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

The Long Term Dangers of W-sitting

The Long Term Dangers of W-sitting

By Teri Roberts, DPT

Kids Place Owner and Pediatric Physical Therapist

One of the greatest milestones achieved during a baby’s first year of life is sitting.  This is an enormous progression towards independence for the child and the parent.  Sitting is typically learned around 5 months of age through “prop sitting,” where the child is placed in a seated position with their hands down in front to assist with balance.  At 5 months, babies do not have the postural control (balance) to sit without some assistance.  Between 6 and 8 months of age, babies can sustain a seated position independently.

There are many varieties of seated positions:

• Long sitting with feet directly out in front
• Ring sitting with legs in a ring position and feet either touching or slightly apart
• Tailor sitting or Indian style sitting
• V-sitting with legs straight like a V
• Side sitting when knees are bent and both feet are pointed to the same direction
• W-sitting when both feet are behind and legs look like a W

Throughout a baby’s normal development, each of these sitting postures is normal.  You will frequently see your child transition in and out of these sitting postures frequently as they lead up to independent walking. 

A Baby W-Sitting

Although I just stated that all of these sitting postures are normal, I want to stress the importance of children not excessively W-sitting.  W-sitting does not pose a long term concern if your child transitions in and out of the position smoothly and efficiently, and does not maintain the position during periods of seated play.  W-sitting regularly can cause secondary hip and knee problems during walking, seen through excessive inward feet because of the position of their legs and hips.  

Not every child who W-sits will acquire a skeletal or muscular problem; however, it is extremely difficult to change these impairments once they begin.  W-sitting limits the amount of rotation that is typical during play, creating a pattern that does not utilize good core strength.  To prevent any negative hip or knee changes and the likelihood of core strength concerns, encourage your child to sit with “feet in front”.

By the time your child is 15 months old, you should rarely see your child in the W-sitting position.  Children are very intelligent and the W-sitting position (if hip flexibility allows for it) is the easiest way to sit without using any core strength.  It allows children to “lock out” at the pelvis and play in a seated position with the least amount of effort.  Children that have lower tone and need to work harder to maintain a seated position choose to W-sit frequently. 

If you notice your child W-sitting too frequently, encourage a feet forward seated position.  You could also bring toys up to a taller surface so your child either has to sit and play on a chair or in standing to discourage the W-sitting position. 

If you spend over a week with cueing and changing environment of play and you still notice constant W-sitting, an appropriate recommendation is to have your child evaluated by a pediatric physical therapist.  The physical therapist will check the range of motion of the hips to make sure that your child has functional external hip rotation to allow for a comfortable tailor sitting.  The physical therapist will also check to make sure that the core strength is appropriate to maintain a seated position with feet in front for functional play.

AZOPT Follow Up: Rehabbing Major Knee Injuries

AZOPT Follow Up: Rehabbing Major Knee Injuries

ACL injuries are a scary thing to see when they happen to athletes on television.  We see them writhing in pain, clutching their leg with tears rolling down their face.  An ACL injury to an athlete is season ending, potentially even career ending.  The rehabilitation is gruesome, tedious, and long.  But professional athletes have teams of doctors, physical therapists, trainers, and coaches to help them get back to 100 percent.  Not to mention their rehabilitation becomes a full time job.  That’s why, over time, most athletes bounce back from major ACL injuries. 

What about the common, middle-aged, weekend athlete?  In February, we posted an article Everyday People: Rehabbing Major Knee Injuries with AZOPT.  In that blog we met Josh, who suffered a grade 3 tear of his ACL and MCL, along with torn meniscus and bone bruising while practicing Judo with another adult in his son’s class.  A 35 year old father of three, Josh was an active person who participated in CrossFit, Judo, bike riding, and golf.  Josh had successful surgery on January 14, 2013 to repair his torn ACL, and he began physical therapy at AZOPT on January 23, 2013 with Ryann Roberts, DPT and Owner.

We interviewed Josh upon completion of his physical therapy March 8, 2013:

Your first appointment following surgery was January 23, your last March 8.  What was the focus of your rehabilitation during that time?

I attended physical therapy three times per week during that time.  We focused on strengthening, stretching, and balancing.  Strengthening exercises included squats, first with both legs, and then one leg at a time.  I also did various lunges and calf raises.  Stretching exercises were aimed at regaining range of motion with physical manipulations, static holds, and soft tissue massages.  The balancing exercises helped improve coordination by standing on one leg and throwing objects, or rocking on a tilted surface.  With going to physical therapy three times each week, I was pretty sore.  At home I tried to get good rest and kept up with stretching exercises Ryann had given me.

How helpful was physical therapy?

Physical therapy was very helpful as the first part of my recovery process.  Physical therapy took me from barely being able to walk to now (May 1) re-entering CrossFit and engaging in fairly rigorous physical activity.

On March 8, at your last physical therapy appointment, how far along were you in your complete rehab?

My rehab was progressing along nicely.  I had just been cleared to return to jogging and strengthening exercises, but not athletic type movements.  At the time, I felt I was ready to go off on my own and continue to rehab.  Ryann had given me a thorough home exercise program that included strengthening, stretching, and balance exercises. 

As of today, how far along are you in your rehab process?

My doctor has just cleared me to gradually return to sport-like activities.  I am participating in a form of modified CrossFit.  My doctor has just cautioned me to proceed slowly as my strength and coordination return.

What do you feel, if any, is the difference in rehabbing your knee with Ryann as oppose to anywhere else?

Ryann was an excellent fit for me.  His own athletic background gave him a unique perspective to appreciate my goals.  His more than capable oversight helped me achieve my best recovery possible.  My doctor has told me my knee represents their hope in all patients and is a best-case scenario. 

In our first article, we talked about your mental state and how faith has played an important role in accepting this injury and moving forward.  Having gone through the rehab now, what can you tell others about your experience?

The last seven months have been an unexpected sequence of events beginning with my injury then dealing with the consequences of the injury including doctor's appointments, rest, rehab, surgery, more rehab, etc.  Each of these has been accompanied with frustration, inconvenience, monetary expenditure, and physical pain and discomfort.   That is the honest reality of getting your leg snapped in two.  However, with that said, the thing that stands out most clearly is how fortunate I am.  God has been good to me.  I have received constant love, care, and encouragement from my family.  I was blessed to receive exceptional medical care from my doctor and the team over at AZOPT, and I have been blessed by the time and place I live so that I now have a reconstructed knee.  Think about how incredible this is.  Doctors used a portion of my hamstring muscle to recreate ligaments in my knee and because there were only minor incisions paired with modern medical techniques I will have a knee capable of returning to play in the NFL--pretty good for a middle-aged guy who is just trying to keep in shape and have an active life with my kids!  I have a lot of which to be thankful.

May is National Arthritis Awareness Month

May is National Arthritis Awareness Month

By: Brooke Smith, DPT

Do you or someone you know have pain in their joints, but do not know the cause?  You may have symptoms of arthritis.  Today, nearly 50 million Americans suffer from arthritis.  Arthritis is often misunderstood as minor aches and pain associated with getting old.  However, there are many different forms of arthritis that can occur at any age.  Two-thirds of the population with arthritis occurs in people under the age of 65, including children.  The three main types of arthritis are Osteoarthritis, Rheumatoid Arthritis, and Juvenile Arthritis.

Osteoarthritis (OA) is the most common form of arthritis and is characterized by progressive degeneration of the joint’s cartilage, causing bone to rub against bone.  It most commonly occurs in weight bearing joints such as the hips, knees, and lower back.  OA has also been known to affect the neck, small finger joints, the base of the thumb, and the big toe.  Some of the symptoms include gradual development of stiffness within the joint, pain or joint soreness after overuse or inactivity, morning stiffness, and loss of motion/movement within the joint.  Several risk factors can lead to the development of OA including obesity/overweight, history of joint injury, overuse, genetics, muscle weakness, and age.   OA usually occurs later in life as a person ages.  It is described as the “wear and tear” of your joints, and the older you are the more you have used your joints, putting them at greater risk for OA.   However, older age does not mean OA is inevitable.

Rheumatoid Arthritis (RA) is a systemic disease characterized as inflammation of the joint lining causing pain, stiffness, warmth, and swelling that can occur throughout the body.  RA is symmetrical, affecting the same joints on both sides of the body.  RA affects nearly three times the amount of women than men and most commonly begins between the ages of 30 and 60 years old.  RA has no cure and progression leads to development of rheumatoid nodules and joint deformities.   Although there is no cure for RA, highly effective treatments exist including medications, physical therapy, physical activity, weight control, and maintaining good overall health.

Juvenile arthritis (JA) can have many different forms but is generally described as an autoimmune and inflammatory condition that can develop in children ages 16 years and younger.  JA affects the joints like RA and OA; however, it can also affect the eyes, skin, and gastrointestinal tract.  There is no known cause for JA, but it has been suggested that toxins, foods, allergies, or genetics can cause a child to develop the disease.  Symptoms are similar to RA and OA and include inflammation of the joints, pain, and joint stiffness.  It is important with JA that the entire family maintains a sense of calm and normalcy, as well as sticking to daily routines and comforting habits.  It is also important to address emotions of sadness, anxiety, and anger the child may have to help maintain the attitude that “arthritis is something I have to live with but not what defines me”.

               

There are options, other than surgery, to help improve your symptoms like stretching, walking, strengthening, Tia Chi, and physical therapy.  As a physical therapist, my goals in treating arthritis are to decrease the amount of pain, improve strength of muscles to increase stability around the joint, stretch muscles that are tight and might be hindering proper body mechanics, and improve joint protection.  It has been shown in recent research that exercising is a valuable tool in decreasing the symptoms of arthritis.  Some specific interventions that physical therapy might provide include modalities, braces and splints to protect joints, and hot or cold packs.  A physical therapist will work with you to modify your daily activities and your environment to provide pain relief and improve function.  Physical therapy will improve flexibility in your hamstrings, quads, calves, and hip flexors while strengthening the muscles around your knee, hip, and ankle.  Your appointments may also include coordination and balance activities.

               

If you or someone you know is experiencing any of the signs and symptoms discussed above, or has been diagnosed with a form of arthritis, you might think about scheduling an evaluation with a physical therapist to address your symptoms.  You can contact AZOPT at (623) 242-6908 if you have any questions or concerns.

For more information, please visit www.arthritis.org.

Child Development of Self-Care Skills

Child Development of Self-Care Skills
By Jessica Holyoke, OTR-L

Activities of daily living (ADLs) are a necessary part of our day and include various tasks such as getting dressed, bathing, brushing our teeth or hair, and feeding ourselves.  Most of us place very little thought or effort when carrying out these tasks, but how did we learn to perform them?  Throughout the first year of our life, we will begin to develop the skills necessary to take care of ourselves.  It is important that children have many opportunities to practice these skills.  This blog will look at the typical development of these self-care skills and give examples of how to encourage your child’s development.

Dressing

A 1 year old child has already begun to explore how to take off clothes by removing their socks and raising their arms to help get a shirt off.  Between 1 and 2 years old, your child will continue this exploration and learn to take off his or her shoes and socks.  They will also begin to help put their arms through holes and hold out their legs for pants.  Between the ages of 2 and 3 years, a child can remove simple clothing on their own.  They are learning to put on front closing tops (jackets, button-up shirts) and to unzip and unbutton large buttons.  By 4 years old, a child can dress and undress themselves with assistance for fasteners and ties.  By 5 or 6 years old, a child is nearly independent with dressing skills needing help only with difficult fasteners such as belts and selecting appropriate clothing to match the weather.

Bathing & Grooming

A 1 year old child is starting to become aware of cleaning themselves.  They can wipe their face with a napkin or towel (not completely).  They can grasp tools such as a toothbrush or spoon, and mimic movements that will develop into controlled use.  Between 1 and 2 years, a child begins to enjoy bathing and takes an interest in helping.  By 3 years, they are actively participating in washing and helping with brushing teeth.  At 3 or 4 years, a child can wash themselves with supervision and some help with hair.  A 5 to 6 years child should be able to complete bathing and grooming tasks on their own with occasional reminders to do a thorough job.

Toileting

When to potty train can often be confusing for parents.  Typically, the first indication that a child is ready to start potty training is their ability to indicate when they are wet or soiled, which typically occurs by age 2.  The next step is their ability to indicate needing to go to the bathroom.  A 3 year old child should be using the bathroom with daytime control, still needing help for wiping and managing clothing.  By 4 years old, a child develops nighttime control and needs less help with wiping and managing fasteners on clothing.  At 5 or 6 years, a child is independent with toileting tasks.

Feeding

Around 6 months, a child develops the upper body and hand strength to hold their own bottle.  By 7-8 months, they can grasp small pieces of cereal or baby cookies and bring it to their mouth. They may start using a spoon for feeding by about 12 months.  Between 1-2 years, a child is using a spoon (with spilling) and can hold and drink from a Sippy Cup.  Between 2 and 5 years, a child develops the ability to use a spoon and fork, and can drink from a cup with no lid (with some spilling).

The most important thing to remember about any skill development in childhood is that is takes time and lots of practice.  Spend time on these skills, especially in the evenings and weekends when there is a bit more time to spare.  Give as little help as possible.  As the child gets older, allow them to work through problems and give more verbal feedback than hands on help.  Children learn through play so turn it into a game.  You can play dress-up or dress a stuffed animal for dressing skills, play peek-a-boo games where the child pulls a napkin or washcloth off their face or head for grooming skills, and use spoons and other utensils while playing in pudding or applesauce for feeding and utensil use.  Give your child as many opportunities as possible to practice their skills, let them make mistakes, and have fun learning new skills.

It is important to remember that these skills develop at a different pace for each child and the ages presented are considered average.  If your child develops these skills slightly faster or slower, there is no need for alarm.  If there is a significant delay in the development of these skills, your child may benefit from an occupational therapy evaluation.  Please feel free to leave your comments in the section below if you have specific questions regarding your child.  

Stretching for the Active Adult Woman

Stretching for the Active Adult Woman

By Ryann Roberts, DPT and Brooke Smith, DPT

It is hard enough to squeeze a daily exercise routine into your busy schedule.  You may think adding extra time with a before or after workout stretch is something you should just fit in when time permits.  The focus is on the exercise, not the stretch, right?  Wrong.

Stretching is just as important in your workout routine as the actual exercise.  Stretching increases flexibility, which in turn will help to increase your athletic performance and decrease your risk of injury.  For the active adult woman, the emphasis is on decreasing the risk of injury.  Understanding why stretching helps, and what stretches the active adult woman should perform, can help reduce and/or eliminate these injuries.

Stretching can help improve flexibility.  Flexibility may decrease your risk of injury by allowing your joints to move through their full range of motion.  For example, let’s say you are a 60 year old woman with tightness in her hips and ankles.  This tightness prevents your body from going through its full range of motion, which eventually can develop into tendonitis in your knee or lower back pain.  Properly stretching can increase the range of motion in your hips thereby reducing the risk of these micro traumas to your tendon that may lead to overload or injury.

Stretching also increases blood flow to the muscles, sending oxygen to the tendons and ligaments, essentially waking them up and preparing them for your workout.  

There are two types of stretching routines to perform – dynamic and static.  Dynamic stretching is stretching with movement, designed to propel the muscle into an extended range of motion.  This form of stretching prepares the body for physical exertion and performance.  Static stretching is used to stretch muscles while the body is at rest.  It is composed of various techniques that gradually lengthen a muscle to an elongated position (to the point of discomfort) and hold that position for 30 seconds to two minutes, two or three times per stretch. 30 seconds is the minimum duration to get the benefits of stretching, whereas two minutes is the maximum.

Always take the time to make sure you are stretching safely and effectively using proper technique.  Stretching incorrectly can actually do more harm than good.  Stretching cold muscles may cause injury, so we recommend warming up with some low intensity cardio for five minutes before beginning any stretching.  When stretching, do not bounce.  Bouncing can cause small tears in a muscle.  These tears cause scar tissue in the muscle that as it heals tightens the muscle even more, making you less flexible and more prone to increasing pain and causing injury.

To help, we have prepared a stretching routine to perform before and after you exercise.  

The following dynamic stretches are performed prior to exercise:

• Walking Lunge with Overhead Rotation
• Lateral Lunge
• Squats
• Walking Russian Kicks
• Arm Circles
• Posterior Deltoids Stretch
• Triceps Stretch

For a detailed description of these stretches, click here.

The following static stretches are performed after exercise:

• Standing Calf Stretch
• Hamstring Stretch
• Ilio-Tibial Band Stretching
• Standing Abductor Stretch
• Posterior Hip Stretch
• Low Lunge with Twist and Hip Flexor Stretch
• Standing Extensions
• Corner Stretch

For a detailed description of these stretches, click here.

It’s very easy to bypass stretching due to time constraints, but keep up with it.  The benefits of stretching are best when stretching is regular.  In some cases, you may need to approach stretching with caution. If you have a chronic condition or an injury, you may need to adjust your stretching techniques. For example, if you already have a strained muscle, stretching it may cause further harm.  

Lastly, stretching does not mean you cannot get injured.   Overuse injuries may still occur.  If you are feeling pain or are injured, please contact AZOPT for your FREE injury and/or performance screen with a licensed physical therapist.

A Newborn Baby's First Year - The Sound Development Parents Can Anticipate

Early Speech Sound Development

By Lanni Reisinger,SLP-CFY

Kids Place Pediatric Speech Therapist

Often times, parents of a newborn will wonder which sounds will first be heard by their baby and how to help produce these sounds.  From the time a newborn baby reaches three months and starts making their first sounds to when a baby is 12 months and forms their first word, parents can expect to hear a wide variety of noises and sounds. 

In this blog, I will address these milestones as well as the activities parents can perform to help their newborn progress.  Please note, these milestones are meant to be generalized.  There is no reason to be alarmed if your baby is slower at hitting certain milestones.  At the end of this article, I will list certain “red flag” milestones that may indicate your newborn needs to be evaluated.

At three months, your baby will begin to make sounds.  The first sounds you can expect to hear are vowel sounds when your baby is cooing and making pleasure sounds (“oo,” “ah,” “uh,” “oh,” “ee”).  At this time, your baby will also begin producing distinctive cries when they are hungry, wet, etc.  They will then begin producing strings of vowels with varying intonation.

When your baby begins babbling at four to six months, the first consonants they are likely to produce are “bilabial” sounds, produced with their lips (p, b, m).  These sounds are learned first because they are easily seen by your baby and fun to make.  This is also around the time you will first see your baby laugh.

At seven months, your baby will produce “reduplicated syllables” - repeating the same sounds over and over again (“babababa”).  Your baby will first produce these sounds in play, without any communicative intent.  You should then begin to notice your baby making sounds to gain attention.  Furthermore, around this time your baby will begin imitating more sounds and “talking” when others are talking.  You can prompt your baby to make sounds playing some basic games in which you take turns making sounds.

Here are some of my favorite games and songs for babies at this age:

• Peek-a-boo (hiding behind hands, blanket, napkin, etc.)
• Patty-cake
• This Little Piggy
• Head, Shoulders, Knees and Toes
• Row, Row, Row Your Boat
• Old MacDonald

It is also important to read with your baby.  It is not necessary to read every word in a book.  Simply talking about the pictures and pointing to things in the book will help.  You can prompt the production of sounds through making silly and nonsensical sounds while you play (“wee!” or “uh-oh!”).  You can also prompt your baby to imitate environmental sounds like animal sounds (“quack-quack!” and “moo!”) and transportation sounds (“vroom!” or “urch!”).

It is important to remember not only to prompt your baby to imitate your sounds, but imitate your baby’s productions as well.  Face-to-face time with your baby is important and using a “sing-song” tone with lots of rising and falling intonation will help your baby attend better to your sounds.  

By your baby’s first birthday, you can anticipate their first word, typically a word they use often (e.g., “mama,” or “hi”).

As a precaution, if your baby is not making any sounds by six months, or no consonant sounds (p, b, m) by ten months, an evaluation by a doctor is appropriate.  By 15 months, a baby should be saying their first word.  If this is not the case, an evaluation should be sought.

Why You Should See a Physical Therapist

Why You Should See a Physical Therapist

We thought it timely to remind readers about the importance of physical therapy. Here are 5 (of the many) reasons you should work with a physical therapist.

1. PTs are highly educated musculoskeletal specialists.

Physical therapists are required to complete extensive training — and to earn at least a master’s degree, if not a doctorate — before applying for state licensure. PT programs require coursework in anatomy, physiology and biomechanics, as well as multiple apprenticeships at physical therapy clinics. Even once a PT graduates and is licensed, the state requires continuing clinical education in order to maintain licensure.

2. PTs are able to treat the whole person, not just a single body part.

Because of their extensive musculoskeletal knowledge, PTs can evaluate your body as a whole. For example, knee pain could be related to weakness in your hip; back pain could be related to your general posture. This is why a physical therapist will do an evaluation of your entire body on your first visit, to assess not only where you feel pain, but the variety of factors that could cause it, and then create a specific treatment plan for your condition.

3. PTs not only do rehab after an injury, but also provide health and wellness programs.

As health care practitioners trained to help people recuperate from injury, physical therapists are uniquely prepared to help people live healthier lives. For example, many PTs offer nutrition and exercise programs through their clinics. The programs can be used to supplement the clinical treatment of a patient, like an arthritis sufferer who needs to lose weight to relieve joint pressure, or a client who is simply interested in living a healthier life. In the same vein, PT clinics offer such programs as wellness/fitness evaluations, strengthening and conditioning classes, and more.

4. PTs can design individualized programs to improve your health.

PTs have the knowledge to treat a variety of symptoms. The most common reason physical therapists are approached is pain relief, but they can also improve posture, body structure, circulation and function, as well as correct deformities and promote healing.

5. PTs often specialize in a variety of fields.

Chances are high that a physical therapist has specialized in a field of interest. While many work with specific types of athletes, others focus on general orthopedic concerns, or children, or seniors. Some PTs choose to do further study of particular health problems, work with cancer patients, help patients with Parkinson’s or multiple sclerosis maintain their strength or grow stronger, or rehabilitate back to independence.

As we continue to fight obesity and improve health throughout our country, it is clear that physical therapists are key partners in living healthier lives. Their training and clinical expertise are essential to maintaining strength and moving forward in all walks of life.

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For further reading:

Richman, Meryle. October 2011 is National Physical Therapy Month. Yorktown Patch, October 2, 2011.
Richman, Meryle. Living a healthier lifestyle. Yorktown Patch, August 30, 2011.
Slayback, Carrie Luger. My turn: Friends shine after physical therapy. Los Angeles Times, July 25, 2011.
Rachlin, Natalia. War wounds and tutus. Wall Street Journal, July 6, 2011.
About physical therapists. APTA, 2011.
Physical therapy eases burden of lymphedema. PennLive.com, November 2, 2010.
Hilton, Lisette. Aging frames: Baby Boomers visit PTs with musculoskeletal complaints. Today in PT, September 6, 2010.
Weinper, Michael. Physical therapists have what it takes: Meeting the health and fitness needs of Americans in challenging times. Impact, May 2010.
Rodriguez, Diana. Physical therapy after a stroke. Everyday Health, March 25, 2009.
Wiggin, Sally. Direct access can save patients time, money for physical therapy. WTAE Pittsburgh, March 9, 2009.

What is Torticollis?

What is Torticollis?

By Nichole Hagerty, DPT

Bringing home your precious newborn is an exciting yet nerve wrecking experience.  Parents will lay awake staring at their little girl, conscious of all their movements.  Her baby pictures will fill your walls, office spaces, and phones.  You will spend endless amounts of time hoping and praying she is perfect.

But then something seems off.  She only looks to the left.  In all of the pictures, her ear is constantly on her shoulder.  When she is placed on her stomach, she will continue to look left, but never right.  As the sleepless nights continue, you begin to notice her head shape is changing.  She begins to have a small flat spot because she is consistently looking left while keeping her ear tilted toward the left shoulder.

You become concerned.  Others may tell you not to worry, that your baby will grow out of it.  But your gut instinct is telling you something is wrong.  A pediatric physical therapy evaluation will determine if your child is affected by torticollis.

Torticollis, derived from the Latin words tortus for twisted and collum for neck, is the tightening of the sternocleidomastoid (SCM).  The SCM is a muscle that goes from the mastoid process of skull to the sternum and clavicle.  You have a right and left side SCM.  When the muscles work together, they flex the head forward.  However, when one is working alone, you bend your head sideways to the right and rotate your head to the left.  This is what occurs when a child has torticollis.  One of the muscles is tight, possibly due to positioning in the womb, birth trauma, or positioning after birth.

The incidence of Torticollis has been steadily increasing since 1997 with the introduction of the “Back to Sleep” campaign.  Not only is your child sleeping on her back, she is often times spending a lot of time in her car seat, her swing, her bouncer, and all of this wonderful baby holding equipment.  However, she is not spending enough time on her stomach.  She is not learning how her body works.  She has difficulty with being on her stomach and has not developed the neck extensors to lift her head that will allow her to explore her world.  Once these are developed, she needs to learn to play on her tummy without as much support, but still being supervised.  She needs to be able to reach and play with both of her hands equal. She needs to discover her body. The best way to do this is to spend time on her stomach.

Torticollis is typically treated with changes in positioning at home, as well as specific strengthening and stretching exercises.   A physical therapist can teach you simple stretching exercises to perform daily at home with your baby.  As time continues, physical therapy will progress to more strengthening exercises.

The best way to decrease continued pressure on the back of the head is to increase the tummy time.  For more reading on tummy time, read our blog post from Kids Place’s Teri Roberts, DPT.

Torticollis is not preventable, but it is treatable with an early referral to a Pediatric Physical Therapist and committed parents who follow the home exercise program recommended by the therapist.  Ask your pediatrician for a physical therapy evaluation if you are concerned your newborn is suffering from torticollis.



Articles referenced:

• Boere-Boonekamp M, van der Linden-Kuiper L. Postional preference: prevelance in infants and follow-up after two years. Pediatrics. 2001 Feb; 107 (2):339-43
• deChalain T, Park S. Torticollis associated with positional plagiocephally: a growing epidemic, J. Craniofac Sugery. 2005 May; 16(3): 411-8
• Do T. Congenital Muscular Torticollis: Current concepts and review of treatment. Curr Opin Pediatr. 2006 Feb; 18(1):26-9.

Part 2: Following AZOPT’s Client through Total Shoulder Replacement Surgery

Part 2: Following AZOPT’s Client through Total Shoulder Replacement Surgery

Read Part 1

In the 1950’s, shoulder replacement surgery was first performed to treat severe shoulder fractures.  Through the years, shoulder replacement surgery has been used to treat many other painful conditions in the shoulder, like arthritis.  Today, according to the Agency for Healthcare Research and Quality, approximately 53,000 people in the U.S. have shoulder replacement surgery each year.  Compared to more than 900,000 Americans who have knee and hip replacement surgery each year, shoulder replacement surgery is not as common, but still just as successful at relieving joint pain.  Just ask AZOPT patient Mr. A.

When we last left AZOPT client Mr. A, he was preparing for total shoulder replacement surgery on his left shoulder on January 10, 2013 following successful shoulder replacement surgery on his right shoulder April 26, 2012.  In fact, the success of rehabilitation on his right shoulder led him to the decision to have the surgery on the left shoulder.  The surgery of his left shoulder was performed by Dr. Jason Scalise, TheCore Institute, at Banner Thunderbird Hospital.  AZOPT’s Doug Lehman, PT, watched the entire surgery over the shoulder of Dr. Scalise.

Mr. A’s total shoulder replacement involved replacing the arthritic joint surfaces with a highly polished metal ball attached to a stem, and a plastic socket.  This was “press fit” into the bone.  To do this, Dr. Scalise saws off the humeral head (ball) and reams out the glenoid fossa (socket).  He then drills a hole into the remaining humerus bone and fits the stem of the prosthetic into the hole.  The plastic socket is screwed into what remains of the glenoid fossa.  The ball is then put back together with the socket, the range of motion is checked, and if all of the movement and alignment is positive, the incisions are sewed up and Mr. A is on his way to recovery.  The entire surgery from wheeling in to wheeling out was approximately three hours, with half of that being actual surgery time.

For the first two weeks following surgery, Mr. A kept his arm in a sling.  He performed basic exercises for the hand, wrist, and elbow along with pendulum exercises for the shoulder.  With his elbows in, Mr. A was asked to simply turn his hands from palm up to palm down, touch his fingers, and straighten then bend his elbow.  Additionally, the pendulum exercises involved allowing the surgical arm to hang loosely in a bent over position, swinging the arm gently front to back, and in circles.

01/25/2013

On January 25, 2013, two weeks after the surgery, Mr. A came to AZOPT for his initial evaluation.  Doug recorded the following active range of motion measurements:

	Right	Left (prior to surgery	Left (initial evaluation)
Flexion	140	150	92
Abduction	120	111	80
External Rotation	75	72
Internal Rotation	72	60

01/25/2013

Active range of motion means Mr. A performs these motions by himself.  Flexion is the range of motion (ROM) measurement from lifting your arm straight forward from your hip to above your head.  Abduction is the ROM measurement from lifting your arm straight from your hip out to the side and above your head.  External rotation is the ROM measurement with your elbow at 90 degree, rotating your hand outward.  Internal rotation is the ROM measurement with your elbow at 90 degrees, rotating your hand inward.  These measurements translate directly to functional activities – washing your hair, tucking in your shirt in the back, putting away dishes in the cupboard.  Generally speaking, a healthy range of motion would be 160 degrees flexion and abduction, and 90 degrees external and internal, although this does vary person to person.

Doug tells us “by observing the surgery, I was able to see the actual structures, how they were cut and reattached, and how the prosthetic pieces were attached.  Dr. Scalise guided me through the specific techniques and we discussed his rehabilitation expectations.  By learning the process and the range of motion available while Mr. A was under anesthesia, I am more comfortable aggressively obtaining range of motion and active movement early in the rehabilitation process.”

Mr. A attends physical therapy at AZOPT three times weekly.  In the first 3 weeks of physical therapy, Mr. A’s physical therapy program consisted of manual therapy focusing on improving range of motion with a slow progression of exercises and activities to regain strength and stability as his pain tolerance allowed.  According to Doug, Mr. A has responded extremely well to therapy.  Mr. A tells us his progress on his left shoulder has been quicker than his right shoulder.  With the factor of the unknown removed, Mr. A is familiar with the process and comfortable with what he needs to do to recover quickly. 

02/15/2013

On February 15, 2013, after ten physical therapy visits, Doug recorded the following active range of motion measurements:

	Right	Left (prior to surgery	Left (i.e.)	Left (02/15)
Flexion	140	150	92	135
Abduction	120	111	80	97
External Rotation	75	72		60
Internal Rotation	72	60		40

02/15/2013

A large factor to Mr. A’s recovery is his compliance with the Home Exercise Program prescribed during physical therapy.  This program ultimately gives him the greatest chance at success.  Mr. A has a pulley at home that helps with his range of motion and strength.  He also uses a golf club at home to do shoulder extensions and shoulder raises.  Furthermore, Mr. A guides a rolled up towel up and down a wall.  It is extremely important for anyone recovering from any injury to keep up with the Home Exercise Program.  Without it, physical therapy will stall and set the patient back.

 

With the addition of the Home Exercise Program, physical therapy visits continued to include progressions of manual therapy and therapeutic exercises to decrease pain and increase range of motion, strength, and stability.  After 21 visits, on March 13, 2013, Mr. A reported an overall improvement of 75% compared to his normal function.  He was still experiencing pain with activities and a decreased ability to complete normal activities of daily life that require the use of the left arm.  On this day, Doug recorded the following active range of motion measurements:

 

	Right	Left (prior to surgery	Left (i.e.)	Left (02/15)	Left (03/13)
Flexion	140	150	92	135	140
Abduction	120	111	80	97	90
External Rotation	75	72		60	67
Internal Rotation	72	60		40	62

Mr. A will continue physical therapy three times per week at this time.  He actually loves coming to AZOPT because he knows this is making him better.  While Mr. A cannot accomplish all of his goals, he realizes he is much closer.  He still cannot lift a mug of coffee, but he is able to drive again.  He also no longer experiences clicking or pain when brushing his hair.  His biggest fear before surgery was the idea of a “frozen arm” – that every time you move the arm, there’s pain, so you just don’t move it.  Through two total shoulder replacement surgeries and rehabilitation at AZOPT, Mr. A no longer has “frozen arm,” and is 75% closer to returning to normal function with no pain.

Check back with us for the third, and final, installment of Mr. A’s recovery, when Mr. A is discharged from physical therapy.