Jump-Start Your Baby’s Language Learning with Baby Sign Language

Jump-Start Your Baby’s Language Learning with Baby Sign Language

By Lanni Reisinger, SLP-CFY

Kids Place Pediatric Speech Therapist

Teaching your baby a few basic signs can help jump-start their language learning at an early age.  By 6-months of age, a baby’s ability to understand language is more developed than their ability to speak.  They are great imitators of motor movements by this age, and typically will enjoy making signs and being able to make their intentions clear.  When exposed to signs at home, many babies are able to produce signs before they are able to verbalize true words.  

You can model simple signs for your baby as early as 3-months-old.  Begin by modeling the sign in familiar routines throughout the day until they are able to produce the signs on their own by 9-12 months old.  Choose signs that make sense for your family and will motivate your baby to learn.  

"MORE"

A good place to start is with the sign for MORE.  You make this sign by flattening your hands then bringing your thumbs underneath to make an “O” shape.  Bring your fingertips of both hands together and apart in front of you repeatedly.  Try modeling this sign during highly motivating activities such as mealtimes.

"EAT"

Another early sign you can try is the sign for EAT.  To make this sign, use the same flattened “O” hand shape as in the sign for MORE, but bring the sign close to your mouth (as if you are taking a bite!).  This is another sign to begin modeling during mealtimes.  

"ALL DONE"

A third, simple sign to try is the sign for ALL DONE.  Make this sign by beginning with both hands flattened and facing forward, palms facing up.  Rotate your palms inward while moving your hands apart until both hands are facing down.  You can begin modeling this sign at mealtimes or at the end of an activity (“We are ALL DONE bubbles/milk”).

If your baby appears to be motivated to use signs and is catching on, some other early signs to try include: HELP, PLEASE, MOMMY or DADDY.  Often, when babies do begin talking, the words they sign will be the first they verbalize.

The “Baby Sign Language” website is a great resource and online signing dictionary to explore more signs (http://www.babysignlanguage.com). 

Ugh, It Is Too Hot Outside and My Children Are Going Stir Crazy

Ugh, It Is Too Hot Outside and My Children Are Going Stir Crazy

By: Teri Roberts, DPT

Kids Place Owner and Pediatric Physical Therapist

An Arizona summer can pose a difficult challenge trying to keep children active, yet safe.  Without a pool, I often find myself telling my two children, 7 and 8 years old, it is too hot to play outside.  At the same time, I become aggravated with their non-stop energy.  This has to be the hardest time of the year for kids and parents.  With school beginning, our children are expected to behave properly and sit an entire day in school before returning home.  After completing homework, our children must entertain themselves with indoor activities until bedtime.  So when do they have the chance to release their energy?  How can we find a happy medium between being active, yet maintaining an inside pace?

As a physical therapist and parent, I have always been more lenient with outside activities coming indoors.  My kids have always been allowed to throw balls in the house (of course, using a softer ball as they begin to throw harder), jump rope in the kitchen, jump on couch cushions placed on the floor, and do handstands and cartwheels in an open room.  However, these rules are probably not the norm in most households and cannot apply to every household.  So, what gross motor activities are appropriate indoors?

Here are some great ideas for indoor activities that will keep your children safe and active during those long, hot summers and early fall evenings:

Play hide and seek

This is actually a very quiet game, yet children find very interesting places in which to stretch or squeeze their bodies.  They often have to hold various positions for a long time, while their seeker is searching.  You can also make a rule that in order to look for the hiders, the seeker needs to walk like a certain animal or jump on one foot.  Children can play hide and seek for a very long time, releasing some energy in a quiet way.

Play the animal game

You can play this game a thousand different ways.  Sometimes, we will play animal charades, or we complete an animal puzzle while walking like the animal with each piece of the puzzle. We may reach an animal book while acting like the animal, instead of just looking at pictures.

Obstacle courses

You can make your entire house an obstacle course, without breaking anything.  Use couch cushions, pillows, blankets, tape on the floor, tiles of your floor, and/or stairs.  Give your child a sequence of activities to complete and time them to see who can complete the obstacle course with the fastest time.  An example of an obstacle course we use at our house starts in the kitchen with a bear walk to the stairs.  The kids then carry a laundry basket (small with about 5 lbs of clothes) upstairs, walk back down stairs,  hop to the living room, and jump over pillows placed on the floor.  They will then gallop to the family room and perform 10 jumping jacks before skipping back to the starting line.  After teaching my kids how to create an obstacle course, it was amazing to see how many variations they could create on their own.

Kids Yoga

This can be both energy releasing and calming at the same time.  There are many companies that have Children Yoga cards, or you can go to different websites and make your own card (www.playtimeyoga.com).  Have your child look at the card, mimic the position and hold for 30 seconds.  They will have more fun if you do the positions with them.

Although the temperature may be hot outside, it is most important to remember to keep your children active.  As a mother, I know it is easier to turn on the television, or allow my children to play video games, but this creates a horrible habit that will be hard to break once the weather becomes enjoyable outdoors.  According to the American Academy of Pediatrics, children should receive more than 60 minutes of moderate to intense activity daily.   In Arizona without a pool, this can prove to be challenging.  

Hopefully, these ideas are a great start.  I would enjoy hearing your ideas.  Which indoor activities work for your family?  Please leave your comments in the section below, and contact me directly if you would like additional indoor activities for your children. 

Protecting Your Child’s Back from Their Own Backpacks

Protecting Your Child’s Back from Their Own Backpacks

By Tyler Guymon, DPT

It is the time of year again when we trade our kid’s swimming suits and flip flops for uniforms and backpacks.  The beginning of the school year brings with it an increase in back pain by school-aged children.  Unfortunately, many of our children suffer from this back pain by improperly wearing their backpacks as they return to the rigorous grind of school.

Here are a few beneficial safety tips for wearing a backpack as the wear and tear of the school year presses forward:

Wear both straps

Use of one strap causes one side of the body to bear the weight of the backpack. By wearing two shoulder straps, the weight of the backpack is better distributed.

Wear the backpack over the strongest mid-back muscles

Pay close attention to the way the backpack is positioned on the back.  It should rest evenly in the middle of the back.  Shoulder straps should be adjusted to allow your child to put on and take off the backpack without difficulty and allow free movement of the arms.  Straps should not be too loose, and the backpack should not extend below the lower back.

Lighten the load

Keep the load at 10-15% or less of your child's bodyweight.  Carry only those items that are required for the day.  Organize the contents of the backpack by placing the heaviest items closest to the back.  Some students even have two sets of books, which allow them to not carry heavy books to and from school.

Children come in all shapes and sizes, and some have physical limitations that require special adaptations.  A physical therapist can help you choose a proper backpack and fit it specifically to your child. 

Additionally, a physical therapist can help improve posture problems, correct muscle imbalances, and treat pain that can result from improper backpack use.  Physical therapists can also design individualized fitness programs to help children get strong and stay strong—and carry their own loads!

Call us at 623.242.6908 if you would like to schedule an appointment with a licensed physical therapy.  Please feel free to leave me your questions or comments in the section below.

Check out this video, provided by MoveForwardPT.com:

Strategies for a Successfully Potty-Trained Toddler

Strategies for a Successfully Potty-Trained Toddler

By Liezel Fernandez, OTR/L

Kids Place Pediatric Occupational Therapist

Potty training is around the corner.  Your child is finally ready to say goodbye to diapers!  But… will you be prepared?

Independent toileting is an important milestone and a complex task in a child’s life.  A child must be ready both physically and psychologically to begin the learning process of toileting.  Parents need to be prepared to devote significant time and effort in toilet training their child.  When starting to potty train, it is important to keep in mind your child’s developmental level, not their chronological age.  Children are likely ready for toileting if they have a regular pattern of urine and feces elimination.

The first sign of readiness is when a child indicates discomfort when wet or soiled.  Consider whether your child is able to follow simple directions and able to tell you through verbal or non-verbal communication (sign language/gestures) they need to go potty. 

Here are some helpful strategies to successfully potty train your child:

• Schedule toileting and use habit training.  For example, go at the same times of the day every day.
• If possible, dedicate a bathroom to toilet training.
• If you child is unable to communicate verbally, provide ways to indicate a need to go by using picture cues.
• Hang visual cues on walls, like step by step picture instructions.  We have all seen the hand washing examples in various bathrooms.  This is a perfect example of these visual cues.
• Demonstrate and explain the process.
• Use a story telling when trying to teach your child the socially acceptable behaviors in public restrooms.  These pretend stories can provide a model to teach your child what is appropriate.
• Teach physical, gestural cues, or sign language so your child can communicate the need easily.
• If your child does not stay long enough on the potty, use a timer and instruct your child to stay seated until timer rings.
• Use positive reinforcement, like a sticker chart to improve motivation.

Remember to teach all aspects of the task.  Independence in toileting or being fully potty trained includes:

1. Getting on and off the toilet. 
2. Managing fasteners and clothing.
3. Cleansing after toileting.
4. Washing and drying efficiently without supervision.

Potty training requires a lot of time and patience.  If you continue to have problems, you may want to consider getting professional assistance from an Occupational Therapist.  Good luck, and happy potty training!

What’s better For Pain - Heat or Cold?

What’s better For Pain - Heat or Cold?

By Doug Lehman, PT

Often times, patients will ask me if they should use heating pads or ice to treat pain.  My answer varies depending on the type of pain.  There are two basic types of pain that we treat: acute and chronic.  Acute pain is pain that occurred recently, usually within the past 24 or 48 hours.  Chronic pain is pain that extends beyond the expected period of healing.

Acute injuries are usually treated with cold therapy.  The general rule with cold therapy is if an area is red, swollen, or inflamed, or the injury just happened, we want to cool the area down and prevent further or reduce any inflammation.  Cold therapy will reduce swelling and pain by constricting blood vessels.  It will also limit any bleeding that may occur.  Cold therapy is generally used after exercise, again to cool the inflamed areas.  Cold should not be used to treat chronic injuries before exercise. 

Some choices for treatment can range from a bag of ice (or snow for cold weather climates), a gel cold pack purchased from a store, or a large bag of frozen peas (yes, this does work, just don't eat the peas!).  Cold treatment can be applied for 20 to 30 minutes before allowing your skin temperature to return to normal before reapplying the cold therapy.

Heat will generally be used for chronic injuries.  It can help sore, stiff, nagging muscles and joint pain.  Heat should not be used with acute injuries or any injury exhibiting signs of swelling or inflammation.  Heat can help relax tight muscles or muscle spasms. Heat used before exercise will increase the elasticity of joint connective tissues and stimulate blood flow. 

Choices for heat treatment include an electric heating pad, a microwavable hot pack, or uncooked rice in a tube sock heated in the microwave (yes, this works too!).  Heat should be used for 15 to 20 minutes at a time with enough layers between the heat source and skin to prevent burning. 

Heat or cold therapy works by stimulating your body's own healing force.  Many arthritis doctors recommend both heat and cold treatments to help reduce inflammation and ease the pain and stiffness that comes with arthritis. It may take a little "trial and error" to learn which therapy works best for your pain, but you can use this blog as a starting point.  For chronic pain, feel comfortable utilizing the method that works best for you.

Your Child is Going to be a Baseball Player!

Your Child is Going to be a Baseball Player!

By Teri Roberts, DPT

Owner and Pediatric Physical Therapist, AZOPT Kids Place

As a parent of a newborn, inevitably you have heard someone tell you “wow, your baby’s grip is so strong; I bet he will be a baseball player.”  While true, in all likelihood your baby’s grip is strong, it does not necessarily mean your child will grow up to be a baseball player.  The reason your baby has a strong grip when you place your finger in their hands is due to the Palmar Grasp Reflex. 

The Palmar Grasp Reflex occurs at birth until approximately 6 months of age.  You can elicit this response by placing your finger into a newborn’s hand from the pinky finger side.  Your child should immediately grasp their hand around your finger.  Even with a slight tug, your baby will most likely not release.  This reflex is important to teach children how to grab objects and use their hands in a functional purpose. 

At approximately 6 months of age, the grasping is no longer reflexive, but an automatic process of grasping objects and subsequently choosing to release these objects.  When this happens, the Palmar Grasp has been integrated.  Many babies develop the ability to grasp and release prior to six months.  These babies still require the use of the Palmar Grasp Reflex with activities like pulling to sit, standing, and bouncing on a parent’s legs with the support of a finger. 

Parents should watch for their baby’s ability to demonstrate open hand postures during awake or sleep times during the first few months.  Additionally, parents should look for their baby to release objects when grabbed after six months.  The inability to complete the above tasks can point to signs of neurological issues.  Please contact your physician or contact me at Kids Place if you are concerned with the overall development of your child.

So yes, your baby may grow up to be a Major League Baseball star, but it has nothing to do with newborn grip. 

Fight Obesity with AZOPT

Fight Obesity with AZOPT

Obesity is an epidemic in the United States.  Adults and children who are obese tend to have an increase in doctors’ visits with complaints of:

• Joint pain
• Headaches
• Foot pain
• Low back pain
• Greater risk for sleep apnea
• Constant fatigue
• Depression
• Unwillingness to perform physical activity

At AZOPT, obese and overweight patients will receive:

• Musculoskeletal evaluation of pain associated with joints, back, feet, and headaches
• Posture assessment
• Strength and endurance testing in a Pain-FREE zone
• Activities through manual therapy, stretching, and strengthening
• Exercise modifications that help meet fitness goals
• Individualized home exercise program
• Introduction to other community activities

Why AZOPT?

People who are obese do not become this way overnight.  It takes months or years of sedentary activity and poor eating habits to cause the obesity problems.  The transition to a healthy lifestyle is VERY difficult.  People who are overweight have honest issues with joint pain, fatigue, headaches, and consistent tiredness.  They are in constant pain when they move, so they simply don't move, creating an even more sedentary lifestyle and increase weight.  AZOPT can help break this cycle.  

AZOPT therapists will:

• Address the pain through manual therapy and therapeutic exercise
• Allow for safe and effective exercises to help the patient feel good when they move
• Adapt and progress the exercise program as these various pains are addressed
• Provide professional guidance while monitoring the exercise program

Through physical therapy, patients will develop the proper foundation for movement in a positive environment through safe and effective leadership.  

For more information or to schedule an appointment, call AZOPT at (623) 242-6908.

Using Physical Therapy to Help Relieve Pain and Ailments Following a Pregnancy

Using Physical Therapy to Help Relieve Pain and Ailments Following a Pregnancy:

How my Own Personal Experiences Guide my Perspective

By Pamela G.Guevarra, PT, DPT

My husband and I waited patiently for years to have a baby.  When our doctor told us we were pregnant with twins, like most families of multiples, we were surprised, yet felt extremely blessed.  However, I had a difficult pregnancy.  A herniated disc in my cervical (neck) spine, which existed prior to my pregnancy, worsened.  The pain I felt in my ribs from the extreme amount of pressure is something I cannot soon forget.  I had carpal tunnel syndrome that started on one wrist and eventually both.  Not to mention the pain in my lower back, which actually increased after my pregnancy, creating a radiating numbness on my right thigh, lower leg, and foot.

While physical therapy treats a wide range of physical ailments and conditions for men and women of all ages, many women are not aware of the benefits of physical therapy following their pregnancy.  During a pregnancy, women and physicians often utilize physical therapy to help relieve ailments and symptoms.  However, most women experience residual, or even new, ailments or symptoms after their pregnancy, yet many never even seek professional assistance.

Following the delivery of my twins, I became very ill.  My primary care physician explained I had an infection, my entire body was inflamed, and I was not recovering fast enough following my C-section.  Yet I still had to care for my newborn, premature twins.  I was so ill that I was not allowed to exercise.  I was so weak that standing up took time.  Sleepless nights led to constant fatigue.  I felt and looked like a frail, old lady stooped over from severe weakness.  After two months, I started to feel better, but was still experience neck pain, a stiff thoracic spine (upper back), pain and stiffness in my lower back, and numbness in my right leg and foot.  It is not normal to have symptoms like lower back pain and leg numbness.

Common symptoms that women experience after giving birth include pain in their back, pelvis, neck, legs, and/or arms along with weakness, stiffness, and headaches.  These symptoms, as well as other musculoskeletal conditions, can be intensified during or after birth, and may last for months to a year after delivery.  During pregnancy, the body's ligaments (tissues that connect bones together) become lax from a hormone called relaxin, which is released to allow the body to adapt with the growth of the baby.  This hormone predisposes pregnant women to injuries or can aggravate already existing conditions.  In addition, other reasons why women have musculoskeletal problems after pregnancy include postural changes, symptoms before and/or during pregnancy, a complicated vaginal delivery, C-section, a complication or illness after delivery, and giving birth to multiples.

Throughout a pregnancy, women experience an altered posture to compensate for the baby bump.  Nine months of pregnancy is more than enough time to stress joints and cause women to continue this altered posture after pregnancy.  An altered posture places unnecessary force on the body’s joints causing increased pain and decreased comfort while caring for the child and performing daily activities.  Another cause of symptoms arises from a complicated vaginal delivery.  A lengthy labor adds stress on top of stress to the pelvic floor muscles, leading to pain in the pelvis and incontinence issues. 

Women who choose to have a C-section, or require one following a lengthy labor, may experience weakness in the abdominal and pelvic muscles causing trunk weakness and low back pain.  A C-Section is now the recommended delivery option for women pregnant with twins (triplets, etc.) because it is safer for the babies and the mother.  However, not all women/couples are aware that a C-section is a major abdominal surgery; risks that are not adequately discussed in a birthing class.  The negative result of a C-section can cause emotional changes to some mothers who feel their body has failed in addition to the weakness and pain.

Physical therapy can treat these musculoskeletal conditions and reduce any residual symptoms.  Unfortunately, very few women seek the assistance of a licensed physical therapist because they assume nothing will help or they ignore their symptoms.  Most moms place themselves second, third, or even last after the demands of their family, their job, and other responsibilities despite the pain that they experience.  However, for a woman to give 100% to the demands of her role as a homemaker, mother, and/or a full-time employee, a woman must take care of her body and remove any and all obstacles or ailments preventing her from physically functioning at 100%.

A licensed physical therapist will be able to evaluate and treat the symptoms by addressing the specific problems individually and setting future health goals.  Treatments may include pain relief with manual therapy and modalities like cold pack, hot pack, and electrical stimulation.  Physical therapy will work to strengthen specific muscle groups, improve stability in specific muscle groups, increase endurance levels to avoid fatigue, improve posture through manual therapy and exercises, and relieve joint stiffness with manual therapy and stretching. 

I am a physical therapist, but I definitely needed another physical therapist to help me get back in shape for my husband, my twins, and to be able to return to work.  I was treated for my neck, my lower back, and thoracic spine.  Manual therapy loosened my spine to correct my posture and relieve pain and stiffness.  A home-exercise program was designed to improve my strength (especially in my core) flexibility, and endurance level.  Despite my daily demands, I had to create the time to complete these exercises at home, not only for my family, but for myself.

While every woman’s symptoms and speed of recovery are different, a licensed physical therapist will be able to frequently modify the treatment plan based on goals and improvement.  Some women, especially those who have an infection or other complication(s) during and after delivery, may need to see their physician prior to seeing a physical therapist.  New mothers must take special care of their bodies after giving birth to help regain energy and strength.  The better a woman takes care of herself, the more she will be able to provide the best care for her child.

Questions or comments?  Leave Pamela a comment below or contact AZOPT at (623) 242-6908 to find out how you can benefit from physical therapy.  Pamela will respond directly to your questions/comments within 24 hours.

Play-Doh®: Fun and Functional

Play-Doh®:  Fun and Functional

By Josh MacDonald, OTR/L

Occupational Therapist and Kids Place Clinic Director

Play-Doh® is a great tool for helping your child develop hand skills.  The texture and resistance are great for building up the muscles in the hands.  However, when it is time to pull out the tub of Play-Doh®, hold off on using all of the cool tools and gadgets. 

Hasbro has made some awesome and exciting accessories to go with the rainbow of colors for Play-Doh®.  Most of these tools do not promote the development of hand skills.  These tools and Play-Doh® factories rely on pushing or pulling levers and holding basic tool handles.  While playing with these items is not terrible for development, to make the most of this awesome Doh put the tools away and let the child’s hands work.

 

Learning how to keep a hand flat and active while rolling out a snake works different muscle groups than giving it a big squeeze to leave grip marks.  Rolling a ball between your palms requires more control than rolling it on the table, but both encourage exposure to different textures.  Pinching the Doh to squish small balls between the thumb and first finger builds up grip strength and thumb skill.  Small items can be hid forcing small finger movements to hunt for objects, and making flat pancakes takes more hand strength than banging with a hammer. 

The tools made for Play-Doh® are fun, but the creative, tactile and fine motor coordination benefits are so much greater when the child simply uses their own hands.  If your child insists on using the toys, try playing without them for 10 minutes, then allow the toys.  Even 10 minutes of direct hand play with Play-Doh® will improve overall hand strength and coordination.

Keeping Your Fluid Levels Up

Keeping Your Fluid Levels Up

By Ryann Roberts, DPT, CrossFit Level 1 Trainer

There’s nothing better than a cold glass of water after a workout, but don’t forget to fuel up on liquids before you hit the gym.  Athletes can lose a significant amount of fluid during physical activity; the more rigorous the routine, the more water they’ll need to replace – and who does not participate in rigorous exercise routines?

Approximately two-thirds of an average adult’s weight is made up of water.  Fluids are essential to proper body functioning, including temperature regulation, joint movement, and the transportation of oxygen throughout the body.  Dehydration, therefore, can elevate body temperatures, strain the cardiovascular system, and lead to heat injury.  Maintaining fluid levels is critical to any exercise routine.

The American College of Sports Medicine not only recommends adequate fluid replenishment, but also advises athletes to increase sodium intake after a strenuous workout.  While current medical advice calls for a reduced sodium diet, the temporary uptick in sodium is necessary to counteract the loss of electrolytes during physical exercise.

The next time you gear up for athletic activity, keep the following in mind:

Load up.  Drink 1 or 2 cups of water 30 minutes before starting exercise.

Maintain your levels.  Drink between ½ and 1 cup of water for every 15 minutes of exercise to replenish your fluids.

Weigh yourself.  Check your weight before and after exercise, and drink 2.5 cups of water for every pound lost during your workout.

Don’t rely on thirst. Water may be known as a “thirst quencher,” but if you’re thirsty, your body is already dehydrated.  Drink plenty of water after a workout, even if you’re not thirsty.  When your thirst is quenched, drink some more; you may not feel you need water, but your body does.

Use your body's natural indicators.  Urine can signal whether you’re adequately hydrated; look for a pale color, as opposed to a dark yellow, to know when your body has enough fluids.

Beware over-consumption.  While dehydration is a danger, drinking too much water can also pose a risk.  Athletes who consume excessive amounts of fluid can suffer from water intoxication, which occurs when sodium levels are depleted.  Be on the lookout for these symptoms: dizziness, nausea, apathy, confusion.

Eat your fluids.  Consider other forms of liquid refreshment to keep hydrated throughout the day.  Fruit, vegetables, and tea provide fluids and nutritional benefits.  But immediately after exercise, stick to water or electrolyte-enhanced fluids – they pack the best replenishing punch.

ACL Reconstruction: Allograft vs. Autograft

ACL Reconstruction:  Allograft vs. Autograft

By Erik Bassett, DPT

Recently, we posted a blog titled “Everyday People Rehabbing Major Knee Injuries with AZOPT.”  In this two part series, we focused on the rehab following a major tear in the ligaments of the knee.  In this scenario, AZOPT patient Josh had a surgical procedure known as an auto graft to repair the tears.  Many people wrote us wondering what exactly an autograft procedure is. 

First, just to refresh the memory, the ACL (anterior cruciate ligament) and PCL (posterior cruciate ligament) are inside the knee joint connecting the femur (thigh bone) to the tibia (large bone of the lower leg). The ACL and PCL form an “X” inside the knee that stabilizes the knee against front-to-back and back-to-front forces.  ACL tears occur approximately 200,000 times each year in America, of which nearly half require reconstruction.

There are two types of reconstructive surgeries to repair an ACL - allograft and autograft.  An allograft is a tendon used from something other than the individual patient, usually a cadaver.  An autograft is tendon used from the individual, usually the hamstring or patellar tendon.   What is the difference between the two types of reconstructive options, and is one better or worse than the other?  There are positives and negatives to each type of reconstructive surgery.

This year, The American Journal of Sports Medicine performed a meta-analysis, the best form of research, reviewing many articles on the subject written between 1999 and 2012[1].  According to the study, patients who received an autograft scored higher on a scale that rates common complaints of the knee.  Further, they report positive outcomes on a subjective report and positive results with a single leg hop test.  Comparatively, patients receiving an allograft report a positive return to pre-injury activity level along with a positive subjective report.  They also report positive results with a pivot shift and decreased anterior knee pain.  However, patients with an allograft procedure had a 3-fold increase in re-rupture rates compared to autografts.    

In March of 2011 I experienced a major ACL tear that required reconstruction.  I chose to have an allograft performed mainly due to the shortened length of recovery time.  With an allograft, there is a decreased recovery time due to smaller amounts of cutting other structures like the patellar and hamstring tendons.  While the recovery time is less with an allograft, after 12 months of rehabilitation both types of grafts result in equal knee range of motion, strength, and activity level if proper rehabilitation occurs.  To this day I am able to perform each and every activity the same as before my ACL reconstruction.  Occasionally, I experience only minimal pain after activity and mild aches during cooler weather. 

Rehabilitation is key to any ACL reconstruction.  Physical therapy is performed after an ACL reconstruction to enable the knee to recover in a timely manner.  Initial treatment following ACL reconstruction includes increasing range of motion both in flexion and extension, mild strengthening of knee and hip musculature, pain and swelling reduction using modalities, and soft tissue mobilization to increase tissue extensibility.   Crutches and a locked knee brace are typically used for the first 3 or 4 weeks.  As rehabilitation progresses, an increased amount of strengthening occurs.  It is important to strengthen the surrounding muscles to help support the ACL graft.

If you have ruptured your ACL and require a reconstruction, speak with your physician.  Generally, they will refer you to a surgeon for a consultation.  The surgeon will speak to you regarding the option for an allograft or an autograft.  Now that you know the difference between the two you can impress the surgeon with your knowledge.  Choose which type would be most beneficial for you in the long run.  When the operation is complete, call AZOPT to begin the rehabilitation process.  Good luck and happy recovery!

[1] American Journal of Sports Medicine. 2013 Apr 12. Bone-Patellar Tendon-Bone Autograft Versus Allograft in Outcomes of Anterior Cruciate Ligament Reconstruction: A Meta-analysis of 5182 Patients. Kraeutler MJ, Bravman JT, McCarty EC.

Premature Introduction of Solids to a Baby

Premature Introduction of Solids to a Baby
By Colleen Riordan, CCC-SLP
Speech and Feeding Therapist, Kids Place

First milestones for babies can be very exciting for a new parent.  First smiles, first words, and first steps are moments to be cherished.  But is there such a thing as pushing for these milestones to happen too early?  In the case of introducing solids to an infant, the answer is yes.  Although common advice is to begin introducing solids at 6 months of age, some health professionals are now giving the green light for solids at 4 months of age.  Recent polls have also revealed that some infants are receiving their first tastes of infant cereals and purees as young as 2 months.  Although it may be tempting to give your baby solids before 6 months of age, it is important to take into account your baby’s nutritional needs, gastrointestinal maturity, oral-motor development and a number of readiness cues.

Nutrition

Through the age of 6 months, breast milk or formula provides all of your baby’s nutritional needs.  In fact, many infants can thrive on breast milk or formula alone through 9 months of age.  Infant cereals and purees cannot provide the necessary calories, fat and nutrients for an infant’s developing body and mind.  Between the ages of 6 and 9 months, introduction of solids is for practice only; breast milk or formula is essential.  Some erroneously believe that infant cereal is necessary for iron supplementation. This is untrue.  Typically developing infants are born with iron stores to last them at least through the seventh month of life.  Another myth is that adding cereal to a bottle before 6 months of age will help a baby sleep through the night.  There are no studies to support this idea.  Adding cereal will change the nutrient content of the formula, and is linked to higher risk of obesity later in life.

Gastrointestinal Maturity

Before 6 months of age, infants have what is referred to as an “open gut”.  They are unable to filer out harmful substances and allergens.  Similarly, the intestinal tract is also unable to facilitate adequate absorption of nutrients in anything other than breast milk or formula, which contains enzymes to digest fats, proteins and starch.   By feeding a baby solids before his GI tract is mature, there is a higher risk of diabetes and food allergies.

Oral-motor Skills

Babies will exhibit a tongue thrust reflex which disappears between the ages of 4 and 6 months.  This reflex exists to protect an infant’s airway.  Before 6 months, infants will exhibit a sucking motion, a movement that is effective for anterior/posterior transit of liquids.  In order to deal with solids effectively, infants need to develop some tongue lateralization and rudimentary munching skills.  These skills are typically developed by 6 months.  Add to this the fact that most infants do not get their first teeth until after 6 months; this may be an evolutionary cue to us that infants are just not fully equipped to begin eating solids until after 6 months.

Reading the Cues

Many books will tell you that once a baby has doubled her birth weight, he is ready to begin solids.  Remember, that it is the combination of maturity of intestinal tract, nutritional needs, and oral motor skills that should be taken into account, instead of age or weight.   Conversely, if your baby is underweight at 4 or 6 months, the best nutrition is provided by breast milk or formula, and not solids.  Another cue parents should look for is the infant’s interest in the food that others are eating around her.  While this may be one readiness cue, it is also important to remember that infants are becoming great imitators at this age, mimicking your movements while eating.  This may be more of a social interaction than a cue that she really wants what’s on your plate!

Introduction of solids is one milestone that does not need to be forced. You will be eating with your baby in no time.  For now, enjoy the special moments breast or bottle feeding your infant, as they will go by quickly!                                                          

When a Home Exercise Program is Not Enough

When a Home Exercise Program is Not Enough
By Ryann Roberts, DPT
Owner and Physical Therapist, AZOPT

Ever had an injury or nagging pain that just won’t go away?  During the course of exercise, sports, and sometimes normal daily activities, these injuries occur frequently.  Some people will turn to word of mouth, YouTube, or a medical professional for assistance.  They will receive an abundance of information, exercise, and movements that may help alleviate or reduce the pain.  Many of these stretches and activities loosen tight muscles, strengthen weak muscles, alleviate the pain, and help you achieve full return to activity.  But what do you do when the home exercise program (HEP) does not resolve your injuries fully?

I see many people in the gym or who come into my office at AZOPT and tell me despite finding a good HEP and performing the exercises correctly and frequently, the pain still will not go away.  My response is always the same – you need the skilled hands of a physical therapist to manually release the restricted tissue.  A skilled physical therapist uses techniques and stretches you will not receive any other way.  A physical therapist will push your limits safely and effectively in a way you cannot on your own.

You can only foam roll or lacrosse ball out a tissue so much and so deep compared to what manual therapy from a physical therapist can perform with their hands.  Physical therapists can ‘feel’ the restriction and use several deep tissue methods to release the restriction deeper than a foam roll or a lacrosse ball.  A physical therapist’s hands can get pin point to the exact restriction and effect positive change. 

I talk with athletes daily about aches and pains they are having and how they should best attack the pain or restriction.  I am happy to give general stretches and advice to best resolve their problem, but nothing compares to the time spent on the table manually working through the pain.  On the table, I am able to feel the restriction and range of motion loss, and trace it to a certain area that is causing the limitation, thus the pain.  Through repeated sessions, I am able to address every factor contributing to the problem. 

HEPs are very good; I give them to my patients all the time, but as a part of a larger program.  I give instruction and advice all the time.  Without actually spending time with the person on the table, my advice is limited.  If your routine is working for you and you are able to function or compete on a daily basis with this program, then keep going!  If you find you are constantly searching for that next great stretch on the Internet to fix your problem, have a physical therapist perform an evaluation.

I treat the CrossFit Fury Games athletes consistently.  I know what their tissues feel like.  I know each individual’s range of motion.  Therefore, I also know their medical ailments and when their bodies are tight.  I can prepare them for competition in a couple sessions because they see me regularly.  I know their bodies.  They know that self-stretching and foam rolling will only take them so far.  At AZOPT, we understand all athletes because we are athletes.  We understand the physical demand of exercise from the everyday person trying to get fit to the competitive athlete we all admire. 

I decided to write this blog because I see too many people looking for the easy answer to their pain.  I do not mind giving advice to anyone who asks, but if you truly want the answer, you need to come see us.  Treating pain without the use of medication takes time and effort.  The easy answer is “take 2 of these and call me in the morning”.  The hard answer is “make an appointment and let’s get to work”.  You spend so much time, money, and energy to get healthy; do not fail yourself at the point of pain.  Put in that extra rep and call to make an appointment; we can only help you if you allow us to.  It was not easy getting to the point where you need help, and it will be work getting beyond the pain.  Physical therapy is the natural cure for the ailing athlete. 

If you are having nagging pain or an injury that just will not go away, give us a call at (623) 242-6908 and make an appointment.  We are here to help you get Stronger, Faster, Safer.  

Bouncers, Walkers and ExerSaucers, Oh My!

Bouncers, Walkers and ExerSaucers, Oh My!

By Bobbi Michels, PT

Kids Place Pediatric Physical Therapist

For a first time parent, standing in a Babies R Us equipment aisle is an overwhelming experience.  With all of the advertisements and Consumer Reports, it’s hard to tell which piece of equipment to use with your child.  There are bouncers, swings, Bumbo seats, ExerSaucers, and more.  So, what do you really need? 

The answer – nothing!  Truthfully, most infants are happy simply being held and listening to familiar voices.  When awake and not being held, infants are best on their stomachs on the floor, where they can explore their bodies and develop motor skills.  But this is an unrealistic proposition.  Parents still must have time for daily household activities like laundry, cooking, and dishes.  You also deserve a shower, maybe even a relaxing bath.

So what do you do with your baby when holding them or placing them on the floor is not an option?  This may be a very appropriate time to place your baby in their crib or playpen.  You may think this would also be a good time to place your baby in special equipment, like walkers or Exersaucers?  We say NO!

Studies indicate the two leading causes of head injuries in babies are from the use of walkers and falling from baby furniture.  Other studies indicate 40 percent of babies are injured during the use of a walker - falling down stairs, climbing out of the device, or tipping over in the device.  In most instances parents were present and supervising their baby prior to the injury, but were unable to react fast enough to prevent the injury. 

What about using an ExerSaucer or jumpy to work on leg strength, balance, and gait skills improvement?  Several studies have examined and concluded that motor development is decreased in infants and toddlers who spend the most time in play-assisted equipment.  On the same lines, in a study by A.L. Abbott and D.J. Bartlett, infants with lower equipment use scored higher on motor development tasks when tested using the standardized test - Alberta Infant Motor Scale. 

When placed in a walker or equipment that allows a baby to stand, the baby uses mostly the muscles in the back of the leg.  This is especially true in the beginning as they will often push forward leaning their chest on the support surface and rise up on tip-toes to move the device using both feet together.  This position does not allow the same use of the muscles at the front of the legs or the use of tummy muscles.  Walking requires equal use and strength of both the front and back leg muscles.  In these types of equipment, the baby’s balance point or center of gravity is lower and behind the normal balance point when leaning forward in equipment.  Further, normal balance reactions and arms are not used in the same manner as normal walking.

You are now asking, what are the possible long-term health risks of what we just described?  Without the proper development of leg muscles and balance there is an increased risk of muscle weakness and tightness which can lead to future surgeries and expensive medical bills.  We treat children who develop into “toe-walkers” which causes the foot and calf to shorten and tighten, eventually requiring surgery to release the muscles and realign the foot.  We also treat children with muscle weakness at the front of their leg, or at their hips and knees, causing many challenges with basic movements like dressing or walking up stairs.  Not all children will develop these issues with the use of these types of equipment, but the possibility exists.

If you find you have acquired a myriad of equipment, our recommendation is to limit the time your baby spends in equipment.  We understand you cannot hold your baby all day.  The floor may not always be the best option with older kids or pets around.  In Arizona, parents often are afraid their tile floors will cause injuries.  Our suggestion: use a pack and go or a playpen.  Using these will allow your baby to explore their environment and bodies to gain strength and awareness the way we did as children.  If you want to use walkers or ExerSaucers, the maximum amount of time per day in any piece of equipment should be 15 minutes.  Please note:  you should always supervise your baby closely in equipment to decrease the incidence of an injury.  As always, encourage your baby to spend most of their "play" time on the floor sitting, crawling, cruising and perfecting other motor skill milestones.

Read more: http://www.livestrong.com/article/495767-is-a-bouncer-harmful-for-a-babys-development/#ixzz2TEbM4D8x

References/Sources:

• Kauffman IB, Ridenour M (1977) Influence of an infant walker on onset and quality of walking pattern of locomotion: an electromyographic investigation. Percept Mot Skills 45:1323–1329. MedlineWeb of Science
• Kavanagh CA, Banco L (1982) The infant walker: a previously unrecognized health hazard. Am J Dis Child 136:205–206. CrossRefMedline
• Fazen LE III., Felizberto PI (1982) Baby walker injuries. Pediatrics 70:106–109. Abstract/FREE Full Text
• Stoffman JM, Bass MJ, Fox AM (1984) Head injuries related to the use of baby walkers. Can Med Assoc J 131:573–575. Abstract
• Infant walkers: developmental tool or weapon? Jacquelyn Chamberlin, OTR/L The Children’s Medical Center.
• Chelsea and Westminster Hospital; Promoting Your Baby's Physical Development; January 2011
• Consumer Reports; Bouncer-Seat Safety; April 2007
• "Child: Care, Health and Development"; Infant Motor Development; A.L. Abbott, D.J. Bartlett; May 2001
• National Institute of Child Health and Human Development; Safe Sleep; August 2009
• Healthy Children; Movement: 8 to 12 Months; May 12, 2011