United Brachial Plexus Network, Inc.

We receive PT and OT from the Early intervention program here in PA. My son will be 2 in April. Lately, our PT has just been raving how wonderfully he's progressing, and that he probably won't need her much longer. That comment just blows me away! Why wouldn't he need her? He can't even climb up on the couch for pete's sake. Her main focus has been kicking a ball, climbing stairs with one hand held, and the balance beam. I think he still needs her to work on several things. Can you all help me with ideas for continuing PT? Do your children still receive PT or just mainly OT? Thanks for your responses!

Steph - it sounds like this PT is not doing the correct evaluations. Can you get a referral to a private PT to do an evaluation? and then present that to the EI case manager. Sounds like you need a new PT quite honestly. She's obviously not "seeing" things that she should be seeing.

When he climbs stairs can he alternate feet or does he have to step both feet on one step and then go to the next? Can he jump? from how high? and how far? Can he stand on one foot? Hop on one foot? Jump a distance on one foot?

We do PT 2-3X a week and OT 2-3X a week. The PT has been SO valuable - Maia is still 24-36 months delayed and she has come a very far way but still needs a lot of work. She still can't do stairs without double stepping or holding on and well - she's very delayed. But PT has been great for her and for her self esteem - she really is so happy when she can do something she has never been able to do. She can actually jump off an 18" platform now - that has taken 6 months of work to accomplish. Maia has low tone so PT is most important for her.

Good luck and don't back down!!! This is important stuff - you have to accomplish this stuff while they are young.

You go girl!!

-francine

Or, instead of paying out of pocket for another PT to do an eval, call your service coordinator and tell her your concerns. See if they will authorize another PT to do an eval for a 2nd opinion; or just switch entirely and see how things go.

Sometimes the focus will switch from PT to just OT if there are more fine motor concerns and it is felt that things can be targeted best by OT. That's not to say the OT shouldn't still cont the stretches and strengthening though. But it sound like your son is having more problems with the gross motor aspect of his arm, if he doesn't have the strength or range to use his arm effectively for climbing. Maybe the PT needs to focus on the gross motor aspect of his arm (not his legs!), and the OT needs to focus on fine motor and self care skills using that arm.

And aren't the kids who are doing well and just need that little bit of extra help going to benefit the most from therapy?!? But that's when therapists tend to want to put them on monitor basis. Use your judgement and go with your heart, maybe your OT is doing a great job and can carryover where the PT is leaving off, but if you feel like he still needs PT, definitely fight for him!

Anna - (this is Anna the OT right?) (just checking)

you brought up a very interesting point and with that can I ask you to list differences between what gross motor and fine motor of the arm would be?- same for the legs? and can you also explain the differences between OT and PT ?

Much appreciated
-francine

Steph,
We're facing the same challenges with pt thourgh Early Intervention. Currently Matthew has pt every other week through them and we see a pt privately weekly.

Early Intervention works off of function. During this years eval I'm sure Matthew's pt will be cut completely. I have gone round and round on them with this and bpi to them is a medical problem not a functional problem.

I would make a list of all the things you would like worked on and send them into your case manager. When she receives this list she will have to make an addendum to your goals list.

We went through this with Matthew's OT through EI. We ended up firing her and getting a new one in. She has been wonderful with Matthew and even pushed for ot twice a week after his mq. If you want to keep services coming you have to find a therapist on their end who will be on your side and will fight for services for you. I hate to say this but with my experience this whole agency is more concerned about saving money then helping kids.
Cindy

Sorry I disappeared for awhile!

Yes this is Anna, the ped OT!

"Physical therapy helps you get to where you're going...Occupational therapy helps you to be able to do what you need to do once you get there"

Basically, PT works on mobility and "big muscle"(gross motor) issues - ROM, strengthening, balance, positioning, transition btw positions (i.e., sit to stand, supine to sit, floor to couch!)

Occupational therapy - the "occupational" comes from the word occupy - what you do to occupy your time - thus the emphasis on functional skills. An OT will focus on anything that has to do with function, rather than just straight exercises. Now that can be ROM, strengthening, balance, positioning, transition btw positions; because those are all prerequisites to function.

Gross motor of the arm or leg would be big muscle skills, which w/ the leg is pretty much all gross motor, unless I guess if you're picking stuff up w/ your toes? Maybe that would be fine motor?!? But with the arm, big movements, like of the shoulder or elbow, would be gross motor. And movements of small muscles (hand and fingers) would be fine motor.

And like I said, a good therapist is transdisciplinary (will cross traditional discipline lines, i.e., the thought that PT "only" works on gross motor and OT "only" works on fine motor) to carry over what another discipline is doing or to take over for a discipline the child is no longer receiving (i.e., if you lost PT).

I hope this helps! Is this what you were looking for, Francine? I hope I didn't just tell you a bunch of stuff you already knew!

Anna that was great!! I love that line at the top...
It's a saver!
Thanks!