The Universal Design for Learning is where companies, products, and the physical layout can accommodate the widest possible range of people. This would include people with all different types of abilities and learning styles.  This is an important concept for so many reasons.  The first being accessibility. 

The ADA prohibits discrimination against an individual with special needs, the IDEA guarantees children in school a free and appropriate education regardless of their condition, but those regulations are just the beginning of creating a framework where individuals with special needs learn, work, and move throughout their community and workforce where appropriate.

The concept of Universal Design is more inclusive of everyone’s needs because it functions across product design, environmental setup, and being sensitive to small changes that can have a great impact on accessibility to more people.  If it’s good enough for a person with any type of limitation, then it must be good for an able-bodied person.  It’s easier to make modifications that take into consideration a variety of body morphology, motor abilities, and processing skills than to teach an individual to use a system with the skills that they may or may not have. 

In a time where equality is the topic of many discussions, there should be a special push for UDL to be considered in schools, product design, environmental structures, city planning, clothes, and most of all education.  Whether we refer to this as being culturally sensitive, a method for the design of products, or a learning principle instituted in education…the concept of UDL is to construct a model that requires little or no changes in a system but simultaneously affords accessibility to a variety of users. I don’t feel like that’s too much to ask for?!  

As a caretaker of a child with special needs, an educator, or a therapist, you know first hand the challenges that these individuals may face, often on a daily basis. My recommendation would be to get out and change the universe, one design at a time!

Dr Sharon Pediatric Physical Therapist

CAREGIVERS INTERACTIONS

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PARENTS BELIEFS AND PERCEPTIONS

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DEVELOPMENTAL OUTCOMES

Studies show that a parent’s perception of their child with special needs impacts the child’s social-emotional and cognitive development. There are many stressors for new parents, and even more so, if your baby was born prematurely or with a chronic condition. 

As an early intervention specialist, I know that the parent is integral to a child’s progress. I’ve worked with parents who believe in treating a child with special needs with kid gloves, and I’ve also worked with parents who believe in tough love and who create opportunities for challenges in motor, speech, and learning throughout the day.  It’s not surprising that a child progresses faster if a parent believes they are can handle challenges that are presented to them. Now, there’s finally a study that proves what I’ve seen for the last 25 years. 

A very interesting study out of the University of Nebraska Medical Center (UNMC) proved that a caretakers’ (this study examined mother’s only but I will go out on a limb and say that this can be generalized to all caretakers) perception often infants’ vulnerability impact the toys a parent choose for them, how often a parent interacts with their baby, and how often a baby is challenged.  As a result, a child may show lower cognitive, motor, and social-emotional skills later on.

It’s traumatic for a parent to see their baby in a NICU and hear all about the challenges that they may face in the future.  The study examines how maternal perception of their baby or themselves impacts a child’s development.  Results show that parents who perceive their babies as being fragile, or sick touch their baby less, change their position less frequently, and play with them differently compared to other children their age fewer a result, children have less opportunities to play, explore and interact with their environment.  In addition, babies who have parents who have less confidence, perceive themselves to be less competent to care for a child, and are more anxious have shown lower scores in areas such as movement, social-emotional development, and learning.

I won’t bore you with all the details, but early intervention specialists educate parents about their child’s condition.  With this knowledge, parents can better recognize a child’s abilities and potential and continue to create opportunities for movement, play and exploration throughout their day.  The more a baby experiences, the more they’ll feel and process.  Every experience is a learning opportunity from which to build on. 

Every child will face numerous challenges, some more than others.  As a parent of a child with special needs, the drive to help them be comfortable and happy may compromise their journey towards using trial and error, motor processing, being independent, and taking pride in one’s accomplishments. Believing in your child and challenging them may be the best thing you’ve ever done for them!

Dr. Sharon Pediatric Physiotherapist

There are many individuals who have different levels of comfort with children of different ages and differing abilities. 

Parents love their child, they enjoy being around them, but don’t really know where to begin to engage them. 

There is no ‘cookie-cutter recipe’ that can tell you how to play with your child, but the stages of play are ubiquitous for child development.

UDL- Universal Design for Learning is the concept that toys, clothes, shoes… are designed with accessibility in mind.Choose toys that can be used forL

1- Sensory exploration- Sensorimotor development is one of the first areas of the brain to develop for newborns.  The more a  child feels, the more they move.  The more they move, the more they learn.

The first stage of play is to feel, handle, explore and sometimes mouth toys. The baby will eventually push, bang, roll, and/or throw  toys.Babies explore toys through their hands and mouths

2- Discovery of cause and effect-First I do this…. Then……

A child learns that their actions result in an outcome.  For example, a pop up toy that is activated when they push a button. 

The child develops the feedforward/feedback system and can anticipate that when they do something specific, a specific action occurs. 

On the most basic level, this teaches a child that they can have an impact on their environment .

3- Imagination and creativity- the next level of play involves discovering new ways to use a toy.  This creativity is the result of participating in activities of daily living, interacting with their peers and family members, and exploring their environment. Little ones will begin matching, sorting and creating new fun ways to use toys, their bodies and their voices. 

4.  Transfer these skills to another setting, and build on them.  A sign of learning a new skills is when a child can master a skill, take what they’ve learned in one setting, and generalize it to a different setting. 

Then the toddler modifies, adjusts and refines their decision making based on their many experiences (trial and error) .

Play is the best way to learn. 

Play can stimulate hand eye coordination, vision, motor, sensory, proprioceptive sense and more. 

Every child can explore toys, it’s up to us to set up their environment in order for them to have easy access to these toys!

While there are many ‘specialty products’ out there, some companies have taken UDL (universal Design) and accessibility to heart. 

More and more mainstream companies are considering different body types, but now they’re also starting to consider different body abilities with respect to donning and doffing clothes and shoes. 

I have actually gone shopping with some parents to help them sort out the pros and cons of each type of shoe for their child’s AFO, SMO or Sure Step.

Getting shoes on and off does not have to be an ordeal of pushing and shoving the heel down, or to torque the lower leg at just the right angle to slide the back of the shoe on.

I have identified a couple of user-friendly brands for parents and kids to use that are easy to get on and off, fashionable and mainstream (ergo, the cost is not inflated as it is for other specialty items like socks!!).

I’m sure there are more that I still haven’t found out about!

• Plae Adaptive-Friendly Sneakers- easy to get on and off. Straight last fit. Nice pull tab in the back.  Removable foot pads to allow for extra room. No heel rise.

• Ikki shoes for little ones who are toe walkers have a squeaky heel that gives auditory feedback to children who can strike with their heels.  If the sound is driving you nuts, or if your child starts to ambulate with a foot flat or heel-toe gait pattern, you can simply slide a small disc and turn the valve off.

• Smart fit sneakers are wide, have a straight last, and are flexible. They come in regular styles and high tops. 

• Nike Flyease – Nike has been producing sneakers with a variety type of end-users in mind.  They have truly come up with some great styles that can accommodate AFO’s but also accommodate a child who has motor limitations in their hands due to weakness or spasticity.  Great pull straps to make donning and doffing shoes an independent ADL skill! Nike obviously has someone on staff who is thinking about Universal design, which turns out to be cool!

• Billy footwear has been around for a while and has a variety of styles and designs.  They’re priced a little higher than some sneakers but I will vouch for the durability of this product.

• Don’t discard Payless, Walmart and Target!

I hope I gave you some leads that can make your life easier.

You may just be starting this journey or you may have some great ideas for other parents as well about these types of finds.

The shoes described here are just a few examples of shoes that can solve the problem of the extra girth and dexterity that is required for an AFO wearer, with the hope that if designers create a good product, it should be accessible to everyone.  Right?!?

Looking to make this world better for us all.

All this together time at home has afforded parents a lot more time to be involved in many aspects of their child’s daily lives. 

Whereas in the past, many parents have often left their home early in the morning, only to reunite with their children 6 or maybe even 8-10 hours later.

Parents have gained easier access to their children by being in and around the house during wake hours and taking more of an active role in day to day and recreational activities.

In many homes, this extra time together has had a positive impact on teaching a child self-regulation skills.

Recent studies have shown that fathers generally engage in more physical play with their children. 

The University of Cambridge has found that this type of play helps a child develop self-regulation.

Parent-child play in early years generally focuses on cognitive and communication skills.

However, even with babies, fathers were found to move limbs up, down, and around. 

Then as the child grows, fathers are found to engage in games such as tag, play wrestling, tickling or chasing one another. 

This type of play typifies a rhythm where there’s a quiet time, an unanticipated movement or explosive sound, and then the cycle repeats. 

The parent generally monitors the child’s reaction and modulates their response based on their findings.   

Simultaneously, from the child’s perspective, a child must anticipate the antecedent, receive and integrate the information, and then wind down in preparation for the next cycle. 

Rough play with your child is in no uncertain terms a sensory experience to the max and another way to teach your child self-regulation.

The sounds, the movement, the tactile touch, be it a squeeze, tickle, or swing, can be very stimulating to any body. 

In a circuitous way, rough play actually trains a child’s self-regulation as they anticipate, and then regroup from, each wave of tactile, auditory, and visual stimulation. 

Longitudinal studies have shown that children who have experienced rough play develop better self-regulation skills when they start school. 

*I acknowledge that the label of  ‘father’ is arbitrary as I know that the family unit can look many different ways. Just to clarify this is not a political nor a social statement.

By now, you’re probably very familiar with teletherapy; as interactions with therapists, doctors and schoolS have become virtual.

You’ve probably also developed an opinion about the efficacy and feasibility for this delivery model as another option for the future. I’m here to either reinforce or sway your opinion, depending on which camp you reside.

There’s no way to replace hands on intervention, but I have found great success in supporting families and caretakers through virtual visits. 

We look, listen and reassess on a consistent basis. 

We want to know what’s working and what’s not working. 

Then we provide you with a slew of solutions. 

Virtual visits, while seem very cordial and laid back from my dining room, are actually a real time analysis of your child’s movement and carefully chosen instruction and videos to help you help your child until the next time we meet. 

Prior to, and following your child’s visit, I’m online researching, writing, collecting resources and connecting with other professionals on your child’s behalf. 

Prior to a visit, I review the child’s online record and I make sure that I share evidence based strategies with you to get your child closer to that end goal. 

I try to find YouTube videos that accurately relay information, websites that have factual information, and images of therapeutic exercises that will demonstrate how you can be my hands.

During every virtual visit, a therapist can help you solve day to day challenges in caring for a child with special needs and provide you solutions and resources in real time because we’ve done this so many times throughout our careers. 

Even though virtual visits can never be a substitute for hands-on intervention; from a therapist’s perspective, seeing a child in their natural environment has often offered us an opportunity to incorporate toys and objects that you already use during play.

We’re also missing fewer appointments because there are fewer schedule conflicts. 

I hope that your outings can be to the park or trail instead of to therapy. I hope that part of your down time at home can be filled with an activity that brings you joy and relaxation. 

I wonder if simulating the use of everyday items during our sessions has increased the probability of you practicing a skill more often, in the same way, at a later time.

I also wonder if you have more time to spend with your other family members, feel less stressed about getting your child somewhere on someone else’s timeline? 

It’s important to let your therapists, teachers, congressmen and local health agencies know what has worked and what hasn’t worked so well from a first person perspective in order to have a voice in building a successful working model for the future. 

I mostly want you to know that we don’t just ‘show up’ to our visit. 

There’s a lot of thought that goes into our time together, even when we’re not together!! 

Envision someone strapping you into a hang glider and asking you to jump off of a cliff? 

Of course, you’ve seen it in the movies, you have a good idea of what it should look like, but you’d definitely perform better had you completed a couple of practice runs prior to that event, in order to be familiar with what it feels like.  

What does it mean? 

Body awareness and proprioception are integral to know where one’s body is in space relative to their surroundings and which part of one’s body should be activated in order to move within that space.

This information is obtained from numerous environmental and sensory factors. 

From superficial to deeper layers, there are skin, joint, muscle and brain receptors that sort and process all of that information. 

If this information is limited by weakness or tightness, some children may not experience movement as frequently, in its fullest ranges, at a variety of speeds, or in a variety of positions. 

As a result, their active movement may be impacted.

What can we do?

Parents and therapists use massage, ball pools, weighted blankets, vibrating toys, and variable sensory materials to provide that information to a child’s body.

In addition, active movement in space such as gentle rocking, swings, and balance boards also provide vestibular stimulation, which is another piece of information that can stimulate the brain and facilitate movement. 

We are moving beings in an ever-changing world. 

I highly recommend exposing any child to a variety of positions and a variety of sensations in order to stimulate the body’s sensorimotor system and to help them assess where they are in space from that basic information. 

Why is it important? 

If a child does not have enough body proprioceptive awareness they may feel like they’re falling in space, or dangling 20 feet high on a ledge. 

As a result, we may see quick, jolting, bursts of movements against a surface, or even a person. 

These experiences can accompany feelings of angst and stress and may predicate socially undesirable behaviors. 

It’s calming to have a solid sense of where one’s body is in space and how to activate one’s body to stay in that space is integral for balance, coordination, and gravitational security. 

THEN, we move on.

Any or all of the above sensory strategies can provide important information to a developing mind in order to improve body proprioception and yield many benefits. 

It’s a new beginning to a new year.

Therefore, I’ve decided to approach active movement in space by starting at square one- at this point in time, I’m sure you would concur that one must know where they were, and where they are, to plan their next move!!