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What is Toe Walking?

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Toe walking means that a child is walking and standing on tiptoes, and their heels do not make contact with the ground. Walking up on their toes can be a normal occurrence in children aged three and under as they continue to develop their ability to walk. Beyond that age, without any definitive medical reason, it is considered idiopathic toe walking (walking on toes without a known cause).

Toe Walking Causes

To understand, what’s not so simple about toe walking is the why behind it. There are many possible reasons that children might develop this pattern:

Developmental phase: A child occasionally walking on the balls of their feet can be part of normal development.  When children first begin walking, usually between 12-15 months of age, they often try different foot positions including walking up on their toes.  However, it is expected that typically developing children will only walk on their toes occasionally.

Neurological concern:

  • Sensory processing concerns: Children with sensory issues, including those on the Autism Spectrum related to the vestibular system, have a different awareness of their body position and feel stabilized during toe walking. The tactile system includes our sense of touch, pain, and temperature. Some studies conclude that children with differences in vestibular processing can also have tactile senses that exacerbate their toe walking. They may not like the feeling of the floor touching their feet, and toe walking minimizes this contact. Children seeking proprioceptive input toe walk because the gait prolongs stimulation of joint receptors and causes their muscles to tighten. The movement provides a calming input sensation for the child. (Williams 2010)
  • Cerebral Palsy: The most common cause of toe walking in those with cerebral palsy is spasticity, which can cause stiffness and involuntary muscle contractions in calf muscles, keeping their heels from touching the ground. Over time, without proper stretching and bracing, these muscles can become shortened, making it challenging to achieve heel contact. 

 

Idiopathic toe walking: Toe walking can occur because of an underlying anatomic or neuromuscular condition, but in most cases, toe walking is idiopathic without a discernible underlying cause. Idiopathic toe walking occurs in children between 3 and 7 years old and is more commonly seen in males than females. Idiopathic toe walking is not related to any specific diagnosis and can presenty of reasons, due to a variet including decreased stability and sensory involvement. For some families, toe walking may be a cosmetic concern, whereas it can cause pain or functional issues in other cases. (Ruzbarsky, Scher, & Dodwell, 2016)

Treatment

You may wonder how to stop toe-walking with your child. Therapeutic treatment depends on the cause, how strong of a habit it is, how tight the calf muscles have become, and what other changes have occurred in the child’s foot and ankle due to walking this way. 

Treatment can include:

  • Stretching: To improve muscle length, increase ankle mobility, and promote heel contact
  • Orthoses: Ankle-foot orthotic worn to keep the foot at a 90-degree angle and promote heel contact
  • *Turtle bracing: New bracing technique utilizing a removable, re-moldable, lightweight brace to achieve optimal ankle positioning, obtain and maintain ankle mobility, and promote heel contact
  • Serial Castings: Hard cast used to obtain and maintain a 90-degree angle at the ankle joint for extended periods (1-2 weeks at a time)
  • Night splints: Braces worn at night to keep the foot in a 90-degree angle and achieve prolonged stretch
  • Botox injections are most commonly used with those dealing with spasticity; they weaken their calf muscles and make them easier to stretch and cast.

A careful history, clinical exam, and selective diagnostic testing can be used to differentiate between different types of toe walking and determine the most appropriate treatment for each child. 

 

How Can Carolina Therapy Connection Help with Toe Walking?

Being evaluated by a Physical or Occupational Therapist can further help determine which treatment routes are appropriate for your child. Call us today at 252-341-9944 for a free screening! 

 

By: Taylor Saunders

 

Stuttering: Developmental or Disordered?

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Stuttering in children is a speech disorder characterized by disruptions in the natural flow of speech. Developmental stuttering is a common experience, typically emerging between the ages of 2 and 5 when children are first learning to speak fluently and developing a large repertoire of words, phrases, and sentences. While many kids experience a phase of disfluency in their normal speech development and may outgrow it, some might continue to stutter as they grow older. In this case, speech therapy may be recommended.

 

 

Causes of Stuttering in Children

The exact cause remains unclear, but it’s believed to arise from a combination of genetic, neurophysiological, and environmental factors. Children with a family history of stuttering are more likely to develop it. Some kids experience stuttering due to differences in brain structure or function related to speech production. Emotional factors like stress, pressure to communicate quickly, or a hurried environment can also increase stuttering. Stuttering occurs at the initiation of voice, which is why we typically hear disfluencies at the beginning of words and phrases.

 

According to Johns Hopkins Hospital, A child is more likely to stutter if he or she has:

 

  • A family history of stuttering
  • Stuttered for 6+ months
  • Other speech or language disorders
  • Strong emotions about stuttering or family members with fears or concerns

 

Types of Disfluencies

Stuttering manifests in various ways, such as repetitions (repeating sounds, syllables, or words), prolongations (elongating sounds), and blocks (inability to produce sounds). These disruptions can lead to tension and anxiety, causing the child to avoid certain words or situations where they might feel pressured to speak.

 

Speech Therapy for Stuttering:

Speech therapists play a crucial role in assessing, diagnosing, and treating stuttering. Here are some primary approaches utilized in speech therapy:

 

Speech Modification Techniques: Therapists teach children to use gentle starts to sentences, and employ smooth, relaxed breathing patterns. This helps in reducing the frequency and severity of stuttering moments. Continuous phonation, for example, is a technique where speakers learn to keep their voice on and vocal folds vibrating throughout speech. 

 

Fluency Shaping: This technique focuses on reshaping the child’s speech patterns by teaching smoother speech movements. It involves controlled breathing, gentle voicing, and gradually increasing sentence length to enhance fluency.

 

Stuttering Modification: This approach concentrates on changing the child’s emotional and cognitive reactions to stuttering. It involves desensitizing the child to the fear and anxiety associated with stuttering and teaching strategies to manage and accept disfluency.

 

Parental Involvement: Educating parents about stuttering and how to support their child’s speech development is key to increasing the child’s success. Therapists often teach parents techniques to practice at home, creating a supportive environment for the child’s progress.

 

Communication Skills Training: This includes enhancing overall communication skills, like turn-taking and using pauses effectively. It helps in building the child’s confidence and reducing the pressure associated with speaking.

 

Long-Term Outlook

Many young children outgrow developmental stuttering; however, some might continue to stutter into adolescence and adulthood. In such cases, ongoing therapy, support groups, and strategies for managing stuttering in social and professional settings become vital.

 

How can Carolina Therapy Connection help?

Children who sutter often benefit from therapy from skilled Speech-Language Pathologists. Stuttering in children is a complex speech disorder that necessitates early intervention and specialized therapy. Speech therapists employ a variety of techniques focusing on speech modification, emotional support, and overall communication enhancement to help children manage and, in many cases, overcome stuttering. Family involvement and a supportive environment are fundamental in the child’s journey towards improved fluency and confidence in communication. At Carolina Therapy Connection, our treatment is highly individualized to your child’s needs. A standardized assessment will be administered to detect any disfluencies, and our therapists will work with you and your child to develop a plan for enhancing skills to build confidence across all social environments (home, school, social groups, etc). If you have any concerns or questions regarding your child’s development, call our clinic at (252) 341-9944.

 

By Ashley Holloway, MS, CCC-SLP, CAS

 

 

Navigating Neurodivergence

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How Occupational Therapy Helps Different Brains

Occupational therapy has long been recognized as a vital therapy for providing neurodiverse individuals with the tools and strategies to lead fulfilling lives. In recent years, the focus on neurodivergent occupational therapy has gained momentum, emphasizing the unique needs and strengths of individuals with neurological differences. This blog aims to explore the transformative role of occupational therapy in supporting neurodivergent individuals on their journey toward independence, empowerment, and a higher quality of life.

 

Understanding Occupational Therapy for Neurodiverse Individuals

Occupational therapy helps neurodiverse individuals by helping them discover who they are, what they can contribute to society, and how they can live their best life.  We start by making a personalized plan with the individual on how to make their life easier for them. 

 

Taking Care of the Whole Person With Occupational Therapy 

Occupational therapy looks at everything – the body, the brain, feelings, and even how someone experiences the world around them. It’s important to consider an individual’s life’s physical, cognitive, emotional, and sensory aspects.  Together with the individual and caregivers, occupational therapists take a holistic approach to help figure out what areas of their lives are challenging and what are their strengths.

 

Making Senses Work Better

It’s common for neurodiverse individuals to have differences in how they experience sensations in their world- they may feel sensitive to things like touch or sounds. Occupational therapists work to identify sensory sensitivities or challenges and implement strategies to regulate and adapt to different sensory inputs. For example- working with the individual to develop adaptive strategies for sensitivities related to food textures and picky eating. Occupational therapists can help progress through different food textures using various techniques that first start with foods the individual can tolerate and eat frequently.  Then, we start adding foods that are similar in texture, color, size, etc.  

 

Skill Development and Independence

Occupational therapy helps learn practical life skills, social skills, and executive functioning abilities.  It could be learning how to tie shoelaces or even making friends. It’s essential to take a strength-based approach to help build trust, confidence, and independence with daily tasks that allow them to engage in meaningful activities.  A strength-based approach is when an occupational therapist builds upon a person’s strengths instead of focusing on their weaknesses.

 

Family and Community Involvement

Families and friends are essential in the therapeutic process, too! Occupational therapists work with families to implement strategies at home and collaborate with community organizations and schools to create supportive spaces for neurodivergent individuals.

 

Technology and Innovation in Therapy

It’s common for a neurodiverse individual to process information differently than we expect; therefore, it is important to utilize various interactive tools and technology to enhance the therapeutic experience and cater to individual needs. Many apps and digital devices are available to help create independence in daily tasks.  Occupational therapists look at ways to support learning through apps, games, and other devices.

 

How Can Carolina Therapy Connection Help With Neurodiverse Individuals?

At Carolina Therapy Connection, all of our therapists are neurodiversity-affirming.  They recognize that neurodivergence is not an illness or disability that needs to be corrected or fixed. They recognize that neurodiverse individuals come with their own set of strengths that can be fostered. Occupational therapy can have a transformative impact in empowering individuals to overcome challenges, embrace their strengths, and lead fulfilling lives.  At Carolina Therapy Connection, we believe it’s all about making sure everyone, no matter how their brain works, can be a part of the fun and excitement in life!

 

 

 

What is AAC?

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AAC stands for Augmentative and Alternative Communication. It encompasses all of the ways in which an individual may communicate outside of speaking verbally. Augmentative communication means to add to someone’s existing speech skills, and alternative means to be used in place of verbal speech. There are many different kinds of AAC including, but not limited to: gestures, facial expressions, writing, pictures symbols (e.g., picture exchange communication system/ PECS), drawing, sign language, high-tech speech generating devices, communication boards, etc. Some people may use one of these modalities, and some may use multiple modalities depending on the way in which they can most quickly and clearly communicate the topic.

Who Needs AAC?

Many different people use AAC throughout their lifetime. It can be used across the lifespan by any age, at any time, and for a variety of different reasons. Some people use AAC for their entire life, and some use it for only a short period of time. AAC can help any person who has difficulty fully or partially meeting their daily communication needs such as expressing wants and needs, socializing, asking questions, and a variety of other functions.

 

 

How can AAC help your child?

AAC may be able to help your child if they have difficulty being understood by others, have a limited vocabulary, demonstrate limited spontaneous speech, are non-speaking, and a variety of other different reasons. There are no prerequisite skills to your child beginning to use AAC. One common misconception is that AAC will hinder language development or cause your child to become dependent on it for communication. While some children may have minimal to no verbal speech throughout their lifetime, there is research to show that AAC can actually help children to develop language. Using AAC can also help to reduce frustration surrounding communication attempts, and help your child to communicate their needs more clearly, quickly, and effectively.

 

 

Parent’s Role in AAC

When introducing AAC to your child, it is important for family members/ caregivers to make the commitment to help the child succeed with the chosen AAC device. Your input is crucial in helping to choose and develop an appropriate AAC system, and using the device at home and in the community is a vital step to help both you and the child continue to learn the system. According to Jane Korsten, SLP, the average 18-month-old has been exposed to 4,380 hours of oral language at a rate of 8 hours/ day from birth. A child who has a communication system (AAC) and receives speech/language therapy 2 times/week for 20-30 minutes will reach the same amount of language exposure (in their AAC language) in 84 years. It is our role as professionals and caregivers to help minimize the communication gap between oral language users and AAC users. 

Modeling:  Modeling is an awesome way to both learn your child’s AAC system, and teach them an example of how they can use it. The best way to model is to speak and use the system at the same time, although you do not always have to select an icon for every word you say. For example, you may verbally say “time to go to school” while modeling “go” and “school” on the AAC system. A general rule of thumb is to model the number of icons your child is currently using, plus one. If your child uses 1 icon at a time, you may choose to model 1-2 icons at this time. It is important to model without expectation, meaning that you use the AAC system without expecting or requiring the child to respond, withholding items or activities, or “testing” their skills. The goal is to provide an example to the AAC learner, which they will then learn by watching and listening to what you do/say.

 

How can CTC help you and your child?

Whether your child is already receiving speech/language therapy services at our clinic or not, CTC is ready to help support both parents and children through their own individual journey with Augmentative and Alternative Communication. If you believe that your child may benefit from the use of AAC, talk to one of our many incredible speech-language pathologists to begin the process of figuring out what type of system (no tech, low-tech, mid-tech, high-tech) will work best. This process can take time, but with your support and the support of your SLP, it is possible to find the right system for your child! 

Down Syndrome Awareness Month!

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October is filled with so many exciting things, the start of fall weather and holidays approaching; but did you know that October is also Down Syndrome Awareness Month? Established for over 40 years, it is a time to recognize and celebrate our friends with Down Syndrome and the amazing abilities they have!

 

What is Down Syndrome?

Down Syndrome is often called Trisomy 21, though there are actually three types: trisomy 21 (nondisjunction) which makes up 95% of cases, translocation (4%), and mosaicism (1%). It occurs in approximately 1 out of every 691 births, and more than 400,000 people are living with Down syndrome in the United States. These individuals are born with an extra copy of the 21st chromosome. They are able to work, go to school, develop meaningful relationships, make their own decisions, and participate in society however they wish! According to the National Down Syndrome Society, “Quality educational programs, a stimulating home environment, good health care, and positive support from family, friends, and the community enable people with Down Syndrome to lead fulfilling and productive lives.”

 

You are welcomed here!

Here at Carolina Therapy Connection, we are honored to serve our families who have children with Down Syndrome! One of our special friends, Hannah Hill, has made tremendous progress in her therapy. Her mother stated, “Because Hannah is very verbal, people often ask me if she has a ‘mild’ case of Down Syndrome. It’s not commonly known that there is no ‘spectrum’ of Down Syndrome! You either have it or you don’t! While the extra chromosome does impact their lives, people with Down Syndrome are unique, and have their own strengths and weaknesses. They have physical features, personality traits, abilities, challenges, interests, successes, and failures just like everyone else!”  

Hannah: Age 8

 

How can therapy help?

  • Speech therapy services provided by a speech-language pathologist reap great benefits. Many children with Down syndrome develop language later than same-age peers. Low muscle tone could also impact the ability to produce speech sounds accurately, and therapy is paramount to helping a child develop the ability to confidently and effectively communicate their thoughts, feelings, wants, and needs. SLPs can provide assistance with prelinguistic and oral-motor skills, as well!
  • Physical therapy can help a child with Down Syndrome starting at a young age to increase strength and gross motor development. From rolling and sitting, to developing an efficient walking pattern, and even participating in sports, physical therapy can make a huge difference in a child’s life. In a physical therapy session, our PT’s will focus on things such as: gross and fine motor development, balance, coordination, and age-appropriate daily living skills. 
  • Occupational therapy can assist people with Down Syndrome in learning to complete many everyday tasks. Occupational therapy will provide support specifically in three areas, motor, cognitive, and sensory integration. Specifically, an occupational therapy session may include activities that promote self-care, fine motor, play, and social skills!

 

A Total Communication Approach 

Many parents are excited to begin therapy and learn ways to promote and enhance communication for their children. According to our colleagues at the Boston Children’s Hospital Down Syndrome Program, a Total Communication Approach can be beneficial! The Total Communication Approach means using any functional means of communication; this could include: verbal speech, ASL, gestures, pictures, and/or simple or high-tech communication devices. Many children with Down syndrome are visual processors, and the goal of Total Communication is multi-sensory (i.e., visual, auditory, tactile, etc.) in order to encourage any form of expression. What are some ways to facilitate this approach at home?

  • Visual input: Pointing to objects and pictures that you are naming or describing. 
  • Use sign language for basic words (eat, want, bath, play, etc.). Research shows using signs increases understanding and offers an additional method for communication. 
  • Incorporate music into pretend play.
  • Joint book reading. Follow your child’s lead!

 

How can Carolina Therapy Connection help?

Children with Down Syndrome often benefit from therapy from skilled professionals, including speech-language pathologists, occupational therapists, and physical therapists. At Carolina Therapy Connection, our treatment is highly individualized to your child’s needs. A standardized assessment will be administered to detect any delays, and our therapists will work with you and your child to develop a plan for enhancing skills to  build confidence across all social environments (home, school, social groups, etc). If you have any concerns or questions regarding your child’s development, call our clinic at (252) 341-9944.

By Ashley Holloway, MS, CCC-SLP, CAS

Is My Child Ready For Potty Training?

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Is My Child Ready For Potty Training?

Many parents ask the question, “Is my child ready for potty training?” Making the transition out of diapers is an important developmental milestone but it can also be a topic that causes frustration and anxiety for both children and their caregivers. Questions about when to start and how to promote a child’s success with potty training can feel overwhelming. If you are a caregiver that can relate to any of those feelings, this blog post is for you!

When Should I Start Potty Training?

This is a question that many caregivers ask themselves. A variety of factors must be considered before initiating the toilet training process. A child must be physically, emotionally, cognitively, and physiologically ready prior to  starting the process. Here are some tips to identify whether your child may be ready:

Emotional readiness – Can your child tolerate sitting on the toilet or potty training seat? Are they excited about wearing “big kid” underwear?

Cognitive readiness: Can your child follow 1-2 step directions? Can they communicate their need to use the restroom?

Physiological readiness: Are they able to stay dry up to two hours at a time or wake up from a nap with a clean pull-up?

Physical readiness: Is your child able to sit on a toilet or potty training seat without assistance? Can they get on and off the toilet with little to no assistance? Can they assist with managing their clothing during toileting tasks?

potty training, occupational therapy, tips and tricks of potty training

If you have said yes to the majority of the above questions, then your child may be ready to begin potty training! 

At what age can I expect my child to start potty training?

 The following list includes general guidelines to help establish a baseline of where a child might be on their journey towards potty training. However, each child has a different timeline in which they are emotionally, physically, cognitively, and physiologically ready for potty training. It is vital that you never push a child towards progressing through the developmental sequence. If you see meltdowns or signs of regression, it may be best to take a break and try again at a later time.

 

Developmental Sequence for Toileting:

1 year – Children indicate that they are wet/soiled through non-verbal signs of distress

2 years – Child begins to tolerate sitting on the toilet

30 months – Child communicates that they need to use the bathroom and will likely require assistance with managing their clothing and wiping

3 years – Children will initiate using the toilet independently. They may attempt to wipe but continue to require assistance for thoroughness. 

4-4.5 years – Children may have a few accidents. They are able to manage their clothing independently. 

5 years – Child is able to complete a full toilet routine independently, including washing and drying their hands. 

5-7 years – Children are consistently able to stay dry throughout the night. 

 

Tips to Help Progress Through the Potty Training Process

  • Make potty training FUN!

Whether it is the sound of the toilet flushing or the new environment, some children may have a fear of sitting on the toilet. If a child is anxious, they may be hesitant to sit on the toilet or may not even tolerate sitting on it. One method to help ease this transition is to allow the child to play with their favorite toys while sitting fully clothed on the toilet. Another method to make potty training fun is to invite the child into the process. You can do this by allowing the child to pick out their underwear and ask them to choose their potty seat. This helps address their newfound need for autonomy and allows them to take pride in the potty training process. 

  • Consistency is key. 

Establishing a consistent routine will help minimize a child’s accidents and increase their likelihood of using the toilet successfully. A general guideline is to prompt the child to sit on the toilet as soon as they wake up, after naps, and in two hour intervals throughout the day. Encourage your child to sit on the toilet for a few minutes at a time. It can be helpful to read a story to them while on the toilet or provide them with a preferred toy to make this time fun and engaging.

  • Know the signs. 

If a child is squatting, holding their genital area, or fidgeting, they may need to use the bathroom. Prompt the child to sit on the toilet when these signs occur. This can help the child become familiar with these signals to increase their ability to identify these signs as well. 

  • Celebrate the small victories. 

It is important that parents and caregivers build up a child’s confidence and self-efficacy during the potty training process. Caregivers can do this by providing their child with positive praise and celebrating the small victories! Some examples of this include praising their child for sitting on the toilet, communicating that they need to use the bathroom, successfully using the toilet, and completing all other steps in the toileting sequence (ex. Pulling up their pants, flushing the toilet, washing their hands). Sticker charts can also help motivate children to use the bathroom by providing them with a tangible reward to work towards!

  • Know there will be accidents. 

In combination with Point 4 above, it is important to know that accidents will happen and how to respond when they do. Never punish a child for soiling their clothing. Instead, always be prepared with an extra set of underwear or clothing, especially when going out in the community. 

You can find more tips on the potty training process here!

 

How can Carolina Therapy Connection Help?

If your kiddo struggles with self-regulation, completing their daily activities, or meeting developmental milestones, call our clinic at (252) 341-9944! Your child may benefit from an occupational therapy screening or formal evaluation!

Blog By: Emily Britt, OT