EI Talk: A Blog for Early
Childhood Professionals


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

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Tummy Time: It’s More Than Just a Place

Early Childhood Interventions February 24, 2014

We have all said it and written it a million times:  Your baby needs Tummy Time every day!  But do we ever take the time to explain what that means or why it’s important?  Maybe if we took the time to explain to caregivers the benefits of Tummy Time, they would understand the need to create opportunities to promote Tummy Time.

What are the benefits of Tummy Time and what are the essential suggestions we should be giving caregivers to promote the use of Tummy Time, throughout the day?

Tummy Time can be more than just a position, it can be an activity to engage with a child and develop necessary strength and developmental skills.  When Tummy Time incorporates active play it gives parents the opportunity to work on head control, eye contact, shoulder girdle strength, vocalizations, engagement, and social interaction.  Playing while on the tummy develops initial upper extremity weight shifting skills, strength of the upper back and trunk muscles, postural control, and   proprioception.  It also helps the baby to dissociate his head from his trunk and use the muscles around his eyes.  Although initially Tummy Time is a passive position, we must encourage caregivers to actively engage with the infant. Suggest to the caregiver to sing songs while the child is laying on their chest in the morning in bed or play peek-a-boo with a blanket on the floor or knock over cups or any other fun age-appropriate activity that engages the child while on their tummy.

closeup image of Asian baby on blanket


Check out these sites for more ideas about Tummy Time. Remember to personalize these guidelines to include active play games for the caregiver and the child.

Erin Wentzell PT, DPT, PCS

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In the Family’s Words

Early Childhood Interventions January 30, 2014

Families who receive early intervention services participate in the development of the Individualized Family Support Plan (IFSP).  The IFSP is the document that describes the family’s resources, priorities, and concerns and identifies the support plan for the family.  The outcomes on the IFSP determine the focus of the support plan as well as services that will help meet the needs of the family and child.  Similar to other benchmarks, the outcomes on the IFSP need to be objective and measurable and time specific.  They also must describe how the child’s participation in activities and routines will be enhanced.  Outcomes are more than skill development goals.  Outcomes must clearly indicate what the child is expected to do or would like to do.

Let’s set up two examples of outcome writing.

Johnny is a two-and-a-half year old boy who is having difficulty communicating his wants and needs.  His family would really like him to talk more.  Sometimes his parents have to go through a whole litany of foods to find out what he would like to eat.  Johnny’s parents told the IFSP team that it would make meal time more fun if he could only tell us what he wants!

To help the family with their concern the IFSP team developed a variety of outcomes that they thought would be appropriate.

  1. In 3 months, Johnny will use a gesture or word to make a choice between two food items during breakfast and lunch each day.
  2. In 3 months, Johnny will label 10 pictures of food correctly for 7/10 trials.
  3. In 6 months, Johnny will increase his vocabulary by saying 15 new words.
  4. In 6 months, Johnny will use a single word to request his cup throughout the day when he is thirsty.

Which of these outcomes do you think best meets the needs of the family?  Why?

Let’s look at these outcomes closely to see which ones are examples of outcomes to include on the IFSP.

  1. This outcome gives a time frame (3 months) for when the outcome is expected to be met and clearly states who the outcome is about (Johnny).  This outcome is measurable in that Johnny will need to perform this skill consistently during 2 meals each day. When Johnny meets this outcome, it will be helpful for his family because they will know what he wants to eat.
  2. This outcome is time specific, child-focused, and measurable.  Let’s look closer at the “measurability” piece of this outcome.  Labeling 10 pictures of foods correctly for 7/10 trials is certainly an objective measure, but how likely is it that Johnny’s parents only want him to use words 70% of the time?  When we examine the helpfulness of this outcome, we see that it is lacking here as well.  Naming 10 pictures of foods is unlikely to be helpful to the family because it lacks context.  It does not address Johnny’s ability to communicate that he wants a certain food, only to name a picture of a food
  3. This outcome also gives a time frame (6 months) and clearly states that Johnny is the person the outcome is about.  This outcome is measureable–We know Johnny will have met this outcome when he has 15 new words.  However, this outcome may or may not be helpful for the family.  Johnny’s new words could be anything from animals to names of family member’s.  Also, Johnny could achieve this outcome without ever learning to use his words to communicate his wants and needs.  While this outcome is measurable and gives a specific time frame, it is not very helpful for the family and would not help Johnny increase participation in routines.
  4. Like outcome #1, this outcome meets our criteria for a good outcome.  It is measurable (Johnny will use a single word to request his cup when he is thirsty.  This would be helpful for the family because they would no longer have to guess if Johnny is thirsty or hungry or neither.  We know that we expect Johnny to meet this outcome in the next 6 months.  This outcome reflects Johnny learning in a natural context.

Writing IFSP outcomes can be challenging.  Teams want to write them in family friendly language and in plain terms, so everyone will know what the outcome is and why it is important to the family and when it should be reached.  Writing good outcomes takes practice.  There are a few hints that you may find helpful when your team creates outcomes with families:

  • Who (usually the child, may be the family or caregiver, NEVER the interventionist)
  • Will do what (the desired behavior)
  • How measured (objective criteria)
  • Under what conditions (are modifications, adaptations, accommodations needed)
  • In what routines/activities
  • When (time frame)

Click this link to the ECTA Center for more resources on writing outcomes.

http://ectacenter.org/topics/families/famresources.asp

 

Jamie Holloway, PT, DPT, PCS

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Isn’t More Better?

Early Childhood Interventions January 15, 2014

“Isn’t more better?”- a question commonly asked by families and providers when first hearing about the Primary Service Provider (PSP) model.  Responses to these questions and more are answered below

Isn’t more better? 

Contrary to popular belief, more service is not always better.  In fact, one study found that multiple services provided at high frequencies actually related negatively to parent well-being and function (Dunst, Brookfield, & Epstein 1998).  However, more intervention is better.  Embedding strategies into daily routines increase the opportunities for practice and increases learning.  The TaCTICS website provides a detailed comparison of a traditional approach (ST and OT one time a week each) vs the PSP approach. http://tactics.fsu.edu/MIH/handouts/steps/step5/adultlearning/JamesJamaal.pdf.  It is our responsibility as providers to educate families about the way young children learn and the role they have

Is one time a week really enough? 

The PSP model does not stipulate that the primary provider can only see the family one time per week.  The frequency of the visits by the PSP model should be determined by the IFSP team during the IFSP meeting.  The decision should take into account the caregiver’s level of comfort in providing strategies and the family’s schedule.  Some professionals advocate for starting with a high frequency of service and tapering off as the caregiver’s confidence and competence increase.  Also remember that the IFSP can be changed at any time.  If the team recommends one time a week initially, but later feels an increase (or decrease) is necessary, the team can call an IFSP meeting to make the change.

Are you sure I only need one provider to meet all of my concerns?

The PSP model does not mean a family will only have one provider.  The intent of the model is not to say that families have to choose between physical therapy or speech therapy.  Remember that the primary provider has a team of professionals working with them to meet the child’s needs.  Consultation visits can occur in which the primary provider, the consultant, and the family all meet together to observe the routines and embed strategies.

How is an SLP supposed to do a PT’s job? 

The short answer is they aren’t.  The focus of early intervention services is on supporting families to increase caregiver confidence and competence.  Providers focus less on direct interaction with the child and more on educating the family about strategies to promote development.  An SLP has basic knowledge of development, including motor development, and is, therefore, capable of making basic recommendations.  Remember that a child does not work on developmental areas in isolation.  An SLP is “working on” on all areas of development all the time.  It is expected that the SLP would ask the PT to consult when questions or concerns arose that she was not comfortable answering or addressing.

For more information:

Shelden ML & Rush DD (2013). The Early Intervention Teaming Handbook The primary service provider approach. Baltimore, MD:  Brookes Publishing.

Dunst, CJ, Brookfield J, & Epstein J (1998). Family-centered early intervention and child, parent and family benefits:  Final report.  Asheville, NC:  Orelena Hawks Puckett Institute. 

– Jamie Holloway

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