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Recommendations to Parents with Children doing PT at Home

Recommendations to Parents with Children doing PT at Home

Jenn Poirier is a pediatric physical therapist located in Fort Mill, SC. In this video, Russ chats with Jenn about how parents can help with their kids’ physical therapy while staying at home. Watch the video above to learn more.

 

Full Transcript:

[Intro]:

A big Thank You to Jenn Poirier for taking the time to speak with us and share her valuable insight into how parents can work with their child’s physical therapist virtually during extended periods of time at home.

Russ Sorrells:

Jenn has her doctorate in physical therapy from Northeastern University, started her career in outpatient orthopedics. Today, her practice philosophy is focusing on increasing independence and improving functional skills.

So, the intent of our conversation today is to talk about some of the challenges that parents are having, as it relates to the pediatric care for your patients. A lot of this is happening via telemedicine, so instead of face to face, now you are essentially doing this via video. So, we want to talk about some of the care challenges that parents are facing and some of the things that you have learned along the way that can help parents to keep their kids moving, keep them active and avoid some of the regression that could occur over this next few weeks or months into the future.

Jenn Poirier:

So, I have been specializing in pediatrics for the last 12 years. As you said, I started in outpatient orthopedics, sports medicine. My goal going to PT school was to kind of break barriers and become a female PT with a major league team. Through my schooling, I was introduced to this world and fell in love with it. And so, this is very much where my passion lies. I love taking kids and families through their first of things, like being able to sit independently and crawl and walk and take their first steps. And, I have been very blessed to be able to be present in the room a lot of times for kids’ for steps.

And, a lot of the kids that I am seeing have some kind of challenge that they’re overcoming, whether it’s prematurity or they have some kind of diagnosis. More frequently than not, first steps are not happening at 12 to 15 months. They’re happening at three, four, five, six, nine. And that’s a really special thing to be a part of, taking first steps when they have been told for so long that this may never happen. So, my goal with every kid that walks in the door, regardless of their diagnosis or their age or anything else, is how can I get you independent?

Russ:

That’s awesome. So, you’re not letting the diagnoses determined your approach to the treatment?

Jenn:

No, because kids are resilient, and the truth is that we don’t really know what they can do until we challenge them. So, independence for Johnny might look different than Sally’s independence, but they both can achieve some degree of independence. It may be with a power wheelchair. It may be with a walker. It may be walking independently. And, my goal for each kid that walks in the door is to kind of figure out, how can I get you to move on your own?

Russ:

What are some of the techniques and methods that you use to increase independence and improve functional skills?

Jenn:

It depends on the child and the diagnosis. Some of the typical pediatric diagnoses that are seen throughout the country are cerebral palsy, down syndrome, muscular dystrophy, multiple forms of that. We see a lot of kids who have autism, spina bifida, traumatic brain injury. And then, sometimes we see kids who don’t have a diagnosis, but they present with abnormalities in gait, like toe walking, or they have abnormalities in posture like scoliosis or torticollis, just like when you’re an infant, and you have one side of the neck that’s different than the other.

We see kids who present with decreased strength or have abnormal muscle tone, whether it be their muscles are floppy, they’re hypotonic, or they’re really stiff, hypertonic. So depending on what it is that we’re working on, we use a lot of strengthening techniques. We’ll work on flexibility or balance, or just general functional ability skills, learning how to roll over and sit up in bed or transfer from one surface to the other, whether that’s standing or from their wheelchair to a classroom chair or whatever that means for different kids. Just teaching them really how to move, so they can go throughout their day.

Russ:

What are some of the physical challenges that you’re experiencing or different things that aren’t happening as a result of a lack of movement?

Jenn:

So typically, a child that is maybe in a self-contained classroom or in a special setting at school, they get up in the morning, mom or dad, or whoever puts on their braces, puts them in their wheelchair or their walker or gets them set up with their crutches and sends them off on the bus. And at school, their teachers have them in all different positions throughout the day. They’re in their standers. They are in their activity chairs. They’re moving from surface to surface, whereas at home, a lot of families like us here, mom and dad are trying to work. They’re trying to do homeschooling and take care of the daily needs of their kids. And so, a lot of what we see across the board as PTs is just parents struggling to figure out, how do I juggle all of the plates, keep everything in the air?

So, it’s been a real challenge. But, I was telling you about a case I had last week, one little fellow that I work with struggles with constipation. And, mom was telling me they had been trying all this stuff back and forth with telehealth visits, trying to figure out how to get stimulating his bowels. And I suggested the stander because we think about standing is so beneficial for the legs and it is, but for those who have a stander and who spend time in their standing frames daily, the benefits are not just for the legs such as allowing our diaphragm to fully contract.

So, we can get a nice deep breath in and fill our lungs with air, which helps aid in digestion and make bowel movements happen a little more easily because a lot of us are spending a lot of our days sitting at the computer and our whole trunk is compressed. But when we stand up, we allow our trunk to elongate, and everything just gets a little bit more space, and everything inside has room to do what it’s supposed to do.

Russ:

Yeah, absolutely. So, you’ve mentioned putting children into a stander. What are some other strategies?

Jenn:

Change positions. Don’t just sit in the same chair all day, every day. Spend time on the floor, get them on their tummies, sit on different surfaces, stand if able to walk, and move around. Even if they’re going to be at their computer, doing schoolwork for a couple of hours through the day, changing positions every time you switch a subject is a good rule of thumb. When you’re changing activities for the kid, think about changing positions for them, too.

For kids that have worked on strengthening activities, their main goal is increasing strength. You can pick an exercise for them and work on it all week. Last week, I had a little boy that is really into competitions, and he’s working on improving upper extremity strength so that he can assist more with his wheelchair transfers. So, I gave him a competition. He does a modified version of a push-up, and I told him he had to finish 100 between last week when I saw him and this week when I see him again. So if he finishes a hundred, then he gets to challenge someone else. So make it fun, make it a competition. Sometimes, I will adapt board games. Candyland is a fan favorite in my house, right now. You can make every color a different exercise. Get the whole family involved in it. When you land on red, you have to do bear walk. When you land on blue, you have to do the crab walk or balancing on one foot, whatever exercises the child is working on in their regular therapy sessions. And ask your PT, if we do one thing this week, what should it be?

Obstacle courses are another really good, fun way to work on strengthening and motor planning. Take a piece of sidewalk chalk and get out on your sidewalk or your driveway and draw a balance beam. Have them walk along the balance beam. You can draw a hopscotch, but try and change up the pattern or do two feet together, two feet apart, or hop on one foot on the left and then hop on one foot on the right. For our kids that are working on increasing their endurance, if they can’t get out to the park or wherever it is that they’re used to walking, take a little activity log. Start a stopwatch and just walk laps around your house and see how many minutes you can go. Or dance. There’s a lot of fun YouTube videos for kids, teaching different steps of a dance. Start with two or three minutes and then slowly build up, but just get them moving. For our kids that are learning to use mobility devices, make an obstacle course for them. Practice starting, stopping, changing speeds, and turning. All those are wonderful skills that when we do get to re-acclimate to society and to be out again, they’re going to need. So, this is a good time to practice. And, an obstacle course is something that you can get the whole family involved in.

Red Light, Green Light is another one I’ve been using a lot via these telehealth sessions for kids that are learning their walkers. They could take a couple of steps. Now we’re learning to transition them to be really walking longer distances. And stopping, believe it or not, is a really hard skill to master—a smooth stop instead of just a fall. So, I have my green and red here. I’m set up in my telehealth spot right here. So, I took my kids’ buckets that they organize their toys in and we do green light, red light, green light, red light. I try and set them up so that they start far back from me and they walk towards me. So, that they can see me and I have something big to hold up, so it covers most of the screen. And I’ll use my words at the same time too, to cue them. Green means go, start going. And then, we pull out our stop.

Russ:

That’s excellent. So obviously, other physical therapists could use that. Parents could use that at home. What other creative ideas have you had as it relates to when you’re in that session?

Jenn:

It has been a creative challenge. For the kids that we’re working on teaching movements, I have my little baby doll here, and I show the parent, take one leg and move it across their body to try and teach them how to roll. Or when we’re working on sitting balance, I have my little baby here, and we work on shifting this way and that way, and really focusing on getting the arm out so that they can learn to protect themselves. I have a stack of kid’s books here that I have adapted to be motor. So, I read them the story and show them the picture, and with each page is an exercise. I read them the story as they’re doing the exercise. And so, I have for my stories, all my little cheat sheets here of the exercises for each book. And I have one for kids that are working on higher-level skills, one for the medium level skills and one for lower-level skills. So, I can kind of cater it towards each kid. I’ve been working on a few new books a week to keep it interesting.

I’m working on putting these all up on YouTube, in between working and taking care of my own kids. My husband has been helping me tape all of this stuff to get it up online, to share this with other people. I’m also working on common toys that you would have at home because it’s hard to adapt a PT session to a house where you don’t know what’s there.

Russ:

Great recommendation. So, if I’m a parent at home, this is pretty overwhelming. I’ve never gone through or performed therapy on my child before. I’ve seen it. I’ve been there, but I maybe didn’t pay a great deal of attention to all of the movements and activities. How do they know that they’re doing it properly? If they’re not on the call, what are some resources they could refer to?

Jenn:

So, for pediatric teletherapy, I make sure they position me, whether they’re on their phone or their tablet or their computer, to make sure it’s angled. I really want to make sure that I can see around them, so that I’ll see in the background, like, “Oh hey, grab that toy or hey, move this a little bit to the right, so that they’re really reaching for that.” And, if we’re working on a balancing activity, I want to see how much assistance the caregiver is giving them so that I can jot that down to know for next time. Like, let’s try a little bit less help.

Russ:

So normally, you meet with a patient a couple of times a week. Has that dropped to one time per week? Do you maintain the same sessions? What’s your schedule?

Jenn:

The goal is to maintain the same sessions, but we are really just doing everything that we can to keep our kids moving in the right direction. We understand that you now have Zoom calls with your child’s school, OT, or speech telehealth sessions, PT, and you may have doctor’s visits. We get it. Talk to us, tell us what’s going on. If you have a super busy week, let’s do one, or maybe we’ll do a home program this week. The goal is to keep it the same. But, we were all in this together right now. We’re just trying to keep your kid moving in the right direction.

Russ:

What are some of the questions that you would like for parents to ask more frequently? What would you like to hear from them as far as guidance and things that could help you more effectively do your job?

Jenn:

I think one of the positive parts of this mess that we’re in right now is parents are really watching their kids all day long. So, they see what happens throughout the course of the day, and they may notice things that they wouldn’t have before. And really, now is the time to watch so we can fine-tune things. If your child has falls and we’re working on balancing and improving their gait and preventing loss of balance, pay attention to when they’re falling. Is it when they change surfaces from the hardwood floor to the carpet? Are they falling when they’re outside walking in the grass? These are things that when you come back and tell your therapist, we’ll know, okay, now we need to work on gait on a nice level surface.

Or you may notice increased stiffness in your child if they have spasticity or they have hypertonicity or if they just are a child that has joint inflammation and swelling with juvenile rheumatoid arthritis. There’re several other diagnoses that would cause joint pain and stiffness. Tell us if they’re having increased pain. It could be because, as we talked about before, they may not be moving around as much as they typically had, or they may not be wearing their braces for as long as they typically do. So, they may need to just increase that wear time to what a typical day pre-COVID looked like, to try and control that specificity and preserve that joint range of motion. Are you noticing that every day they fatigue at two o’clock? What can we do to keep them going until three or four? Pay attention and tell us if you’re having an especially hard week. We understand.

Russ:

So, you’re creating resources, and are working on that to put out there. Where else could a parent go for resources?

Jenn:

It has been really nice to see on Instagram, on Facebook, on YouTube. If you just type in a hashtag, “pediatric PT” or “PT” and your child’s diagnosis, you’re going to come up with tons and tons of research. There have been new groups made on Facebook for pediatric PTs for creative telehealth ideas. And, it’s been a really nice place to just share ideas and get creative. I use a pool noodle to do these five things, but I had never thought to do these other five things or, here are two things I usually do with bubble wrap, but this person in Montana had three other ideas.

Russ:

Are there any inexpensive tools of the trade that you might recommend for parents to purchase or get it delivered to help them?

Jenn:

A pool noodle, sidewalk chalk, bubbles, a ball. You’d be amazed at what you can do with very little. Painter’s tape for an inside obstacle course, that way it won’t scratch, mess your floors or your walls up.

Russ:

If you could pick one of those resources to recommend for a parent, which one of those would you send them to, do you think?

Jenn:

Probably YouTube, but sometimes those videos are a little longer, so they can really break the movement down if it’s something new that you’re trying. But if it’s an exercise that you’re normally doing in your telehealth sessions, ask the PT to make sure your kid is doing it right. And, record it so that you know how that activity should look, so that when you go back and practice it, you can do that.

Russ:

Do you ever encourage your patients and parents to video when they’re on their own and then share that with you?

Jenn:

Absolutely, especially if it’s a new skill that we’re working on. Take a picture. We want to see it. We are invested in your kid. We want to see that they’re continuing to move, and we want to just see them succeed.

Russ:

What resources would you recommend for physical therapists?

Jenn:

Facebook groups for PT’s have come up with the best ideas. For me, it’s the pediatric telehealth Facebook groups. It’s been a really nice place to just collaborate and share, and there are people from all over, so it’s nice to know it’s not just us in North and South Carolina in this position. Everyone is kind of in the same boat. One other thing I want to mention that is not therapy related at all, but I am feeling this very much with my own kids. Talk to your kids about why they are not coming to therapy. Reassure them every day that this is not their fault. Nobody is mad at them. They are not in timeout. They are not in trouble. That is not why they’re home. And, just reassure them—everybody’s home.

Russ:

You’ve given a lot of great information that will be helpful for parents, as well as other physical therapists out there. How can people find you and learn how to connect with you?

Jenn:

I have an Instagram and Facebook page. It’s Energize Therapy Services. And my last remarks are just to stay safe and stay healthy. Keep moving forward mentally, physically, everything, every which direction, just keep going. This weekend, I took the kids out. We needed to get out of the house. So, we did some socially distancing visiting with family in the area. And, we drew a sidewalk obstacle course at each neighborhood we visited, through the windows with the grandparents and just left each neighborhood with a little motor activity for anyone walking by to do. We’re all doing the best we can and have grace if you’re a PT. Have a little grace for your families and vice versa for us PTs. A lot of us just made the switch to electronic documentation a few years ago, and that was quite a challenge for some. And so, you can imagine this whole new level of technology is challenging for some families and some therapists, so just know we’re all just doing the best we can.

Russ:

Well, excellent. You’re a pleasure to talk to and a real joy, and we’re grateful. We look forward to connecting with you soon.

Ankle Foot Orthosis Initial Wear Schedule

Ankle Foot Orthosis Initial Wear Schedule

Suggested Wearing Schedule:

Your doctor has prescribed an AFO to address a foot and ankle issue. Because the AFO is made of a rigid material, it is important to get used to it gradually. Use the AFO as recommended by your doctor or therapist, and keep all of your follow up appointments.

Day 1 – Wear 1 hour on, 1 hour off, up to 3 times a day.
Day 2 – Wear 2 hours on, 1 hour off, up to 3 times a day.
Day 3 – Wear 3 hours on, 1 hour off, up to 2 times a day.
Day 4 – Wear 4 hours on, 1 hour off, up to 2 times a day.

At this point, move up to full time during the day. Inspect skin after taking the AFO off. Redness needs to go away after 30 minutes of removing the AFO. Wearing a long cotton sock protects your skin and shin from friction.

If you change shoes, be aware that you might walk a little differently. Try to stay with the same height of heel as the shoe you were fitted in.

If any issues arise with your Ankle Foot Orthoses, contact POI asap. Photos can be helpful if you are trying to decide if redness is normal or excessive.