Archive for March, 2014


    What does Natural Environments Really Mean?

    Early Childhood Interventions March 28, 2014

    IDEA defines the natural environment as “the home and community settings in which children without disabilities participate.”  In other words, a natural environment is anywhere a child would go in her regular day whether or not she had a disability.  Providers often think of natural environments as home or childcare, but the grocery store, park, library, or shopping mall are also good examples of natural environments.  When IDEA was first implemented the makers of the law and the regulations that guide the law’s implementation meant for natural environments to mean more than location. 

    Delivering services and supports in an environment means that we must consider environment as the “the aggregate of social and cultural conditions that influence the life of an individual or community.”  (Webster).  Thus our services and supports to the families we serve must take into account all the things that influence the life of an individual:

    • their social interactions and expectations,
    • their cultural influences and priorities, and
    • the routines and activities that are accomplished throughout the day.

    Intervention planning considers these elements by partnering with families to determine appropriate and meaningful learning opportunities that reflect the family’s life style, priorities, concerns, and resources.


    Two key components that are often missed in discussions about services in the natural environment are the concept of naturally occurring learning opportunities and the goal of participation in family routines.  Children learn best through meaningful interaction and engagement within a familiar context, such as daily routines.   Naturally occurring learning opportunities are the experiences that happen throughout a child’s day that allow for learning to occur in a natural, familiar context.  Embedding strategies into naturally occurring learning opportunities increases opportunities for practice and, thus, maximizes learning.  In addition, natural environment services focus on participation rather than the remediation of deficits.  Increasing participation in daily routines increases the child’s engagement and interaction, which serves to help maximize learning. 

    Consider the following two scenarios.  The IFSP team has written an outcome for a child to begin to identify colors.  In order to meet this outcome, the provider sees the child at home.  During the session, the provider sets up a small table and uses little animal figures to help the child identify colors.  After the animal game, the provider and child play a special iPad game that uses sounds and animation to learn colors.  The child’s older sister becomes very interested in the iPad, so the provider allows her to join in so the younger child will learn to take turns during play.  At the end of the session, the provider tells the mother that they can play similar games using the toys in his bedroom.    

    In the second scenario, the provider meets the mother and child at the grocery store.  The mother has been very distracted during sessions lately and mentioned having “so much to do next week” several times during the last session.  The provider agreed to meet mom at the grocery store around the corner from the child’s home.  As they walked through the produce section, the provider and mother talked about ways to help the child learn colors.  The provider suggested that mom pick up two vegetables (carrots and cucumbers) and ask the child to point to the one that is green.  They repeated this several more times as the mother gathered the vegetables for that night’s dinner salad.  As they traveled to the cereal aisle, the provider asked the mom if she could think of a game to play on that aisle.  Mom looked at her shopping list and saw “Cheerios,” so she asked her child to point to the yellow box.  They continued to repeat similar strategies on different aisles throughout the session.  As they were leaving the provider reminded mom that they can play similar games at home as she puts the groceries away. 

    Both scenarios address the IFSP outcome of learning colors.  But, which of these two scenarios is reflective of true NE service?  The first scenario takes place at the home and includes a developmentally appropriate game to teach the child colors.  The provider uses family involvement by incorporating the sister and gives mom an activity to work on over the next week.  The problem with this scenario is that it is unlikely to occur naturally.  It is unlikely the toddler will sit at a small table on his own to participate in a learning game.  In addition, the provider will take the animal figures and iPad with her when she leaves and the child will wait a full week before he sees those items again.  The provider did give the mom an activity to work on, but it wasn’t in a naturally occurring way either.  This scenario also does not address participation in family routines.  How does this activity help the family’s daily life? 

    The second scenario takes place at the grocery store because mom’s schedule was too busy for the session to occur at home.  The provider worked with the mom to identify and deliver strategies to help the child learn the colors.  The mom is able to practice and gains confidence throughout the session, making it more likely that she will repeat the activity on the next grocery trip.  Because grocery shopping is something this family does often, this scenario will occur again naturally and, from the sound of it, frequently.  The provider also suggested a way to continue the learning activity when the family gets home.  In addition, the mother and provider worked together to come up with strategies.  Most of the intervention occurred through interactions between the child and mother.  The provider used her expertise and knowledge of development to guide the mother to a developmentally appropriate game to learn colors.  Lastly, the child was able to participate in the grocery shopping routine.  He wasn’t just along for the ride as mom hurried through her day. He was actively engaged in the activity and the learning opportunities were increased. 

    What are some methods you have used to identify Naturally Occurring Learning Opportunities (NOLO) with the families you serve? 

    Listed below are some resources that are helpful in identifying Naturally Occurring Learning Opportunities:

    FIPP CASETools: Checklists for Promoting Parent-Mediated Everyday Learning Opportunities—this can be downloaded from FIPP.  It is a structured way to help providers identify with families NOLO.  There is also an article about this in CASEinPoint by Dunst and Swanson. http://www.fipp.org/Collateral/casetools/casetools_vol2_no1.pdf

     

    The ECTA center has several helpful resources to explain more about what contemporary early intervention practice considers intervention in the natural environment.  http://ectacenter.org/~pdfs/topics/families/Principles_LooksLike_DoesntLookLike3_11_08.pdf

    •        Key Principles and Practices for Providing Early Intervention Services in Natural Environments:

    o   Mission and Key Principles for Providing Early Intervention Services in Natural Environments

    o   Seven Key Principles: Looks Like/Doesn’t Look like

    o   Agreed upon Practices for Providing Early Intervention Services in Natural Environments

     

    McWilliam RA (2000).  It’s only natural to have early intervention in the environments where it’s needed.  Young Exceptional Children Monograph Series No 2:  Natural Environments and Inclusion, 17-26.

    Woods J (2004). Enhancing services in natural environments. NECTAC Conference Call. retrieved on August 30, 2013 from:  http://ectacenter.org/~calls/2004/partcsettings/woods.asp.

    — Jamie Holloway


    Read More

    Taping Tots: Using Kinesiotape in Early Intervention

    Early Childhood Interventions March 11, 2014

    Kinesiotape’s popularity is increasing with therapists, athletes, and the general public.  Kinesiotape was once known only to orthopedic physical therapists who applied the tape skillfully for specific uses it is now available to the general public at any running or sports store.  There are many on-line resources such as YouTube videos available demonstrating the uses and application of kinesiotape to solve everything from shin splints to tempomandibular joint pain.  Although popular the use of kinesiotape in adults and athletes has not been proven to be effective. 1 The use of kinesiotape with children, especially those with developmental disabilities or delays has not even been studied.

    So is there a case to use kinesiotape in EI?

    Kinesiotape is often used to promote alignment either with children with torticollis or decreased abdominal control.  The research, based on few small population studies, indicates that kinesiotape may be beneficial for use with children with  torticollis to reduce the asymmetrical position of their head 2.  The tape can be applied to relax (or inhibit) the tight sternocleidomastoid muscle (SCM).  Alternately tape can be applied to encourage contraction (or facilitation) of the weaker or lengthened opposite lateral flexor muscles.

    Applying tape to young children can be challenging for parents and therapists, for that reason it is often used as an adjunct to an intervention, applied by the therapist with instruction to the family on removing it.  When used for children whose muscles have adequate range of motion the “facilitation” technique can help cue kids through tactile pressure to activate the SCM.  The tape serves as a tactile reminder to maintain proper alignment.

    Example of facilitating the lengthened SCM: image from  http://ot4kids.co.uk/kinesio-taping/benefits

    Child with diffculty flexing and turning head with kinesco taping


    Children with decreased abdominal control and decreased muscular endurance, are more likely to have trunk deviations affecting their sitting balance and overall stability.  While there have not been any large pediatric population studies examining the benefit of using kinesiotape for abdominal control it is commonly applied by therapists.  Studies that have examined the effect of kinesiotape on sitting posture in children with cerebral palsy have been inconclusive.  Ssimssek and Mazzone found improvements in sitting posture and improved arm movements3,4, although Footer5  found no benefit.  Children need adequate abdominal strength and need to maintain the abdominal contraction to independently roll, sit, crawl and walk efficiently.  Kinesiotape can act as a tactile reminder to contract the abdominals and prevent any deviations in trunk alignment.  Taping techniques to encourage use of the abdominals is easily replicated by parents once they are instructed.

    The use of kinesiotape in young children demands research and clear data collection from those of us who are using it in practice.

      Do you use kinesiotape in your practice?
    • What techniques do you use or what do you find beneficial or useless about it?
    • How are you collecting data to determine its effectiveness?

    References

    1.  Morris D, Jones D, Ryan H, Ryan CG. (2012). The clinical effects of Kinesio(®) Tex taping: A systematic review. Physiotherapy Theory and  Practice, 259-270.
    2. Ohman A. The immediate effect of kinesiology taping on muscular imbalance for infants with congenital muscular torticollis. Physical Medicine and Rehabilitation, 4:504-508.
    3. ŞŞimşşek TT, Türkücüoğğlu B, Çokal N, Üstünbaşş G, and ŞŞimşşek İE. (2011). The effects of Kinesio® taping on sitting posture, functional independence and gross motor function in children with cerebral palsy. Disability and Rehabilitation, 33 : 2058-2063.
    4. Mazzone SSerafini AIosa MAliberti MNGobbetti TPaolucci SMorelli D. (2011). Functional taping applied to upper limb of children with hemiplegic cerebral palsy: a pilot study, 42(6):249-53.
    5. Footer CB. (2006). The effects of therapeutic taping on gross motor function in children with cerebral palsy. Pediatric Physical Therapy, 18: 245-52.

     

    – Erin Wentzell

    Read More