DISCLOSURE - apraxia-kids.org · Sewing is the Company recommended by Dr. Massery. You can google...
Transcript of DISCLOSURE - apraxia-kids.org · Sewing is the Company recommended by Dr. Massery. You can google...
DISCLOSURE
Mary McLaurine, M.SP., CCC-SLP Lisa Sheff, OTR/L Amanda Drawbaugh, PT, DPT
Speech Tree, LLC 2020
© All rights reserved
In an effort to comply with the
appropriate boards and
associations, We declare that we do not
have any affiliation with or financial
interest in a commercial
organizations that could pose a conflict of
interest with our presentation
TANDEM A Different Approach to
Verbal Apraxia
Mary McLaurine, M.SP., CCC-SLP Lisa Sheff, OTR/L Amanda Drawbaugh, PT, DPT,CIMI
Speech Tree, LLC 2020
© All rights reserved
1983
Intro to NDT
(Neurodevelopmental
Treatment)
1985
Washington D.C.
NDT Techniques
1991
Daughter is
born
2003
Lisa Sheff
enters the
picture
Conduit to Tandem
Lisa Sheff & Amanda Drawbaugh
Let’s Look at Apraxia in a New Way
Review of the Integrated Treatment Modalities used by Tandem
Tandem has integrated selected treatment principles and therapeutic strategies of :
Neurodevelopmental Treatment (NDT)
Occupational Therapy Treatment Strategies,
Sensory Integration, and Manual Therapy
Physical Therapy
Myofascil Release
Kinesio Taping
APRAXIC KIDS DISRUPT THE BASIC PRINCIPLES OF MOVEMENT THEY CHOOSE SELF GENERATED CREATIVE MOVEMENT PATTERNS
INTERRUPTING THE ORDERLY EMERGENCE OF SPEECH AND LANGUAGE
STABILITY BEFORE MOBILITY
STUCK IN LINEAR PLANE
(STRAIGHT PLANE)
SEPARATION OF MOVEMENT ANTIGRAVITY
POOR DEVELOPMENT OF ANTIGRAVITY MUSCLES
ROTATIONAL SKILLS
HAVE DIFFICULTY EMERGING APRAXIC KIDS STUCK IN LINEAR PLANE
(STRAIGHT PLNE)
TRANSITION OF MOVEMENT REQUIRES CO-CONTRACTION
RESPIRATION AND BREATH SUPPORT FOR SPEECH
DISRUPTED UNABLE TO SUPPORT MOVEMENT AND SPEECH
( If you Can't Breathe you can’t function Mary Massery DPT)
MUSCLE TONE IS WEAK MOVEMENT MUST BE BALANCED
MUST HAVE BALANCED
BASE OF SUPPORT.
STABILITY AND ALIGNMENT WORKING FROM THE BASE UP
DO NOT PRESENT OR REQUEST A MOTOR PLAN TO BE PERFORMED IN THE SAME MANNER CONTINUOUSLY.
THIS ON;Y REINFORCERS INAPPROPRIATE MOTOR PLANS
NEW MOTOR PLANS CANNOT EMERGE OR BE ESTABLISHED IF ONLY USING A PREFERRED MOVEMENT ALL THE TIME.
APRAXIC CHILDREN WILL APPEAR STRONG BECAUSE THEY HAVE
LEARNED TO LOCK MUSCLES TO GIVE THE ILLUSION OF STREGNTH
DIFFICULTY WITH SENSORY REGULATION
Speech Tree, LLC 2020
© All rights reserve
Let’s review a few movement
principles that Apraxicchildren circumvent disrupting speech
THREE PLANES OF
MOVEMENT
Stuck in Sagittal Plane
Apraxic Children turn Movement
muscles into Postural muscles
Thus the Tin Man posture
Apraxic Children have difficulty
Transitioning from
Sagittal Plane
to Frontal Plane,
to Transverse Plane
The Tinman
LINEARLINEAR PLANE (STRAIGHT PLANE) can be
either in
A side to side movement or forward/backward
movement
Children who show signs of Apraxia also
demonstrate movements that are
limited to the LINEAR PLANE
Apraxic children have little to no
TRANSVERSE PLANE
(Rotational Plane)
incorporated into daily transitional/play
activities
Amanda Drawbaugh, PT, DPT, CMI
SAGITTAL PLANE
Apraxic children are stuck in
Linear Plane (Straight Plane) causing muscles to shorten and become
immobile.
This immobility is due to their creative body fixing to support gross and fine motor movements which then disrupt
orderly emerge of speech and language skills
Apraxic children use Linear Plane (straight plane)
as their compensatory
Plane of Choice
When Apraxic children use
prolonged “fixing”, the muscle
becomes tight, rigid, and
shortened
The Specific Muscle or Muscle
Groups being contracted are at
risk for reduced flexibility.
APRAXIC CHLDREN LOVE TO SKIP REQUIRED
DEVELOPMENTAL STAGES TO ACCOMPLISH THEIR
MOVEMENT GOALS
Question 1 for the Parents: Do you remember if your baby was able to pull their knees to their chest
when on their backs (FLEXION)?
Question 2 for the Parents: How well can your child perform this sustained flexion pattern NOW despite
their age?
This is 4-6 month
old skill that
Apraxic children
avoid.
APRAXIC CHILDREN LOVE TO STAY IN EXTENSION
OR LINEAR PLANE
EXTENSION
Specifically
Supine Extension
This is an extension posture noted in a child
approximatley
2-3 months of age
From Early Infancy and beyond Apraxic children
continue to use extension to support movement
HOW TO AVOID USING
FLEXION
JUST TAKE A STAND
Or keep those legs
straight out in Sitting
Extension is a compensatory strategy Apraxic Children use very frequently
The Apraxic Child’sDiaphragm is used to support standing and/or extension vs using the Diaphragm to Support Breathing and Speech
Abdominal Muscles
”BOOTY SQUAT”Using Joints and Ligaments not
Abdominal Muscles among others to Squat
o Apraxic kids use their joints and ligaments and not abdominal muscles to squat.
o Apraxic children bypass weaker or locked/immobile muscles and find other muscles to solve their movement issues
o This position allows for shifting to play with “pseudo” moving across midline
YOU CANNOT TALK USING JOINTS AND LIGAMENTS
If you see your children doing this pattern, make the child sit on their sit bones (ischial tuberosity)
How To Stop the “BOOTY SQUAT”
LINEAR PLANE CHEAT
HYPEREXTENSION PATTERNS
Standing to avoid flexion and to Avoid
using Abdominals
Leaning back vs taking head out of
upright to look at the toy.
Pulling on neck muscles to support his
head during his chosen activity vs using
arms and aligning his shoulders to play in
midline
Lateral leaning posture the neck and no
rotation of the trunk
Posturing his right shoulder for support
so he can use his left hand and retrieve a
toy.
FIGHT EXTENSION WITH
FLEXION
This is Lisa placing a little guy we had at least 10 years ago into sustained flexion.
This is a position Lisa uses frequently
Apraxic children over work their extension
muscles and extension patterns and need to practice more flexion
According to NDT, Speech is a FLEXION ACTIVITY
Flexion is required to help activate the diaphragm
W SITTING
W-sitting is when a child sits on their bottom with bent
knees and their feet are resting on either side of their
body.
It is called ‘W-sitting’ because from a bird’s eye view,
the child’s legs form a “W.”
This position provides a wider base of support and
increased stability to the child’s trunk and core when
sitting. This is a major “Fix”
This is just a flat “Booty Squat”
It is often used to compensate for decreased trunk
strength or increased flexibility© 2020 Chicago Occupational Therapy.
All Rights Reserved.
W Sitting should be avoided
W sitting provides a larger base of support
allowing the child to use ligaments and bony
structures for stability and decreasing the
amount of work required for the core muscles
Posterior pelvic tilts disrupts the Diaphragm
Poor trunk positioning allows the child to
compress the Diaphragm
POSITIONS TO CONSIDER TO COUNTERACT W SITTING
Apraxic kids must sit on
sit bones (Ischial Tuberosity)
A true sitting pattern with sustained flexion must be
integrated into your Treatment and everyday activities
Flexion is required to help activate the diaphragm and
abdominal muscles
This is a foam stair used to help encourage sustained flexion
FRONTAL PLANE
Frontal Plane Movements
Divides the body into the front and the back and is seen as a side bend
The Apraxic Child
Is “fixing” because of overusing frontal plane so a more complete and complex movement pattern does not develop.
ENCOURAGEMENT OF
FRONTAL PLANE
ECOURAGMENT OF LATERAL
PLANE
CHILD WITH ELEVATED
SHOULDERS TRYING
TO INITIATE
FRONTAL/TRANSVERSE PLANE
A LAUNDRY BASKET IS GREAT TO
HELP ENCOURAGMENT FLEXION
AND POSTURAL STABLITY
TRANSVERSE PLANE
TRANSVERSE PLANE
The Third and Final Plane of Movement
TRANSVERSE PLANEIS A MOVEMENT PATTERN IN WHICH AN OBJECT MOVES AROUND A FIXED AXIS INA CURVED PATH
TRANSVERSE PLANE is a 6-8 MONTH OLD DEVELOPMENTAL SKILL
• Rotation is difficult and disorienting for Apraxic children, since they are not
moving their heads out of the upright position. Apraxic children continue to
use straight plane positions
• You can observe Hanging Obliques
• Restricted Separation of Movment or Disassociation of upper extremities
and lower extremities have not emerged (Tin Man)
APRAXIC CHILDREN
HAVE POOR
TO
NO Transverse Plane Skills
(rotational plane)
No Elongation
of the
Internal and External Intercostals
in the Ribcage
Disrupts
TRANSVERSE PLANE
ED SULLIVAN NECK
Ed Sullivan is showing his
hyperstable or elevated
shoulder patterns which are
helping to shorten his neck
HYPERSTABILITY OF THE NECK
Apraxic children tend
to hyperstabilize with
neck, shoulders, and
hip flexors to move
from supine to sit, sit
to stand, and
everything in between.
LINEAR PLANE PATTERNS THAT PERSISIT
►Transverse skills begin with babies preparing to roll over
►Typically, developing children will use head and neck to initiate the rolling and evolve to using the flexion (knees to chest) and the abdominals (belly muscles).
►Children with motor planning issues will continue to primarily alry use movement with their head and neck beyond the infant stage (Ed Sullivan neck).
►This will disrupt rotation through elevating and hyperstabilizing the neck and shoulders and disrupting respiration to support speech and especially oral motor skills
The Dreaded Pretzel
Lisa helping to facilitate Transverse
Plane movements
This Pool Floatie has been
The best piece of equipment for
encouraging rotation
And movement in general
Stairs
►Great to Encourage Transverse Plane in Daily Activities(Rotational Skills)
►Transverse Plane movements (Rotation) support airgrading for word, phrase, and connected speech through increasing core strength therefore you are able to use the diaphragm as intended for breath support and speech
►Transverse Plane supports balance reactions
►Transverse Plane supports crossing midline
TRANSVERSE PLANE CHEATS
Not progressing through
the 3 planes of movement
tends to obstructs the
Orderly Emergence
and Development
Speech/Language
in Apraxic Children
RESPIRATION IS THE FOUNDATION OF SPEECH
PRODUCTION
Apraxic children attempt to initiate and sustain speech with “Quiet Respiration” skills vs
“Forced Respiration” skills for speech.
Apraxic Children tend to present with weak core strength
Playing to their strength leads to creative muscle locking or
“Fixing”
These are compensations disrupting
respiration for speech
SODA POP MODELDeveloped byDr. Mary Massery PT, DPT, DSc
Dr. Mary Massery is a Physical
Therapist who is a National and
International Expert on
Respiration
SODA POP MODEL
Respiration for Speech
and the
Soda Pop Can Theory
Developed by
Dr. Mary Massery PT, DPT DSc
Dr. Massery Teaches a Respiration
Course
If you Can’t Breathe you Can’t
Function
Dr. Massery explains respiration skills
using a
Soda Pop Can
(She is a diehard Chicago Girl)
DR. MASSERY DIVIDES THE
BODY INTO TWO CHAMBERS
THORACIC
AND
ADOMINAL CHAMBERS
DIVIDED BY THE
DIAPHRAGM
SODA POP MODELUpper Chamber
Vocal Cords
Thoracic Cavity
The Upper
Diaphragm
SODA POP MODELThe Lower
Chamber
Lower Diaphragm
Abdominal
Cavity
Pelvic Floor
SODA POP CAN MODEL
Aluminium Can Skelton
Aluminium Around the Can
Does not provide Strength to
Can
Skelton does not
provide strength to body
SODA POP CAN MODEL
Vocal cords
Pelvis
Carbonation
In the Can
Trunk Pressure
of Chambers (Upper and Lower Chambers)
Internal Carbonation
Pressure Maintains the Can’s shape and
strength
Air Pressure
Upper and Lower ChambersPressure supports Posture and Strength
SODA POP MODEL
FOR RESPIRATION
The Soda Pop Can looses strength when opened (pressure is compromised)
The can is easy to deform into different configurations
PRESSURE ISSUES ARE EFFECTED BY CHALLENGES WITH MOTOR PLANNING
VOCAL CORDS
AS
CHAMBER
REGULATORS
IMPORTANT AREA NOT ADDRESSED WITH
APRAXIC CHILDREN UPPER CHAMBER
VOCAL FOLDS
THORACIC CAVITY
UPPER DIAPHRAGM
THORACIC CAVITY
Apraxic Kids are
unable to build,
sustain, and grade
pressure in the
Upper and Lower
Chambers to support
speech
LOWER CHAMBER
LOWER DIAPHRAGM
ABDOMINAL CAVITY
PELVIC FLOOR
NEW DEFINITION OF “CORE”by Dr. Mary Massery
CORE STABILITY EXTENDS FROM THE
VOCAL FOLDS ON TOP
TO THE PELVIC FLOOR ON THE
BOTTOM
AND INCLUDES EVERY MUSCLE
IN BETWEEN
ABDOMINAL BINDER
TO SUPPORT ABDOMINAL AREA AND DIAPHRAGM
Please discuss wearing these options with your Therapist.
Smart Knit Kids Compression
-Deep Pressure Sensory
Compressions Undershirt
Depending on the
Size costs $15.71-$22.46
Amazon sells this product
www.smartknitkids.com
].
CUSTOM ABDOMINAL BINDER The American Sewing is the Company recommended by
Dr. Massery. You can google Custom Abdominal Binder to review all the companies providing
Binders
Dr. Massery recommends only wearing the Binder
8 hours per day. You will need to determine the
best protocol for your child
The Top of the Soda Pop Can Vocal Folds
and Supporting Structures
are the
Gate Keepers of Pressue Regulation
Then Dr. Massery Asks
Are YOUR vocal folds really
related to postural demands ?
STAND UP
The Vocal Cords Considerations for Verbal Apraxia
Stability for Mobility
Yes, Apraxic children have difficulty with Voicing
The Breath Holding is a major issue when the vocal cords should be in neutral
In Sitting or playing with the Apraxic Child you can hear multiple breath holding and releases
“uh” ”uh” “uh” of varying intensity and frequency or something similar
The Apraxic child is attempting to regulate pressure and support their body movements.
Stability (holding my breath and trunk muscles) before Mobility (using my arms and fingers)
Not enough strength and stability to add speech to the motor plan
PRESSURE ISSUES
DURING INFANCY
Apraxic children are often described as the
“Good Babies” who rarely cried or made any
sounds
Babies should be loud and raucous
Research Summary
This is Tandem’s partial list of the muscles to assess in Children with Motor planning issues.
The following muscles are helping to disrupt the orderly emergence of speech and language
Shoulders
Intercostals
Paraspinals
Diaphragm
Abdominals
Pelvic Floor (Hips)
TANDEM’S ADDITION to Dr. Massery’s
List of muscles above
Eyes
Feet
Dr. Massey confirms through research
The trunk muscles are simultaneously
supporting
Respiratory
And
Postural Systems
SODA CAN MODEL
Dr. Massery says
“Appropriate Balanced
Pressure allows
talking, walking, and
chewing gum”
PITCH PLAY
Respiration Issues with Thoracic and Pelvic Pressure
Upper and Lower Chambers
YELLINGWHISPERING
GRUNTING
OR
BUILDING VALSALVA
Issues with Thoracic and Pelvic Pressure
Sneezing/Blowing Nose
Laughing
Apraxic children can have difficult with these pressure patterns to varying degrees
More Pressure
Sensitive
Requirements
Sniffing
Raspberries
Sniffing is something that Apraxic
Children have difficulty producing.
You must activate your facial muscles and respiratory
skills. For example, Making a pig face and sniffing in
and out quickly.
This is a pattern seen at approximatley
6-7 months of age.
Apraxic children of all ages have trouble with this
pre-linguistic pattern due to restricted pressure play
Apraxic children of all ages
have difficulty with
producing raspberries
DECREASED PELVIC AND THORACIC PRESSURE
Can’t Blow out Candles?
Not building, sustaining, and grading
pressure to support blowing
IT IS NOT ABOUT THE INABILITY TO
ROUND THE LIPS
SOME OF THE MOVEMENT
MUSCLES USED TO SUPPORT SUSTAINED
LINEAR PLANE PATTERNS
In Correct Usage of the Primary
Muscle for
Respiration:
Postural Muscle Stability
►The Diaphragm controls forced and quiet inhalation and exhalation
►The Diaphragm is unable to function as a primary muscle for respiration (Quiet and Forced) because Apraxic children use the Diaphragm as a postural support muscle not for breath support for speech
Feet Turning Blue from Hyperstabiliy
Patterns or Severe “Hanging On”
On Occasion, Lisa and I have treated children whose
feet are blue from hyperstable patterns of the feet. These
children are attempting
to sit, play, stand, and walk with hyperstable feet
patterns disrupting circulation
Although, this is generally a sign of heart issues
in children but can be a hyperstability pattern
Please check with your pediatrician and/or cardiologist
MOVEMENT PATTERNS VIOLATED
EXTERNAL INTERCOSTALS SUPPORT
INHALATION
▶ The rib cage provides core stability and support that
helps with dynamic movement and appropriate
static placement
▶ Apraxic kids lock and hold the external intercostals
disrupting quiet and forced respiration
▶ It will be difficult for the rib cage to move side to
▶ small shifts in the rotational plane are also difficult
to facilitate
▶ Intercostals must elongate to support inhalation
▶ The intercostals are not elongated in children with
Verbal Apraxia
STABILITY BEFORE MOBILITY
QUIET RESPIRATION
MUSCLES OF FORCED EXHALATION
Apraxic children have significant
difficulty with forced exhalation skills
Internal Intercostals helps to form the
chest wall
The intercostal muscles are
between your ribs and help
enlarge the chest cavity. The
Intercostals contract to pull your
rib cage both upward and outward
when you inhale.
STABILITY BEFORE MOBILITY Muscles of Quiet and Forced Respiration
The Apraxic children will generally present with elevated ribcages and or asymmetrical ribcages
The chest might look boxy
You might see the bottom portion of the ribcage flaring out
You will also see a divot in the middle of the chest that resembles the beginnings of pectus excavatum
We call this Pseudo-pectus excavatum
A DIAGNOSTIC INDICATOR
What you might see in our Apraxic Children
APRAXIC
Pseudo Pectus Excavatum
True Pectus Excavatum
USING THE RIBCAGE
FOR STABILITY vs MOBILITY
DISRUPTS SPEECH PRODUCTION
Flaring Ribcage
Elevated ribcage which means restricted
elongation of the intercostals
This floppy belly is also an indication of Poor
core stability
Flaring at the bottom of the ribcage signifies
weakness through the abdominals and
ribcage
The wrinkle in the belly signify inactivity
Might observe diastasis recti
WEAK MUSCLES IN THE EXTERNAL AND INTERNAL INTERCOSTALS
POT BELLY
NOTHING SAY WEAKS ABDOMINALS
LIKE A
POT BELLY
Separation of Movement
Disassociation
T
This Photo by Unknown Author is licensed under CC BY-NC
ANOTHER MYSTERY SOLVED BY
PHYSICAL THERAPY AND OCCUPATIONAL THERAPY
Apraxic kids do not have separation of movement of the eyes from the head, neck, jaws, tongue,
lips, tongue, and jaws.
Apraxic children are unable to move their eyes into various positions to support processing the
world around them.
Apraxic kids will use their eyes to support head and other body movements.
The eye movements between Apraxic children and Autistic children should be researched.
This could be an important differential diagnosis between the two disorders.
Hyper Stability of the Eyes disrupting
pending Rotational Skills
This is Noah at 1 month. He is hyper stabilizing his head and shoulders using his eyes to support elevation of his head. When Amanda saw this picture and stated his cervical flexion strength is poor. Cervical extension is being overused and control against gravity is poor.
Hyperstability with the eyes can disrupt his motor development and overall development of head control
This is the normal posture of a
1-2 month old child.
NoahI saw Noah for only Six Months. He was
2.5 years when I started treating him through Early
Intervention. Mom showed me this picture on our last
session
Here is the Baby as at almost 3 years old. Look at the the upper and lower pictures Noah is having difficulty transitioning to his right side. He is hyper stablilizing and overusing his right side for support
Look how he has his tilted to the right so he can use his eyes to review his environment. Remember he uses his eyes to support his head
The Coshee Seat (Blue seat that Noah is sitting on) is trying to disrupt his W sitting. He postures to right which is his preferred position
SEPARATION OF MOVEMENT OF EYES FROM HEAD
AND NECK, TONGUE, AND JAWS
INFANT EYE DEVELOPMENT
THE EYES MUST BEGIN TO DEMOSTRATE
SEPARATION OF MOVEMENT OF HEAD, NECK,
TONGUE, LIPS, AND JAWS FOR ORAL MOTOR
SKILLS TO EMERGE
IN the first few weeks of life an
infant Infant’s eyes are fixed.
Approximately 3 months later,
Children begin to move their eyes
independently of their head
SEPARATION OF MOVEMENT OF EYES FROM
HEAD AND NECK, TONGUE, AND JAWS
INFANT EYE DEVELOPMENT
Apraxic children have NO to PARTIAl SEPARATION of Movement or Disassociation
of EYES from the head and neck
Apraxic childen have much difficulty moving and
Holding the eyes in the far quadrants
One way to observe this Eye Movment pattern is with a platform such as Zoom
You will have enlarged view allowing for better observation of the eyes, head, neck, and chin
SEPARATION OF MOVEMENT VISUAL DEVELOPMENT
By 6 months of age
Separation of movement of
EYES from the …
Head
Neck.
Jaws.
Tongue is necessary
so the Babbling can begin to
emerge
Son of Michaela Gahman from Apraxic Kids
Mom posted this picture and asked
about Apraxic children’s ability to
eat with their mouth closed. The
Lip smacking was driving her crazy
You might also see Apraxic
children counterbalancing with
their eyes
Lids will be half closed
chin slightly elevated
using the lower quadrant of the
eyes to view the world
STABILITY BEFORE MOBILITY Counter Balancing
the Head with their Eyes Will not be be able to shift eyes without moving
the head
(no separation of movement )
You can see this posture in varying degrees
Also look the right hand. It is fisted and resting
on the chair for stability. Sign of poor core
strength
This is one of the tricks that you might find
Apraxic Children using. They have masterful
compensations that go unnoticed
Look at River’s eyes. He was
positioned on the foam stairs to
provide better stability through his
shoulder girdle and he was able to
move his eyes to the far quadrant
without moving his head
Hyperstable Neck The Valley of the Neck
You will see overactive capital (head) extensors
As separation of movement of the eyes improve, you will hear the speech improve
HYPERSTABLE NECK
THE VALLEY OF THE NECK
This is dip in the neck is from using eyes
muscles for head control and this is an effort of
counterbalance the head.
Speech can be difficult to initiate because of
the lack of separation of movement of the eyes
from the oral motor system.
You might also note that the Occiput can also is
elevated
The back of the neck should be smooth
indicating appropriate balance of the head, neck
and shoulder muscles
The back of the neck should be smooth
indicating appropriate balance of the head, neck
and shoulder muscles
Separation of MovementEyes from the Head, Neck, and Oral-Motor system
Emerging verbal language sample can/will:
Be dominated by nouns
Some Apraxic children can/will Have difficulty with visual processing movement in their environment
This is because of restricted separation of movement of the eyes from the head and neck
They view items and events that are static
WHY LOOK AT THE FEET FOR
VERBAL APRAXIA
Deviations in Feet Positions Can Effect Alignment Which
Can….
INFLUENCE POSTURES AND GAIT
DISRUPTS THE LOWER CHAMBER NEEDED TO SUPPORT
RESPIRATION SKILLS FOR SPEECH
Lindsay Haycraft
Lindsay Haycraft, PT, DPT Helped to unravel another Apraxicmystery
I had been asking this question for years (25 years) with no supportive answer for the observed patterns; I had noted over the years with Apraxic kid’s feet
“Lindsay, what is up with Pronation and
Supination in my kids ??” Pronation or Supination of the
feet is noted consistently in Children Verbal Apraxia
Sign of reduced core strength and children actively seeking support by any means necessary
Supination (walking on the outside of the feet forming a soup bowl (Learned from Lisa)
Pronation (walking on the insides of the feet and or the ankles). You might also see uneven wear of the shoes depending on the posture used
And Dr. Haycraft said……
THEN LINDSAY SAID…….
How about
a
Patti Bob
PATTI BOBS
Primary goal of foot orthosis: to create a neutral position to allow for more optimal function
MAIN AREAS OF DOCUMENTED VALUE FOR BRACING IN PEDIATRIC POPULATION:
Prevention of deformity
Correction of positioning deformity
Promotion of a Stable Base
Facilitating development of skills
Improving efficiency of gait
-Campbell et all
COMPANY IMFORMATION IN REFERENCES
SUBTALAR JOINTArticulating surface of talus (ankle bone) and heel (calcaneus)
https://reembodyme.files.wordpress.com/2014/05/img_0281.jpg
PRONATION /SUPINATION IN APRAXIC CHILDREN
Without changing from supination and/or pronation for the
push off, Apraxic kids are stuck in the initial phase of gait development
Pes Planus: foot that exhibits no arch and an ankle that is everted*can also be called flat foot or pronatedhttps://file.scirp.org/Html/4-2100559/ec2bce50-e8f3-4139-a59d-c812fc84ed60.jpg
ATYPICAL FOOT POSITION
Let’s
Take a Brief Look at Typical Gait
Development!
(Approximately 12-15 months)
Gait’s Progress
Movement patterns are refined
Around 18 months a heel strike
2 years more bend in the knees
Gait pattern matures and the
feet strengthen and develop
3 years walking pattern is maturing and looks more like adult
TAKE HOME MESSAGE
When walking first emerges, stability reigns
supreme over efficiency.
Your child is more concerned with falling than
being fast.
As the child gets more comfortable efficiency
states to take over
Changes in patterns emerge
Get to where they’re going fast
HOW DO I KNOW IF FLAT
FEET ARE A PROBLEM
So how do I know if my child’s flat feet are a problem? Here are some questions to ask yourself:
Does my child seem anxious/nervous about standing/moving?
Is my child is late with walking or can walk but not keep up with peers?
Does he/she falls a lot either over his/her own feet or when presented with obstacles or varying surfaces?
Alignment or gait mechanic deviations could be happening
This Photo by Unknown Author is licensed under CC BY-ND
Support emergence of Speech
These shoes inserts or
Patti Bobs have made
the greatest difference…
Helping to build pressure
lower chamber pressure
Extinguishing pronation
and/or supination
Increasing separation of
movement of upper and
lower extremities
Tandem Theory Patti Bobs
assist Apraxic Kids
sustaining and grading pressure
in the Pelvis/Lower Chamber to support
speech
“
”
Learning new skills is difficult for anyone
with Praxis issues.
YOU CANNOT BUILD A SOLID HOUSE ON A WEAK
FOUNDATION
WHY FIX IT. IT
AIN’T BROKEN
Apraxic kids can present as Stubborn
but this a protective response
Apraxic Kids do not like to have their
preferred motor plan disrupted
through touch, facilitation, or words.
The slightest change introduced
outside their neurological system, can
be met with retreat, avoidance,
and/or tantrums of varying levels.
Apraxic Children lock their favorite parts of the body
disrupting the interconnected
systems needed to support the
emergence of Speech and
Language skills.
Circa 2010
USE WALKING MUSCLES FOR WALKING
AND SPEECH MUSCLES FOR SPEAKING
Lindsay Haycraft, PT, DPT
Hope to be able to present
this information to you in
person at the Apraxic Kids
Conference next year 2021
Cascade
Maker of Patti Bobs
800.848.7332
+1 360 543 9306(international)
Smart Knit Kids Vests
www.smartknitkids.com You want the
vest a little snug to provide the support to the trunk
muscles. Kids might not like the vest initially as you
are changing their base of support which is
disorienting for the Apraxic Child
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Muscles of Respiration
Inhalation Diaphragm
Pectoralis Major
Pectoralis Minor
Subclavius
Serratus Anterior
External Intercostal
Levators costalis
Serratus posterior superior
Sternocleidomastiod
Scalenus anterior
Latissimus Dorsi
Sacrospinalis
Expiration Internal Intercostals
Serratus posterior inferior
Quadratus Lumborum
Abdominal Muscles
Transverse Abdominis
REFERENCES