This week’s guest contributor: Life from the physical therapists point of view

I am honored and proud to introduce you to my fabulous friend J (Jean) as this weeks guess contributor. Jean is a pediatric physical therapist, who works with a growing population of children with ASD, and other disabilities. Jean is a mom to two beautiful children, including Willy’s best girl E. Jean will always hold a special place in my heart for a million and one reasons, but the number one reason she connects so well with my son, is because she gets it. She always has, and you can see it every time she and my son interact.

Jean holds her expectations high for her clients, because she knows that they can do it. And besides instilling self-confidence and self-reliance, Jean also believes that physical therapy should be fun! Calming even. She knows the right questions to ask her clients parents during the evaluation process, and heavily rewards them with positive reinforcement, high-fives, fist bumps, etc.

Please enjoy the article that Jean has written, along with the two websites that she has provided for you. If you have any questions or comments regarding pediatric physical therapy, please feel free to ask her, and I will forward them to her so she can get back to you in a timely manner.

Why does a child with autism need physical therapy??? This is a question I have gotten from from some of my colleagues that do not work with pediatric patients… This was also the question I planned to address in this blog. However, as I started writing, my story took a different turn. Maybe Jill will honor me at a different time by allowing me to write again…

What does an out patient physical therapist do with a diagnosis of autism? Well, evaluate and treat, of course!
Our main focus is decreasing tone, increasing balance and coordination.
However, even though it’s not part of our proper training, we, as PTs indirectly work on skills such as turn taking, self esteem, and transitioning, because these are all skills used within a session.

One thing I have learned ever the years is transitions and self esteem tend to be the most difficult skills for this special population.
My husband and I got married six and a half years ago. The week after I ended up out of work for a couple of weeks, on workers compensation, with a broken nose and a concussion. What the heck happened you may be asking… Well here is the story.
I had been working with a 13 year old boy with a diagnosis of ASD. (At the time I knew a lot less than I do now.)
He had come to his first visit with mom and his ABA. For all subsequent visits it was just him and his ABA. Well, I may have forgotten to mention that this 13 year old boy was about 6’2″ and solidly built. His ABA was a tiny thing, and I’m not exactly big myself. My job won’t train us in restraints, so I was at a loss.
Anyway, I knew enough to give this boy warning that we were changing tasks soon, but he was having a particularly rough day. I went to take away the ball we were playing with and ended up getting cornered, hair pulled and a swift forearm to the nose. (Hence the concussion and broken nose). He had had a full on melt down because he wasn’t done playing ball.
Where was mom in story number one. Well, the ABA called her to let her know what was going on and ask her to come help. Her reply “I’m at an appointment down the street. If it’s that bad, call 911!” Terrible, huh?
It was a rough day, but from it came a ton of great lessons. He knew the speech therapy room was next door, he opened the door and started trashing the room. I let him… I knew his happy place was looking at books… And sure enough he was able to calm himself and get grounded again.
Moral of this story… Always find common ground. If you can find what interests the child most, you will almost always be able to relate… As a result I added two very important questions to my evaluation form. (1). What are your childs favorite topics and toys/games, (2) what are your child triggers.

Story number two. Recently I met a wonderful six year old boy, and his not as wonderful mom. We had a blast during his initial evaluation. He responded well to my techniques and enjoyed the activities I was doing to test his balance, coordination, tone and strength. Unfortunately, mom kept putting him down and you could see his self esteem plumit. By the end of the session he was melting down big time. He began lashing out, crying, and hitting. Between the activities becoming more difficult, and mom yelling him he wasn’t trying hard enough, the poor boy lost it.

Good news about story number two is that he came in for session number two and kicked butt! Mom stayed quiet, and his confidence sored! I had him doing all sorts of things that he had no clue he could do. Standing on one foot, hopping, tandem walking (one for in front of another) all things that take focus and drive. (Also examples of what we do in PT!)??
What can be done in situations like these. Unfortunately nothing can be done from my side in terms of parental behavior. There was no sign of true abuse, so I had nothing to report. A big part of what we do is caregiver education on handling these tough situations. Patient number one never returned, so I have no follow up. Pt number two is on my caseload still today. After asking mom to be positive and encourage the tasks he is doing well he has more self esteem and is improving in balance coordination and decreasing his overall muscle tone. So far, a success!

A few sites that maybe helpful…
This is a great book that describes the difference between a true melt down and a tantrum. Also gives very detailed, but straight forward steps on how to deal with a true melt down.
I went to a course the author gave. It was interesting to hear information right from the source.

From Anxiety to Meltdown: How Individuals on the Autism Spectrum Deal with Anxiety, Experience Meltdowns, Manifest Tantrums, and How You Can Intervene Effectively

Autism speaks gives a quick run down on the comprehensive approach to treating autism, and a bit about what each discipline has to offer this population.

Jean and her beautiful family on Christmas Eve

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