August 11, 2017

How Development therapy benefits our transplant kids

What is Developmental therapy?


“So, you’re just going to play with him” or “So what exactly do you do then?”  These are some common questions Developmental Therapists (DT) will hear when they begin working with children in Early Intervention. It’s fair. All the other therapist’s kind of have what they do in their name. Speech therapists work on speech. Physical therapists work on gross motor skills. Occupational therapists work on the occupations using the fine motor skills. So, what exactly DOES a DT do? Developmental Therapy focuses on the growth of the whole child. Developmental therapists look at how a child develops during the most critical time in their lives, birth to age 3. So, where Occupational therapists might focus specifically on fine motor skills or sensory integration, DT’s focus on how do these skills integrate in to the whole child? http://www.illinoisdta.org/devlopment_therapy.php?page=13

How Developmental therapy works


DT’s do work on everything through play. While you might look at each session and think, “the therapist is ‘just playing’ with my child.” It is so much more than just playing. A typical session can look like the therapist guiding mom through a game of back and forth play with a ball while saying, “1,2,3, go” “ok, your turn.”

During this, the child is learning how to take turns, they are hearing numbers and learning to wait until they hear the word “go,” they might also be working on mimicking the word go or the numbers they hear. They could also be working on “my turn, your turn.”

Functional play


Another thing that could be worked on is functional play skills. So, this could look like a simple game of using Legos to build towers. Parents might say, “Well, we build towers all day. How is this any different than what we are doing?” The DT can teach you how to work on using the Legos to not only build in routines like turn taking (so, mom puts one Lego on and then child puts one Lego on), but also working on skills like counting how high the towers are, what color did you make the tower? Mimicking the color name or numbers when counting how high the Lego towers are. These are all skills your DT will help show you how to work on with your child through play so that they don’t think they are “working”, they are just having fun playing.

Assessing ongoing development


Your DT will also perform an annual assessment using a global assessment tool once your child has been seeing his DT for 1 year. This tool assesses 6 areas. So, your DT is looking at many different areas and seeing how your child functions in his or her daily life. They are looking at the child’s cognitive skills (and this includes play skills as well), their expressive and receptive language, their gross motor development, their fine motor development, their social-emotional development and their adaptive skills. All of these are skills that, if there is any delay, your DT will help write up outcomes and strategies on the Individual Family Service Plan (IFSP) along with the other team members input. http://pediatricresources.org/developmental.html

You might ask, “Well, my child had a transplant, of course he will need Physical therapy, but I don’t think he or she requires any other therapy.” And perhaps you are right. Many children come through transplant and have no delay in function at all.  They don’t need EI services or any other outside resources. But, this is where we highly encourage you to call your local Child and Family Connections for an evaluation if you do notice anything that seems slightly off. Again, the evaluation and initial IFSP meeting are free. It never hurts to find out.

Developmental therapy and transplant kids


Children who are pre-or post-transplant may be on medications that makes it hard to interact with other children due to risk of infections. They may have been sedated at a critical learning time. They may also have been on a ventilator or Extracorporeal Membrane Oxygenation (ECMO) which research has shown can cause developmental delays when used for an extended period of time. http://www.medpagetoday.com/cardiology/prevention/33975

Obviously, when ECMO is used it is to save the child’s life. You worry about anything else later.  Once the child has come through transplant and has been lifted from any precautions from their medical team, you can start therapy. And this may be done even in the hospital. There may be specialists that can come to the hospital to help your child start therapy as soon as possible if you have already started in Early Intervention pre-transplant. If not, once you have been discharged and are at home, you can begin therapy and again start learning those skills such as how to play with toys functionally, even things like teaching your child how to dress and undress themselves or how to hold a fork or spoon to learn to feed themselves. Yes, DT’s also work on that. Sometimes they do it with fun things like pomp oms, or beans, if they are sure the child won’t try to eat the items, other times they may do it with water in a scoop and pour tasks. Always, the focus is on helping your child learn while having fun.  We want to get your child back to functioning in their daily life, without it seeming like work. And the way we do that is teaching you (the parents or caregivers) how to do that through every day normal routines.

Another thing DT’s work on is any behavioral or attention issues that may come up. These can happen with any child, but especially a transplant child that may have extra behavioral issues due possibly to speech issues from not forming expressive language during the critical months for learning language. Or due to frustration with not being able to be around peers from isolation precautions. Once the child is out of the hospital, they may not know how to interact with the world around them and may have to relearn these skills, Your DT can help with this through play. You may ask to go on outings to the park, or just have friends over (if your medical team approves it, of course) to help your child learn or relearn peer interactions. In the age range of EI, this would most likely look like either parallel play or parents helping the child learn to start back and forth play. Obviously, with certain things you will want to be careful when introducing your child to other playmates for risk of infections and you will want to talk to your DT about this before bringing other children together during your session. There are always other ways to help your child with any behavioral issues and/or help reintroduce them to play with children.  https://www.cdc.gov/ncbddd/actearly/pdf/checklists/all_checklists.pdf

As you can see here, DT’s are well versed in the developmental needs of the whole child. They are able to assess and help the family work through many different challenges that they may come across. As always, if you have any concerns, please contact your pediatrician or your local CFC to have an assessment done. It is never too soon to get started. The sooner you start, the farther they can go!

-Written by Stacy Hillenburg (parent of transplant recipient and Early Intervention Specialist)