Neurotypical is a catch all phrase for anyone who is not atypical. 

I prefer the term neurodiversity. 

Neurodiversity is another opportunity for us to make room in this world for children who are ‘different’. 

When I use the term different I’m referring to children who have challenges with either communication, mobility or understanding, or all of the above. 

The world will not make room for these children unless we, as the caretakers and the therapists, believe this wholeheartedly. 

Every child thrives with love, every child benefits from positive reinforcement/as well as understanding inhibitory cues. 

Every child enjoys interacting with something or someone at different points of the day. 

Every child has the ability to interact with their environment if we, as their caretakers and therapist can create an environment that is accessible to them.

If you will it, it shall be. Necessity is the mother of invention. 

Find and create a motivational and supportive team who shares your vision for your child. 

Think outside the box and constantly create opportunities to introduce new challenges, you may be surprised. 

Always, read your child’s cues and concentrate on activities that motivate them.

We are all different. We all have likes and dislikes. 

I believe that in the era of diversity, inclusion and acceptance, it is also a great time to create a platform for the world to start thinking more globally about education, product design and accessibility, and even clothes.

For example, there are certain major name brand shoe companies who have started to make shoes that can accommodate an AFO. WHY SHOULDN’T YOUR CHILD WHO WEARS AFO’S BE IN STYLE LIKE THEIR PEERS!! 

It’s often up to us to understand how each child is a capable learner and to adapt the environment in order to help them relay to use what they know in a verbal or non verbal way.    

Learning occurs throughout the day. 

It is a group effort form the teacher, an aide, a school, a community, therapists, friends, extended family and everyone who is in contact with your child to make their environment interactive and accessible because everyone will benefit from this mindset.   

This process starts at home. 

I know that these past several months have probably been the most challenging, and in some ways, the most rewarding times of being a parent of a child with special needs. 

How has your consistent attention and caretaking impacted your child? 

I bet you have seen some differences.  Keep your eye on the prize, but celebrate the small victories along the way. 

I’m just sayin, we’re all different. 

Technology and new products are making it easier to address these differences. 

Seek out a team of players that will support your vision to help your child achieve their potential. 

Check DIY websites of other creative parents. 

Make sure you take care of yourself (mind and body).

Try to celebrate these differences, see the potential in any of these differences, and march forward. 

I started this blog because I felt that parents had a lot of questions that went unanswered.

Wishing everyone a brighter year, a year that builds on the self-realizations of this year, a celebration of a child’s ‘neurodiversity’, and an ability to stay steady on this marathon of parenting a child with different needs because this may be one of your greatest challenges in life, as well as your greatest success!

You’re not in this alone. 

There’s no way to sugar coat the precariousness of this time in our children’s and our own lives.

We can’t look a week, a month or a year ahead, because we’re still unsure. Nevertheless, one certainty is that today brings a new opportunity for you to reach deep inside, to find that inspiration, and to make today count.

Each of us bears the ability to make ONE SMALL CHANGE. For some of us it may be to drink more water throughout the day, commit to stretching, to eat healthy, or to use our phones for less time throughout the day. However, there are those of us who face more dire challenges such as caring and nurturing for a medical involved child, a child on the spectrum or a child with multiple physical, social, emotional or cognitive challenges, and this letter is to you.

I’m sure you’ve learned a lot about your child over the considerable time that you’ve been cohabitating.  Many families report that they’re seeing some amazing results as the caretaker has become the primary provider for intervention.  I love that caretakers have learned their children’s rhythm, new likes and dislikes, new abilities; as well as other functional skills that are still difficult that may have otherwise have gone unnoticed.

Many times, if left to their own creativity, caretakers will come up with a solution for an area of need that the industry simply has not addressed, because it’s their own.  You know your child the best, and you know how to motivate them. Now that you’ve gotten over the initial shock and embraced the good and the bad of this existence, this could very well be the time that you create a new plan to move ahead for the foreseeable future.  What will your action item be?

If you could work on one skill that would change your child’s life, what would it be?

There are many resources out there, some with more and some with less validity.  While you’re perusing Facebook groups, Instagram, and Pinterest…I would still urge you to consult with a physiotherapist.  The wrong piece of equipment, the wrong time, or the wrong size may not only be frustrating to you and your child, but can be downright dangerous. Most physiotherapist are guided by evidence based information for decision making, combined with creative, out of the box solutions in real time, to help maximize the child’s function and quality of life.

Our mission is your child’s success. Success is relative to each child and that’s the discussion that you, your child and your physiotherapist should have. Create a plan today!  The confluence of practice, repetition, positive reinforcement and challenging the child’s system can make the ultimate difference in what your child learns today.  So, what shall we learn today?

What’s spasticity? Spasticity is an abnormal prolonged tightness of the muscle which is often as the result of some type of neurological condition.  As a result, movement can be difficult.  In order to move, opposing muscles on the opposite sides of a joint contract and relax, much like a pulley system.  When that pulley arm is shortened, it’s more difficult to generate force and movement can be difficult.

So, what to do?  Spasticity is chronic, and can impact play, function and self-care. This will look different at every age, and for every child. So, understanding some simple facts about spasticity is the most basic step, because knowledge is power.  Consequently, a rich conversation with your child’s specialists will lead to the best intervention.  Here are some facts about spasticity that are important for you to know:

There are many strategies and treatment methods to treat spasticity.

Simple things such as gentle and frequent range of motion, and positioning are encouraged.  Splints provide a prolonged stretch and can maintain or increase range of motion.  Depending on the age and condition of the child, knee immobilizers, night splints, serial casting and standing frames may also be appropriate methods of intervention that provide multiple physiological benefits. Please speak with a therapist or physician to discuss your options.

Spasticity can impact joint integrity.

When spasticity occurs over any joint for a prolonged period of time, the constant line of pull in one direction from spasticity may cause joint instability. If you hear any clicking, notice a leg length or arm length discrepancy, or if your child’s affect or mood changes, if they wince with active movement during bathing, dressing, or weight bearing, check with your pediatrician just to be safe.

Range of motion is important because for optimal positioning and balance a child should be able to achieve flat feet in sitting and standing.

Imagine sitting on the edge of skyscraper, with nothing under foot.  How stable would you feel?  Sitting in a child size chair, a highchair, on a stool, or on a bench…. Support underfoot helps support balance higher up on the chain. If your child’s feet don’t have support, get creative and create a platform for their feet.

It may not look pretty, but it’s still active movement.

We, as parents and as therapists, must celebrate any effort put forth by a child because that means they’re thinking, they’re trying, and active movement shows effort; every effort should be recognized as a success. With that being said, visual, verbal and tactile feedback on their movement may enhance performance.  Refining their movement is specific to each child’s abilities, so set realistic goals, start easy and increase the challenge to meet their abilities, aim for the sky, but always celebrate the small victories of participation.

Spasticity looks different at different stages of development

When a child presents with spasticity, it may take extra effort to move.  So, first and foremost, please consider the energy consumption that a child must exert to accomplish activities of daily living, self-care, and mobility changes.  Adapt the environment to make the child as independent as possible.  There are great new adaptive pieces of adaptive equipment out there to buy or borrow.  It’s just another way to support your child’s development.

I’ve been working with children for many years and spasticity always changes (based on the day, time, mood of the child, and whether the child is well, tired or sick).  More importantly, there are many ways to manage spasticity and remember that it will be a marathon, not a sprint.  Go slow and steady!

Raising a child with special needs comes with its own challenges and demands.

Every parent worries about their child and their well-being, but parents who have children with special needs get a little more of that, on a daily basis, especially during this time period.

It’s ok to feel that way, and it’s also ok to say it.  However, parenting a child with special needs almost morphs you into superwoman/superman.  You always muster enough power to charge forward and save the day, without stopping to think or feel.   You just get it done!

If you’re feeling overwhelmed and melancholy, you’re not alone.

We all must create some light in our lives during this dark time. If you have someone to share with, someone to give you a break, or someone that can support you emotionally, that’s great.  Meaningful interaction with other adults is vital during times like these.  Many of us are taking care of everything, all the time. I’m here to tell you that only you can make a change.  Just make one small change, during the day, each day, which is just for you.  On your ‘to do’ list, please add the following for yourself:

1. Identify a relaxation technique that you enjoy (mediation, contract-relax your muscles and start from your toes and work your way up, deep breathing, yoga, reading or gardening….). There are many free opportunities online.

2. Write a letter to your child about how they are special to you.

3. Get outside-Nature is cheaper than therapy.

4. Exercise- whether exercising means doing an online yoga class, a quick HIIT workout, or go for a quick 10-minute walk or run.

5. Touch base with an old friend or family member.

6. Make a list of the 5 positive changes you’ve seen in your children since the pandemic started.

7. Is there a project that you simply always wanted to do, but you haven’t?  Start it and dedicate a little time to this project every day.

8. Read a blog/write a blog- There are many communities out there. Find a group that you can identify with, a group that makes you laugh or cry, or where you can simply share.

There are so many things that we MUST DO each day.  Choose one or two things that you WANT to do today.  This is our new norm and we all have to create a “happy place” that serves as our respite.

I won’t preach to you about how you deserve this time, I’m urging you to keep yourself whole, the best way you can. I hope this blog planted the seed for a couple of changes that you can implement right now.  Only you can make it happen!

Dr. Sharon Galitzer, PT, DScPT, MS, CIMI

Pediatric physiotherapist

You should know about UDL – Universal Design for Learning

Every child has the potential to learn from their environment!  As a society, have we made it as easy as possible for these children to learn, play and move amongst their peers?  Probably not!

UDL (Universal Design for Learning) is a philosophy that creates an environment that everyone can access in order to learn, and then actively show that they have learned something from this exposure.

It is incumbent upon us (the caretakers, the family, the educators, the school, the stores, the transportation system, and the workplace) to be creative and design an environment that is accessible to any individual.  The changes that we make may be low tech or high tech, in school, at home or at work, and will look different at every age, but the concept stays the same.

The main principles of UDL are as follows:

1.  Teach or play in different ways. Use visual cues, auditory cues, tactile cues, sensory cues, and movement.

2.  Watch your child’s cues. Let a child show you what they’ve learned.  For the little ones, read their cues. For the older ones, this may be an art project, a written project or just a discussion.

3.  Provide support to keep child engaged and motivated

This will look different depending on the age of your child, their motor and cognitive abilities.  However, to help your child become an active participant in their environment some recommended strategies include:

1.  Provide adaptive seating, or upright support, as needed.

2.  Set up activity (work or play) for success! Make it easy, and then increase complexity and slowly implement minor changes to the set up.

3.  Ask your child show you that they recognized, enjoyed or want more of what you were doing. This may be drawing, writing, or acting for some.  This can also be by singing, moving, smiling, or looking to let you know that enjoyed that.

UDL simply gives each child the same opportunity to succeed by removing barriers AND creating opportunities for experiencing the world. Get creative!! Think UDL at home, share these successes with your child’s teacher and other parents, and hopefully this can pave the path for ongoing success. I promise you that your children will constantly surprise you if you set the bar high.

Dr. Sharon Galitzer PT, DScPT, MS, CIMI

Pediatric Physical Therapist

Teletherapy sessions is more than a feasible solution for the near future – it’s a win-win!

These past couple of months have probably been the most stressful of our adult lives.  By now, the sting of this new reality is subtle, and you’ve probably gotten into a new rhythm, a new schedule and a new norm. There are endless stressors (financial, emotional, social…) that we can identify, however I’m going to present a different narrative.

These past couple of months of staying in place have awarded parents the opportunity to be present for their children in a way that would have otherwise been impossible.

I’ve worked with many families, to coach them in strategies/activities/schedules to help them push through each day with their children.

Those are the same parents who’ve I’ve coached for the past several years.  However, NOW they aren’t busy with work, travel, transport, entertaining, vacation and recreation… just to name a few.  Now it’s all about filling time at home, until the end of the day, repeat.

Thus, parents are searching for fun, therapeutic and educational ways to play with their children.  All studies indicate that the greatest progress is achieved when parent’s carryover, and expand on, the exercises and activities that are done during therapy sessions.

The best progress is achieved when parents understand the goal of an activity and why the therapist is suggesting a specific activity, in order for the parent to simulate the activity and imbed it into their child’s daily routine.  In technical terms, which some may appreciate, parents are executing trials of blocked practice.

‘Practice makes perfect is not just a cliché’.

Blocked practice is described as practicing the same skill over and over again, which uses the same neuromotor pathways, which makes the connections between brain and body faster and smoother. Blocked practice is a great way to teach a new skill or to improve the quality of movement during a familiar skill.

My job has not changed, the way that I execute it has. During teletherapy visits, I observe the child’s movements, I analyze what muscles are working, which ones are not, and I recommend an activity that incorporates motor, cognition and communication.

The goal-oriented tasks are always a game or a fun activity that promotes independence, a better quality of life, or to gain a functional skill.  Because the parents are executing this, the parent also becomes a participant in active learning, which both empowers them and is most beneficial for the child because most parents will revisit that task at a later date.  We have all gotten more creative in using household items to create interactive and fun therapy sessions.

So, while this period of time is full of unknowns, I know that this can be a time of learning and fun and even progress! We’re all in this together is not just a cliché’, its reality.

Parents and physiotherapist working together have always been integral for a child’s success, now more than ever.  To the parents out there, I recognize that this is far from easy, but I want to thank you for making a tremendous difference in your child’s life right now.  Regardless of what’s keeping you up at night, every parent’s dream of doing everything we can for our children, is still being fulfilled!

This period of togetherness has given many parents to participate in therapy sessions and actually implement the carryover that the children need to learn and progress.

Dr. Sharon Galitzer, PT, DScPT, MS, CIMI

Pediatric Physical Therapist

Whether you’re in the US, Europe, Asia, Africa……we will have to live our daily lives a little differently than ever before.

Kids are home, caretakers may not be able to be available as much, family members may need our help, supplies are limited, and nerves are high.

Each of us has to figure out a way to push through the next couple of weeks.

I surmise that many of you are stressing that you won’t be able to access your typical therapy providers so here are some creative ways to incorporate active movement:

1. Keep up with school work

2. Create a healthy menu, cook or bake together.

3. Arts and crafts activities

a. In sitting- can promote range of motion for shoulders
b. While lying on your belly- can strengthen head and back extensors
c. Sitting on a swiss ball- can promote balance

4. Take a walk-whether you’re all walking or whether you’re pushing someone outside, it’s great to be outside. Just consider social distancing.

5. Practice yoga by viewing video through your cable network- make it a game, a competition, or a contest

6. Play outdoors (sidewalk chalk, finger paint on plexiglass, footprints on the grass, slip and slide, sprinkles)

7. Limit screen time to certain times of the day

8. Clean out closets and create a pile for donations

9. Post free items on your community list serve

10. Have a dance party (moving and stopping as the music is turned on and off, respectively).

11. 2×15 minutes of dedicated time to exercises to stay strong and flexible (if you don’t feel that you know what to do- google it. For example” Ideas for sensorimotor activities for 1 year old..)

We can’t change the reality of the situation; however we can surely change the narrative that goes with it.

Our children feel our angst, so think positive; take frequent mental and physical breaks.

Remember, this too shall pass!

Your child has been diagnosed with a condition and immediately you turn to the internet.

You probably read about numerous therapeutic interventions that may treat this condition, a clinician half way across the world who specializes in this, a specific diet or therapy intervention that has been shown to help some children with this condition, parent’s blogs or Facebook groups with a plethora of information.

What should we do?

First, as a physiotherapist, I’ll caution you that not all websites contain accurate information, so be careful where you’re looking.

Ask your physicians and other medical professionals for reliable resources.

As the parent of a child that has any medical condition, it is important that you understand the pathology and the long term effects of this condition.

It will definitely be surreal as you sit and listen to a physician explain the condition.

If you don’t understand what their saying, ask them to repeat and explain in it different terms. As a lay person, you may be unfamiliar with the medical terminology that is used.

Knowledge is power, and this will increase your ability to advocate for your child and their needs.

There will be numerous decisions to make, now and moving forward.

Be straight forward, and ask people to explain to you what they’re doing and why they’re doing it. Don’t worry about seeming ungrateful or annoying those people who are helping with your child.

Professionals will applaud your vested interest in your child’s care and hopefully they will initiate being more informative.

You may be referred to numerous specialists to confirm the diagnosis or create a differential diagnosis.

It’s beneficial to have one source to see all of your scheduled appointments (and those of everyone in your family).

This will prevent you from overbooking or overscheduling yourself during any day or week, and from creating schedule conflicts between professionals.

At the beginning of this journey it may be helpful to connect with friends and family for house chores, carpool, and respite breaks as needed.

Despite the turmoil occurring in your own life, people you know will show up because they care about you and this little person in your life.

Let them in, to your comfort level. It takes a village, and you’ll feel the benefits of creating your own little village, early on!

Being a parent is probably the most challenging and most rewarding job you’ll ever have in your life.

This may be overwhelming, nonetheless as a parent it’s amazing how strong we become when a little life depends on us. If you’ve read nothing else, let me leave you with these thoughts

Knowledge is power! It takes a village! Stay calm and march forward!