Occupational Therapy Basics

Occupational therapy treatment focuses on helping people achieve independence in all areas of their lives. OT can help kids with various needs improve their cognitive, physical, and motor skills and enhance their self-esteem and sense of accomplishment.
Some people may think that occupational therapy is only for adults; kids, after all, do not have occupations. But a child's main job is playing and learning, and occupational therapists can evaluate kids' skills for playing, school performance, and daily activities and compare them with what is developmentally appropriate for that age group.

According to the American Occupational Therapy Association (AOTA), in addition to dealing with an someone's physical well-being, OT practitioners address psychological, social, and environmental factors that can affect functioning in different ways. This approach makes OT a vital part of health care for some kids.

Kids Who Might Need Occupational Therapy

According to the AOTA, kids with these medical problems might benefit from OT:

• birth injuries or birth defects
• sensory processing disorders
• traumatic injuries (brain or spinal cord)
• learning problems
• autism/pervasive developmental disorders
• juvenile rheumatoid arthritis
• mental health or behavioral problems
• broken bones or other orthopedic injuries
• developmental delays
• post-surgical conditions
• burns
• spina bifida
• traumatic amputations
• cancer
• severe hand injuries
• multiple sclerosis, cerebral palsy, and other chronic illnesses

Occupational therapists might:

• help kids work on fine motor skills so they can grasp and release toys and develop good handwriting skills
• address hand-eye coordination to improve kids' play skills (hitting a target, batting a ball, copying from a blackboard, etc.)
• help kids with severe developmental delays learn basic tasks (such as bathing, getting dressed, brushing their teeth, and feeding themselves)
• help kids with behavioral disorders learn anger-management techniques (i.e., instead of hitting others or acting out, using positive ways to deal with anger, such as writing about feelings or participating in a physical activity)
• teach kids with physical disabilities the coordination skills needed to feed themselves, use a computer, or increase the speed and legibility of their handwriting
• evaluate a child's need for specialized equipment, such as wheelchairs, splints, bathing equipment, dressing devices, or communication aids
• work with kids who have sensory and attentional issues to improve focus and social skills

How Physical Therapy and OT Differ

Although both physical and occupational therapy help improve kids' quality of life, there are differences. Physical therapy (PT) deals with pain, strength, joint range of motion, endurance, and gross motor functioning, whereas OT deals more with fine motor skills, visual-perceptual skills, cognitive skills, and sensory-processing deficits.

Occupational Therapy Practitioners

There are two professional levels of occupational practice — occupational therapist (OT) and occupational therapist assistant (OTA).

Since 2007, an OT must complete a master's degree program (previously, only a bachelor's degree was required). An OTA is only required to complete an associate's degree program and can carry out treatment plans developed by the occupational therapist but can't complete evaluations.

All occupational therapy practitioners must complete supervised fieldwork programs and pass a national certification examination. A license to practice is mandatory in most states, as are continuing education classes to maintain that licensure.

Occupational therapists work in a variety of settings, including:

• hospitals
• schools
• rehabilitation centers
• mental health facilities
• private practices
• children's clinics
• nursing homes

Finding Care for Your Child

If you think your child might benefit from occupational therapy, ask your doctor to refer you to a specialist. The school nurse or guidance counselor also might be able to recommend someone based on your child's academic or social performance.

You also can check your local yellow pages, search online, or contact your state's occupational therapy association or a nearby hospital or rehabilitation center for referrals.

However you find an occupational therapist for your child, make sure that your health insurance company covers the program you select.

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Neurofibromatosis Information

Neurofibromatosis (NF) is a neurocutaneous syndrome that can affect many parts of the body, including the brain, spinal cord, nerves, skin, and other body systems. NF can cause growth of non-cancerous tumors on nerve tissue, producing skin and bone abnormalities.

Effects of NF vary widely — some children live almost unaffected by it; rarely, others can be severely disabled.

NF is defined by tumors, called neurofibromas, that grow along nerves in the body or on or under the skin. As the tumors increase in size, they can press on vital areas of the body, causing problems in the way the body functions.

Neurofibromas often first appear in childhood, especially during puberty. NF is occasionally diagnosed in infancy (in children with more apparent cases), but more often in kids between 3 and 16 years old.

The first noticeable sign is almost always the presence of brown café au lait spots. These distinctive spots don't hurt or itch and never progress to anything more serious than spots. They can be found anywhere on the body, though not usually on the face. Tiny ones — freckles — may be seen under the arms or in the groin area.

Many neurofibromas can be removed. Although usually benign (noncancerous), an estimated 3%-5% become cancerous.

There's no specific cure for NF, but tumors usually can be removed and complications treated. Because learning disabilities occur in about half the children with NF, some might need extra help in the classroom.

Types of NF

Of the two types of neurofibromatosis — NF1 and NF2 — NF1 is more common, occurring in 1 of every 2,500-3,000 births and affecting an estimated 100,000 Americans. It is also known as von Recklinghausen disease.

NF2 is characterized by the presence of bilateral acoustic neurofibroma-like tumors and is rarer, seen in 1 in 25,000 births. People with NF2 usually develop benign tumors on the nerves in their ears, causing hearing loss, eventual deafness, and problems with balance.

The severity of both types of neurofibromatosis varies greatly. In families where more than one person has NF, it can present with different physical signs and complications for each person. At diagnosis, it isn't possible to know right away whether a case will be mild or lead to severe complications.

Causes of NF

Both types of neurofibromatosis are autosomal dominant genetic disorders, which means an affected person has 1 chance in 2 of passing it on with each pregnancy.

Neurofibromatosis also can be the result of a spontaneous change (mutation) in the genetic material of the sperm or egg at conception in families with no previous history of NF. About half of cases are inherited, and the other half are due to spontaneous genetic mutation.
NF 1 and NF 2 are each related to changes in separate genes:

• The NF1 gene is located on chromosome 17.
• NF2 has been traced to chromosome 22.

These findings are important because they have led to the development of a genetic test that can reliably confirm NF in affected individuals.

Signs and Symptoms

NF1 is sometimes diagnosed in younger children, especially those with more severe forms of the disorder. One key to early diagnosis of mild NF is the appearance of café-au-lait spots on the skin.
Many people who do not have NF have a few café-au-lait spots. But if a young child has five or more, at least ½ inch in size (roughly the size of a dime), a doctor will look for other clues that may indicate NF, including neurofibromas — tumors on, under, or hanging off the skin — and Lisch nodules, tiny, noncancerous tumors on the iris (the colored part of the eye). Lisch nodules are of no clinical significance except that they help confirm a diagnosis of NF.

Neurofibromas often become evident on various parts of the body, beginning at the arms, around 10 years of age. A child may also develop freckling in the folds of the skin of the armpit or groin or on other parts of the body where the skin creases.

Abnormalities of the skeleton, such as the thinning or overgrowth of the bones in the arms or lower leg, curvature of the spine (scoliosis), and other bone deformities also may be features of NF1.

NF2 is usually not diagnosed until a child is older. Hearing loss in the late teens and early twenties is often among the first symptoms of the disorder, and is caused by tumors growing on the auditory nerves (which carry electrical impulses from the inner ear to the brain, allowing us to hear) on one or both sides.

Other symptoms of NF2 include continuous ringing in the ears, headache, facial pain or weakness, and feeling unsteady or off balance.

Diagnosis

Neurofibromatosis is usually diagnosed based on a combination of findings. A child must have at least two of the following signs to be diagnosed with NF1:

• café-au-lait spots of a certain number, size, and location
• the appearance of two or more neurofibromas (often resembling pea-sized bumps on the skin)
• Lisch nodules on the irises
• an optic glioma (tumor along the main nerve of the eye that is responsible for sight)
• certain skeletal abnormalities
• a family member with NF1
• freckling under the arms or in the groin

Tests like magnetic resonance imaging (MRI) and X-rays may be used to screen for tumors or evidence of skeletal problems. A child's head circumference will be measured, as kids with symptoms of NF can have a circumference that's larger than normal for their age. Blood pressure will be monitored. Doctors also take a detailed personal history, looking for signs of learning difficulties.
To diagnose NF2, doctors will check for any evidence of hearing loss. They'll order audiometry (hearing tests) as well as imaging tests to look for tumors in the nerves of the ears, spinal cord, or brain. They'll also determine if there's a family history of NF2.

Genetic testing is now available for people with a family history of either NF1 or NF2. Although testing is still not 100% sensitive, recent advances have increased sensitivity to over 90%. Amniocentesis or chorionic villus sampling can sometimes determine if an unborn child has the condition.

Treatment

Treatment for NF1 includes removal of the neurofibromas for cosmetic purposes, treating the complications, and getting intervention for children with learning disabilities. Kids will be referred to appropriate medical specialists to monitor and treat complications, which may include:

• seizures (up to 40% of children with NF1 have them)
• high blood pressure
• scoliosis
• speech impairment
• optic nerve tumors (which can cause vision problems leading to blindness)
• early or delayed onset of puberty

Rarely, neurofibromas can become cancerous (3%-5% of cases). In these occurrences, surgery, chemotherapy, or radiation may be necessary.

With NF2, surgeons will likely need to remove the auditory nerve tumors, which may cause deafness afterward. When parts of the auditory nerve are removed, hearing aids won't work.

In 2000, the U.S. Food and Drug Administration (FDA) approved an auditory brainstem implant for people with NF2 who have lost their hearing. This device transmits sound signals directly to the brain, enabling the person to hear certain sounds and speech.

Currently, researchers are conducting trials with medications in the hopes they'll be able to offer more treatment options.

Caring for Your Child

The first noticeable sign of neurofibromatosis usually is the presence of multiple café-au-lait spots. If your child has several of these spots, ask your doctor to do a thorough examination; he or she may need to screen your child for other signs of NF.

If your child has already been diagnosed with NF and you notice that a growing tumor is beginning to cause a problem, tell your doctor immediately.

One of the most important things you can do is get early intervention if your child has learning disabilities. It also helps to seek out support groups that can provide your family with practical advice and encouragement.

Remember, most people (about 60%) diagnosed with NF1 have only relatively mild signs of the disorder, like café-au-lait spots and a few neurofibromas on the surface of the skin, which require little or no treatment.

Kids diagnosed with mild NF who remain fairly healthy into early adulthood are less likely to develop more serious complications later in life. Kids diagnosed with more serious forms often have correctable complications and with appropriate help and support can lead happy and productive lives.

"I pray that this article empowers you to Get A L.I.F.E."

Be on the lookout for my new highly anticipated book; “Don’t Let the 4 Wheels F.O.O.L. You”!!!If you have ever felt as though society has counted you out! You won’t want to miss this inspirational road map to success!

The ER

When your child is sick or injured, it's natural to panic and head straight for the emergency room (ER), because you know that you can get care, regardless of the time, day, or severity of your child's injury. In some cases, it is a true medical emergency and the ER is the most appropriate place to get care. In other cases, the illness or injury can be handled at an urgent care clinic, or treatment can wait until your child's doctor can see you. When the ER is the right place to go, it's important to know what to expect once you get there. Having this information ahead of time can help make the experience a little less stressful. Finding the Right ER at the Right Time In certain situations, you should dial 911 to get an ambulance instead of taking your child to the ER yourself. Call 911 if: Your child is having trouble breathing and is turning blue. There has been a car accident and your child is unconscious or seriously injured. Your child is having a seizure that lasts 3-5 minutes, is having difficulty breathing, or is turning blue. Your child loses consciousness or is not responsive. Your child might have a neck or spine injury. Your child has a head injury with a loss of consciousness, persistent vomiting, or is not responding normally. Your child has significant uncontrolled bleeding. Your child has a possible poisoning and is not responding normally or having difficulty breathing. In any possible poisoning, call the Poison Control Center (1-800-222-1222) for expert advice and they may direct you to the ER. Planning Ahead Talk with your doctor about what to do — and which ER to go to — before you're in a situation where you might need to visit one. The doctor may direct you to an ER that's close to you or one in a hospital where he or she regularly sees patients. Should your child go to an ER at a children's hospital? Because they're dedicated to caring for kids, children's hospitals probably have the most pediatric staff, specialists, and facilities. So if it's an emergency and a children's hospital is conveniently located, consider going there. Otherwise, the community hospital nearest you will provide the medical care needed. If for any reason the hospital isn't equipped to treat your child's specific condition, the doctors there will arrange a transfer to a facility that is. Preparing to Go to the ER When you go to the ER, it's important to have a good handle on your child's symptoms. It's also important to know your child's medical history — allergies, past illnesses, injuries, surgeries, immunization history, or chronic conditions. Even if you know the medical history by heart, consider writing it down so it's handy during the chaos of an emergency. And keeping a written record readily available at home will let anyone caring for your child — such as a babysitter — provide it should your child be taken to the ER. To prepare a medical history, include: medications your child is taking allergies history of previous hospitalizations any previous surgeries illnesses relevant family history immunization history You also might be asked when your child last had anything to eat or drink. You should know the name and number of your child's primary care provider. And it's good to know the name and number of the pharmacy where you usually get your prescriptions filled. If you go to the ER because your child has ingested a particular medication or household product, bring the container of whatever was ingested. That will help the doctors understand what kind of treatment is required. If your child has swallowed an object, bring an example of that object, if possible. At any ER, except in the most serious emergencies, be prepared to wait. If you have time before you leave the emergency room, consider bringing something to do while you wait, such as a book, magazines, or bills to pay. You may also want to bring pen and paper to write down any questions you have for the doctor. If your child is not too ill, bring things for him or her to do as well, such as crayons, books, toys, and comforting objects, like stuffed animals. If you think there's a chance that your child might have to be admitted to the hospital, you may want to grab a change of clothes and toothbrushes for you and your child. Most ERs have some translation services or someone who can help translate. If you do not speak English fluently, consider bringing along a family member or friend who can help you translate. What to Expect at the ER There's no way to predict how long you'll have to wait to be seen at the ER. If your child has a severe medical problem, be assured that the doctors will provide whatever attention is needed right away. Because doctors attend to the most severe injuries and illnesses first, there's a good chance that if you are there with a minor injury, you'll have to wait longer. Even if the waiting room is empty, you still may have to wait if the exam rooms are filled or many doctors and nurses are attending to a particularly serious case. If your child's condition becomes worse while you are waiting to see a doctor, tell the medical staff. Before offering any food or drink to your child, make sure to ask the medical staff if it is OK. In some situations, your doctor would prefer your child has nothing to eat or drink. While you wait, there's a chance that you — and your child — may see some very sick and injured people come into the ER. The sights and sounds of those who are seriously hurt or sick can be frightening. So assure your child that the ER is the best place for the hurt people to be and that this is where the doctors can help them feel better. You might even give an example of a time when someone you know was injured and, as scary as it was at the time, all was fine after the doctor's care. Soon after arriving at the ER, your child probably will be seen by a nurse, who will ask about symptoms, check vital signs, and make a quick assessment. This evaluation, also called triage, will prioritize your child's medical needs based on the severity of his or her condition. You'll also go through a registration process where you'll be asked to sign consent for treatment forms. And if you have health insurance, be sure to have your member card with you. When you're in the ER, try to write down important information that you hear. It's scary and stressful when your child is in the ER, so it can be hard to remember details you may need later, such as: the names of the doctors what they say about the illness or injury any medications or treatment they give your child any directions for follow-up or care at home If your child is being discharged, make sure you understand the home care instructions and ask questions if you don't. A specialist might not be on-site if you go to the ER on the weekend or at night, but if the problem requires it, one will be called in. If it requires surgery, a surgeon will be contacted. Some hospitals even have a child life specialist. They can help children cope with the stress of being in the ER, help prepare them for procedures, and provide them with non-pharmacological pain management techniques even at very young ages. In many cases, the doctor who treats your child in the ER will contact your primary care doctor afterward. If your child is admitted to the hospital, the emergency room doctor will let your doctor know. Some ERs provide written or computer-generated documentation of the visit and others dictate and fax the report to the primary care doctor. Carry a copy of the papers you receive when your child is discharged to share with your doctor. "I pray that this article empowers you to Get A L.I.F.E." Be on the lookout for my new highly anticipated book; “Don’t Let the 4 Wheels F.O.O.L. You”!!!If you have ever felt as though society has counted you out! You won’t want to miss this inspirational road map to success!