Parenting neurodiverse children often requires us to have contact with many different kinds of professionals. This creates, what can be, an overwhelming amount of appointments, and many appointments, that in and of themselves are overwhelming.
We often find it necessary to put children with autism spectrum disorders (ASD) into situations that make them especially uncomfortable in order to help them overcome some of the challenges they face. Finding solutions which make these situations a little easier for them, though complicated, can bring so much relief to us and our families.
For this article, I contacted someone who can help us understand one of those solutions: physical therapy (PT). I asked Melissa Perez, a Pediatric Physical Therapist, to answer some questions for us. Her answers can help us understand what options are available for physical therapy for kids, how PT sessions can help, and how we can help our kids feel more comfortable participating so they can benefit from physical therapy.
Q. Can you tell me about you and your background?
A: My name is Melissa Perez. I have been a Pediatric Physical Therapist since 2001 when I graduated in Brazil. I have been working for Sunshine Physical Therapy Clinic in Vero Beach, Florida for three years.
I just recently accepted the position of Department Head of Pediatrics for our clinic. Sunshine is a non-profit organization stabilized in 1953 and we provide PT, occupational therapy (OT), and speech-language therapy (ST) for adults and children. We proudly provide free services for seniors and children who cannot afford services, with the help of many sponsors.
It is a huge privilege to work for an organization that prioritizes quality individualized services for all locals in need. I also work for Treasure Coast Early Steps and as an independent contractor to provide home services to children from zero to three years of age.
Q. What are some of the challenges kids face that PT can help with?
A. Treating children is very different from treating adults. We do have some orthopedic, postural, neurological, and surgical issues, just like the adults, but the vast majority of children that seek PT services is due to developmental issues.
Developmental delays can happen for many reasons, such as:
- premature birth
- positioning in womb
- decreased muscle tone
- increased muscle tone
- lack of stimulation
- genetic disorders
- sensory issues
- neurological disorders
- without a medical cause
PT is crucial to help these kids overcome their motor delays and to help them develop their gross motor, visual-motor, and motor-coordination skills.
Q. What are some specific challenges kids with ASD face that can be helped by PT?
A. The majority of children with ASD present with decreased muscle tone, joint laxity (loosey goosey joints), postural problems, sensory issues, balance and coordination issues, muscle weakness, and gross motor delay. I am proud to say that I have witnessed physical therapy help many kids with ASD over the years to achieve their milestones. We cannot forget that kids with genetic disorders, such as Down syndrome for example, and children with Cerebral Palsy, can also have ASD associated.
Q. How does PT therapy work?
A. First, an evaluation is done to determine what kind of issues the child needs help with. It is protocol to use a standardized test to assess gross motor development, such as the Peabody Developmental Motor Scale and others. After that, we create a Plan of Care with goals and strategies according to each individual’s needs.
Treatment starts with activities and repetition of movements that will help the child:
- learn appropriate motor skills
- strengthen weak muscles
- improve balance
- develop playing skills
- promote motor development as much as possible.
We also rely on families to continue treatment at home with home exercise programs, postures, positions, and activities that will help maximize the rehabilitation process.
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If needed, we refer patients to an Occupational Therapist (OT), Speech-Language Therapist (ST), Developmental Optometrist, Early Intervention Services, Hydrotherapy, Orthopedic Doctor, or Orthotic Specialist, etc. At Sunshine, we are lucky to have a very cohesive team of OTs, PTs and STscommunicating, working together, and helping make the child’s treatment as unified as possible when the patient needs more than just PT.
Q. What are some of the favorite treatments/techniques for kids with ASD?
A. In PT, we use neurodevelopmental techniques for facilitation of gait and movement transitions, stretching/flexibility exercises, strengthening exercises, balance activities, gross motor activities, gait training, posture training, endurance exercises, sensorimotor activities, and coordination exercises.
Q. How can parents work with their child with ASD before their appointment to help ease anxiety?
A. Communication is key! Parents can contact the therapist beforehand and discuss the session to come, that way, parents will be able to inform the child of what to expect at the next session. Depending on the anxiety level, we sometimes have parents participating and exercising with us. I’ve even recommended in the past, that before an evaluation or the first day of therapy, the child visits the facility, meets the therapist, and sees other children in therapy. ABA Therapists (ABAs) and Registered Behavior Technicians (RBTs) are welcome to join as well.
Q. What are some things PTs do to help children with autism feel comfortable during treatment?
A. At our center, we use an activity board with pictures of each activity in sequence, so the kids know exactly what to expect one activity after another. We use communication devices, lights, breaks, music, bubbles, a weighted vest, a weighted blanket, compression, swinging, oral sensory chews, fidget toys, aroma therapy, vibration, and anything that helps the kids feel comfortable and helps them perform their activities and exercises the best they can. At Sunshine we are privileged to have a sensory room available which is full of sensory tools. Seriously, our sensory room is amazing! We have a vibration chair, bubble columns, lights, ball pits, a waterbed, aroma therapy, sensory steps, and several other sensory toys available to provide the sensory input needed by any kid.
Q. How important is PT for kids with ASD?
A. PT is very important to help kids with ASD develop age appropriate skills and keep up with their peers in strength, visual-motor-coordination, balance, and gross motor skills.
What is your favorite thing about PT?
My favorite thing about Pediatric PT is being able to help kids achieve their milestones in childhood as they have fun doing it. Not to mention the wonderful families I get to meet through the process, as many of them have become my friends and partners for life. I really think I have the best job ever!
How can parents find a PT near them?
Normally the easiest way is to contact their health insurance to see what professionals are in- network in the area. Also, a quick Google search helps to find professionals and you can see their reviews online.
Most, if not all physical therapists are trained to work with children when needed. However, a pediatric physical therapist is generally a good choice as they will work directly with, and specialize in, helping children.
For families wondering if their child needs physical therapy, or wanting to help their child understand what to expect, I hope what we learned from Melissa can help.
Something I took away from my interaction with Melissa is her enthusiasm for her job and for helping children. For any children with autism who are apprehensive about starting PT, knowing that their therapist cares, and is part of their team, can ease their minds.
There are facilities which provide a host of therapies available for children, all working together, in one place, to help kids. Finding the right PT is crucial.
Your insurance company may be able to help. Asking others for their recommendations can also help you know if the therapist available to you is going to be good for your family.
The internet can also be a great resource. Reviews from others who have experiences with the therapists recommended by friends, family, or insurance, can provide a good idea about the kind of facility, and staff there.
Resources for parents
Finding and securing professionals can be overwhelming. If you need any extra assistance, ask the professionals you already work with for help and recommendations. There are also special needs consultants available that can help you advocate for your child, and put you in touch with a physical therapist or other professional.
In the meantime, if you want to do all you can at home for your child, I encourage you to go to Autism Parenting Magazine, scroll to the bottom, and search for the particular challenge your family is facing. Chances are, the articles there will help you manage until, and even after, the professionals in your life can step in to help.