “ears and brain were not talking”.  In school she would become easily distracted, would struggle with multi-step instructions, and did much better in classes that were smaller, less chaotic, or when she sat closer to the teacher.  At home the presence of her APD was apparent when my instruction “change your shirt” would be met with the response “I am not wearing shorts”.   Or, when the instructions “brush your hair, grab your lunch and put your coat on” might result in one, maybe two, but rarely three of those instructions being followed.  But my favorite remains when my daughter told her sisters they were “turtle twins” as she had misheard the word “fraternal”.

The diagnosis of APD is made by an audiologist when the child is at least 7 or 8 years old.  However, psycho-educational tests can also be helpful to rule out other or comorbid problems.  In adults, APD also exists, and can be the result of many factors, including acquired brain injury.  Also, some research suggests that men start to struggle with APD after age 35 and women after menopause.  My next blog will focus on ways we managed our daughter’s APD at home, in sports and school, and these same strategies could also be used by others who have, treat, or know someone with APD.

 

by

Best of The Blog: When Children Can’t Communicate Pain

Recognizing it is Autism Awareness Month, we wanted to re-run a popular blog about children, communication, and pain.  Recognizing that communication is key in all aspects of life, it is essential that children learn how to display this when needed.  However, sometimes, especially for those with Autism Spectrum Disorder, communicating feelings, discomforts and pain can be quite difficult.  The following post written in November 2013 discusses non-verbal pain communication and helps parents to know what to watch for.

When Children Can’t Communicate Pain

A few years back my daughter (age five at the time) seemed a bit “off” when she came home from school.  She was withdrawn, tired, and “didn’t want to talk about it”.  She is my kid that struggles to communicate her needs, especially when she is upset, so I tried to give her some time and control over when she would be comfortable talking about it.  Eventually, I went over to her and in stroking her hair realized this had blood in it.  I pulled her bangs aside and noticed a bump, large bruise, and blood on her head, in her hair, and around her temple.  When I asked her what happened, she burst into tears.  Through some coaxing, I got her to tell me that she had fallen on the playground, hit her head, and was so embarrassed about this she didn’t want to tell anyone.  Her teacher picked up on the fact that something was wrong and sent her to talk to the principal.  To the principal she reported nausea, a headache, and was visibly upset, but wouldn’t tell the principal what happened, and the bump and blood on her head and hair was not noticed.  After I got her to calm down, and did some basic mommy first aid, I explained to her the importance of telling adults about these things in case they are serious and need immediate attention.

The ability to communicate pain and discomfort is invaluable – it not only allows a person to express how they are feeling in order to receive medical attention, but also can help them to obtain medication or treatment to make the pain more manageable.  However, many children (and some adults for that matter) are unable to express their pain due to a difficulty with communication, or a developmental or intellectual disability.  This can make it very difficult for health practitioners and family members to decipher their level of pain following an injury, medical procedure, or with illness.

For children that cannot verbally communicate pain, there are other methods that can help.  For example, the Non-communicating Children’s Pain Checklist (NCCPC-R) was designed for children who are unable to speak due to a cognitive disability.  The NCCPC-R can be completed by a caregiver within the child’s home environment, and measures observations of the child’s vocalizations, social interactions, facial expressions, activity level, appearance of body and limbs, physiological signs, eating, and sleeping.  In addition to the home-based version, a postoperative version of the NCCPC-R also exists.

Interestingly, studies have shown that the expression of pain by children with Autism Spectrum Disorder is not significantly different from typically developing children or even from children with intellectual disabilities. However, what does seem to be different is the length of the behavioral reactions of children with Autism, after the source of pain has been removed. This information may be surprising to some, as it is often thought that children with Autism are insensitive or have a high tolerance to pain.  Therefore, caregivers and healthcare professionals need to be aware that although a child with Autism (or any developmental disability for that matter) may be unable to verbally communicate their level of pain, we cannot assume that they are not in pain.  We need to be able to look beyond verbal communication.  One method, using observation, is the FLACC scale (Face, Legs, Activity, Cry, Consolability).  With this, pain in children and adults who are unable to communicate are observed through are range of symptoms that are scored from 0 to 2.

So while my daughter is capable of communicating verbally, emotional upset and embarrassment prevented her from taking the important step of telling an adult about what happened.  Through her behavior and presentation, her teacher, the principal and I were able to see that something was wrong, and eventually, when she was comfortable talking about it, I figured out what happened.  Thus, behavior, verbal or not, is a key indication of how a child is feeling.  It is important for parents and healthcare providers to be aware of the signs of pain in children, verbal or non-verbal, as their bodies can very well communicate their level of pain when they cannot do so through words.

by

Service Dogs are in the Grocery Store, Why Not the Schools?

Julie Entwistle, MBA, BHSc (OT), BSc (Health / Gerontology)

In a previous blog called “Dog Awesomeness” I outlined how service dogs are being used more and more to help disabled children and adults function more independently and safely in their home and communities.  These dogs have been so widely recognized as useful for people with disabilities, that they are now allowed in public places, on airplanes, and even privately owned commercial establishments.   People with disabilities have fought long and hard to make this happen, and society has accepted these animals as working assistive devices – well trained and not to be tampered with or touched.

More recently, there has been growing research to support the use of service dogs for children with Autism to help them manage both inside and outside the home.  To recap, Autism is a complex developmental disability that typically appears during the first three years of life and affects a person’s ability to communicate and interact with others. This disorder is defined by a certain set of behaviors and is a “spectrum disorder” that affects individuals differently and to varying degrees. There is no known single cause, and no cure.

Inside the home, Autism service dogs can help to modify behavior in these children. Many parents have reported that the service dog provides a calming influence as the child pets the dog, or has it lying close by. This comfort can also allow a child to cope with transitions between places, activities, changes in routines, and may even help to improve sleep patterns. The child is able to get through anxieties that may be associated with daily activities with the help of his or her dog.

When outside the home, the service dogs is trained to respond to commands given by the caregiver or educator, particularly “stop”. As a result, this prevents the child from entering into potentially dangerous situations and gives the caregiver or educator time to intervene if needed. The service dog also prevents the child from wandering away from the family while out in public settings, and provides opportunities for parents and caregivers to teach their child about staying with their service dog and walking safely outdoors. The dog also acts as a companion for the child, constantly next to them to pet or cuddle which relieves anxiety.  Essentially, the dog forms a physical anchor, making public outings easier to cope with for all involved. Because the child also shares in the responsibility for caring for their service dog through exercise, grooming and feeding, this increases the opportunities to enhance the child’s independence, while also allowing them to achieve a sense of responsibility.

Considering the immense benefits of these dogs for children with Autism, I was surprised to read a Toronto Star article that reported that Canadian parents of these children have had to fight to get service dogs allowed at school. While parents are getting some legal help to lobby for a fair and standardized policy on this, nothing has been developed and most parents are having to fight on an individual basis as each school, and school board policy, is different.

My mom told me a comical (and gross) story of a puppy service dog (“in training”) who she saw in the grocery store.  As the trainer was obtaining items from the bulk bins, the dog was head deep in another bin eating mouthfuls of something while drooling and slobbering all over the place.  The owner didn’t notice.  As the man walked away with the dog, my mom alerted a clerk who had the bin emptied and cleaned.  But the story leads to the question – if service dogs are allowed in the grocery store, why not the schools?

If service dogs are truly “assistive devices” aimed at improving independence, behavior, providing comfort and safety, and reducing anxiety in a child with Autism, then the schools should be required to accommodate.  Now I recognize that some other children could be allergic or fearful of dogs, but this will be the minority and with some careful planning, classes could be organized to meet the needs of all.  I think society, and the parents of today, are more apt at supporting these accommodations – we have already adapted to nut-free schools, litter-less lunches, nutrition policies, technology for learning, multiple page trip waivers – evidence that we are open, understanding and willing to evolve the meet the changing needs of our times, and our children.

References

Autism Dog Services www.autismdogservices.ca

The Toronto Star:  The Toronto Star:  Parents With Autistic Kids Fight To Get Service Dogs in Schools

by

World “Wear Purple Day” For Epilepsy: Explaining Epilepsy to A Child

Traumatic brain injury (TBI) and epilepsy have close ties. Studies show that often epilepsy develops following TBI. When you have children, both brain injury and epilepsy can be hard to both explain and discuss. However, more recently this has been made easier through the use of some newly developed children’s books that help kids to be learn about, and understand, these conditions:

Epilepsy Today: New Brain Injury Books Launched

by

Printing Therapy Success Becomes a Letter to Santa

Guest Blogger: Justine Huszczynski, Occupational Therapist

One of the benefits of being an Occupational Therapist is seeing a client reach, and sometimes surpass, their goals.  One of my favorite moments as an OT came this past December, when my paediatric client, Joshua, made my heart melt with how far he had come in therapy.

When I first started seeing Joshua earlier in the year, he was unable to print much more than his first name.  He had a lot of difficulty holding a pencil and his fine motor strength was minimal.  His mother, Connie, and I made a plan for Joshua to receive OT treatment twice a week for six months, with the help of President’s Choice Children’s Charity as the funding source.  Joshua’s goals involved working on underlying fine motor skills that were needed for the skill (or occupation) of printing.  For months we worked on strengthening Joshua’s fingers and hands.  We used a pencil grip to help him learn where his fingers needed to be placed to hold a pencil.  We worked endlessly on learning letter and number formations, through the use of the Handwriting Without Tears programs.  Eventually, by the time Christmas time rolled around, I was seeing Joshua once a week because he had made so many gains.

During one of our sessions leading up to Christmas, I challenged Joshua to write a letter to Santa. He was going to the Santa Claus Parade that weekend and could hand deliver his letter.  Joshua’s face lit up at the thought of this and his little hands got to work.  After 15 minutes of writing, Joshua finished his very first letter to Santa at the age of 10 years old!

santa

Occupational Therapists are taught to break down tasks into components in order to properly assess where difficulties with that task may lie.  Therefore, when assessing a child’s printing skills, we have to look at the whole task from the moment the child sits down in their chair until they put down their pencil and have completed writing.  More specifically, an Occupational Therapist will assess and observe the following aspects during a printing assessment:

  • Workstation (e.g. desk height, chair size, classroom or home environment)
  • Postural control
  • Attention to task
  • Pencil grasp
  • Pressure on pencil
  • Angle of paper
  • Handwriting speed
  • Size of letters
  • Spacing between letters and words
  • Formation of letters
  • Use of punctuation
  • Formation of ideas for written sentences
  • Ability to copy words or sentences from a near and far point position

Treatment for printing difficulties often will target different aspects from the list above, depending on each specific child’s needs.  However, one of the biggest contributors to a child’s success in any printing program is parent and teacher involvement.  Parents and teachers are key support systems that can remind a child of their printing strategies at home and school, which often leads to an increase in generalization of the skills a that the child may have learned in session with their Occupational Therapist.

Here are some basic ideas for parents and teachers for working on printing skills:

  • Make learning to print a multi-sensory experience! Use trays of rice, sand, shaving cream, or cornmeal to write or trace letters with the child’s index finger.
  • Incorporate printing (and drawing) to bath time with bathtub markers.
  • Use various writing utensils such as pencils, markers, crayons, and chalk.
  • Little crayons for little hands – use smaller writing utensils for younger children to promote the use of a more mature grasp.
  • Teach a maximum of two letters per week so that a child can focus on properly learning and printing those letter formations.
  • Hide the eraser! When a child is in the process of learning to print, do not point out every mistake. Instead, have them look at their finished product and ask them what they like about their work, and what they would change. This will keep the learning process a positive one.

If you have concerns about your child’s printing skills, contact our office to discuss these issues with an Occupational Therapist who can guide you through the next steps for your child.