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Summer ACTIVE-ities – Part One!

All the spring weather we’ve been having the last two weeks has made me VERY anxious for summer to get here. (This California girl is choosing to ignore the fact that it was “snowing heavily” in North Bend only yesterday…and the fact that summer doesn’t come to this area until July 5th…)

sun

Pretty spring weather (and the promise of eventual summer) brings with it the opportunity to get outside and take advantage of the beautiful outdoor activities available to us in the Pacific Northwest.  One of my favorite activities for taking advantage of the precious sunshine is biking.

As a PT, I love biking for a lot of reasons.

Biking promotes:

- upright posture.

- bilateral coordination (two legs working together in that reciprocal pedaling motion).

- coordination of upper and lower extremities (pedaling AND steering).

- lower extremity strength (pedaling up those steep driveways and hills).

- cardiovascular fitness (getting hearts pumping and blood flowing).

The great thing about biking is that it develops the important things listed above, and it’s FUN!!! This means that it is inherently motivating! Kids know that biking is a blast and that is all that they need to know!  Biking with family and friends also provides a great opportunity for social interaction.

With this in mind, I’d like to invite you all to a biking event at Lakeside Center for Autism this Friday… Outdoors for All is coming!!

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Outdoors for All is an organization that provides adaptive equipment and assistance to allow all people to access outdoor activities, and they are bringing an actual TRUCKLOAD of adaptive bicycles to the clinic.  Stop by the clinic from 5-7pm THIS FRIDAY MAY 3RD for some fun biking activities! Your LCA physical therapists will be on hand to answer any questions, and provide tips and strategies to maximize your child’s success on wheels!

Hope you can join us!!

Posted by: Amanda, Physical Therapist

Sensory Stories!

You’ve probably heard of Social StoriesTM, an intervention to teach social skills developed by Carol Gray. Social Stories are effective at teaching kids what to expect during new or unpredictable situations. They also help kids learn what behaviors are acceptable choices in different situations. Sensory Stories are very similar to Social Stories with the focus of what to do in a challenging sensory situation.  Occupational therapists Deborah Marr and Victoria Nackley describe how to use Sensory Stories in their article “Using Social Stories & Sensory Stories in Autism Intervention” (2010) and they describe how to create an individualized Sensory Story in the article “Writing Your Own Sensory Story” (2007). An effective Sensory Story helps children learn how to self-regulate using sensory strategies.

There are many Activities of Daily Living (ADLs) that include challenging sensory components. Many of these ADLs such as bathing, eating, school routines, going to a restaurant, and sleeping are difficult for many kids. There are some pre-made Sensory Stories available from the website http://www.sensorystories.com/. This website requires a subscription fee and the stories can be customized for individuals based on their challenges and sensory strategies that work for them.

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Sensory Stories can also be created with the help of your Lakeside occupational therapist (OT)! Since your OT knows your child’s sensory system, they can work with you to develop a Sensory Story, while keeping in mind the sensory strategies that work for your child. They will also use language, images, and self-implemented strategies that are appropriate for your child. Other considerations include how you or other adults in your child’s life can make small changes to the environment to help make sure the strategies are effective. They will also consider what strategies are considered socially appropriate for your child’s age as well as the environment.  Sensory Stories are meant to be read repeatedly to prepare your child for the experience before it occurs. This helps generalize what your child has been working on in OT to carry over to other environments.

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Since Sensory Stories are customizable, they can be presented to your child in a variety of formats that will engage their interest. Your child might help create line drawings for a book. Peer models or siblings might help demonstrate the strategies using short video modeling clips. An e-book with photos can be created for viewing on an iPad, computer, or be printed to take to school.

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If you are concerned about a particular ADL that seems to be impacted by sensory challenges, talk to your OT about creating a Sensory Story!

Posted by: Kavita, Occupational Therapist

Dyspraxia!

Dyspraxia. Have you heard of it? Can you guess what it means? Even if you think you have no idea what it is, you’ve undoubtedly seen it in kids and adults and didn’t know what to call it! Check out this brief overview from the National Center for Learning Disabilities that explains what dyspraxia is and how it affects individuals.

Have you noticed these characteristics in kids or adults that you know? Just as some kids have trouble with learning math or reading skills, kids with dyspraxia have trouble learning motor skills. Think about how often and in how many places kids need to move… everywhere! Playgrounds, home, school, sports teams, community places like museums, stores, parks! If kids are having trouble moving their bodies in all these places, can you imagine what that might feel like? If kids want to play a ball game with other kids, how long will they want to stick with it if they just can’t get their body to catch a ball? If they can’t climb up to reach a slide at the playground, would it simply look to someone else like they don’t want to play? All of those scenarios sound pretty frustrating to me!

This week, our preschool staff was able to get a small glimpse of what that feels like. Thankfully, they were up for the challenge to try to experience something that so many kids experience everyday. Each staff member had one of their eyes covered with an eye patch (to simulate difficulty with visual tracking and teaming of eyes together), their dominant hand tied behind their back (to simulate difficulty coordinating the Left and Right sides of the body, also called bilateral coordination), and their legs tied together (to simulate balance and body control difficulties). They were then given tasks to attempt to do that we ask kids to do on a daily basis. While it was silly to see the attempts, it was also an eye-opening experience to see how frustrating seemingly simple tasks can be with dyspraxia! All of a sudden, asking a kid to sit “criss-cross applesauce” doesn’t seem like such an easy request!

Sara tries to build a Lego structure to match the one that already was made:

Sara building Legos

 

Here’s Tina trying the balance beam and jumping with two feet:

Kavita attempts to put a shirt on:

kavita putting on a shirt

Jaimi learned how difficult it is to catch and throw a ball:

 

Posted by: Carrie, Physical Therapist

Feeding Series Continued

Last month we started a blog series on mealtime challenges in children with autism. In continuing with this series, here is some more information on making mealtime a more positive experience:

 

Making Meal Time Fun!

 

How many of your kids grimace each time you go to wipe their face?  Pat, Pat, Pat is an engaging face wiping technique to increase oral motor awareness, decrease facial over-responsivity and decrease aversion and stimulation to the facial muscles.

pat pat pat

Pat, Pat, Pat

  1. Apply firm pressure with a rolled up wash cloth.  Do symmetrically on both sides of the face.
  2. Pat three times from check bone to corner of the mouth (“Pat, Pat, Pat)
  3. Press and swipe top lip down (“lip down”)
  4. Press and push bottom lip up(“chin up”)
  5. Firmly press washcloth to lips (“kiss”)
  6. Complete two times

 

Click this link for a video demonstration…Pat,pat,pat

 

We have started implementing this strategy with many of our LCA kids and they seem to catch on to the rhyme quickly and enjoy incorporating it into their meal time routine.

 

The Importance of Toothbrushing!

Tooth brushing happens every day!! Often times getting a child to brush their teeth seems to take a lot of effort and we just want to get the job done.  There are some things we can do to reduce the effort required. If tooth brushing happens in the same pattern every time, your child can begin to tolerate and even enjoy the experience.  Incorporating songs and silliness around tooth brushing helps the child “buy in” to the activity.

We learned that you don’t even need to use toothpaste; the most important part of brushing teeth is actually brushing the gums!!

 

One of the benefits of a tooth brushing routine is increased awareness to help with organization of the tongue, lips, and teeth for motor planning, which is necessary for speaking and eating. Improvement in organization is shown by your child demonstrating decreased sensitivity to touch which makes it easier for them to try new foods.  Additionally, it reduces drooling, which also benefits speech.

spoon

 

Learning through Exploration

 

Parents of picky eaters want nothing more than to have their children eating a wider variety of food. However this only comes through practice, often over time. Remember the process of introducing new foods to a baby? We introduce foods one at a time gradually as they become more proficient at eating.  There are a variety of reasons a child can avoid foods such as texture, temperature and color and we must take this into account when working with our kids.

cake

It is developmentally expected and socially accepted for babies to explore food through food play (just like a child eating their first piece of birthday cake)…. with our kids who have sensory difficulties around food, we have to make food safe and fun!!  This means that we can’t expect them to eat everything on their plate.  We have to allow kids to be comfortable with how a food smells, how it feels, how it looks, and how it tastes, before expecting them to eat it.   This level of comfort is achieved through food exploration.  Remember to try and make food a positive experience.  It’s ok for kids to get messy…. and adults too.  Make it a positive family meal time experience.

 

 family

 

As part of Autism Awareness Month, LCA is hosting a Food and Nutrition Night on April 19th from 5:30-7:30.  We will be giving short presentations throughout the night and will be available to answer any questions that you may have.  It’ll be an opportunity to learn more about the topics that we have covered and more.  We will also have Janey Yoo, a Registered Dietician and Family Nutritional Counselor.  She has experience working with families who have children with Autism and will be discussing common nutritional needs for children.  We look forward to seeing you.  Stop by the front desk to RSVP.

 

Check back for more on our feeding series in the future.

 

 

Written by Shana Speer, OTD, OTR/L and Lyndsey Aston, MA, SLP-CF

Making Meal Time a Positive Experience

messyspaghetti

When thinking about and interacting with kids who have autism we are often treating skills related to social interactions, play and motor skills.  After all, these are some of the areas most commonly associated with autism.

A frequent area of concern that often goes unnoticed are frustrations around mealtime.

“My child can’t sit at meal time!”

“My child will only eat carbs!”

“He never chews anything. He just swallows the food!”

“My kid is such a messy eater, the food always falls out of his mouth!”

So what are parents and therapists to do?

In early February, Lakeside Center for Autism sent us (Lyndsey and Shana) to attend a fabulous three day conference on oral motor/feeding in toddlers, preschool and school-aged children.  This conference was instructed by Gay Lloyd Pinder, Ph.D., CCC-SLP.

The conference provided us the opportunity to learn appropriate and effective strategies to help and empower our LCA kids and families to successfully participate in mealtime.

We wanted to share some of our favorite information that we learned.

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It’s all connected!!

Did you know that the first sounds we hear babies make always happen at the same time that their bodies are moving?  If you watch a newborn closely you might be surprised that the first sounds they make (e.g., cooing and crying) are always occurring at the same time their bodies are moving. This is speech production that requires whole body motor coordination rather than just oral motor coordination.  As children mature they are able to separate the finer movements needed for speech from larger motor movements.

The developmental progression of children (e.g., nursing, crying, tummy time, head control, babbling, bringing hands to mouth) are all necessary for our kids to eat independently.  What is fascinating is how missing one of these milestones such as tummy time, can impact a child down the road.  Without tummy time, kids have difficulty with head and trunk control which affects sitting and jaw stability necessary for eating.  Without jaw stability, kids have decreased tongue mobility and may have difficulty chewing food.  When kids don’t have the stability to sit independently, they aren’t getting enough sensory exploration in their mouths, which can lead to decreased tolerance of textures due to lack of experience.  Each benchmark is important for reaching the next developmental milestones.  When we say that everything is connected, this is what we are referring to.

Favorite one liners

Our favorite quote from the weekend was “hips before lips.”  What does this mean?  Basically, this means that a child has to demonstrate stability in their hips in order for them to develop the motor skills in their mouth to produce speech and manipulate food while eating.  To support stability for babies we provide a cradle during nursing or feeding.  As they get older they develop that stability.  We can’t expect kids to have functional control and mobility in their lips and mouth before they exhibit functional control and mobility in their hips.

hipslips

Our second favorite quote is, “tongue follows the thumb” or “thumb before tongue.” This mirrors what you see developmentally in the thumb and fingers (i.e., the thumb’s ability to move side to side). We would expect to see this movement for the thumb happen before we see similar signs of movement in the tongue (e.g., the tongue’s ability to control food in the mouth and the ability to produce speech).

Capture2

Take Home Message

  • Mealtime challenges are common with children with autism and other developmental diagnoses.
  • The development of the mouth happens concurrently and progressively with the development of the rest of the body
  • REMEMBER: Hips before Lips & Tongue follows the Thumb!

 

Please check back for an announcement on our feeding night at LCA in April.

This blog post is a part of a mealtime series. Check back over the next few weeks for the continuation of this blog series.

Posted by: Shana Speer, OTD, OTR/L and Lyndsey Aston, MA, SLP-CF

 

PROMPT workshop

charprompt

An example of what PROMPT looks like -  here I am providing an organizing, supportive parameter prompt to Charlotte.

 

Last week I attended a workshop to receive training in PROMPT – the acronym stands for “Prompts for Restructuring Oral Muscular Phonetic Targets.” This a short description of what PROMPT is from the program’s official website (http://www.promptinstitute.com/):

The (PROMPT) technique is a tactile-kinesthetic approach that uses touch cues to a patient’s articulators (jaw, tongue, lips) to manually guide them through a targeted word, phrase or sentence. The technique develops motor control and the development of proper oral muscular movements, while eliminating unnecessary muscle movements, such as jaw sliding and inadequate lip rounding.

I look forward to using the techniques I learned in the PROMPT workshop to provide additional sensory input and postural support to encourage the production of speech and development of articulatory control. I have already began using the techniques with some of my clients, and have noticed some positive results – although they might have been initially hesitant to allow me to touch their faces (as was Charlotte).

Posted by: Andy, Speech-Language Pathologist

Presentation for the Everett Clinic

Presentation at WhistlerWhistler

Dr. Reilly and Dan Stachelski recently had the honor to present at the 5th annual Everett Clinic Ski-M.E. Conference. The event has been established to provide continuing education opportunities for the team at the Everett Clinic. Dan and Dr. Reilly were asked to present on the following topics.

·         Describing coping & developmental skills (in which they can then teach to relevant patients)

·         Review Updates in Autism

·         Discuss Common Myths (which could also include ways to dispel them)

At the time of the presentation there were between 30-40 health practitioners. When queried about contact either personally or professionally, an overwhelming majority of attendees raised their hands. This is a reflection of the growing number of individuals affected by autism and that many of us have a connection to autism. Dan and Dr. Reilly presented for approximately 50 minutes, followed by a question and answer period. The practitioners asked great questions and we expect that with the information provided, they will be able to provide excellent support to individuals with autism within their practices. We have attached the presentation for you to enjoy. If you are in need to training or continuing education regarding autism, please feel free to get in touch with us at any time.

Autism Update 2013

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LCA Seeking Typical Pears: Lakeside Academy

LCA’s preschool program, is looking for typical peer models. The program, based on the principles of PRT, offers appropriate learning and sensory experiences in a group environment through an intensive, comprehensive program for children with autism spectrum disorders ages 3-6. Our holistic and interdisciplinary approach gives all our children a running start when they start school. Our team consists of Masters level teachers, a speech language pathologist, an occupational therapist, a physical therapist, an assistive technology specialist, and three therapy assistants, all with their bachelors in education, psychology, or a related field. Lakeside Academy has a maximum of 8 children and has an adult to child ratio no higher than 1:2 with one on one support when needed. Integrating peer models into the classroom provides excellent learning opportunities for the typically developing peers as well as the children with developmental delays. We are confident that our curriculum is appropriate and challenging for typically developing children and with our high staff to child ratios every child receives individual attention. Early childhood programs encourage child-initiated learning and children’s active physical engagement with each other and with the environment which is developmentally appropriate for both children with disabilities as well as typically developing children. With our emphasis on social interaction, we find that our typical peers develop higher social emotional intelligence and empathy for people with differences. Research suggests that inclusive settings are beneficial for both children with or without ASD for many reasons. Inclusive classrooms have shown positive effects on the following areas of development:

Communication, Language and Literacy: Communication can take on many different forms and some children with disabilities need other forms of communication than the more common oral/aural or writing/reading literate exchanges within classrooms. Many individuals who have significant communication difficulties use alternative means of communication such as sign language, Facilitated Communication or Picture Exchange Communication picture cards. Within inclusive classrooms children have the opportunity to learn how to communicate with others who may communicate in nontraditional ways. In addition, students have access to multiple ways of expressing themselves and understanding others. Typically developing peers can benefit from seeing the visual representation used in sign language especially when developing language. They are in essence learning a second language, which some research has shown to contribute to later language proficiency.
Social & Emotional: Inclusive classrooms create opportunities where all students can at one point or another be given the role of a leader or supporter. Conversely, all students can and should be supported based upon specific needs to a particular situation. This reciprocal process of collaboration fosters an awareness and understanding of the diversity that exists within the classroom as well as in the broader community. In a community of learners, students are encouraged to work together and discover ways to support one another.

Working with MEDRIX to support the autism population in Vietnam

LCAMEDRIX
Lakeside Center for Autism was contacted by MEDRIX in July of 2012 to work together to support children affected by autism in Vietnam. We would collaborate on an assessment that takes the best evaluation and treatment information available and would help develop an understanding of what support services are available for children with autism in Vietnam. This information would then be utilized to create a report containing recommendations for further development of autism services in Vietnam. When we originally sat down with MEDRIX, we were hoping that we could travel with them to help evaluate services and provide recommendations. As time progressed we knew we would be unable to make the trip. However, Lakeside was focused on continuing to provide support to these efforts so we offered for MEDRIX to come to Lakeside Center for Autism and observe our clinic as a model example of services for children and families affected by autism. After concluding the observation and supporting the development of questions to ask the hospitals and schools in Vietnam, MEDRIX would be able to go to Vietnam and gather information and make recommendations for the improvement of services. In addition to the tour and the development of the questionnaire, we also provided a model intake and diagnostic report that we utilize at Lakeside. This report is the most thorough and comprehensive in our area and will be studied by the professionals in Vietnam to support the development of the quality of their evaluations.
The team from MEDRIX went to Vietnam in late October and stopped in this week and provided an update from their visit. In their report it was great to hear that there are very committed people in Vietnam that want to do everything they can to support the children. They reported that the community in Vietnam is overwhelmed by the number of children that need support with limited support staff. Providers in Vietnam have to provide care to 30 to 60 kids per day. This is quite an astounding number and you wonder how it is possible. This was certainly an area that needs improvement not only for the kids but also for the treatment providers. By in large, the services available and provided in Vietnam are improving and they are very hungry for more support in their training to continue to improve their care. The individuals in charge of programs for autism are very interested in continued work with MEDRIX and we will continue to provide support in the capacity we are able to. It was great to have this opportunity and we look forward to more collaboration in the future. If you would like to find out more about MEDRIX, you can find them online at www.medrix.org.