starting early: early intervention concepts, strategies and ...perlman center dev disabil res rev....
TRANSCRIPT
Starting Early Early Intervention Concepts
Strategies and Delivery of Therapy for
Infants in the First Two Years
Cincinnati Childrenrsquos Hospital Medical Center
The Aaron W Perlman Center
October 21 2015
Julie Linebach OTRL
Melissa Tally PT MPT ATP
Elizabeth Willig-Kroner MA CCC-SLP
Perlman Center AACPDM 69th Annual Meeting | October 21-24 2015
AACPDM 69th Annual Meeting | October 21-24 2015
Disclosure Information
AACPDM 69th Annual Meeting | October 21-24
2015
DM 69th Annual Meeting | October 21-24 2015
AACPDM 69th Annual Meeting | October 21-24 2015
Speaker Names
Julie Linebach OTRL
Melissa Tally PT MPT ATP
Elizabeth Willig-Kroner MA CCC-SLP
Disclosure of relevant financial relationships We have the following financial relationships to disclose
Employees of Aaron W Perlman Center Cincinnati Childrenrsquos Hospital Medical Center
Disclosure of off-label andor investigative uses I will not discuss off label use andor investigational use in my presentation
The Perlman Center has releases for all photos and videos used in this presentation
Note The Perlman Center uses a variety of adaptive equipment The hands-on portion of this presentation includes common commercial infant products and complex rehab equipment The Perlman Center has not been paid to represent any of the products discussed in the presentation or shown this date
Perlman Center
Perlman Center
Participants will be able to discuss
1 New evidence supporting early intervention for the high risk
infant for CP from birth to two years and the potential to maximize
outcomes
2 How to engage parents in goal setting and high value
interventions
3 The importance of child-centered therapy within an enriched
environment focuses on early motor learning exploratory play and
mastery
4 Current commercial products adaptive equipment and assistive
technology available to support an enriched environment
Objectives
Perlman Center
Why Early Intervention
Limited experiences may cause long-term
deficits
bull Capitalize on increased neural-
plasticity during critical period
bull Most neural connections are
established by 3 years of age
bull Sensory motor pathways are
established and strengthened
through repetition and practice
during daily activities and
routines
Perlman Center
Key Elements
bull Shared goal-setting
bull Activity-based intervention
bull Routine-based practice
bull Enriched environment
A Multi-Disciplinary Early Intervention Model
Perlman Center
J Child Neurol 2014 Aug29(8)1141-56
Evidence-based diagnosis health care and rehabilitation for
children with cerebral palsy Novak I
Key Concepts Supported by Research
bull A diagnosis is an important step to helping a family access parental support
and evidence based information to help their child
bull It is ethically prudent to recommend early intervention even if not sure of
diagnosis
bull Best practice-paradigm child actively participating in real-life task in real-life
environment
bull Early environmental and task modification to accommodate disability and
promote inclusion and independence
bull Manage comorbidities of complex diagnosis
bull Services framed by the child and familyrsquos goals are considered best practice
and more enjoyable more effective
Perlman Center
Phys Ther 2010 Dec90(12)1868-80
Opportunities for early intervention based on theory basic
neuroscience and clinical science Ulrich BD
Key Concepts Supported by Research
bull We are missing the boat on opportunities for
infants with motor disabilities
bull Young babies create adaptive goal-directed
movements and demonstrate systematic learning
from experiences
bull Change happens with self-organized interaction
goal directed and repetitive actions within context
bull Activity based interventions can be administered
by caregivers and guided by therapists
Perlman Center
Dev Disabil Res Rev 201117(2)114-29
Cerebral palsy--dont delay McIntyre S Morgan C Walker K Novak I
Key Concepts Supported by Research
bull It is the responsibility of the health care professional who observed major risk
factors or a motor delay to investigate further diagnose at risk CP early and
refer to early intervention to optimize cognitive function
bull Refer for intervention when an infant is at high risk without a formal diagnosis
bull Delaying diagnosis can worsen parental depression and stress
bull All children with suspected injury should have MRI imaging
bull Qualitative assessment of general movements are predictive of CP Routinely
used neuro observations and standardized developmental tests are not
designed to detect CP
Perlman Center
Pediatrics 2013 Sep132(3)e735-46
Enriched environments and motor outcomes in cerebral
palsy systematic review and meta-analysis Morgan C Novak I Badawi N
Key Concepts Supported by Research
Perlman Center
Morgan et al BMC Pediatrics (2015) 1530
Optimizing motor learning in infants at high risk of cerebral palsy
a pilot study Catherine Morgan Iona Novak Russell C Dale and Nadia Badawi
Key Concepts Supported by Research
bull GAME (Goals- Activity- Motor- Enrichment) appears to offer a promising and
feasible new motor intervention for CP
bull Parents coached in simple motor task analysis and appropriate strategies to
enhance development and in setting up motor enriched environments
bull Favorable short-term motor outcomes were noted in standardized testing of
motor ability
bull Parents reported improvements in the COPM performance and satisfaction
bull Important to monitor parents well-being due to higher depression and anxiety
levels more than parents with children without disabilities
Perlman Center
Morgan et al BMC Neurology 2014 1420
GAME (Goals - Activity - Motor Enrichment)protocol of a single blind
randomised controlled trial of motor training parent education and
environmental enrichment for infants at high risk of cerebral palsy Catherine Morgan Iona Novak Russell C Dale Andrea Guzzetta and Nadia Badawi
Key Concepts Supported by Research
RCT of a goal driven motor learning approach with environmental interventions
and parent education
bull Prechtlrsquos Qualitative Assessment of General Movements (GMs) has allowed
earlier diagnosis of high risk CP at 3 months of age
bull Set goals with family educate parents enrich the environment
bull ldquostandard carerdquo- varied approaches to therapy intervention including
neurodevelopmental therapy developmental skills approach group therapy
or motor learning approaches
bull Outcome measures PDMS-2 GMFM COPMAHEMD-IS DASS BSID-III
Perlman Center
Key Elements
bull Shared goal-setting
bull Activity-based intervention
bull Routine-based practice
bull Enriched environment
A Multi-Disciplinary Early Intervention Model
It takes a team
Perlman Center
Patient
PT
DI
OT
Parent
Social
Work
SLP
Neurologist
Primary Care Physician
Rehabilitation doctor
Vision specialist
Other care providers
Orthopedic
ENT Nutrition
Neonatologist
Perlman Center
What is the best way to coordinate the
multidisciplinary team bull Determine the primary team (the team that sees the client and
family the most including a social worker)
bull Include parents in meetings with team discussing parents
priorities and goals (Routine Based Assessments Circle
Conferences)
bull Encourage a parent notebookbinder (contact information for
the team educational materials questions recommendations)
bull Communication with physicians before appointments- make
sure you have all necessary releases on front end
bull Use Technology group emails My Chart EPIC Care
Everywhere
Perlman Center
Parent Resource Binder
Educational Topics
Development
Nutrition
Diagnosis
Role of the Clinician
Multidisciplinary team
Muscle tone
Language development
Sensory Integration
Positioning
Sleep
Financial Resourceshelliphellip
Medical Management
Birth History
Medications
Medical Team
Insurance Information
Appointments
EquipmentVendor
Perlman Center
EMPOWER PARENTS
Perlman Center
We know that CP results in complex problems
How do we address multiple areas
Pain
Cognition
Mobility
Bone development
Language
Seizures
Behavior
Bowel and Bladder
Sleep
Vision
Nutrition
Hearing Novak April 2014
The Evaluation Process
Not just focusing on your clinical
area
You are not just
evaluating the infant
Perlman Center
Perlman Center
The Evaluation Process Holistic Picture
Ongoing Assessment of the Infant
Family-Centered Care
General Assessment
Perlman Center
Multidisciplinary Checklist Tools
Perlman Center
Perlman Multidisciplinary Checklist
Perlman Center
ParentChild Assessment of Routines
Perlman Center
Providing Therapy Services
Clinical
assessment Parents Goals
and Priorities
What are the therapy options to meet the above needs
Perlman Center
Bridging the gap between clinical
assessments and family need
bull Identify Limitations
bull Developmental Delays
bull Medical needs
Clinical Finding
bull Family Routines
bull Family Priorities
bull Overcome Barriers and Obstacles
Family Need
Perlman Center
10 minutes
Perlman Center
bull Considering severity and complexity of diagnosis delays
parentsrsquo level of education acceptance and understanding of
their childrsquos diagnosis
bull Frequency Does the childfamily need weekly treatment once
per month or a burst of therapy every couple of months
bull Most supportive environment group or individual home-based
or clinic-based
bull Referrals for specialized intervention (splinting constraint
therapy adaptive equipment oral-motorfeeding therapy vision
therapy Kinesiotherapy etc)
Develop a Therapy Plan
Perlman Center
Perlman Case Study Examples
Mild delays
Infant has risks for CP
Moderate Delays
Infant presents abnormal motor delays
Severe Delays
Infant presents with significant
neuro-motor impairments
Perlman Center M
ild d
ela
ys-a
t risk
bull Full term
bull Difficult delivery
bull Seizure after delivery
bull Abnormal MRI
bull Mom has degree in child development
Mod
era
te d
ela
ys
bull Full term
bull Seizure activity and HIE following birth
bull Abnormal movements of UELE
bull Abnormal MRI
bull Sensory issues
bull Feeding difficulty S
eve
re d
ela
ys
bull Preemie
bull Difficult pregnancy
bull Ruptured placenta
bull Seizures NICU
bull Tonic posturing
bull Feeding difficulty
bull Family lost another child
Case Studies Patient Medical History
Perlman Center M
ild d
ela
ys-A
t R
isk
bull MRI- basal ganglia
bull Clinic check-ups have been on track
bull Underlying weakness observed by PT
bull Slight catch in Right hamstring
bull 1x every 3-4 weeks
Modera
te d
ela
ys
bull Presents with tonal posturing
bull External support for positioning
bull Sensitive to vestibular movement
bull Home based EI OP equipment planning
bull Group tx
Severe
dela
ys
bull Severe posturing
bull FeedingGI issues
bull Mom needs lots of support
bull Positioning needs
bull Medical needs
bull 2x week group setting (OT PT SLP SW MDs feeding team)
Perlman Center
Build high value
interventions
Perlman Center
bull Therapy to support early parent-infant relationships
bull Build parent confidence
bull Education and training
bull Build opportunities for practice
bull Incorporate into daily routines
Engaging Parents
bull Adapt access to play play is FUN
bull Stimulate exploration inquiry and learning
bull Enrich for cognitive motor sensory and social development
Building Enriched
Environments
bull Goal-oriented intensive motor training (Morgan et al 2015)
bull Build in repetition
bull Scaffold so infant is able to complete at least part of the task
bull Experience-based activities will engage self-initiation of movement
bull Occurs while participating in daily routines (ie at the grocery)
Applying Early Motor Learning
Specific Strategies
Perlman Center
Engaging Parents Education
Topic Lists
Identify parent priorities and begin education based
on parentsrsquo perceived need
child diagnoses
parent support and resources
oral-motor and feeding
seating and positioning
disabilities across the lifespan
gross motor development
patient advocacy
adapted equipment fine motor development
home positioning techniques
financial resources
sensory integration
types of rehabilitation therapy
speech and language
Perlman Center
Engaging Parents Goal Setting
Perlman Center
Educate
Model
Engage
Observe
Connect
Perlman Center
Purposeful Play ishellip
Goal oriented
Activity based
Motivating
In an Enriched environment
Perlman Center
Perlman Center
cognitive
sensory
motor
social
Perlman Center
Building Enriched Environments
Perlman Center
Building Enriched Environments
bull Is the child positioned within
reach to explore the activity
bull Are all senses being utilized
bull Is the child being motivated to
move throughout the
environment
bull Is the environment adapted to
increase access to play
Perlman Center
Building Enriched Environments
bull Can the child have an effect
on the activity within the
environment
bull Is the activity appropriately
challenging the child within the
environment
bull Is the child presented with the
need for problem solving
Perlman Center
Building Enriched Environments
bull Is the child motivated to repeat
the task for motor learning
bull Does the environment support
learning (ie appropriate
noise level social motivators
peer groups developmental
learning supports visual
supports auditory feedback
etc)
Perlman Center
Bridging the gap between the clinic and the
home environment
bull Discipline focused
bull Clinic equipment closet
bull May have group option
Clinic
bull Incorporate into Family Routines
bull Functional activities
bull High Value
bull Adapted environment
Home
Mobility
Early Literacy
Sensory Motor Learning
Social Connections
Perlman Center
Early Learning
Functional MRIs show positive long-term neuro-
cognitive effects of reading to very young
infants
Sensory experiences shape a babyrsquos
knowledge about the world
The average toddler moves 8
out of 10 waking hoursday
Perlman Center
Learning through Experience
Adapting the environment with positioning equipment allows children with disabilities to experience their world and build relationships Allows the child to participate in typical experiences to foster learning
Activities need to promote active engagement
and allow a child to
ndash Actively explore move and participate in play
ndash Assist with self-help routines
ndash Interact and connect with family amp friends
ndash Participate in community activities
ndash Have a means to effectively communicate
ndash Make choices about their wants and need
Perlman Center
Perlman Center
bull Headpointing painting
bull Universal cuffs large pegs splints
bull Switch toys for art activitiesdramatic play-pourer
bull Switch computer access- helpkidzlearncom
bull Fischer Price game with keyboard binder switch
bull Walking in different textures while in standers and walkers
bull Cameramouseorg with dwell click
bull Partner assisted scanning
Alternative amp Adaptive Access to Play
Perlman Center
Change the environment Not the body Adaptations will be critical for success
Gross Motor Fine Motor
Social
Communication
Perlman Center Consider Communication Young children need a reliable form of communication as early as possible
Augmentative Communication is shown to support verbal skills and enhance lives of
birth to three children and their families (Romski et al 2015)
Perlman Center
Holistic approach to AAC intervention should
Build on individual strengths
Focus on participation in real-world contexts
Address psychosocial factors (ie motivation attitude confidence resilience)
Focus on environmental factors to reduce barriers and maximize social supports
In the absence of a holistic approach to communication a child is at risk for failing to engage in social contexts beyond their immediate family or educationalvocational personnel (Light and Mcnaughton 2015)
Augmentative amp Alternative Communication (AAC)
Perlman Center
Early Literacy
Perlman Center
Early Mobility
There is more than one way
Hands Free Matters
Perlman Center
Early Mobility
Should I get a gait trainer if
they are going to walk YES
Are they too young for power NO
Perlman Center
Sensory Motor Learning
Perlman Center
Sensory Motor Learning
Perlman Center
Social Connection
Perlman Center
Total Access to Play
Perlman Center
Perlman defines functional positioning bull Positioning which promotes active movement and participation and
provides an opportunity to positively impact cognitive function
bull Equipment should promote function and participation across the lifespan
Perlman Center
Principles of seating and positioning
bull Obtain a stable base of support
bull Decrease the influence of atypical muscle tone
bull Accommodate fixed deformities and correct flexible deformities
bull Provide the least amount of intervention needed to achieve the greatest level of function
bull There is no one solution or product but typically a combination of tools that provide success
Adapted from Radell (1997) and York and Weimann (1991)
Perlman Center
Key Positioning Components
bull Postural Control Strengthening
bull Range of Motion Weight Bearing
bull Home Activity Programs
Developmental Positioning
bull ADLs-Play Feeding Bathing Sleeping
bull Computer AccessAAC-Integrated Technology
bull Vision Sensory Processing Participation
Upright Positioning
bull EARLY MOBILITY- developmental sequence
bull Gait Trainer Stander amp or Wheelchair
bull Manual wheelchair vs Power Mobility- BOTH
bull Recreational
ldquoTotalrdquo Mobility
bull Body Mechanics Hoyer Lifts Overhead Systems
bull Car Seat ampor Tie Downs
bull Adapted VanRamps
Transfers ampTransportation
Perlman Center
Equipment Plan of Care
Birth to Three
Adapting baby
equipment
Floor Play
StanderWalker
Bath Seat
Car Seat
Braces
Seating for Function
Early ACCESS
Wheelchair
Bed Positioning
Bike amp Swing
Preschool
Stander
Walker
Braces
Bath Seat
Potty Seat
Wheelchair
HiLo seating
AACAccess
Adapted Bed
Car Seat
Transportation
RecreationHEP
School-Age
to Adult
Wheelchair
AACACCESS
Integrated AT
Hilo chair
Standerwalker
Bath chair
Potty chair
Adapted Bed
Car SeatVan
Home modslifts
LeisureWork
Perlman Center
Commercial Products strollers car seats cribs bath seats high chairs
playpen infant swings floor mats nursing pillow ExerSaucers
Perlman Center
Creative Commercial Adaptations
Pool noodles
Snug and Go
Crib Wedges
Bed tableart desk
Laundry baskets
Inflatable bathtub
Inflatable infant pools
Boxesstools
Perlman Center Creative Commercial Adaptations
Laundry basket $400
Pool Noodle x 2 $300
Floor sitterbath support $700
table (BLACK) $800
Garbage can $600
Large pool noodle $300
Stander with anterior support and
Visual adaptation $1700
Perlman Center
Complex Rehab Equipment
Standers
Gait trainers
Bath Support
Car seat
Seating
Feeding tools
AAC
Sensory tools
vibration
Compression garments
NUK brushes
Z Vibe
Modified utensils
Swings
Weight
Head phones
Positioning
Neck supports
Bracing
Bobby pillowU cushion
Benches
Fireflyfriendscom
PlayPaK
Upsee
Go To Seat
Early Literacy
Picture symbols
Voice output switches
Adapted books
Adapted Equipment
Perlman Center
You got this baby Nowhellip Questions
Perlman Center
LETrsquoS PLAY
Hands on Equipment Demonstration
Perlman Center
bull Ulrich B (2010) Opportunities for Early Intervention Based on Theory Basic Neuroscience and Clinical Science Physical Therapy 90(12) 1868-1880
bull McIntyre S Morgan C amp Walker K (2011) Cerebral Palsy Dont Delay Developmental Disabilities Research Reviews 17(2) 114-129
bull Novak I (2014) Evidence-Based Diagnosis Health Care and Rehabilitation for Children with Cerebral Palsy Journal of Child Neurology 29(8) 1141-1156
bull Morgan C Novak I amp Badawi N (2013) Enriched Environments and Motor Outcomes in Cerebral Palsy Systematic Review and Meta-analysis Pediatrics 132 (3)e 735 -e746
bull Morgan C Novak I Dale R Guzzetta A amp Badawi N (2014) GAME (Goals- Activity-Motor Enrichment) protocol of a single blind randomised controlled trial of motor training parent education and environmental enrichment for infants at high risk of cerebral palsy BMC Neurology 14(203)
bull Whittingham K Wee D amp Boyd R (2010) Systematic review of the efficacy of parenting interventions for children with cerebral palsy Child care health and development 37(4) 475-483
bull Morgan C Novak I dale R amp Badawi N (2015) Optimising motor learning in infants at high risk of cerebral palsy a pilot study BMC Pediatrics 15(1) n pag Web
bull Vos R Dallmeijer A Verhoef M et al (2014) Developmental trajectories of receptive and expressive communication in children and young adults with cerebral palsy Developmental Medicine amp Child Neurology 56 951-959
bull Light J and McNaughton D (2015) Designing AAC research and intervention to improve outcomes for individuals with complex communication needs Augmentative and Alternative Communication 31(2) 85-96
bull Romski M Sevcik R Barton-Hulsey A amp Whitmore A (2015) Early Intervention and AAC What a difference 30 years makes Augmentative and Alternative Communication 31 (3) 181-202
References
Perlman Center
bull Novak I Cusick A Lannin N (2009) Occupational therapy home programs for cerebral palsy Double-blind randomised controlled trial Pediatrics 124 e606-e614
bull Gericke T (2006) Postural management for children with cerebral palsy consensus statement Dev Med Child Neurol 48 (4) 244-244
bull McKeever P Rossen B Scott H Robinson-Vincent K amp Wright V (2013) The significance of uprightness parentsrsquo reflections on childrenrsquos responses to a hands-free walker for children Disability amp Society 28(3) 380-392
bull Law M Pollock N Russell D Walter S et al (2011) Focus on function a cluster randomised controlled trial comparing child-versus context-focused intervention for young children with cerebral palsy Dev Med Child Neurol 53 621-629
bull ldquoSensory Processing Developmental Chartrdquo Sensory Processing Developmental Chart Np nd Web 12 Oct 2015
bull Folio MR amp Fewell RR(2000) Peabody Developmental Motor Scales- Second edition Austin TX PRO ED
bull Voress Judith K amp Pearson Nils A (2013) Early Childhood Development Chart-Third edition Austin TX PRO ED
bull Paul Rhea (2007) Language Disorders from Infancy Through Adolescence Assessment amp Intervention Third edition St Louis MA Mosby Inc
bull Prosser L Ohlrich L Curatalo L Alter K amp Damiano D (2012) Feasibility and preliminary effectiveness of a novel mobility training intervention in infants and toddlers with cerebral palsy Developmental Neurorehabilitation 15(4) 259-266
References
AACPDM 69th Annual Meeting | October 21-24 2015
Disclosure Information
AACPDM 69th Annual Meeting | October 21-24
2015
DM 69th Annual Meeting | October 21-24 2015
AACPDM 69th Annual Meeting | October 21-24 2015
Speaker Names
Julie Linebach OTRL
Melissa Tally PT MPT ATP
Elizabeth Willig-Kroner MA CCC-SLP
Disclosure of relevant financial relationships We have the following financial relationships to disclose
Employees of Aaron W Perlman Center Cincinnati Childrenrsquos Hospital Medical Center
Disclosure of off-label andor investigative uses I will not discuss off label use andor investigational use in my presentation
The Perlman Center has releases for all photos and videos used in this presentation
Note The Perlman Center uses a variety of adaptive equipment The hands-on portion of this presentation includes common commercial infant products and complex rehab equipment The Perlman Center has not been paid to represent any of the products discussed in the presentation or shown this date
Perlman Center
Perlman Center
Participants will be able to discuss
1 New evidence supporting early intervention for the high risk
infant for CP from birth to two years and the potential to maximize
outcomes
2 How to engage parents in goal setting and high value
interventions
3 The importance of child-centered therapy within an enriched
environment focuses on early motor learning exploratory play and
mastery
4 Current commercial products adaptive equipment and assistive
technology available to support an enriched environment
Objectives
Perlman Center
Why Early Intervention
Limited experiences may cause long-term
deficits
bull Capitalize on increased neural-
plasticity during critical period
bull Most neural connections are
established by 3 years of age
bull Sensory motor pathways are
established and strengthened
through repetition and practice
during daily activities and
routines
Perlman Center
Key Elements
bull Shared goal-setting
bull Activity-based intervention
bull Routine-based practice
bull Enriched environment
A Multi-Disciplinary Early Intervention Model
Perlman Center
J Child Neurol 2014 Aug29(8)1141-56
Evidence-based diagnosis health care and rehabilitation for
children with cerebral palsy Novak I
Key Concepts Supported by Research
bull A diagnosis is an important step to helping a family access parental support
and evidence based information to help their child
bull It is ethically prudent to recommend early intervention even if not sure of
diagnosis
bull Best practice-paradigm child actively participating in real-life task in real-life
environment
bull Early environmental and task modification to accommodate disability and
promote inclusion and independence
bull Manage comorbidities of complex diagnosis
bull Services framed by the child and familyrsquos goals are considered best practice
and more enjoyable more effective
Perlman Center
Phys Ther 2010 Dec90(12)1868-80
Opportunities for early intervention based on theory basic
neuroscience and clinical science Ulrich BD
Key Concepts Supported by Research
bull We are missing the boat on opportunities for
infants with motor disabilities
bull Young babies create adaptive goal-directed
movements and demonstrate systematic learning
from experiences
bull Change happens with self-organized interaction
goal directed and repetitive actions within context
bull Activity based interventions can be administered
by caregivers and guided by therapists
Perlman Center
Dev Disabil Res Rev 201117(2)114-29
Cerebral palsy--dont delay McIntyre S Morgan C Walker K Novak I
Key Concepts Supported by Research
bull It is the responsibility of the health care professional who observed major risk
factors or a motor delay to investigate further diagnose at risk CP early and
refer to early intervention to optimize cognitive function
bull Refer for intervention when an infant is at high risk without a formal diagnosis
bull Delaying diagnosis can worsen parental depression and stress
bull All children with suspected injury should have MRI imaging
bull Qualitative assessment of general movements are predictive of CP Routinely
used neuro observations and standardized developmental tests are not
designed to detect CP
Perlman Center
Pediatrics 2013 Sep132(3)e735-46
Enriched environments and motor outcomes in cerebral
palsy systematic review and meta-analysis Morgan C Novak I Badawi N
Key Concepts Supported by Research
Perlman Center
Morgan et al BMC Pediatrics (2015) 1530
Optimizing motor learning in infants at high risk of cerebral palsy
a pilot study Catherine Morgan Iona Novak Russell C Dale and Nadia Badawi
Key Concepts Supported by Research
bull GAME (Goals- Activity- Motor- Enrichment) appears to offer a promising and
feasible new motor intervention for CP
bull Parents coached in simple motor task analysis and appropriate strategies to
enhance development and in setting up motor enriched environments
bull Favorable short-term motor outcomes were noted in standardized testing of
motor ability
bull Parents reported improvements in the COPM performance and satisfaction
bull Important to monitor parents well-being due to higher depression and anxiety
levels more than parents with children without disabilities
Perlman Center
Morgan et al BMC Neurology 2014 1420
GAME (Goals - Activity - Motor Enrichment)protocol of a single blind
randomised controlled trial of motor training parent education and
environmental enrichment for infants at high risk of cerebral palsy Catherine Morgan Iona Novak Russell C Dale Andrea Guzzetta and Nadia Badawi
Key Concepts Supported by Research
RCT of a goal driven motor learning approach with environmental interventions
and parent education
bull Prechtlrsquos Qualitative Assessment of General Movements (GMs) has allowed
earlier diagnosis of high risk CP at 3 months of age
bull Set goals with family educate parents enrich the environment
bull ldquostandard carerdquo- varied approaches to therapy intervention including
neurodevelopmental therapy developmental skills approach group therapy
or motor learning approaches
bull Outcome measures PDMS-2 GMFM COPMAHEMD-IS DASS BSID-III
Perlman Center
Key Elements
bull Shared goal-setting
bull Activity-based intervention
bull Routine-based practice
bull Enriched environment
A Multi-Disciplinary Early Intervention Model
It takes a team
Perlman Center
Patient
PT
DI
OT
Parent
Social
Work
SLP
Neurologist
Primary Care Physician
Rehabilitation doctor
Vision specialist
Other care providers
Orthopedic
ENT Nutrition
Neonatologist
Perlman Center
What is the best way to coordinate the
multidisciplinary team bull Determine the primary team (the team that sees the client and
family the most including a social worker)
bull Include parents in meetings with team discussing parents
priorities and goals (Routine Based Assessments Circle
Conferences)
bull Encourage a parent notebookbinder (contact information for
the team educational materials questions recommendations)
bull Communication with physicians before appointments- make
sure you have all necessary releases on front end
bull Use Technology group emails My Chart EPIC Care
Everywhere
Perlman Center
Parent Resource Binder
Educational Topics
Development
Nutrition
Diagnosis
Role of the Clinician
Multidisciplinary team
Muscle tone
Language development
Sensory Integration
Positioning
Sleep
Financial Resourceshelliphellip
Medical Management
Birth History
Medications
Medical Team
Insurance Information
Appointments
EquipmentVendor
Perlman Center
EMPOWER PARENTS
Perlman Center
We know that CP results in complex problems
How do we address multiple areas
Pain
Cognition
Mobility
Bone development
Language
Seizures
Behavior
Bowel and Bladder
Sleep
Vision
Nutrition
Hearing Novak April 2014
The Evaluation Process
Not just focusing on your clinical
area
You are not just
evaluating the infant
Perlman Center
Perlman Center
The Evaluation Process Holistic Picture
Ongoing Assessment of the Infant
Family-Centered Care
General Assessment
Perlman Center
Multidisciplinary Checklist Tools
Perlman Center
Perlman Multidisciplinary Checklist
Perlman Center
ParentChild Assessment of Routines
Perlman Center
Providing Therapy Services
Clinical
assessment Parents Goals
and Priorities
What are the therapy options to meet the above needs
Perlman Center
Bridging the gap between clinical
assessments and family need
bull Identify Limitations
bull Developmental Delays
bull Medical needs
Clinical Finding
bull Family Routines
bull Family Priorities
bull Overcome Barriers and Obstacles
Family Need
Perlman Center
10 minutes
Perlman Center
bull Considering severity and complexity of diagnosis delays
parentsrsquo level of education acceptance and understanding of
their childrsquos diagnosis
bull Frequency Does the childfamily need weekly treatment once
per month or a burst of therapy every couple of months
bull Most supportive environment group or individual home-based
or clinic-based
bull Referrals for specialized intervention (splinting constraint
therapy adaptive equipment oral-motorfeeding therapy vision
therapy Kinesiotherapy etc)
Develop a Therapy Plan
Perlman Center
Perlman Case Study Examples
Mild delays
Infant has risks for CP
Moderate Delays
Infant presents abnormal motor delays
Severe Delays
Infant presents with significant
neuro-motor impairments
Perlman Center M
ild d
ela
ys-a
t risk
bull Full term
bull Difficult delivery
bull Seizure after delivery
bull Abnormal MRI
bull Mom has degree in child development
Mod
era
te d
ela
ys
bull Full term
bull Seizure activity and HIE following birth
bull Abnormal movements of UELE
bull Abnormal MRI
bull Sensory issues
bull Feeding difficulty S
eve
re d
ela
ys
bull Preemie
bull Difficult pregnancy
bull Ruptured placenta
bull Seizures NICU
bull Tonic posturing
bull Feeding difficulty
bull Family lost another child
Case Studies Patient Medical History
Perlman Center M
ild d
ela
ys-A
t R
isk
bull MRI- basal ganglia
bull Clinic check-ups have been on track
bull Underlying weakness observed by PT
bull Slight catch in Right hamstring
bull 1x every 3-4 weeks
Modera
te d
ela
ys
bull Presents with tonal posturing
bull External support for positioning
bull Sensitive to vestibular movement
bull Home based EI OP equipment planning
bull Group tx
Severe
dela
ys
bull Severe posturing
bull FeedingGI issues
bull Mom needs lots of support
bull Positioning needs
bull Medical needs
bull 2x week group setting (OT PT SLP SW MDs feeding team)
Perlman Center
Build high value
interventions
Perlman Center
bull Therapy to support early parent-infant relationships
bull Build parent confidence
bull Education and training
bull Build opportunities for practice
bull Incorporate into daily routines
Engaging Parents
bull Adapt access to play play is FUN
bull Stimulate exploration inquiry and learning
bull Enrich for cognitive motor sensory and social development
Building Enriched
Environments
bull Goal-oriented intensive motor training (Morgan et al 2015)
bull Build in repetition
bull Scaffold so infant is able to complete at least part of the task
bull Experience-based activities will engage self-initiation of movement
bull Occurs while participating in daily routines (ie at the grocery)
Applying Early Motor Learning
Specific Strategies
Perlman Center
Engaging Parents Education
Topic Lists
Identify parent priorities and begin education based
on parentsrsquo perceived need
child diagnoses
parent support and resources
oral-motor and feeding
seating and positioning
disabilities across the lifespan
gross motor development
patient advocacy
adapted equipment fine motor development
home positioning techniques
financial resources
sensory integration
types of rehabilitation therapy
speech and language
Perlman Center
Engaging Parents Goal Setting
Perlman Center
Educate
Model
Engage
Observe
Connect
Perlman Center
Purposeful Play ishellip
Goal oriented
Activity based
Motivating
In an Enriched environment
Perlman Center
Perlman Center
cognitive
sensory
motor
social
Perlman Center
Building Enriched Environments
Perlman Center
Building Enriched Environments
bull Is the child positioned within
reach to explore the activity
bull Are all senses being utilized
bull Is the child being motivated to
move throughout the
environment
bull Is the environment adapted to
increase access to play
Perlman Center
Building Enriched Environments
bull Can the child have an effect
on the activity within the
environment
bull Is the activity appropriately
challenging the child within the
environment
bull Is the child presented with the
need for problem solving
Perlman Center
Building Enriched Environments
bull Is the child motivated to repeat
the task for motor learning
bull Does the environment support
learning (ie appropriate
noise level social motivators
peer groups developmental
learning supports visual
supports auditory feedback
etc)
Perlman Center
Bridging the gap between the clinic and the
home environment
bull Discipline focused
bull Clinic equipment closet
bull May have group option
Clinic
bull Incorporate into Family Routines
bull Functional activities
bull High Value
bull Adapted environment
Home
Mobility
Early Literacy
Sensory Motor Learning
Social Connections
Perlman Center
Early Learning
Functional MRIs show positive long-term neuro-
cognitive effects of reading to very young
infants
Sensory experiences shape a babyrsquos
knowledge about the world
The average toddler moves 8
out of 10 waking hoursday
Perlman Center
Learning through Experience
Adapting the environment with positioning equipment allows children with disabilities to experience their world and build relationships Allows the child to participate in typical experiences to foster learning
Activities need to promote active engagement
and allow a child to
ndash Actively explore move and participate in play
ndash Assist with self-help routines
ndash Interact and connect with family amp friends
ndash Participate in community activities
ndash Have a means to effectively communicate
ndash Make choices about their wants and need
Perlman Center
Perlman Center
bull Headpointing painting
bull Universal cuffs large pegs splints
bull Switch toys for art activitiesdramatic play-pourer
bull Switch computer access- helpkidzlearncom
bull Fischer Price game with keyboard binder switch
bull Walking in different textures while in standers and walkers
bull Cameramouseorg with dwell click
bull Partner assisted scanning
Alternative amp Adaptive Access to Play
Perlman Center
Change the environment Not the body Adaptations will be critical for success
Gross Motor Fine Motor
Social
Communication
Perlman Center Consider Communication Young children need a reliable form of communication as early as possible
Augmentative Communication is shown to support verbal skills and enhance lives of
birth to three children and their families (Romski et al 2015)
Perlman Center
Holistic approach to AAC intervention should
Build on individual strengths
Focus on participation in real-world contexts
Address psychosocial factors (ie motivation attitude confidence resilience)
Focus on environmental factors to reduce barriers and maximize social supports
In the absence of a holistic approach to communication a child is at risk for failing to engage in social contexts beyond their immediate family or educationalvocational personnel (Light and Mcnaughton 2015)
Augmentative amp Alternative Communication (AAC)
Perlman Center
Early Literacy
Perlman Center
Early Mobility
There is more than one way
Hands Free Matters
Perlman Center
Early Mobility
Should I get a gait trainer if
they are going to walk YES
Are they too young for power NO
Perlman Center
Sensory Motor Learning
Perlman Center
Sensory Motor Learning
Perlman Center
Social Connection
Perlman Center
Total Access to Play
Perlman Center
Perlman defines functional positioning bull Positioning which promotes active movement and participation and
provides an opportunity to positively impact cognitive function
bull Equipment should promote function and participation across the lifespan
Perlman Center
Principles of seating and positioning
bull Obtain a stable base of support
bull Decrease the influence of atypical muscle tone
bull Accommodate fixed deformities and correct flexible deformities
bull Provide the least amount of intervention needed to achieve the greatest level of function
bull There is no one solution or product but typically a combination of tools that provide success
Adapted from Radell (1997) and York and Weimann (1991)
Perlman Center
Key Positioning Components
bull Postural Control Strengthening
bull Range of Motion Weight Bearing
bull Home Activity Programs
Developmental Positioning
bull ADLs-Play Feeding Bathing Sleeping
bull Computer AccessAAC-Integrated Technology
bull Vision Sensory Processing Participation
Upright Positioning
bull EARLY MOBILITY- developmental sequence
bull Gait Trainer Stander amp or Wheelchair
bull Manual wheelchair vs Power Mobility- BOTH
bull Recreational
ldquoTotalrdquo Mobility
bull Body Mechanics Hoyer Lifts Overhead Systems
bull Car Seat ampor Tie Downs
bull Adapted VanRamps
Transfers ampTransportation
Perlman Center
Equipment Plan of Care
Birth to Three
Adapting baby
equipment
Floor Play
StanderWalker
Bath Seat
Car Seat
Braces
Seating for Function
Early ACCESS
Wheelchair
Bed Positioning
Bike amp Swing
Preschool
Stander
Walker
Braces
Bath Seat
Potty Seat
Wheelchair
HiLo seating
AACAccess
Adapted Bed
Car Seat
Transportation
RecreationHEP
School-Age
to Adult
Wheelchair
AACACCESS
Integrated AT
Hilo chair
Standerwalker
Bath chair
Potty chair
Adapted Bed
Car SeatVan
Home modslifts
LeisureWork
Perlman Center
Commercial Products strollers car seats cribs bath seats high chairs
playpen infant swings floor mats nursing pillow ExerSaucers
Perlman Center
Creative Commercial Adaptations
Pool noodles
Snug and Go
Crib Wedges
Bed tableart desk
Laundry baskets
Inflatable bathtub
Inflatable infant pools
Boxesstools
Perlman Center Creative Commercial Adaptations
Laundry basket $400
Pool Noodle x 2 $300
Floor sitterbath support $700
table (BLACK) $800
Garbage can $600
Large pool noodle $300
Stander with anterior support and
Visual adaptation $1700
Perlman Center
Complex Rehab Equipment
Standers
Gait trainers
Bath Support
Car seat
Seating
Feeding tools
AAC
Sensory tools
vibration
Compression garments
NUK brushes
Z Vibe
Modified utensils
Swings
Weight
Head phones
Positioning
Neck supports
Bracing
Bobby pillowU cushion
Benches
Fireflyfriendscom
PlayPaK
Upsee
Go To Seat
Early Literacy
Picture symbols
Voice output switches
Adapted books
Adapted Equipment
Perlman Center
You got this baby Nowhellip Questions
Perlman Center
LETrsquoS PLAY
Hands on Equipment Demonstration
Perlman Center
bull Ulrich B (2010) Opportunities for Early Intervention Based on Theory Basic Neuroscience and Clinical Science Physical Therapy 90(12) 1868-1880
bull McIntyre S Morgan C amp Walker K (2011) Cerebral Palsy Dont Delay Developmental Disabilities Research Reviews 17(2) 114-129
bull Novak I (2014) Evidence-Based Diagnosis Health Care and Rehabilitation for Children with Cerebral Palsy Journal of Child Neurology 29(8) 1141-1156
bull Morgan C Novak I amp Badawi N (2013) Enriched Environments and Motor Outcomes in Cerebral Palsy Systematic Review and Meta-analysis Pediatrics 132 (3)e 735 -e746
bull Morgan C Novak I Dale R Guzzetta A amp Badawi N (2014) GAME (Goals- Activity-Motor Enrichment) protocol of a single blind randomised controlled trial of motor training parent education and environmental enrichment for infants at high risk of cerebral palsy BMC Neurology 14(203)
bull Whittingham K Wee D amp Boyd R (2010) Systematic review of the efficacy of parenting interventions for children with cerebral palsy Child care health and development 37(4) 475-483
bull Morgan C Novak I dale R amp Badawi N (2015) Optimising motor learning in infants at high risk of cerebral palsy a pilot study BMC Pediatrics 15(1) n pag Web
bull Vos R Dallmeijer A Verhoef M et al (2014) Developmental trajectories of receptive and expressive communication in children and young adults with cerebral palsy Developmental Medicine amp Child Neurology 56 951-959
bull Light J and McNaughton D (2015) Designing AAC research and intervention to improve outcomes for individuals with complex communication needs Augmentative and Alternative Communication 31(2) 85-96
bull Romski M Sevcik R Barton-Hulsey A amp Whitmore A (2015) Early Intervention and AAC What a difference 30 years makes Augmentative and Alternative Communication 31 (3) 181-202
References
Perlman Center
bull Novak I Cusick A Lannin N (2009) Occupational therapy home programs for cerebral palsy Double-blind randomised controlled trial Pediatrics 124 e606-e614
bull Gericke T (2006) Postural management for children with cerebral palsy consensus statement Dev Med Child Neurol 48 (4) 244-244
bull McKeever P Rossen B Scott H Robinson-Vincent K amp Wright V (2013) The significance of uprightness parentsrsquo reflections on childrenrsquos responses to a hands-free walker for children Disability amp Society 28(3) 380-392
bull Law M Pollock N Russell D Walter S et al (2011) Focus on function a cluster randomised controlled trial comparing child-versus context-focused intervention for young children with cerebral palsy Dev Med Child Neurol 53 621-629
bull ldquoSensory Processing Developmental Chartrdquo Sensory Processing Developmental Chart Np nd Web 12 Oct 2015
bull Folio MR amp Fewell RR(2000) Peabody Developmental Motor Scales- Second edition Austin TX PRO ED
bull Voress Judith K amp Pearson Nils A (2013) Early Childhood Development Chart-Third edition Austin TX PRO ED
bull Paul Rhea (2007) Language Disorders from Infancy Through Adolescence Assessment amp Intervention Third edition St Louis MA Mosby Inc
bull Prosser L Ohlrich L Curatalo L Alter K amp Damiano D (2012) Feasibility and preliminary effectiveness of a novel mobility training intervention in infants and toddlers with cerebral palsy Developmental Neurorehabilitation 15(4) 259-266
References
Perlman Center
Participants will be able to discuss
1 New evidence supporting early intervention for the high risk
infant for CP from birth to two years and the potential to maximize
outcomes
2 How to engage parents in goal setting and high value
interventions
3 The importance of child-centered therapy within an enriched
environment focuses on early motor learning exploratory play and
mastery
4 Current commercial products adaptive equipment and assistive
technology available to support an enriched environment
Objectives
Perlman Center
Why Early Intervention
Limited experiences may cause long-term
deficits
bull Capitalize on increased neural-
plasticity during critical period
bull Most neural connections are
established by 3 years of age
bull Sensory motor pathways are
established and strengthened
through repetition and practice
during daily activities and
routines
Perlman Center
Key Elements
bull Shared goal-setting
bull Activity-based intervention
bull Routine-based practice
bull Enriched environment
A Multi-Disciplinary Early Intervention Model
Perlman Center
J Child Neurol 2014 Aug29(8)1141-56
Evidence-based diagnosis health care and rehabilitation for
children with cerebral palsy Novak I
Key Concepts Supported by Research
bull A diagnosis is an important step to helping a family access parental support
and evidence based information to help their child
bull It is ethically prudent to recommend early intervention even if not sure of
diagnosis
bull Best practice-paradigm child actively participating in real-life task in real-life
environment
bull Early environmental and task modification to accommodate disability and
promote inclusion and independence
bull Manage comorbidities of complex diagnosis
bull Services framed by the child and familyrsquos goals are considered best practice
and more enjoyable more effective
Perlman Center
Phys Ther 2010 Dec90(12)1868-80
Opportunities for early intervention based on theory basic
neuroscience and clinical science Ulrich BD
Key Concepts Supported by Research
bull We are missing the boat on opportunities for
infants with motor disabilities
bull Young babies create adaptive goal-directed
movements and demonstrate systematic learning
from experiences
bull Change happens with self-organized interaction
goal directed and repetitive actions within context
bull Activity based interventions can be administered
by caregivers and guided by therapists
Perlman Center
Dev Disabil Res Rev 201117(2)114-29
Cerebral palsy--dont delay McIntyre S Morgan C Walker K Novak I
Key Concepts Supported by Research
bull It is the responsibility of the health care professional who observed major risk
factors or a motor delay to investigate further diagnose at risk CP early and
refer to early intervention to optimize cognitive function
bull Refer for intervention when an infant is at high risk without a formal diagnosis
bull Delaying diagnosis can worsen parental depression and stress
bull All children with suspected injury should have MRI imaging
bull Qualitative assessment of general movements are predictive of CP Routinely
used neuro observations and standardized developmental tests are not
designed to detect CP
Perlman Center
Pediatrics 2013 Sep132(3)e735-46
Enriched environments and motor outcomes in cerebral
palsy systematic review and meta-analysis Morgan C Novak I Badawi N
Key Concepts Supported by Research
Perlman Center
Morgan et al BMC Pediatrics (2015) 1530
Optimizing motor learning in infants at high risk of cerebral palsy
a pilot study Catherine Morgan Iona Novak Russell C Dale and Nadia Badawi
Key Concepts Supported by Research
bull GAME (Goals- Activity- Motor- Enrichment) appears to offer a promising and
feasible new motor intervention for CP
bull Parents coached in simple motor task analysis and appropriate strategies to
enhance development and in setting up motor enriched environments
bull Favorable short-term motor outcomes were noted in standardized testing of
motor ability
bull Parents reported improvements in the COPM performance and satisfaction
bull Important to monitor parents well-being due to higher depression and anxiety
levels more than parents with children without disabilities
Perlman Center
Morgan et al BMC Neurology 2014 1420
GAME (Goals - Activity - Motor Enrichment)protocol of a single blind
randomised controlled trial of motor training parent education and
environmental enrichment for infants at high risk of cerebral palsy Catherine Morgan Iona Novak Russell C Dale Andrea Guzzetta and Nadia Badawi
Key Concepts Supported by Research
RCT of a goal driven motor learning approach with environmental interventions
and parent education
bull Prechtlrsquos Qualitative Assessment of General Movements (GMs) has allowed
earlier diagnosis of high risk CP at 3 months of age
bull Set goals with family educate parents enrich the environment
bull ldquostandard carerdquo- varied approaches to therapy intervention including
neurodevelopmental therapy developmental skills approach group therapy
or motor learning approaches
bull Outcome measures PDMS-2 GMFM COPMAHEMD-IS DASS BSID-III
Perlman Center
Key Elements
bull Shared goal-setting
bull Activity-based intervention
bull Routine-based practice
bull Enriched environment
A Multi-Disciplinary Early Intervention Model
It takes a team
Perlman Center
Patient
PT
DI
OT
Parent
Social
Work
SLP
Neurologist
Primary Care Physician
Rehabilitation doctor
Vision specialist
Other care providers
Orthopedic
ENT Nutrition
Neonatologist
Perlman Center
What is the best way to coordinate the
multidisciplinary team bull Determine the primary team (the team that sees the client and
family the most including a social worker)
bull Include parents in meetings with team discussing parents
priorities and goals (Routine Based Assessments Circle
Conferences)
bull Encourage a parent notebookbinder (contact information for
the team educational materials questions recommendations)
bull Communication with physicians before appointments- make
sure you have all necessary releases on front end
bull Use Technology group emails My Chart EPIC Care
Everywhere
Perlman Center
Parent Resource Binder
Educational Topics
Development
Nutrition
Diagnosis
Role of the Clinician
Multidisciplinary team
Muscle tone
Language development
Sensory Integration
Positioning
Sleep
Financial Resourceshelliphellip
Medical Management
Birth History
Medications
Medical Team
Insurance Information
Appointments
EquipmentVendor
Perlman Center
EMPOWER PARENTS
Perlman Center
We know that CP results in complex problems
How do we address multiple areas
Pain
Cognition
Mobility
Bone development
Language
Seizures
Behavior
Bowel and Bladder
Sleep
Vision
Nutrition
Hearing Novak April 2014
The Evaluation Process
Not just focusing on your clinical
area
You are not just
evaluating the infant
Perlman Center
Perlman Center
The Evaluation Process Holistic Picture
Ongoing Assessment of the Infant
Family-Centered Care
General Assessment
Perlman Center
Multidisciplinary Checklist Tools
Perlman Center
Perlman Multidisciplinary Checklist
Perlman Center
ParentChild Assessment of Routines
Perlman Center
Providing Therapy Services
Clinical
assessment Parents Goals
and Priorities
What are the therapy options to meet the above needs
Perlman Center
Bridging the gap between clinical
assessments and family need
bull Identify Limitations
bull Developmental Delays
bull Medical needs
Clinical Finding
bull Family Routines
bull Family Priorities
bull Overcome Barriers and Obstacles
Family Need
Perlman Center
10 minutes
Perlman Center
bull Considering severity and complexity of diagnosis delays
parentsrsquo level of education acceptance and understanding of
their childrsquos diagnosis
bull Frequency Does the childfamily need weekly treatment once
per month or a burst of therapy every couple of months
bull Most supportive environment group or individual home-based
or clinic-based
bull Referrals for specialized intervention (splinting constraint
therapy adaptive equipment oral-motorfeeding therapy vision
therapy Kinesiotherapy etc)
Develop a Therapy Plan
Perlman Center
Perlman Case Study Examples
Mild delays
Infant has risks for CP
Moderate Delays
Infant presents abnormal motor delays
Severe Delays
Infant presents with significant
neuro-motor impairments
Perlman Center M
ild d
ela
ys-a
t risk
bull Full term
bull Difficult delivery
bull Seizure after delivery
bull Abnormal MRI
bull Mom has degree in child development
Mod
era
te d
ela
ys
bull Full term
bull Seizure activity and HIE following birth
bull Abnormal movements of UELE
bull Abnormal MRI
bull Sensory issues
bull Feeding difficulty S
eve
re d
ela
ys
bull Preemie
bull Difficult pregnancy
bull Ruptured placenta
bull Seizures NICU
bull Tonic posturing
bull Feeding difficulty
bull Family lost another child
Case Studies Patient Medical History
Perlman Center M
ild d
ela
ys-A
t R
isk
bull MRI- basal ganglia
bull Clinic check-ups have been on track
bull Underlying weakness observed by PT
bull Slight catch in Right hamstring
bull 1x every 3-4 weeks
Modera
te d
ela
ys
bull Presents with tonal posturing
bull External support for positioning
bull Sensitive to vestibular movement
bull Home based EI OP equipment planning
bull Group tx
Severe
dela
ys
bull Severe posturing
bull FeedingGI issues
bull Mom needs lots of support
bull Positioning needs
bull Medical needs
bull 2x week group setting (OT PT SLP SW MDs feeding team)
Perlman Center
Build high value
interventions
Perlman Center
bull Therapy to support early parent-infant relationships
bull Build parent confidence
bull Education and training
bull Build opportunities for practice
bull Incorporate into daily routines
Engaging Parents
bull Adapt access to play play is FUN
bull Stimulate exploration inquiry and learning
bull Enrich for cognitive motor sensory and social development
Building Enriched
Environments
bull Goal-oriented intensive motor training (Morgan et al 2015)
bull Build in repetition
bull Scaffold so infant is able to complete at least part of the task
bull Experience-based activities will engage self-initiation of movement
bull Occurs while participating in daily routines (ie at the grocery)
Applying Early Motor Learning
Specific Strategies
Perlman Center
Engaging Parents Education
Topic Lists
Identify parent priorities and begin education based
on parentsrsquo perceived need
child diagnoses
parent support and resources
oral-motor and feeding
seating and positioning
disabilities across the lifespan
gross motor development
patient advocacy
adapted equipment fine motor development
home positioning techniques
financial resources
sensory integration
types of rehabilitation therapy
speech and language
Perlman Center
Engaging Parents Goal Setting
Perlman Center
Educate
Model
Engage
Observe
Connect
Perlman Center
Purposeful Play ishellip
Goal oriented
Activity based
Motivating
In an Enriched environment
Perlman Center
Perlman Center
cognitive
sensory
motor
social
Perlman Center
Building Enriched Environments
Perlman Center
Building Enriched Environments
bull Is the child positioned within
reach to explore the activity
bull Are all senses being utilized
bull Is the child being motivated to
move throughout the
environment
bull Is the environment adapted to
increase access to play
Perlman Center
Building Enriched Environments
bull Can the child have an effect
on the activity within the
environment
bull Is the activity appropriately
challenging the child within the
environment
bull Is the child presented with the
need for problem solving
Perlman Center
Building Enriched Environments
bull Is the child motivated to repeat
the task for motor learning
bull Does the environment support
learning (ie appropriate
noise level social motivators
peer groups developmental
learning supports visual
supports auditory feedback
etc)
Perlman Center
Bridging the gap between the clinic and the
home environment
bull Discipline focused
bull Clinic equipment closet
bull May have group option
Clinic
bull Incorporate into Family Routines
bull Functional activities
bull High Value
bull Adapted environment
Home
Mobility
Early Literacy
Sensory Motor Learning
Social Connections
Perlman Center
Early Learning
Functional MRIs show positive long-term neuro-
cognitive effects of reading to very young
infants
Sensory experiences shape a babyrsquos
knowledge about the world
The average toddler moves 8
out of 10 waking hoursday
Perlman Center
Learning through Experience
Adapting the environment with positioning equipment allows children with disabilities to experience their world and build relationships Allows the child to participate in typical experiences to foster learning
Activities need to promote active engagement
and allow a child to
ndash Actively explore move and participate in play
ndash Assist with self-help routines
ndash Interact and connect with family amp friends
ndash Participate in community activities
ndash Have a means to effectively communicate
ndash Make choices about their wants and need
Perlman Center
Perlman Center
bull Headpointing painting
bull Universal cuffs large pegs splints
bull Switch toys for art activitiesdramatic play-pourer
bull Switch computer access- helpkidzlearncom
bull Fischer Price game with keyboard binder switch
bull Walking in different textures while in standers and walkers
bull Cameramouseorg with dwell click
bull Partner assisted scanning
Alternative amp Adaptive Access to Play
Perlman Center
Change the environment Not the body Adaptations will be critical for success
Gross Motor Fine Motor
Social
Communication
Perlman Center Consider Communication Young children need a reliable form of communication as early as possible
Augmentative Communication is shown to support verbal skills and enhance lives of
birth to three children and their families (Romski et al 2015)
Perlman Center
Holistic approach to AAC intervention should
Build on individual strengths
Focus on participation in real-world contexts
Address psychosocial factors (ie motivation attitude confidence resilience)
Focus on environmental factors to reduce barriers and maximize social supports
In the absence of a holistic approach to communication a child is at risk for failing to engage in social contexts beyond their immediate family or educationalvocational personnel (Light and Mcnaughton 2015)
Augmentative amp Alternative Communication (AAC)
Perlman Center
Early Literacy
Perlman Center
Early Mobility
There is more than one way
Hands Free Matters
Perlman Center
Early Mobility
Should I get a gait trainer if
they are going to walk YES
Are they too young for power NO
Perlman Center
Sensory Motor Learning
Perlman Center
Sensory Motor Learning
Perlman Center
Social Connection
Perlman Center
Total Access to Play
Perlman Center
Perlman defines functional positioning bull Positioning which promotes active movement and participation and
provides an opportunity to positively impact cognitive function
bull Equipment should promote function and participation across the lifespan
Perlman Center
Principles of seating and positioning
bull Obtain a stable base of support
bull Decrease the influence of atypical muscle tone
bull Accommodate fixed deformities and correct flexible deformities
bull Provide the least amount of intervention needed to achieve the greatest level of function
bull There is no one solution or product but typically a combination of tools that provide success
Adapted from Radell (1997) and York and Weimann (1991)
Perlman Center
Key Positioning Components
bull Postural Control Strengthening
bull Range of Motion Weight Bearing
bull Home Activity Programs
Developmental Positioning
bull ADLs-Play Feeding Bathing Sleeping
bull Computer AccessAAC-Integrated Technology
bull Vision Sensory Processing Participation
Upright Positioning
bull EARLY MOBILITY- developmental sequence
bull Gait Trainer Stander amp or Wheelchair
bull Manual wheelchair vs Power Mobility- BOTH
bull Recreational
ldquoTotalrdquo Mobility
bull Body Mechanics Hoyer Lifts Overhead Systems
bull Car Seat ampor Tie Downs
bull Adapted VanRamps
Transfers ampTransportation
Perlman Center
Equipment Plan of Care
Birth to Three
Adapting baby
equipment
Floor Play
StanderWalker
Bath Seat
Car Seat
Braces
Seating for Function
Early ACCESS
Wheelchair
Bed Positioning
Bike amp Swing
Preschool
Stander
Walker
Braces
Bath Seat
Potty Seat
Wheelchair
HiLo seating
AACAccess
Adapted Bed
Car Seat
Transportation
RecreationHEP
School-Age
to Adult
Wheelchair
AACACCESS
Integrated AT
Hilo chair
Standerwalker
Bath chair
Potty chair
Adapted Bed
Car SeatVan
Home modslifts
LeisureWork
Perlman Center
Commercial Products strollers car seats cribs bath seats high chairs
playpen infant swings floor mats nursing pillow ExerSaucers
Perlman Center
Creative Commercial Adaptations
Pool noodles
Snug and Go
Crib Wedges
Bed tableart desk
Laundry baskets
Inflatable bathtub
Inflatable infant pools
Boxesstools
Perlman Center Creative Commercial Adaptations
Laundry basket $400
Pool Noodle x 2 $300
Floor sitterbath support $700
table (BLACK) $800
Garbage can $600
Large pool noodle $300
Stander with anterior support and
Visual adaptation $1700
Perlman Center
Complex Rehab Equipment
Standers
Gait trainers
Bath Support
Car seat
Seating
Feeding tools
AAC
Sensory tools
vibration
Compression garments
NUK brushes
Z Vibe
Modified utensils
Swings
Weight
Head phones
Positioning
Neck supports
Bracing
Bobby pillowU cushion
Benches
Fireflyfriendscom
PlayPaK
Upsee
Go To Seat
Early Literacy
Picture symbols
Voice output switches
Adapted books
Adapted Equipment
Perlman Center
You got this baby Nowhellip Questions
Perlman Center
LETrsquoS PLAY
Hands on Equipment Demonstration
Perlman Center
bull Ulrich B (2010) Opportunities for Early Intervention Based on Theory Basic Neuroscience and Clinical Science Physical Therapy 90(12) 1868-1880
bull McIntyre S Morgan C amp Walker K (2011) Cerebral Palsy Dont Delay Developmental Disabilities Research Reviews 17(2) 114-129
bull Novak I (2014) Evidence-Based Diagnosis Health Care and Rehabilitation for Children with Cerebral Palsy Journal of Child Neurology 29(8) 1141-1156
bull Morgan C Novak I amp Badawi N (2013) Enriched Environments and Motor Outcomes in Cerebral Palsy Systematic Review and Meta-analysis Pediatrics 132 (3)e 735 -e746
bull Morgan C Novak I Dale R Guzzetta A amp Badawi N (2014) GAME (Goals- Activity-Motor Enrichment) protocol of a single blind randomised controlled trial of motor training parent education and environmental enrichment for infants at high risk of cerebral palsy BMC Neurology 14(203)
bull Whittingham K Wee D amp Boyd R (2010) Systematic review of the efficacy of parenting interventions for children with cerebral palsy Child care health and development 37(4) 475-483
bull Morgan C Novak I dale R amp Badawi N (2015) Optimising motor learning in infants at high risk of cerebral palsy a pilot study BMC Pediatrics 15(1) n pag Web
bull Vos R Dallmeijer A Verhoef M et al (2014) Developmental trajectories of receptive and expressive communication in children and young adults with cerebral palsy Developmental Medicine amp Child Neurology 56 951-959
bull Light J and McNaughton D (2015) Designing AAC research and intervention to improve outcomes for individuals with complex communication needs Augmentative and Alternative Communication 31(2) 85-96
bull Romski M Sevcik R Barton-Hulsey A amp Whitmore A (2015) Early Intervention and AAC What a difference 30 years makes Augmentative and Alternative Communication 31 (3) 181-202
References
Perlman Center
bull Novak I Cusick A Lannin N (2009) Occupational therapy home programs for cerebral palsy Double-blind randomised controlled trial Pediatrics 124 e606-e614
bull Gericke T (2006) Postural management for children with cerebral palsy consensus statement Dev Med Child Neurol 48 (4) 244-244
bull McKeever P Rossen B Scott H Robinson-Vincent K amp Wright V (2013) The significance of uprightness parentsrsquo reflections on childrenrsquos responses to a hands-free walker for children Disability amp Society 28(3) 380-392
bull Law M Pollock N Russell D Walter S et al (2011) Focus on function a cluster randomised controlled trial comparing child-versus context-focused intervention for young children with cerebral palsy Dev Med Child Neurol 53 621-629
bull ldquoSensory Processing Developmental Chartrdquo Sensory Processing Developmental Chart Np nd Web 12 Oct 2015
bull Folio MR amp Fewell RR(2000) Peabody Developmental Motor Scales- Second edition Austin TX PRO ED
bull Voress Judith K amp Pearson Nils A (2013) Early Childhood Development Chart-Third edition Austin TX PRO ED
bull Paul Rhea (2007) Language Disorders from Infancy Through Adolescence Assessment amp Intervention Third edition St Louis MA Mosby Inc
bull Prosser L Ohlrich L Curatalo L Alter K amp Damiano D (2012) Feasibility and preliminary effectiveness of a novel mobility training intervention in infants and toddlers with cerebral palsy Developmental Neurorehabilitation 15(4) 259-266
References
Perlman Center
Why Early Intervention
Limited experiences may cause long-term
deficits
bull Capitalize on increased neural-
plasticity during critical period
bull Most neural connections are
established by 3 years of age
bull Sensory motor pathways are
established and strengthened
through repetition and practice
during daily activities and
routines
Perlman Center
Key Elements
bull Shared goal-setting
bull Activity-based intervention
bull Routine-based practice
bull Enriched environment
A Multi-Disciplinary Early Intervention Model
Perlman Center
J Child Neurol 2014 Aug29(8)1141-56
Evidence-based diagnosis health care and rehabilitation for
children with cerebral palsy Novak I
Key Concepts Supported by Research
bull A diagnosis is an important step to helping a family access parental support
and evidence based information to help their child
bull It is ethically prudent to recommend early intervention even if not sure of
diagnosis
bull Best practice-paradigm child actively participating in real-life task in real-life
environment
bull Early environmental and task modification to accommodate disability and
promote inclusion and independence
bull Manage comorbidities of complex diagnosis
bull Services framed by the child and familyrsquos goals are considered best practice
and more enjoyable more effective
Perlman Center
Phys Ther 2010 Dec90(12)1868-80
Opportunities for early intervention based on theory basic
neuroscience and clinical science Ulrich BD
Key Concepts Supported by Research
bull We are missing the boat on opportunities for
infants with motor disabilities
bull Young babies create adaptive goal-directed
movements and demonstrate systematic learning
from experiences
bull Change happens with self-organized interaction
goal directed and repetitive actions within context
bull Activity based interventions can be administered
by caregivers and guided by therapists
Perlman Center
Dev Disabil Res Rev 201117(2)114-29
Cerebral palsy--dont delay McIntyre S Morgan C Walker K Novak I
Key Concepts Supported by Research
bull It is the responsibility of the health care professional who observed major risk
factors or a motor delay to investigate further diagnose at risk CP early and
refer to early intervention to optimize cognitive function
bull Refer for intervention when an infant is at high risk without a formal diagnosis
bull Delaying diagnosis can worsen parental depression and stress
bull All children with suspected injury should have MRI imaging
bull Qualitative assessment of general movements are predictive of CP Routinely
used neuro observations and standardized developmental tests are not
designed to detect CP
Perlman Center
Pediatrics 2013 Sep132(3)e735-46
Enriched environments and motor outcomes in cerebral
palsy systematic review and meta-analysis Morgan C Novak I Badawi N
Key Concepts Supported by Research
Perlman Center
Morgan et al BMC Pediatrics (2015) 1530
Optimizing motor learning in infants at high risk of cerebral palsy
a pilot study Catherine Morgan Iona Novak Russell C Dale and Nadia Badawi
Key Concepts Supported by Research
bull GAME (Goals- Activity- Motor- Enrichment) appears to offer a promising and
feasible new motor intervention for CP
bull Parents coached in simple motor task analysis and appropriate strategies to
enhance development and in setting up motor enriched environments
bull Favorable short-term motor outcomes were noted in standardized testing of
motor ability
bull Parents reported improvements in the COPM performance and satisfaction
bull Important to monitor parents well-being due to higher depression and anxiety
levels more than parents with children without disabilities
Perlman Center
Morgan et al BMC Neurology 2014 1420
GAME (Goals - Activity - Motor Enrichment)protocol of a single blind
randomised controlled trial of motor training parent education and
environmental enrichment for infants at high risk of cerebral palsy Catherine Morgan Iona Novak Russell C Dale Andrea Guzzetta and Nadia Badawi
Key Concepts Supported by Research
RCT of a goal driven motor learning approach with environmental interventions
and parent education
bull Prechtlrsquos Qualitative Assessment of General Movements (GMs) has allowed
earlier diagnosis of high risk CP at 3 months of age
bull Set goals with family educate parents enrich the environment
bull ldquostandard carerdquo- varied approaches to therapy intervention including
neurodevelopmental therapy developmental skills approach group therapy
or motor learning approaches
bull Outcome measures PDMS-2 GMFM COPMAHEMD-IS DASS BSID-III
Perlman Center
Key Elements
bull Shared goal-setting
bull Activity-based intervention
bull Routine-based practice
bull Enriched environment
A Multi-Disciplinary Early Intervention Model
It takes a team
Perlman Center
Patient
PT
DI
OT
Parent
Social
Work
SLP
Neurologist
Primary Care Physician
Rehabilitation doctor
Vision specialist
Other care providers
Orthopedic
ENT Nutrition
Neonatologist
Perlman Center
What is the best way to coordinate the
multidisciplinary team bull Determine the primary team (the team that sees the client and
family the most including a social worker)
bull Include parents in meetings with team discussing parents
priorities and goals (Routine Based Assessments Circle
Conferences)
bull Encourage a parent notebookbinder (contact information for
the team educational materials questions recommendations)
bull Communication with physicians before appointments- make
sure you have all necessary releases on front end
bull Use Technology group emails My Chart EPIC Care
Everywhere
Perlman Center
Parent Resource Binder
Educational Topics
Development
Nutrition
Diagnosis
Role of the Clinician
Multidisciplinary team
Muscle tone
Language development
Sensory Integration
Positioning
Sleep
Financial Resourceshelliphellip
Medical Management
Birth History
Medications
Medical Team
Insurance Information
Appointments
EquipmentVendor
Perlman Center
EMPOWER PARENTS
Perlman Center
We know that CP results in complex problems
How do we address multiple areas
Pain
Cognition
Mobility
Bone development
Language
Seizures
Behavior
Bowel and Bladder
Sleep
Vision
Nutrition
Hearing Novak April 2014
The Evaluation Process
Not just focusing on your clinical
area
You are not just
evaluating the infant
Perlman Center
Perlman Center
The Evaluation Process Holistic Picture
Ongoing Assessment of the Infant
Family-Centered Care
General Assessment
Perlman Center
Multidisciplinary Checklist Tools
Perlman Center
Perlman Multidisciplinary Checklist
Perlman Center
ParentChild Assessment of Routines
Perlman Center
Providing Therapy Services
Clinical
assessment Parents Goals
and Priorities
What are the therapy options to meet the above needs
Perlman Center
Bridging the gap between clinical
assessments and family need
bull Identify Limitations
bull Developmental Delays
bull Medical needs
Clinical Finding
bull Family Routines
bull Family Priorities
bull Overcome Barriers and Obstacles
Family Need
Perlman Center
10 minutes
Perlman Center
bull Considering severity and complexity of diagnosis delays
parentsrsquo level of education acceptance and understanding of
their childrsquos diagnosis
bull Frequency Does the childfamily need weekly treatment once
per month or a burst of therapy every couple of months
bull Most supportive environment group or individual home-based
or clinic-based
bull Referrals for specialized intervention (splinting constraint
therapy adaptive equipment oral-motorfeeding therapy vision
therapy Kinesiotherapy etc)
Develop a Therapy Plan
Perlman Center
Perlman Case Study Examples
Mild delays
Infant has risks for CP
Moderate Delays
Infant presents abnormal motor delays
Severe Delays
Infant presents with significant
neuro-motor impairments
Perlman Center M
ild d
ela
ys-a
t risk
bull Full term
bull Difficult delivery
bull Seizure after delivery
bull Abnormal MRI
bull Mom has degree in child development
Mod
era
te d
ela
ys
bull Full term
bull Seizure activity and HIE following birth
bull Abnormal movements of UELE
bull Abnormal MRI
bull Sensory issues
bull Feeding difficulty S
eve
re d
ela
ys
bull Preemie
bull Difficult pregnancy
bull Ruptured placenta
bull Seizures NICU
bull Tonic posturing
bull Feeding difficulty
bull Family lost another child
Case Studies Patient Medical History
Perlman Center M
ild d
ela
ys-A
t R
isk
bull MRI- basal ganglia
bull Clinic check-ups have been on track
bull Underlying weakness observed by PT
bull Slight catch in Right hamstring
bull 1x every 3-4 weeks
Modera
te d
ela
ys
bull Presents with tonal posturing
bull External support for positioning
bull Sensitive to vestibular movement
bull Home based EI OP equipment planning
bull Group tx
Severe
dela
ys
bull Severe posturing
bull FeedingGI issues
bull Mom needs lots of support
bull Positioning needs
bull Medical needs
bull 2x week group setting (OT PT SLP SW MDs feeding team)
Perlman Center
Build high value
interventions
Perlman Center
bull Therapy to support early parent-infant relationships
bull Build parent confidence
bull Education and training
bull Build opportunities for practice
bull Incorporate into daily routines
Engaging Parents
bull Adapt access to play play is FUN
bull Stimulate exploration inquiry and learning
bull Enrich for cognitive motor sensory and social development
Building Enriched
Environments
bull Goal-oriented intensive motor training (Morgan et al 2015)
bull Build in repetition
bull Scaffold so infant is able to complete at least part of the task
bull Experience-based activities will engage self-initiation of movement
bull Occurs while participating in daily routines (ie at the grocery)
Applying Early Motor Learning
Specific Strategies
Perlman Center
Engaging Parents Education
Topic Lists
Identify parent priorities and begin education based
on parentsrsquo perceived need
child diagnoses
parent support and resources
oral-motor and feeding
seating and positioning
disabilities across the lifespan
gross motor development
patient advocacy
adapted equipment fine motor development
home positioning techniques
financial resources
sensory integration
types of rehabilitation therapy
speech and language
Perlman Center
Engaging Parents Goal Setting
Perlman Center
Educate
Model
Engage
Observe
Connect
Perlman Center
Purposeful Play ishellip
Goal oriented
Activity based
Motivating
In an Enriched environment
Perlman Center
Perlman Center
cognitive
sensory
motor
social
Perlman Center
Building Enriched Environments
Perlman Center
Building Enriched Environments
bull Is the child positioned within
reach to explore the activity
bull Are all senses being utilized
bull Is the child being motivated to
move throughout the
environment
bull Is the environment adapted to
increase access to play
Perlman Center
Building Enriched Environments
bull Can the child have an effect
on the activity within the
environment
bull Is the activity appropriately
challenging the child within the
environment
bull Is the child presented with the
need for problem solving
Perlman Center
Building Enriched Environments
bull Is the child motivated to repeat
the task for motor learning
bull Does the environment support
learning (ie appropriate
noise level social motivators
peer groups developmental
learning supports visual
supports auditory feedback
etc)
Perlman Center
Bridging the gap between the clinic and the
home environment
bull Discipline focused
bull Clinic equipment closet
bull May have group option
Clinic
bull Incorporate into Family Routines
bull Functional activities
bull High Value
bull Adapted environment
Home
Mobility
Early Literacy
Sensory Motor Learning
Social Connections
Perlman Center
Early Learning
Functional MRIs show positive long-term neuro-
cognitive effects of reading to very young
infants
Sensory experiences shape a babyrsquos
knowledge about the world
The average toddler moves 8
out of 10 waking hoursday
Perlman Center
Learning through Experience
Adapting the environment with positioning equipment allows children with disabilities to experience their world and build relationships Allows the child to participate in typical experiences to foster learning
Activities need to promote active engagement
and allow a child to
ndash Actively explore move and participate in play
ndash Assist with self-help routines
ndash Interact and connect with family amp friends
ndash Participate in community activities
ndash Have a means to effectively communicate
ndash Make choices about their wants and need
Perlman Center
Perlman Center
bull Headpointing painting
bull Universal cuffs large pegs splints
bull Switch toys for art activitiesdramatic play-pourer
bull Switch computer access- helpkidzlearncom
bull Fischer Price game with keyboard binder switch
bull Walking in different textures while in standers and walkers
bull Cameramouseorg with dwell click
bull Partner assisted scanning
Alternative amp Adaptive Access to Play
Perlman Center
Change the environment Not the body Adaptations will be critical for success
Gross Motor Fine Motor
Social
Communication
Perlman Center Consider Communication Young children need a reliable form of communication as early as possible
Augmentative Communication is shown to support verbal skills and enhance lives of
birth to three children and their families (Romski et al 2015)
Perlman Center
Holistic approach to AAC intervention should
Build on individual strengths
Focus on participation in real-world contexts
Address psychosocial factors (ie motivation attitude confidence resilience)
Focus on environmental factors to reduce barriers and maximize social supports
In the absence of a holistic approach to communication a child is at risk for failing to engage in social contexts beyond their immediate family or educationalvocational personnel (Light and Mcnaughton 2015)
Augmentative amp Alternative Communication (AAC)
Perlman Center
Early Literacy
Perlman Center
Early Mobility
There is more than one way
Hands Free Matters
Perlman Center
Early Mobility
Should I get a gait trainer if
they are going to walk YES
Are they too young for power NO
Perlman Center
Sensory Motor Learning
Perlman Center
Sensory Motor Learning
Perlman Center
Social Connection
Perlman Center
Total Access to Play
Perlman Center
Perlman defines functional positioning bull Positioning which promotes active movement and participation and
provides an opportunity to positively impact cognitive function
bull Equipment should promote function and participation across the lifespan
Perlman Center
Principles of seating and positioning
bull Obtain a stable base of support
bull Decrease the influence of atypical muscle tone
bull Accommodate fixed deformities and correct flexible deformities
bull Provide the least amount of intervention needed to achieve the greatest level of function
bull There is no one solution or product but typically a combination of tools that provide success
Adapted from Radell (1997) and York and Weimann (1991)
Perlman Center
Key Positioning Components
bull Postural Control Strengthening
bull Range of Motion Weight Bearing
bull Home Activity Programs
Developmental Positioning
bull ADLs-Play Feeding Bathing Sleeping
bull Computer AccessAAC-Integrated Technology
bull Vision Sensory Processing Participation
Upright Positioning
bull EARLY MOBILITY- developmental sequence
bull Gait Trainer Stander amp or Wheelchair
bull Manual wheelchair vs Power Mobility- BOTH
bull Recreational
ldquoTotalrdquo Mobility
bull Body Mechanics Hoyer Lifts Overhead Systems
bull Car Seat ampor Tie Downs
bull Adapted VanRamps
Transfers ampTransportation
Perlman Center
Equipment Plan of Care
Birth to Three
Adapting baby
equipment
Floor Play
StanderWalker
Bath Seat
Car Seat
Braces
Seating for Function
Early ACCESS
Wheelchair
Bed Positioning
Bike amp Swing
Preschool
Stander
Walker
Braces
Bath Seat
Potty Seat
Wheelchair
HiLo seating
AACAccess
Adapted Bed
Car Seat
Transportation
RecreationHEP
School-Age
to Adult
Wheelchair
AACACCESS
Integrated AT
Hilo chair
Standerwalker
Bath chair
Potty chair
Adapted Bed
Car SeatVan
Home modslifts
LeisureWork
Perlman Center
Commercial Products strollers car seats cribs bath seats high chairs
playpen infant swings floor mats nursing pillow ExerSaucers
Perlman Center
Creative Commercial Adaptations
Pool noodles
Snug and Go
Crib Wedges
Bed tableart desk
Laundry baskets
Inflatable bathtub
Inflatable infant pools
Boxesstools
Perlman Center Creative Commercial Adaptations
Laundry basket $400
Pool Noodle x 2 $300
Floor sitterbath support $700
table (BLACK) $800
Garbage can $600
Large pool noodle $300
Stander with anterior support and
Visual adaptation $1700
Perlman Center
Complex Rehab Equipment
Standers
Gait trainers
Bath Support
Car seat
Seating
Feeding tools
AAC
Sensory tools
vibration
Compression garments
NUK brushes
Z Vibe
Modified utensils
Swings
Weight
Head phones
Positioning
Neck supports
Bracing
Bobby pillowU cushion
Benches
Fireflyfriendscom
PlayPaK
Upsee
Go To Seat
Early Literacy
Picture symbols
Voice output switches
Adapted books
Adapted Equipment
Perlman Center
You got this baby Nowhellip Questions
Perlman Center
LETrsquoS PLAY
Hands on Equipment Demonstration
Perlman Center
bull Ulrich B (2010) Opportunities for Early Intervention Based on Theory Basic Neuroscience and Clinical Science Physical Therapy 90(12) 1868-1880
bull McIntyre S Morgan C amp Walker K (2011) Cerebral Palsy Dont Delay Developmental Disabilities Research Reviews 17(2) 114-129
bull Novak I (2014) Evidence-Based Diagnosis Health Care and Rehabilitation for Children with Cerebral Palsy Journal of Child Neurology 29(8) 1141-1156
bull Morgan C Novak I amp Badawi N (2013) Enriched Environments and Motor Outcomes in Cerebral Palsy Systematic Review and Meta-analysis Pediatrics 132 (3)e 735 -e746
bull Morgan C Novak I Dale R Guzzetta A amp Badawi N (2014) GAME (Goals- Activity-Motor Enrichment) protocol of a single blind randomised controlled trial of motor training parent education and environmental enrichment for infants at high risk of cerebral palsy BMC Neurology 14(203)
bull Whittingham K Wee D amp Boyd R (2010) Systematic review of the efficacy of parenting interventions for children with cerebral palsy Child care health and development 37(4) 475-483
bull Morgan C Novak I dale R amp Badawi N (2015) Optimising motor learning in infants at high risk of cerebral palsy a pilot study BMC Pediatrics 15(1) n pag Web
bull Vos R Dallmeijer A Verhoef M et al (2014) Developmental trajectories of receptive and expressive communication in children and young adults with cerebral palsy Developmental Medicine amp Child Neurology 56 951-959
bull Light J and McNaughton D (2015) Designing AAC research and intervention to improve outcomes for individuals with complex communication needs Augmentative and Alternative Communication 31(2) 85-96
bull Romski M Sevcik R Barton-Hulsey A amp Whitmore A (2015) Early Intervention and AAC What a difference 30 years makes Augmentative and Alternative Communication 31 (3) 181-202
References
Perlman Center
bull Novak I Cusick A Lannin N (2009) Occupational therapy home programs for cerebral palsy Double-blind randomised controlled trial Pediatrics 124 e606-e614
bull Gericke T (2006) Postural management for children with cerebral palsy consensus statement Dev Med Child Neurol 48 (4) 244-244
bull McKeever P Rossen B Scott H Robinson-Vincent K amp Wright V (2013) The significance of uprightness parentsrsquo reflections on childrenrsquos responses to a hands-free walker for children Disability amp Society 28(3) 380-392
bull Law M Pollock N Russell D Walter S et al (2011) Focus on function a cluster randomised controlled trial comparing child-versus context-focused intervention for young children with cerebral palsy Dev Med Child Neurol 53 621-629
bull ldquoSensory Processing Developmental Chartrdquo Sensory Processing Developmental Chart Np nd Web 12 Oct 2015
bull Folio MR amp Fewell RR(2000) Peabody Developmental Motor Scales- Second edition Austin TX PRO ED
bull Voress Judith K amp Pearson Nils A (2013) Early Childhood Development Chart-Third edition Austin TX PRO ED
bull Paul Rhea (2007) Language Disorders from Infancy Through Adolescence Assessment amp Intervention Third edition St Louis MA Mosby Inc
bull Prosser L Ohlrich L Curatalo L Alter K amp Damiano D (2012) Feasibility and preliminary effectiveness of a novel mobility training intervention in infants and toddlers with cerebral palsy Developmental Neurorehabilitation 15(4) 259-266
References
Perlman Center
Key Elements
bull Shared goal-setting
bull Activity-based intervention
bull Routine-based practice
bull Enriched environment
A Multi-Disciplinary Early Intervention Model
Perlman Center
J Child Neurol 2014 Aug29(8)1141-56
Evidence-based diagnosis health care and rehabilitation for
children with cerebral palsy Novak I
Key Concepts Supported by Research
bull A diagnosis is an important step to helping a family access parental support
and evidence based information to help their child
bull It is ethically prudent to recommend early intervention even if not sure of
diagnosis
bull Best practice-paradigm child actively participating in real-life task in real-life
environment
bull Early environmental and task modification to accommodate disability and
promote inclusion and independence
bull Manage comorbidities of complex diagnosis
bull Services framed by the child and familyrsquos goals are considered best practice
and more enjoyable more effective
Perlman Center
Phys Ther 2010 Dec90(12)1868-80
Opportunities for early intervention based on theory basic
neuroscience and clinical science Ulrich BD
Key Concepts Supported by Research
bull We are missing the boat on opportunities for
infants with motor disabilities
bull Young babies create adaptive goal-directed
movements and demonstrate systematic learning
from experiences
bull Change happens with self-organized interaction
goal directed and repetitive actions within context
bull Activity based interventions can be administered
by caregivers and guided by therapists
Perlman Center
Dev Disabil Res Rev 201117(2)114-29
Cerebral palsy--dont delay McIntyre S Morgan C Walker K Novak I
Key Concepts Supported by Research
bull It is the responsibility of the health care professional who observed major risk
factors or a motor delay to investigate further diagnose at risk CP early and
refer to early intervention to optimize cognitive function
bull Refer for intervention when an infant is at high risk without a formal diagnosis
bull Delaying diagnosis can worsen parental depression and stress
bull All children with suspected injury should have MRI imaging
bull Qualitative assessment of general movements are predictive of CP Routinely
used neuro observations and standardized developmental tests are not
designed to detect CP
Perlman Center
Pediatrics 2013 Sep132(3)e735-46
Enriched environments and motor outcomes in cerebral
palsy systematic review and meta-analysis Morgan C Novak I Badawi N
Key Concepts Supported by Research
Perlman Center
Morgan et al BMC Pediatrics (2015) 1530
Optimizing motor learning in infants at high risk of cerebral palsy
a pilot study Catherine Morgan Iona Novak Russell C Dale and Nadia Badawi
Key Concepts Supported by Research
bull GAME (Goals- Activity- Motor- Enrichment) appears to offer a promising and
feasible new motor intervention for CP
bull Parents coached in simple motor task analysis and appropriate strategies to
enhance development and in setting up motor enriched environments
bull Favorable short-term motor outcomes were noted in standardized testing of
motor ability
bull Parents reported improvements in the COPM performance and satisfaction
bull Important to monitor parents well-being due to higher depression and anxiety
levels more than parents with children without disabilities
Perlman Center
Morgan et al BMC Neurology 2014 1420
GAME (Goals - Activity - Motor Enrichment)protocol of a single blind
randomised controlled trial of motor training parent education and
environmental enrichment for infants at high risk of cerebral palsy Catherine Morgan Iona Novak Russell C Dale Andrea Guzzetta and Nadia Badawi
Key Concepts Supported by Research
RCT of a goal driven motor learning approach with environmental interventions
and parent education
bull Prechtlrsquos Qualitative Assessment of General Movements (GMs) has allowed
earlier diagnosis of high risk CP at 3 months of age
bull Set goals with family educate parents enrich the environment
bull ldquostandard carerdquo- varied approaches to therapy intervention including
neurodevelopmental therapy developmental skills approach group therapy
or motor learning approaches
bull Outcome measures PDMS-2 GMFM COPMAHEMD-IS DASS BSID-III
Perlman Center
Key Elements
bull Shared goal-setting
bull Activity-based intervention
bull Routine-based practice
bull Enriched environment
A Multi-Disciplinary Early Intervention Model
It takes a team
Perlman Center
Patient
PT
DI
OT
Parent
Social
Work
SLP
Neurologist
Primary Care Physician
Rehabilitation doctor
Vision specialist
Other care providers
Orthopedic
ENT Nutrition
Neonatologist
Perlman Center
What is the best way to coordinate the
multidisciplinary team bull Determine the primary team (the team that sees the client and
family the most including a social worker)
bull Include parents in meetings with team discussing parents
priorities and goals (Routine Based Assessments Circle
Conferences)
bull Encourage a parent notebookbinder (contact information for
the team educational materials questions recommendations)
bull Communication with physicians before appointments- make
sure you have all necessary releases on front end
bull Use Technology group emails My Chart EPIC Care
Everywhere
Perlman Center
Parent Resource Binder
Educational Topics
Development
Nutrition
Diagnosis
Role of the Clinician
Multidisciplinary team
Muscle tone
Language development
Sensory Integration
Positioning
Sleep
Financial Resourceshelliphellip
Medical Management
Birth History
Medications
Medical Team
Insurance Information
Appointments
EquipmentVendor
Perlman Center
EMPOWER PARENTS
Perlman Center
We know that CP results in complex problems
How do we address multiple areas
Pain
Cognition
Mobility
Bone development
Language
Seizures
Behavior
Bowel and Bladder
Sleep
Vision
Nutrition
Hearing Novak April 2014
The Evaluation Process
Not just focusing on your clinical
area
You are not just
evaluating the infant
Perlman Center
Perlman Center
The Evaluation Process Holistic Picture
Ongoing Assessment of the Infant
Family-Centered Care
General Assessment
Perlman Center
Multidisciplinary Checklist Tools
Perlman Center
Perlman Multidisciplinary Checklist
Perlman Center
ParentChild Assessment of Routines
Perlman Center
Providing Therapy Services
Clinical
assessment Parents Goals
and Priorities
What are the therapy options to meet the above needs
Perlman Center
Bridging the gap between clinical
assessments and family need
bull Identify Limitations
bull Developmental Delays
bull Medical needs
Clinical Finding
bull Family Routines
bull Family Priorities
bull Overcome Barriers and Obstacles
Family Need
Perlman Center
10 minutes
Perlman Center
bull Considering severity and complexity of diagnosis delays
parentsrsquo level of education acceptance and understanding of
their childrsquos diagnosis
bull Frequency Does the childfamily need weekly treatment once
per month or a burst of therapy every couple of months
bull Most supportive environment group or individual home-based
or clinic-based
bull Referrals for specialized intervention (splinting constraint
therapy adaptive equipment oral-motorfeeding therapy vision
therapy Kinesiotherapy etc)
Develop a Therapy Plan
Perlman Center
Perlman Case Study Examples
Mild delays
Infant has risks for CP
Moderate Delays
Infant presents abnormal motor delays
Severe Delays
Infant presents with significant
neuro-motor impairments
Perlman Center M
ild d
ela
ys-a
t risk
bull Full term
bull Difficult delivery
bull Seizure after delivery
bull Abnormal MRI
bull Mom has degree in child development
Mod
era
te d
ela
ys
bull Full term
bull Seizure activity and HIE following birth
bull Abnormal movements of UELE
bull Abnormal MRI
bull Sensory issues
bull Feeding difficulty S
eve
re d
ela
ys
bull Preemie
bull Difficult pregnancy
bull Ruptured placenta
bull Seizures NICU
bull Tonic posturing
bull Feeding difficulty
bull Family lost another child
Case Studies Patient Medical History
Perlman Center M
ild d
ela
ys-A
t R
isk
bull MRI- basal ganglia
bull Clinic check-ups have been on track
bull Underlying weakness observed by PT
bull Slight catch in Right hamstring
bull 1x every 3-4 weeks
Modera
te d
ela
ys
bull Presents with tonal posturing
bull External support for positioning
bull Sensitive to vestibular movement
bull Home based EI OP equipment planning
bull Group tx
Severe
dela
ys
bull Severe posturing
bull FeedingGI issues
bull Mom needs lots of support
bull Positioning needs
bull Medical needs
bull 2x week group setting (OT PT SLP SW MDs feeding team)
Perlman Center
Build high value
interventions
Perlman Center
bull Therapy to support early parent-infant relationships
bull Build parent confidence
bull Education and training
bull Build opportunities for practice
bull Incorporate into daily routines
Engaging Parents
bull Adapt access to play play is FUN
bull Stimulate exploration inquiry and learning
bull Enrich for cognitive motor sensory and social development
Building Enriched
Environments
bull Goal-oriented intensive motor training (Morgan et al 2015)
bull Build in repetition
bull Scaffold so infant is able to complete at least part of the task
bull Experience-based activities will engage self-initiation of movement
bull Occurs while participating in daily routines (ie at the grocery)
Applying Early Motor Learning
Specific Strategies
Perlman Center
Engaging Parents Education
Topic Lists
Identify parent priorities and begin education based
on parentsrsquo perceived need
child diagnoses
parent support and resources
oral-motor and feeding
seating and positioning
disabilities across the lifespan
gross motor development
patient advocacy
adapted equipment fine motor development
home positioning techniques
financial resources
sensory integration
types of rehabilitation therapy
speech and language
Perlman Center
Engaging Parents Goal Setting
Perlman Center
Educate
Model
Engage
Observe
Connect
Perlman Center
Purposeful Play ishellip
Goal oriented
Activity based
Motivating
In an Enriched environment
Perlman Center
Perlman Center
cognitive
sensory
motor
social
Perlman Center
Building Enriched Environments
Perlman Center
Building Enriched Environments
bull Is the child positioned within
reach to explore the activity
bull Are all senses being utilized
bull Is the child being motivated to
move throughout the
environment
bull Is the environment adapted to
increase access to play
Perlman Center
Building Enriched Environments
bull Can the child have an effect
on the activity within the
environment
bull Is the activity appropriately
challenging the child within the
environment
bull Is the child presented with the
need for problem solving
Perlman Center
Building Enriched Environments
bull Is the child motivated to repeat
the task for motor learning
bull Does the environment support
learning (ie appropriate
noise level social motivators
peer groups developmental
learning supports visual
supports auditory feedback
etc)
Perlman Center
Bridging the gap between the clinic and the
home environment
bull Discipline focused
bull Clinic equipment closet
bull May have group option
Clinic
bull Incorporate into Family Routines
bull Functional activities
bull High Value
bull Adapted environment
Home
Mobility
Early Literacy
Sensory Motor Learning
Social Connections
Perlman Center
Early Learning
Functional MRIs show positive long-term neuro-
cognitive effects of reading to very young
infants
Sensory experiences shape a babyrsquos
knowledge about the world
The average toddler moves 8
out of 10 waking hoursday
Perlman Center
Learning through Experience
Adapting the environment with positioning equipment allows children with disabilities to experience their world and build relationships Allows the child to participate in typical experiences to foster learning
Activities need to promote active engagement
and allow a child to
ndash Actively explore move and participate in play
ndash Assist with self-help routines
ndash Interact and connect with family amp friends
ndash Participate in community activities
ndash Have a means to effectively communicate
ndash Make choices about their wants and need
Perlman Center
Perlman Center
bull Headpointing painting
bull Universal cuffs large pegs splints
bull Switch toys for art activitiesdramatic play-pourer
bull Switch computer access- helpkidzlearncom
bull Fischer Price game with keyboard binder switch
bull Walking in different textures while in standers and walkers
bull Cameramouseorg with dwell click
bull Partner assisted scanning
Alternative amp Adaptive Access to Play
Perlman Center
Change the environment Not the body Adaptations will be critical for success
Gross Motor Fine Motor
Social
Communication
Perlman Center Consider Communication Young children need a reliable form of communication as early as possible
Augmentative Communication is shown to support verbal skills and enhance lives of
birth to three children and their families (Romski et al 2015)
Perlman Center
Holistic approach to AAC intervention should
Build on individual strengths
Focus on participation in real-world contexts
Address psychosocial factors (ie motivation attitude confidence resilience)
Focus on environmental factors to reduce barriers and maximize social supports
In the absence of a holistic approach to communication a child is at risk for failing to engage in social contexts beyond their immediate family or educationalvocational personnel (Light and Mcnaughton 2015)
Augmentative amp Alternative Communication (AAC)
Perlman Center
Early Literacy
Perlman Center
Early Mobility
There is more than one way
Hands Free Matters
Perlman Center
Early Mobility
Should I get a gait trainer if
they are going to walk YES
Are they too young for power NO
Perlman Center
Sensory Motor Learning
Perlman Center
Sensory Motor Learning
Perlman Center
Social Connection
Perlman Center
Total Access to Play
Perlman Center
Perlman defines functional positioning bull Positioning which promotes active movement and participation and
provides an opportunity to positively impact cognitive function
bull Equipment should promote function and participation across the lifespan
Perlman Center
Principles of seating and positioning
bull Obtain a stable base of support
bull Decrease the influence of atypical muscle tone
bull Accommodate fixed deformities and correct flexible deformities
bull Provide the least amount of intervention needed to achieve the greatest level of function
bull There is no one solution or product but typically a combination of tools that provide success
Adapted from Radell (1997) and York and Weimann (1991)
Perlman Center
Key Positioning Components
bull Postural Control Strengthening
bull Range of Motion Weight Bearing
bull Home Activity Programs
Developmental Positioning
bull ADLs-Play Feeding Bathing Sleeping
bull Computer AccessAAC-Integrated Technology
bull Vision Sensory Processing Participation
Upright Positioning
bull EARLY MOBILITY- developmental sequence
bull Gait Trainer Stander amp or Wheelchair
bull Manual wheelchair vs Power Mobility- BOTH
bull Recreational
ldquoTotalrdquo Mobility
bull Body Mechanics Hoyer Lifts Overhead Systems
bull Car Seat ampor Tie Downs
bull Adapted VanRamps
Transfers ampTransportation
Perlman Center
Equipment Plan of Care
Birth to Three
Adapting baby
equipment
Floor Play
StanderWalker
Bath Seat
Car Seat
Braces
Seating for Function
Early ACCESS
Wheelchair
Bed Positioning
Bike amp Swing
Preschool
Stander
Walker
Braces
Bath Seat
Potty Seat
Wheelchair
HiLo seating
AACAccess
Adapted Bed
Car Seat
Transportation
RecreationHEP
School-Age
to Adult
Wheelchair
AACACCESS
Integrated AT
Hilo chair
Standerwalker
Bath chair
Potty chair
Adapted Bed
Car SeatVan
Home modslifts
LeisureWork
Perlman Center
Commercial Products strollers car seats cribs bath seats high chairs
playpen infant swings floor mats nursing pillow ExerSaucers
Perlman Center
Creative Commercial Adaptations
Pool noodles
Snug and Go
Crib Wedges
Bed tableart desk
Laundry baskets
Inflatable bathtub
Inflatable infant pools
Boxesstools
Perlman Center Creative Commercial Adaptations
Laundry basket $400
Pool Noodle x 2 $300
Floor sitterbath support $700
table (BLACK) $800
Garbage can $600
Large pool noodle $300
Stander with anterior support and
Visual adaptation $1700
Perlman Center
Complex Rehab Equipment
Standers
Gait trainers
Bath Support
Car seat
Seating
Feeding tools
AAC
Sensory tools
vibration
Compression garments
NUK brushes
Z Vibe
Modified utensils
Swings
Weight
Head phones
Positioning
Neck supports
Bracing
Bobby pillowU cushion
Benches
Fireflyfriendscom
PlayPaK
Upsee
Go To Seat
Early Literacy
Picture symbols
Voice output switches
Adapted books
Adapted Equipment
Perlman Center
You got this baby Nowhellip Questions
Perlman Center
LETrsquoS PLAY
Hands on Equipment Demonstration
Perlman Center
bull Ulrich B (2010) Opportunities for Early Intervention Based on Theory Basic Neuroscience and Clinical Science Physical Therapy 90(12) 1868-1880
bull McIntyre S Morgan C amp Walker K (2011) Cerebral Palsy Dont Delay Developmental Disabilities Research Reviews 17(2) 114-129
bull Novak I (2014) Evidence-Based Diagnosis Health Care and Rehabilitation for Children with Cerebral Palsy Journal of Child Neurology 29(8) 1141-1156
bull Morgan C Novak I amp Badawi N (2013) Enriched Environments and Motor Outcomes in Cerebral Palsy Systematic Review and Meta-analysis Pediatrics 132 (3)e 735 -e746
bull Morgan C Novak I Dale R Guzzetta A amp Badawi N (2014) GAME (Goals- Activity-Motor Enrichment) protocol of a single blind randomised controlled trial of motor training parent education and environmental enrichment for infants at high risk of cerebral palsy BMC Neurology 14(203)
bull Whittingham K Wee D amp Boyd R (2010) Systematic review of the efficacy of parenting interventions for children with cerebral palsy Child care health and development 37(4) 475-483
bull Morgan C Novak I dale R amp Badawi N (2015) Optimising motor learning in infants at high risk of cerebral palsy a pilot study BMC Pediatrics 15(1) n pag Web
bull Vos R Dallmeijer A Verhoef M et al (2014) Developmental trajectories of receptive and expressive communication in children and young adults with cerebral palsy Developmental Medicine amp Child Neurology 56 951-959
bull Light J and McNaughton D (2015) Designing AAC research and intervention to improve outcomes for individuals with complex communication needs Augmentative and Alternative Communication 31(2) 85-96
bull Romski M Sevcik R Barton-Hulsey A amp Whitmore A (2015) Early Intervention and AAC What a difference 30 years makes Augmentative and Alternative Communication 31 (3) 181-202
References
Perlman Center
bull Novak I Cusick A Lannin N (2009) Occupational therapy home programs for cerebral palsy Double-blind randomised controlled trial Pediatrics 124 e606-e614
bull Gericke T (2006) Postural management for children with cerebral palsy consensus statement Dev Med Child Neurol 48 (4) 244-244
bull McKeever P Rossen B Scott H Robinson-Vincent K amp Wright V (2013) The significance of uprightness parentsrsquo reflections on childrenrsquos responses to a hands-free walker for children Disability amp Society 28(3) 380-392
bull Law M Pollock N Russell D Walter S et al (2011) Focus on function a cluster randomised controlled trial comparing child-versus context-focused intervention for young children with cerebral palsy Dev Med Child Neurol 53 621-629
bull ldquoSensory Processing Developmental Chartrdquo Sensory Processing Developmental Chart Np nd Web 12 Oct 2015
bull Folio MR amp Fewell RR(2000) Peabody Developmental Motor Scales- Second edition Austin TX PRO ED
bull Voress Judith K amp Pearson Nils A (2013) Early Childhood Development Chart-Third edition Austin TX PRO ED
bull Paul Rhea (2007) Language Disorders from Infancy Through Adolescence Assessment amp Intervention Third edition St Louis MA Mosby Inc
bull Prosser L Ohlrich L Curatalo L Alter K amp Damiano D (2012) Feasibility and preliminary effectiveness of a novel mobility training intervention in infants and toddlers with cerebral palsy Developmental Neurorehabilitation 15(4) 259-266
References
Perlman Center
J Child Neurol 2014 Aug29(8)1141-56
Evidence-based diagnosis health care and rehabilitation for
children with cerebral palsy Novak I
Key Concepts Supported by Research
bull A diagnosis is an important step to helping a family access parental support
and evidence based information to help their child
bull It is ethically prudent to recommend early intervention even if not sure of
diagnosis
bull Best practice-paradigm child actively participating in real-life task in real-life
environment
bull Early environmental and task modification to accommodate disability and
promote inclusion and independence
bull Manage comorbidities of complex diagnosis
bull Services framed by the child and familyrsquos goals are considered best practice
and more enjoyable more effective
Perlman Center
Phys Ther 2010 Dec90(12)1868-80
Opportunities for early intervention based on theory basic
neuroscience and clinical science Ulrich BD
Key Concepts Supported by Research
bull We are missing the boat on opportunities for
infants with motor disabilities
bull Young babies create adaptive goal-directed
movements and demonstrate systematic learning
from experiences
bull Change happens with self-organized interaction
goal directed and repetitive actions within context
bull Activity based interventions can be administered
by caregivers and guided by therapists
Perlman Center
Dev Disabil Res Rev 201117(2)114-29
Cerebral palsy--dont delay McIntyre S Morgan C Walker K Novak I
Key Concepts Supported by Research
bull It is the responsibility of the health care professional who observed major risk
factors or a motor delay to investigate further diagnose at risk CP early and
refer to early intervention to optimize cognitive function
bull Refer for intervention when an infant is at high risk without a formal diagnosis
bull Delaying diagnosis can worsen parental depression and stress
bull All children with suspected injury should have MRI imaging
bull Qualitative assessment of general movements are predictive of CP Routinely
used neuro observations and standardized developmental tests are not
designed to detect CP
Perlman Center
Pediatrics 2013 Sep132(3)e735-46
Enriched environments and motor outcomes in cerebral
palsy systematic review and meta-analysis Morgan C Novak I Badawi N
Key Concepts Supported by Research
Perlman Center
Morgan et al BMC Pediatrics (2015) 1530
Optimizing motor learning in infants at high risk of cerebral palsy
a pilot study Catherine Morgan Iona Novak Russell C Dale and Nadia Badawi
Key Concepts Supported by Research
bull GAME (Goals- Activity- Motor- Enrichment) appears to offer a promising and
feasible new motor intervention for CP
bull Parents coached in simple motor task analysis and appropriate strategies to
enhance development and in setting up motor enriched environments
bull Favorable short-term motor outcomes were noted in standardized testing of
motor ability
bull Parents reported improvements in the COPM performance and satisfaction
bull Important to monitor parents well-being due to higher depression and anxiety
levels more than parents with children without disabilities
Perlman Center
Morgan et al BMC Neurology 2014 1420
GAME (Goals - Activity - Motor Enrichment)protocol of a single blind
randomised controlled trial of motor training parent education and
environmental enrichment for infants at high risk of cerebral palsy Catherine Morgan Iona Novak Russell C Dale Andrea Guzzetta and Nadia Badawi
Key Concepts Supported by Research
RCT of a goal driven motor learning approach with environmental interventions
and parent education
bull Prechtlrsquos Qualitative Assessment of General Movements (GMs) has allowed
earlier diagnosis of high risk CP at 3 months of age
bull Set goals with family educate parents enrich the environment
bull ldquostandard carerdquo- varied approaches to therapy intervention including
neurodevelopmental therapy developmental skills approach group therapy
or motor learning approaches
bull Outcome measures PDMS-2 GMFM COPMAHEMD-IS DASS BSID-III
Perlman Center
Key Elements
bull Shared goal-setting
bull Activity-based intervention
bull Routine-based practice
bull Enriched environment
A Multi-Disciplinary Early Intervention Model
It takes a team
Perlman Center
Patient
PT
DI
OT
Parent
Social
Work
SLP
Neurologist
Primary Care Physician
Rehabilitation doctor
Vision specialist
Other care providers
Orthopedic
ENT Nutrition
Neonatologist
Perlman Center
What is the best way to coordinate the
multidisciplinary team bull Determine the primary team (the team that sees the client and
family the most including a social worker)
bull Include parents in meetings with team discussing parents
priorities and goals (Routine Based Assessments Circle
Conferences)
bull Encourage a parent notebookbinder (contact information for
the team educational materials questions recommendations)
bull Communication with physicians before appointments- make
sure you have all necessary releases on front end
bull Use Technology group emails My Chart EPIC Care
Everywhere
Perlman Center
Parent Resource Binder
Educational Topics
Development
Nutrition
Diagnosis
Role of the Clinician
Multidisciplinary team
Muscle tone
Language development
Sensory Integration
Positioning
Sleep
Financial Resourceshelliphellip
Medical Management
Birth History
Medications
Medical Team
Insurance Information
Appointments
EquipmentVendor
Perlman Center
EMPOWER PARENTS
Perlman Center
We know that CP results in complex problems
How do we address multiple areas
Pain
Cognition
Mobility
Bone development
Language
Seizures
Behavior
Bowel and Bladder
Sleep
Vision
Nutrition
Hearing Novak April 2014
The Evaluation Process
Not just focusing on your clinical
area
You are not just
evaluating the infant
Perlman Center
Perlman Center
The Evaluation Process Holistic Picture
Ongoing Assessment of the Infant
Family-Centered Care
General Assessment
Perlman Center
Multidisciplinary Checklist Tools
Perlman Center
Perlman Multidisciplinary Checklist
Perlman Center
ParentChild Assessment of Routines
Perlman Center
Providing Therapy Services
Clinical
assessment Parents Goals
and Priorities
What are the therapy options to meet the above needs
Perlman Center
Bridging the gap between clinical
assessments and family need
bull Identify Limitations
bull Developmental Delays
bull Medical needs
Clinical Finding
bull Family Routines
bull Family Priorities
bull Overcome Barriers and Obstacles
Family Need
Perlman Center
10 minutes
Perlman Center
bull Considering severity and complexity of diagnosis delays
parentsrsquo level of education acceptance and understanding of
their childrsquos diagnosis
bull Frequency Does the childfamily need weekly treatment once
per month or a burst of therapy every couple of months
bull Most supportive environment group or individual home-based
or clinic-based
bull Referrals for specialized intervention (splinting constraint
therapy adaptive equipment oral-motorfeeding therapy vision
therapy Kinesiotherapy etc)
Develop a Therapy Plan
Perlman Center
Perlman Case Study Examples
Mild delays
Infant has risks for CP
Moderate Delays
Infant presents abnormal motor delays
Severe Delays
Infant presents with significant
neuro-motor impairments
Perlman Center M
ild d
ela
ys-a
t risk
bull Full term
bull Difficult delivery
bull Seizure after delivery
bull Abnormal MRI
bull Mom has degree in child development
Mod
era
te d
ela
ys
bull Full term
bull Seizure activity and HIE following birth
bull Abnormal movements of UELE
bull Abnormal MRI
bull Sensory issues
bull Feeding difficulty S
eve
re d
ela
ys
bull Preemie
bull Difficult pregnancy
bull Ruptured placenta
bull Seizures NICU
bull Tonic posturing
bull Feeding difficulty
bull Family lost another child
Case Studies Patient Medical History
Perlman Center M
ild d
ela
ys-A
t R
isk
bull MRI- basal ganglia
bull Clinic check-ups have been on track
bull Underlying weakness observed by PT
bull Slight catch in Right hamstring
bull 1x every 3-4 weeks
Modera
te d
ela
ys
bull Presents with tonal posturing
bull External support for positioning
bull Sensitive to vestibular movement
bull Home based EI OP equipment planning
bull Group tx
Severe
dela
ys
bull Severe posturing
bull FeedingGI issues
bull Mom needs lots of support
bull Positioning needs
bull Medical needs
bull 2x week group setting (OT PT SLP SW MDs feeding team)
Perlman Center
Build high value
interventions
Perlman Center
bull Therapy to support early parent-infant relationships
bull Build parent confidence
bull Education and training
bull Build opportunities for practice
bull Incorporate into daily routines
Engaging Parents
bull Adapt access to play play is FUN
bull Stimulate exploration inquiry and learning
bull Enrich for cognitive motor sensory and social development
Building Enriched
Environments
bull Goal-oriented intensive motor training (Morgan et al 2015)
bull Build in repetition
bull Scaffold so infant is able to complete at least part of the task
bull Experience-based activities will engage self-initiation of movement
bull Occurs while participating in daily routines (ie at the grocery)
Applying Early Motor Learning
Specific Strategies
Perlman Center
Engaging Parents Education
Topic Lists
Identify parent priorities and begin education based
on parentsrsquo perceived need
child diagnoses
parent support and resources
oral-motor and feeding
seating and positioning
disabilities across the lifespan
gross motor development
patient advocacy
adapted equipment fine motor development
home positioning techniques
financial resources
sensory integration
types of rehabilitation therapy
speech and language
Perlman Center
Engaging Parents Goal Setting
Perlman Center
Educate
Model
Engage
Observe
Connect
Perlman Center
Purposeful Play ishellip
Goal oriented
Activity based
Motivating
In an Enriched environment
Perlman Center
Perlman Center
cognitive
sensory
motor
social
Perlman Center
Building Enriched Environments
Perlman Center
Building Enriched Environments
bull Is the child positioned within
reach to explore the activity
bull Are all senses being utilized
bull Is the child being motivated to
move throughout the
environment
bull Is the environment adapted to
increase access to play
Perlman Center
Building Enriched Environments
bull Can the child have an effect
on the activity within the
environment
bull Is the activity appropriately
challenging the child within the
environment
bull Is the child presented with the
need for problem solving
Perlman Center
Building Enriched Environments
bull Is the child motivated to repeat
the task for motor learning
bull Does the environment support
learning (ie appropriate
noise level social motivators
peer groups developmental
learning supports visual
supports auditory feedback
etc)
Perlman Center
Bridging the gap between the clinic and the
home environment
bull Discipline focused
bull Clinic equipment closet
bull May have group option
Clinic
bull Incorporate into Family Routines
bull Functional activities
bull High Value
bull Adapted environment
Home
Mobility
Early Literacy
Sensory Motor Learning
Social Connections
Perlman Center
Early Learning
Functional MRIs show positive long-term neuro-
cognitive effects of reading to very young
infants
Sensory experiences shape a babyrsquos
knowledge about the world
The average toddler moves 8
out of 10 waking hoursday
Perlman Center
Learning through Experience
Adapting the environment with positioning equipment allows children with disabilities to experience their world and build relationships Allows the child to participate in typical experiences to foster learning
Activities need to promote active engagement
and allow a child to
ndash Actively explore move and participate in play
ndash Assist with self-help routines
ndash Interact and connect with family amp friends
ndash Participate in community activities
ndash Have a means to effectively communicate
ndash Make choices about their wants and need
Perlman Center
Perlman Center
bull Headpointing painting
bull Universal cuffs large pegs splints
bull Switch toys for art activitiesdramatic play-pourer
bull Switch computer access- helpkidzlearncom
bull Fischer Price game with keyboard binder switch
bull Walking in different textures while in standers and walkers
bull Cameramouseorg with dwell click
bull Partner assisted scanning
Alternative amp Adaptive Access to Play
Perlman Center
Change the environment Not the body Adaptations will be critical for success
Gross Motor Fine Motor
Social
Communication
Perlman Center Consider Communication Young children need a reliable form of communication as early as possible
Augmentative Communication is shown to support verbal skills and enhance lives of
birth to three children and their families (Romski et al 2015)
Perlman Center
Holistic approach to AAC intervention should
Build on individual strengths
Focus on participation in real-world contexts
Address psychosocial factors (ie motivation attitude confidence resilience)
Focus on environmental factors to reduce barriers and maximize social supports
In the absence of a holistic approach to communication a child is at risk for failing to engage in social contexts beyond their immediate family or educationalvocational personnel (Light and Mcnaughton 2015)
Augmentative amp Alternative Communication (AAC)
Perlman Center
Early Literacy
Perlman Center
Early Mobility
There is more than one way
Hands Free Matters
Perlman Center
Early Mobility
Should I get a gait trainer if
they are going to walk YES
Are they too young for power NO
Perlman Center
Sensory Motor Learning
Perlman Center
Sensory Motor Learning
Perlman Center
Social Connection
Perlman Center
Total Access to Play
Perlman Center
Perlman defines functional positioning bull Positioning which promotes active movement and participation and
provides an opportunity to positively impact cognitive function
bull Equipment should promote function and participation across the lifespan
Perlman Center
Principles of seating and positioning
bull Obtain a stable base of support
bull Decrease the influence of atypical muscle tone
bull Accommodate fixed deformities and correct flexible deformities
bull Provide the least amount of intervention needed to achieve the greatest level of function
bull There is no one solution or product but typically a combination of tools that provide success
Adapted from Radell (1997) and York and Weimann (1991)
Perlman Center
Key Positioning Components
bull Postural Control Strengthening
bull Range of Motion Weight Bearing
bull Home Activity Programs
Developmental Positioning
bull ADLs-Play Feeding Bathing Sleeping
bull Computer AccessAAC-Integrated Technology
bull Vision Sensory Processing Participation
Upright Positioning
bull EARLY MOBILITY- developmental sequence
bull Gait Trainer Stander amp or Wheelchair
bull Manual wheelchair vs Power Mobility- BOTH
bull Recreational
ldquoTotalrdquo Mobility
bull Body Mechanics Hoyer Lifts Overhead Systems
bull Car Seat ampor Tie Downs
bull Adapted VanRamps
Transfers ampTransportation
Perlman Center
Equipment Plan of Care
Birth to Three
Adapting baby
equipment
Floor Play
StanderWalker
Bath Seat
Car Seat
Braces
Seating for Function
Early ACCESS
Wheelchair
Bed Positioning
Bike amp Swing
Preschool
Stander
Walker
Braces
Bath Seat
Potty Seat
Wheelchair
HiLo seating
AACAccess
Adapted Bed
Car Seat
Transportation
RecreationHEP
School-Age
to Adult
Wheelchair
AACACCESS
Integrated AT
Hilo chair
Standerwalker
Bath chair
Potty chair
Adapted Bed
Car SeatVan
Home modslifts
LeisureWork
Perlman Center
Commercial Products strollers car seats cribs bath seats high chairs
playpen infant swings floor mats nursing pillow ExerSaucers
Perlman Center
Creative Commercial Adaptations
Pool noodles
Snug and Go
Crib Wedges
Bed tableart desk
Laundry baskets
Inflatable bathtub
Inflatable infant pools
Boxesstools
Perlman Center Creative Commercial Adaptations
Laundry basket $400
Pool Noodle x 2 $300
Floor sitterbath support $700
table (BLACK) $800
Garbage can $600
Large pool noodle $300
Stander with anterior support and
Visual adaptation $1700
Perlman Center
Complex Rehab Equipment
Standers
Gait trainers
Bath Support
Car seat
Seating
Feeding tools
AAC
Sensory tools
vibration
Compression garments
NUK brushes
Z Vibe
Modified utensils
Swings
Weight
Head phones
Positioning
Neck supports
Bracing
Bobby pillowU cushion
Benches
Fireflyfriendscom
PlayPaK
Upsee
Go To Seat
Early Literacy
Picture symbols
Voice output switches
Adapted books
Adapted Equipment
Perlman Center
You got this baby Nowhellip Questions
Perlman Center
LETrsquoS PLAY
Hands on Equipment Demonstration
Perlman Center
bull Ulrich B (2010) Opportunities for Early Intervention Based on Theory Basic Neuroscience and Clinical Science Physical Therapy 90(12) 1868-1880
bull McIntyre S Morgan C amp Walker K (2011) Cerebral Palsy Dont Delay Developmental Disabilities Research Reviews 17(2) 114-129
bull Novak I (2014) Evidence-Based Diagnosis Health Care and Rehabilitation for Children with Cerebral Palsy Journal of Child Neurology 29(8) 1141-1156
bull Morgan C Novak I amp Badawi N (2013) Enriched Environments and Motor Outcomes in Cerebral Palsy Systematic Review and Meta-analysis Pediatrics 132 (3)e 735 -e746
bull Morgan C Novak I Dale R Guzzetta A amp Badawi N (2014) GAME (Goals- Activity-Motor Enrichment) protocol of a single blind randomised controlled trial of motor training parent education and environmental enrichment for infants at high risk of cerebral palsy BMC Neurology 14(203)
bull Whittingham K Wee D amp Boyd R (2010) Systematic review of the efficacy of parenting interventions for children with cerebral palsy Child care health and development 37(4) 475-483
bull Morgan C Novak I dale R amp Badawi N (2015) Optimising motor learning in infants at high risk of cerebral palsy a pilot study BMC Pediatrics 15(1) n pag Web
bull Vos R Dallmeijer A Verhoef M et al (2014) Developmental trajectories of receptive and expressive communication in children and young adults with cerebral palsy Developmental Medicine amp Child Neurology 56 951-959
bull Light J and McNaughton D (2015) Designing AAC research and intervention to improve outcomes for individuals with complex communication needs Augmentative and Alternative Communication 31(2) 85-96
bull Romski M Sevcik R Barton-Hulsey A amp Whitmore A (2015) Early Intervention and AAC What a difference 30 years makes Augmentative and Alternative Communication 31 (3) 181-202
References
Perlman Center
bull Novak I Cusick A Lannin N (2009) Occupational therapy home programs for cerebral palsy Double-blind randomised controlled trial Pediatrics 124 e606-e614
bull Gericke T (2006) Postural management for children with cerebral palsy consensus statement Dev Med Child Neurol 48 (4) 244-244
bull McKeever P Rossen B Scott H Robinson-Vincent K amp Wright V (2013) The significance of uprightness parentsrsquo reflections on childrenrsquos responses to a hands-free walker for children Disability amp Society 28(3) 380-392
bull Law M Pollock N Russell D Walter S et al (2011) Focus on function a cluster randomised controlled trial comparing child-versus context-focused intervention for young children with cerebral palsy Dev Med Child Neurol 53 621-629
bull ldquoSensory Processing Developmental Chartrdquo Sensory Processing Developmental Chart Np nd Web 12 Oct 2015
bull Folio MR amp Fewell RR(2000) Peabody Developmental Motor Scales- Second edition Austin TX PRO ED
bull Voress Judith K amp Pearson Nils A (2013) Early Childhood Development Chart-Third edition Austin TX PRO ED
bull Paul Rhea (2007) Language Disorders from Infancy Through Adolescence Assessment amp Intervention Third edition St Louis MA Mosby Inc
bull Prosser L Ohlrich L Curatalo L Alter K amp Damiano D (2012) Feasibility and preliminary effectiveness of a novel mobility training intervention in infants and toddlers with cerebral palsy Developmental Neurorehabilitation 15(4) 259-266
References
Perlman Center
Phys Ther 2010 Dec90(12)1868-80
Opportunities for early intervention based on theory basic
neuroscience and clinical science Ulrich BD
Key Concepts Supported by Research
bull We are missing the boat on opportunities for
infants with motor disabilities
bull Young babies create adaptive goal-directed
movements and demonstrate systematic learning
from experiences
bull Change happens with self-organized interaction
goal directed and repetitive actions within context
bull Activity based interventions can be administered
by caregivers and guided by therapists
Perlman Center
Dev Disabil Res Rev 201117(2)114-29
Cerebral palsy--dont delay McIntyre S Morgan C Walker K Novak I
Key Concepts Supported by Research
bull It is the responsibility of the health care professional who observed major risk
factors or a motor delay to investigate further diagnose at risk CP early and
refer to early intervention to optimize cognitive function
bull Refer for intervention when an infant is at high risk without a formal diagnosis
bull Delaying diagnosis can worsen parental depression and stress
bull All children with suspected injury should have MRI imaging
bull Qualitative assessment of general movements are predictive of CP Routinely
used neuro observations and standardized developmental tests are not
designed to detect CP
Perlman Center
Pediatrics 2013 Sep132(3)e735-46
Enriched environments and motor outcomes in cerebral
palsy systematic review and meta-analysis Morgan C Novak I Badawi N
Key Concepts Supported by Research
Perlman Center
Morgan et al BMC Pediatrics (2015) 1530
Optimizing motor learning in infants at high risk of cerebral palsy
a pilot study Catherine Morgan Iona Novak Russell C Dale and Nadia Badawi
Key Concepts Supported by Research
bull GAME (Goals- Activity- Motor- Enrichment) appears to offer a promising and
feasible new motor intervention for CP
bull Parents coached in simple motor task analysis and appropriate strategies to
enhance development and in setting up motor enriched environments
bull Favorable short-term motor outcomes were noted in standardized testing of
motor ability
bull Parents reported improvements in the COPM performance and satisfaction
bull Important to monitor parents well-being due to higher depression and anxiety
levels more than parents with children without disabilities
Perlman Center
Morgan et al BMC Neurology 2014 1420
GAME (Goals - Activity - Motor Enrichment)protocol of a single blind
randomised controlled trial of motor training parent education and
environmental enrichment for infants at high risk of cerebral palsy Catherine Morgan Iona Novak Russell C Dale Andrea Guzzetta and Nadia Badawi
Key Concepts Supported by Research
RCT of a goal driven motor learning approach with environmental interventions
and parent education
bull Prechtlrsquos Qualitative Assessment of General Movements (GMs) has allowed
earlier diagnosis of high risk CP at 3 months of age
bull Set goals with family educate parents enrich the environment
bull ldquostandard carerdquo- varied approaches to therapy intervention including
neurodevelopmental therapy developmental skills approach group therapy
or motor learning approaches
bull Outcome measures PDMS-2 GMFM COPMAHEMD-IS DASS BSID-III
Perlman Center
Key Elements
bull Shared goal-setting
bull Activity-based intervention
bull Routine-based practice
bull Enriched environment
A Multi-Disciplinary Early Intervention Model
It takes a team
Perlman Center
Patient
PT
DI
OT
Parent
Social
Work
SLP
Neurologist
Primary Care Physician
Rehabilitation doctor
Vision specialist
Other care providers
Orthopedic
ENT Nutrition
Neonatologist
Perlman Center
What is the best way to coordinate the
multidisciplinary team bull Determine the primary team (the team that sees the client and
family the most including a social worker)
bull Include parents in meetings with team discussing parents
priorities and goals (Routine Based Assessments Circle
Conferences)
bull Encourage a parent notebookbinder (contact information for
the team educational materials questions recommendations)
bull Communication with physicians before appointments- make
sure you have all necessary releases on front end
bull Use Technology group emails My Chart EPIC Care
Everywhere
Perlman Center
Parent Resource Binder
Educational Topics
Development
Nutrition
Diagnosis
Role of the Clinician
Multidisciplinary team
Muscle tone
Language development
Sensory Integration
Positioning
Sleep
Financial Resourceshelliphellip
Medical Management
Birth History
Medications
Medical Team
Insurance Information
Appointments
EquipmentVendor
Perlman Center
EMPOWER PARENTS
Perlman Center
We know that CP results in complex problems
How do we address multiple areas
Pain
Cognition
Mobility
Bone development
Language
Seizures
Behavior
Bowel and Bladder
Sleep
Vision
Nutrition
Hearing Novak April 2014
The Evaluation Process
Not just focusing on your clinical
area
You are not just
evaluating the infant
Perlman Center
Perlman Center
The Evaluation Process Holistic Picture
Ongoing Assessment of the Infant
Family-Centered Care
General Assessment
Perlman Center
Multidisciplinary Checklist Tools
Perlman Center
Perlman Multidisciplinary Checklist
Perlman Center
ParentChild Assessment of Routines
Perlman Center
Providing Therapy Services
Clinical
assessment Parents Goals
and Priorities
What are the therapy options to meet the above needs
Perlman Center
Bridging the gap between clinical
assessments and family need
bull Identify Limitations
bull Developmental Delays
bull Medical needs
Clinical Finding
bull Family Routines
bull Family Priorities
bull Overcome Barriers and Obstacles
Family Need
Perlman Center
10 minutes
Perlman Center
bull Considering severity and complexity of diagnosis delays
parentsrsquo level of education acceptance and understanding of
their childrsquos diagnosis
bull Frequency Does the childfamily need weekly treatment once
per month or a burst of therapy every couple of months
bull Most supportive environment group or individual home-based
or clinic-based
bull Referrals for specialized intervention (splinting constraint
therapy adaptive equipment oral-motorfeeding therapy vision
therapy Kinesiotherapy etc)
Develop a Therapy Plan
Perlman Center
Perlman Case Study Examples
Mild delays
Infant has risks for CP
Moderate Delays
Infant presents abnormal motor delays
Severe Delays
Infant presents with significant
neuro-motor impairments
Perlman Center M
ild d
ela
ys-a
t risk
bull Full term
bull Difficult delivery
bull Seizure after delivery
bull Abnormal MRI
bull Mom has degree in child development
Mod
era
te d
ela
ys
bull Full term
bull Seizure activity and HIE following birth
bull Abnormal movements of UELE
bull Abnormal MRI
bull Sensory issues
bull Feeding difficulty S
eve
re d
ela
ys
bull Preemie
bull Difficult pregnancy
bull Ruptured placenta
bull Seizures NICU
bull Tonic posturing
bull Feeding difficulty
bull Family lost another child
Case Studies Patient Medical History
Perlman Center M
ild d
ela
ys-A
t R
isk
bull MRI- basal ganglia
bull Clinic check-ups have been on track
bull Underlying weakness observed by PT
bull Slight catch in Right hamstring
bull 1x every 3-4 weeks
Modera
te d
ela
ys
bull Presents with tonal posturing
bull External support for positioning
bull Sensitive to vestibular movement
bull Home based EI OP equipment planning
bull Group tx
Severe
dela
ys
bull Severe posturing
bull FeedingGI issues
bull Mom needs lots of support
bull Positioning needs
bull Medical needs
bull 2x week group setting (OT PT SLP SW MDs feeding team)
Perlman Center
Build high value
interventions
Perlman Center
bull Therapy to support early parent-infant relationships
bull Build parent confidence
bull Education and training
bull Build opportunities for practice
bull Incorporate into daily routines
Engaging Parents
bull Adapt access to play play is FUN
bull Stimulate exploration inquiry and learning
bull Enrich for cognitive motor sensory and social development
Building Enriched
Environments
bull Goal-oriented intensive motor training (Morgan et al 2015)
bull Build in repetition
bull Scaffold so infant is able to complete at least part of the task
bull Experience-based activities will engage self-initiation of movement
bull Occurs while participating in daily routines (ie at the grocery)
Applying Early Motor Learning
Specific Strategies
Perlman Center
Engaging Parents Education
Topic Lists
Identify parent priorities and begin education based
on parentsrsquo perceived need
child diagnoses
parent support and resources
oral-motor and feeding
seating and positioning
disabilities across the lifespan
gross motor development
patient advocacy
adapted equipment fine motor development
home positioning techniques
financial resources
sensory integration
types of rehabilitation therapy
speech and language
Perlman Center
Engaging Parents Goal Setting
Perlman Center
Educate
Model
Engage
Observe
Connect
Perlman Center
Purposeful Play ishellip
Goal oriented
Activity based
Motivating
In an Enriched environment
Perlman Center
Perlman Center
cognitive
sensory
motor
social
Perlman Center
Building Enriched Environments
Perlman Center
Building Enriched Environments
bull Is the child positioned within
reach to explore the activity
bull Are all senses being utilized
bull Is the child being motivated to
move throughout the
environment
bull Is the environment adapted to
increase access to play
Perlman Center
Building Enriched Environments
bull Can the child have an effect
on the activity within the
environment
bull Is the activity appropriately
challenging the child within the
environment
bull Is the child presented with the
need for problem solving
Perlman Center
Building Enriched Environments
bull Is the child motivated to repeat
the task for motor learning
bull Does the environment support
learning (ie appropriate
noise level social motivators
peer groups developmental
learning supports visual
supports auditory feedback
etc)
Perlman Center
Bridging the gap between the clinic and the
home environment
bull Discipline focused
bull Clinic equipment closet
bull May have group option
Clinic
bull Incorporate into Family Routines
bull Functional activities
bull High Value
bull Adapted environment
Home
Mobility
Early Literacy
Sensory Motor Learning
Social Connections
Perlman Center
Early Learning
Functional MRIs show positive long-term neuro-
cognitive effects of reading to very young
infants
Sensory experiences shape a babyrsquos
knowledge about the world
The average toddler moves 8
out of 10 waking hoursday
Perlman Center
Learning through Experience
Adapting the environment with positioning equipment allows children with disabilities to experience their world and build relationships Allows the child to participate in typical experiences to foster learning
Activities need to promote active engagement
and allow a child to
ndash Actively explore move and participate in play
ndash Assist with self-help routines
ndash Interact and connect with family amp friends
ndash Participate in community activities
ndash Have a means to effectively communicate
ndash Make choices about their wants and need
Perlman Center
Perlman Center
bull Headpointing painting
bull Universal cuffs large pegs splints
bull Switch toys for art activitiesdramatic play-pourer
bull Switch computer access- helpkidzlearncom
bull Fischer Price game with keyboard binder switch
bull Walking in different textures while in standers and walkers
bull Cameramouseorg with dwell click
bull Partner assisted scanning
Alternative amp Adaptive Access to Play
Perlman Center
Change the environment Not the body Adaptations will be critical for success
Gross Motor Fine Motor
Social
Communication
Perlman Center Consider Communication Young children need a reliable form of communication as early as possible
Augmentative Communication is shown to support verbal skills and enhance lives of
birth to three children and their families (Romski et al 2015)
Perlman Center
Holistic approach to AAC intervention should
Build on individual strengths
Focus on participation in real-world contexts
Address psychosocial factors (ie motivation attitude confidence resilience)
Focus on environmental factors to reduce barriers and maximize social supports
In the absence of a holistic approach to communication a child is at risk for failing to engage in social contexts beyond their immediate family or educationalvocational personnel (Light and Mcnaughton 2015)
Augmentative amp Alternative Communication (AAC)
Perlman Center
Early Literacy
Perlman Center
Early Mobility
There is more than one way
Hands Free Matters
Perlman Center
Early Mobility
Should I get a gait trainer if
they are going to walk YES
Are they too young for power NO
Perlman Center
Sensory Motor Learning
Perlman Center
Sensory Motor Learning
Perlman Center
Social Connection
Perlman Center
Total Access to Play
Perlman Center
Perlman defines functional positioning bull Positioning which promotes active movement and participation and
provides an opportunity to positively impact cognitive function
bull Equipment should promote function and participation across the lifespan
Perlman Center
Principles of seating and positioning
bull Obtain a stable base of support
bull Decrease the influence of atypical muscle tone
bull Accommodate fixed deformities and correct flexible deformities
bull Provide the least amount of intervention needed to achieve the greatest level of function
bull There is no one solution or product but typically a combination of tools that provide success
Adapted from Radell (1997) and York and Weimann (1991)
Perlman Center
Key Positioning Components
bull Postural Control Strengthening
bull Range of Motion Weight Bearing
bull Home Activity Programs
Developmental Positioning
bull ADLs-Play Feeding Bathing Sleeping
bull Computer AccessAAC-Integrated Technology
bull Vision Sensory Processing Participation
Upright Positioning
bull EARLY MOBILITY- developmental sequence
bull Gait Trainer Stander amp or Wheelchair
bull Manual wheelchair vs Power Mobility- BOTH
bull Recreational
ldquoTotalrdquo Mobility
bull Body Mechanics Hoyer Lifts Overhead Systems
bull Car Seat ampor Tie Downs
bull Adapted VanRamps
Transfers ampTransportation
Perlman Center
Equipment Plan of Care
Birth to Three
Adapting baby
equipment
Floor Play
StanderWalker
Bath Seat
Car Seat
Braces
Seating for Function
Early ACCESS
Wheelchair
Bed Positioning
Bike amp Swing
Preschool
Stander
Walker
Braces
Bath Seat
Potty Seat
Wheelchair
HiLo seating
AACAccess
Adapted Bed
Car Seat
Transportation
RecreationHEP
School-Age
to Adult
Wheelchair
AACACCESS
Integrated AT
Hilo chair
Standerwalker
Bath chair
Potty chair
Adapted Bed
Car SeatVan
Home modslifts
LeisureWork
Perlman Center
Commercial Products strollers car seats cribs bath seats high chairs
playpen infant swings floor mats nursing pillow ExerSaucers
Perlman Center
Creative Commercial Adaptations
Pool noodles
Snug and Go
Crib Wedges
Bed tableart desk
Laundry baskets
Inflatable bathtub
Inflatable infant pools
Boxesstools
Perlman Center Creative Commercial Adaptations
Laundry basket $400
Pool Noodle x 2 $300
Floor sitterbath support $700
table (BLACK) $800
Garbage can $600
Large pool noodle $300
Stander with anterior support and
Visual adaptation $1700
Perlman Center
Complex Rehab Equipment
Standers
Gait trainers
Bath Support
Car seat
Seating
Feeding tools
AAC
Sensory tools
vibration
Compression garments
NUK brushes
Z Vibe
Modified utensils
Swings
Weight
Head phones
Positioning
Neck supports
Bracing
Bobby pillowU cushion
Benches
Fireflyfriendscom
PlayPaK
Upsee
Go To Seat
Early Literacy
Picture symbols
Voice output switches
Adapted books
Adapted Equipment
Perlman Center
You got this baby Nowhellip Questions
Perlman Center
LETrsquoS PLAY
Hands on Equipment Demonstration
Perlman Center
bull Ulrich B (2010) Opportunities for Early Intervention Based on Theory Basic Neuroscience and Clinical Science Physical Therapy 90(12) 1868-1880
bull McIntyre S Morgan C amp Walker K (2011) Cerebral Palsy Dont Delay Developmental Disabilities Research Reviews 17(2) 114-129
bull Novak I (2014) Evidence-Based Diagnosis Health Care and Rehabilitation for Children with Cerebral Palsy Journal of Child Neurology 29(8) 1141-1156
bull Morgan C Novak I amp Badawi N (2013) Enriched Environments and Motor Outcomes in Cerebral Palsy Systematic Review and Meta-analysis Pediatrics 132 (3)e 735 -e746
bull Morgan C Novak I Dale R Guzzetta A amp Badawi N (2014) GAME (Goals- Activity-Motor Enrichment) protocol of a single blind randomised controlled trial of motor training parent education and environmental enrichment for infants at high risk of cerebral palsy BMC Neurology 14(203)
bull Whittingham K Wee D amp Boyd R (2010) Systematic review of the efficacy of parenting interventions for children with cerebral palsy Child care health and development 37(4) 475-483
bull Morgan C Novak I dale R amp Badawi N (2015) Optimising motor learning in infants at high risk of cerebral palsy a pilot study BMC Pediatrics 15(1) n pag Web
bull Vos R Dallmeijer A Verhoef M et al (2014) Developmental trajectories of receptive and expressive communication in children and young adults with cerebral palsy Developmental Medicine amp Child Neurology 56 951-959
bull Light J and McNaughton D (2015) Designing AAC research and intervention to improve outcomes for individuals with complex communication needs Augmentative and Alternative Communication 31(2) 85-96
bull Romski M Sevcik R Barton-Hulsey A amp Whitmore A (2015) Early Intervention and AAC What a difference 30 years makes Augmentative and Alternative Communication 31 (3) 181-202
References
Perlman Center
bull Novak I Cusick A Lannin N (2009) Occupational therapy home programs for cerebral palsy Double-blind randomised controlled trial Pediatrics 124 e606-e614
bull Gericke T (2006) Postural management for children with cerebral palsy consensus statement Dev Med Child Neurol 48 (4) 244-244
bull McKeever P Rossen B Scott H Robinson-Vincent K amp Wright V (2013) The significance of uprightness parentsrsquo reflections on childrenrsquos responses to a hands-free walker for children Disability amp Society 28(3) 380-392
bull Law M Pollock N Russell D Walter S et al (2011) Focus on function a cluster randomised controlled trial comparing child-versus context-focused intervention for young children with cerebral palsy Dev Med Child Neurol 53 621-629
bull ldquoSensory Processing Developmental Chartrdquo Sensory Processing Developmental Chart Np nd Web 12 Oct 2015
bull Folio MR amp Fewell RR(2000) Peabody Developmental Motor Scales- Second edition Austin TX PRO ED
bull Voress Judith K amp Pearson Nils A (2013) Early Childhood Development Chart-Third edition Austin TX PRO ED
bull Paul Rhea (2007) Language Disorders from Infancy Through Adolescence Assessment amp Intervention Third edition St Louis MA Mosby Inc
bull Prosser L Ohlrich L Curatalo L Alter K amp Damiano D (2012) Feasibility and preliminary effectiveness of a novel mobility training intervention in infants and toddlers with cerebral palsy Developmental Neurorehabilitation 15(4) 259-266
References
Perlman Center
Dev Disabil Res Rev 201117(2)114-29
Cerebral palsy--dont delay McIntyre S Morgan C Walker K Novak I
Key Concepts Supported by Research
bull It is the responsibility of the health care professional who observed major risk
factors or a motor delay to investigate further diagnose at risk CP early and
refer to early intervention to optimize cognitive function
bull Refer for intervention when an infant is at high risk without a formal diagnosis
bull Delaying diagnosis can worsen parental depression and stress
bull All children with suspected injury should have MRI imaging
bull Qualitative assessment of general movements are predictive of CP Routinely
used neuro observations and standardized developmental tests are not
designed to detect CP
Perlman Center
Pediatrics 2013 Sep132(3)e735-46
Enriched environments and motor outcomes in cerebral
palsy systematic review and meta-analysis Morgan C Novak I Badawi N
Key Concepts Supported by Research
Perlman Center
Morgan et al BMC Pediatrics (2015) 1530
Optimizing motor learning in infants at high risk of cerebral palsy
a pilot study Catherine Morgan Iona Novak Russell C Dale and Nadia Badawi
Key Concepts Supported by Research
bull GAME (Goals- Activity- Motor- Enrichment) appears to offer a promising and
feasible new motor intervention for CP
bull Parents coached in simple motor task analysis and appropriate strategies to
enhance development and in setting up motor enriched environments
bull Favorable short-term motor outcomes were noted in standardized testing of
motor ability
bull Parents reported improvements in the COPM performance and satisfaction
bull Important to monitor parents well-being due to higher depression and anxiety
levels more than parents with children without disabilities
Perlman Center
Morgan et al BMC Neurology 2014 1420
GAME (Goals - Activity - Motor Enrichment)protocol of a single blind
randomised controlled trial of motor training parent education and
environmental enrichment for infants at high risk of cerebral palsy Catherine Morgan Iona Novak Russell C Dale Andrea Guzzetta and Nadia Badawi
Key Concepts Supported by Research
RCT of a goal driven motor learning approach with environmental interventions
and parent education
bull Prechtlrsquos Qualitative Assessment of General Movements (GMs) has allowed
earlier diagnosis of high risk CP at 3 months of age
bull Set goals with family educate parents enrich the environment
bull ldquostandard carerdquo- varied approaches to therapy intervention including
neurodevelopmental therapy developmental skills approach group therapy
or motor learning approaches
bull Outcome measures PDMS-2 GMFM COPMAHEMD-IS DASS BSID-III
Perlman Center
Key Elements
bull Shared goal-setting
bull Activity-based intervention
bull Routine-based practice
bull Enriched environment
A Multi-Disciplinary Early Intervention Model
It takes a team
Perlman Center
Patient
PT
DI
OT
Parent
Social
Work
SLP
Neurologist
Primary Care Physician
Rehabilitation doctor
Vision specialist
Other care providers
Orthopedic
ENT Nutrition
Neonatologist
Perlman Center
What is the best way to coordinate the
multidisciplinary team bull Determine the primary team (the team that sees the client and
family the most including a social worker)
bull Include parents in meetings with team discussing parents
priorities and goals (Routine Based Assessments Circle
Conferences)
bull Encourage a parent notebookbinder (contact information for
the team educational materials questions recommendations)
bull Communication with physicians before appointments- make
sure you have all necessary releases on front end
bull Use Technology group emails My Chart EPIC Care
Everywhere
Perlman Center
Parent Resource Binder
Educational Topics
Development
Nutrition
Diagnosis
Role of the Clinician
Multidisciplinary team
Muscle tone
Language development
Sensory Integration
Positioning
Sleep
Financial Resourceshelliphellip
Medical Management
Birth History
Medications
Medical Team
Insurance Information
Appointments
EquipmentVendor
Perlman Center
EMPOWER PARENTS
Perlman Center
We know that CP results in complex problems
How do we address multiple areas
Pain
Cognition
Mobility
Bone development
Language
Seizures
Behavior
Bowel and Bladder
Sleep
Vision
Nutrition
Hearing Novak April 2014
The Evaluation Process
Not just focusing on your clinical
area
You are not just
evaluating the infant
Perlman Center
Perlman Center
The Evaluation Process Holistic Picture
Ongoing Assessment of the Infant
Family-Centered Care
General Assessment
Perlman Center
Multidisciplinary Checklist Tools
Perlman Center
Perlman Multidisciplinary Checklist
Perlman Center
ParentChild Assessment of Routines
Perlman Center
Providing Therapy Services
Clinical
assessment Parents Goals
and Priorities
What are the therapy options to meet the above needs
Perlman Center
Bridging the gap between clinical
assessments and family need
bull Identify Limitations
bull Developmental Delays
bull Medical needs
Clinical Finding
bull Family Routines
bull Family Priorities
bull Overcome Barriers and Obstacles
Family Need
Perlman Center
10 minutes
Perlman Center
bull Considering severity and complexity of diagnosis delays
parentsrsquo level of education acceptance and understanding of
their childrsquos diagnosis
bull Frequency Does the childfamily need weekly treatment once
per month or a burst of therapy every couple of months
bull Most supportive environment group or individual home-based
or clinic-based
bull Referrals for specialized intervention (splinting constraint
therapy adaptive equipment oral-motorfeeding therapy vision
therapy Kinesiotherapy etc)
Develop a Therapy Plan
Perlman Center
Perlman Case Study Examples
Mild delays
Infant has risks for CP
Moderate Delays
Infant presents abnormal motor delays
Severe Delays
Infant presents with significant
neuro-motor impairments
Perlman Center M
ild d
ela
ys-a
t risk
bull Full term
bull Difficult delivery
bull Seizure after delivery
bull Abnormal MRI
bull Mom has degree in child development
Mod
era
te d
ela
ys
bull Full term
bull Seizure activity and HIE following birth
bull Abnormal movements of UELE
bull Abnormal MRI
bull Sensory issues
bull Feeding difficulty S
eve
re d
ela
ys
bull Preemie
bull Difficult pregnancy
bull Ruptured placenta
bull Seizures NICU
bull Tonic posturing
bull Feeding difficulty
bull Family lost another child
Case Studies Patient Medical History
Perlman Center M
ild d
ela
ys-A
t R
isk
bull MRI- basal ganglia
bull Clinic check-ups have been on track
bull Underlying weakness observed by PT
bull Slight catch in Right hamstring
bull 1x every 3-4 weeks
Modera
te d
ela
ys
bull Presents with tonal posturing
bull External support for positioning
bull Sensitive to vestibular movement
bull Home based EI OP equipment planning
bull Group tx
Severe
dela
ys
bull Severe posturing
bull FeedingGI issues
bull Mom needs lots of support
bull Positioning needs
bull Medical needs
bull 2x week group setting (OT PT SLP SW MDs feeding team)
Perlman Center
Build high value
interventions
Perlman Center
bull Therapy to support early parent-infant relationships
bull Build parent confidence
bull Education and training
bull Build opportunities for practice
bull Incorporate into daily routines
Engaging Parents
bull Adapt access to play play is FUN
bull Stimulate exploration inquiry and learning
bull Enrich for cognitive motor sensory and social development
Building Enriched
Environments
bull Goal-oriented intensive motor training (Morgan et al 2015)
bull Build in repetition
bull Scaffold so infant is able to complete at least part of the task
bull Experience-based activities will engage self-initiation of movement
bull Occurs while participating in daily routines (ie at the grocery)
Applying Early Motor Learning
Specific Strategies
Perlman Center
Engaging Parents Education
Topic Lists
Identify parent priorities and begin education based
on parentsrsquo perceived need
child diagnoses
parent support and resources
oral-motor and feeding
seating and positioning
disabilities across the lifespan
gross motor development
patient advocacy
adapted equipment fine motor development
home positioning techniques
financial resources
sensory integration
types of rehabilitation therapy
speech and language
Perlman Center
Engaging Parents Goal Setting
Perlman Center
Educate
Model
Engage
Observe
Connect
Perlman Center
Purposeful Play ishellip
Goal oriented
Activity based
Motivating
In an Enriched environment
Perlman Center
Perlman Center
cognitive
sensory
motor
social
Perlman Center
Building Enriched Environments
Perlman Center
Building Enriched Environments
bull Is the child positioned within
reach to explore the activity
bull Are all senses being utilized
bull Is the child being motivated to
move throughout the
environment
bull Is the environment adapted to
increase access to play
Perlman Center
Building Enriched Environments
bull Can the child have an effect
on the activity within the
environment
bull Is the activity appropriately
challenging the child within the
environment
bull Is the child presented with the
need for problem solving
Perlman Center
Building Enriched Environments
bull Is the child motivated to repeat
the task for motor learning
bull Does the environment support
learning (ie appropriate
noise level social motivators
peer groups developmental
learning supports visual
supports auditory feedback
etc)
Perlman Center
Bridging the gap between the clinic and the
home environment
bull Discipline focused
bull Clinic equipment closet
bull May have group option
Clinic
bull Incorporate into Family Routines
bull Functional activities
bull High Value
bull Adapted environment
Home
Mobility
Early Literacy
Sensory Motor Learning
Social Connections
Perlman Center
Early Learning
Functional MRIs show positive long-term neuro-
cognitive effects of reading to very young
infants
Sensory experiences shape a babyrsquos
knowledge about the world
The average toddler moves 8
out of 10 waking hoursday
Perlman Center
Learning through Experience
Adapting the environment with positioning equipment allows children with disabilities to experience their world and build relationships Allows the child to participate in typical experiences to foster learning
Activities need to promote active engagement
and allow a child to
ndash Actively explore move and participate in play
ndash Assist with self-help routines
ndash Interact and connect with family amp friends
ndash Participate in community activities
ndash Have a means to effectively communicate
ndash Make choices about their wants and need
Perlman Center
Perlman Center
bull Headpointing painting
bull Universal cuffs large pegs splints
bull Switch toys for art activitiesdramatic play-pourer
bull Switch computer access- helpkidzlearncom
bull Fischer Price game with keyboard binder switch
bull Walking in different textures while in standers and walkers
bull Cameramouseorg with dwell click
bull Partner assisted scanning
Alternative amp Adaptive Access to Play
Perlman Center
Change the environment Not the body Adaptations will be critical for success
Gross Motor Fine Motor
Social
Communication
Perlman Center Consider Communication Young children need a reliable form of communication as early as possible
Augmentative Communication is shown to support verbal skills and enhance lives of
birth to three children and their families (Romski et al 2015)
Perlman Center
Holistic approach to AAC intervention should
Build on individual strengths
Focus on participation in real-world contexts
Address psychosocial factors (ie motivation attitude confidence resilience)
Focus on environmental factors to reduce barriers and maximize social supports
In the absence of a holistic approach to communication a child is at risk for failing to engage in social contexts beyond their immediate family or educationalvocational personnel (Light and Mcnaughton 2015)
Augmentative amp Alternative Communication (AAC)
Perlman Center
Early Literacy
Perlman Center
Early Mobility
There is more than one way
Hands Free Matters
Perlman Center
Early Mobility
Should I get a gait trainer if
they are going to walk YES
Are they too young for power NO
Perlman Center
Sensory Motor Learning
Perlman Center
Sensory Motor Learning
Perlman Center
Social Connection
Perlman Center
Total Access to Play
Perlman Center
Perlman defines functional positioning bull Positioning which promotes active movement and participation and
provides an opportunity to positively impact cognitive function
bull Equipment should promote function and participation across the lifespan
Perlman Center
Principles of seating and positioning
bull Obtain a stable base of support
bull Decrease the influence of atypical muscle tone
bull Accommodate fixed deformities and correct flexible deformities
bull Provide the least amount of intervention needed to achieve the greatest level of function
bull There is no one solution or product but typically a combination of tools that provide success
Adapted from Radell (1997) and York and Weimann (1991)
Perlman Center
Key Positioning Components
bull Postural Control Strengthening
bull Range of Motion Weight Bearing
bull Home Activity Programs
Developmental Positioning
bull ADLs-Play Feeding Bathing Sleeping
bull Computer AccessAAC-Integrated Technology
bull Vision Sensory Processing Participation
Upright Positioning
bull EARLY MOBILITY- developmental sequence
bull Gait Trainer Stander amp or Wheelchair
bull Manual wheelchair vs Power Mobility- BOTH
bull Recreational
ldquoTotalrdquo Mobility
bull Body Mechanics Hoyer Lifts Overhead Systems
bull Car Seat ampor Tie Downs
bull Adapted VanRamps
Transfers ampTransportation
Perlman Center
Equipment Plan of Care
Birth to Three
Adapting baby
equipment
Floor Play
StanderWalker
Bath Seat
Car Seat
Braces
Seating for Function
Early ACCESS
Wheelchair
Bed Positioning
Bike amp Swing
Preschool
Stander
Walker
Braces
Bath Seat
Potty Seat
Wheelchair
HiLo seating
AACAccess
Adapted Bed
Car Seat
Transportation
RecreationHEP
School-Age
to Adult
Wheelchair
AACACCESS
Integrated AT
Hilo chair
Standerwalker
Bath chair
Potty chair
Adapted Bed
Car SeatVan
Home modslifts
LeisureWork
Perlman Center
Commercial Products strollers car seats cribs bath seats high chairs
playpen infant swings floor mats nursing pillow ExerSaucers
Perlman Center
Creative Commercial Adaptations
Pool noodles
Snug and Go
Crib Wedges
Bed tableart desk
Laundry baskets
Inflatable bathtub
Inflatable infant pools
Boxesstools
Perlman Center Creative Commercial Adaptations
Laundry basket $400
Pool Noodle x 2 $300
Floor sitterbath support $700
table (BLACK) $800
Garbage can $600
Large pool noodle $300
Stander with anterior support and
Visual adaptation $1700
Perlman Center
Complex Rehab Equipment
Standers
Gait trainers
Bath Support
Car seat
Seating
Feeding tools
AAC
Sensory tools
vibration
Compression garments
NUK brushes
Z Vibe
Modified utensils
Swings
Weight
Head phones
Positioning
Neck supports
Bracing
Bobby pillowU cushion
Benches
Fireflyfriendscom
PlayPaK
Upsee
Go To Seat
Early Literacy
Picture symbols
Voice output switches
Adapted books
Adapted Equipment
Perlman Center
You got this baby Nowhellip Questions
Perlman Center
LETrsquoS PLAY
Hands on Equipment Demonstration
Perlman Center
bull Ulrich B (2010) Opportunities for Early Intervention Based on Theory Basic Neuroscience and Clinical Science Physical Therapy 90(12) 1868-1880
bull McIntyre S Morgan C amp Walker K (2011) Cerebral Palsy Dont Delay Developmental Disabilities Research Reviews 17(2) 114-129
bull Novak I (2014) Evidence-Based Diagnosis Health Care and Rehabilitation for Children with Cerebral Palsy Journal of Child Neurology 29(8) 1141-1156
bull Morgan C Novak I amp Badawi N (2013) Enriched Environments and Motor Outcomes in Cerebral Palsy Systematic Review and Meta-analysis Pediatrics 132 (3)e 735 -e746
bull Morgan C Novak I Dale R Guzzetta A amp Badawi N (2014) GAME (Goals- Activity-Motor Enrichment) protocol of a single blind randomised controlled trial of motor training parent education and environmental enrichment for infants at high risk of cerebral palsy BMC Neurology 14(203)
bull Whittingham K Wee D amp Boyd R (2010) Systematic review of the efficacy of parenting interventions for children with cerebral palsy Child care health and development 37(4) 475-483
bull Morgan C Novak I dale R amp Badawi N (2015) Optimising motor learning in infants at high risk of cerebral palsy a pilot study BMC Pediatrics 15(1) n pag Web
bull Vos R Dallmeijer A Verhoef M et al (2014) Developmental trajectories of receptive and expressive communication in children and young adults with cerebral palsy Developmental Medicine amp Child Neurology 56 951-959
bull Light J and McNaughton D (2015) Designing AAC research and intervention to improve outcomes for individuals with complex communication needs Augmentative and Alternative Communication 31(2) 85-96
bull Romski M Sevcik R Barton-Hulsey A amp Whitmore A (2015) Early Intervention and AAC What a difference 30 years makes Augmentative and Alternative Communication 31 (3) 181-202
References
Perlman Center
bull Novak I Cusick A Lannin N (2009) Occupational therapy home programs for cerebral palsy Double-blind randomised controlled trial Pediatrics 124 e606-e614
bull Gericke T (2006) Postural management for children with cerebral palsy consensus statement Dev Med Child Neurol 48 (4) 244-244
bull McKeever P Rossen B Scott H Robinson-Vincent K amp Wright V (2013) The significance of uprightness parentsrsquo reflections on childrenrsquos responses to a hands-free walker for children Disability amp Society 28(3) 380-392
bull Law M Pollock N Russell D Walter S et al (2011) Focus on function a cluster randomised controlled trial comparing child-versus context-focused intervention for young children with cerebral palsy Dev Med Child Neurol 53 621-629
bull ldquoSensory Processing Developmental Chartrdquo Sensory Processing Developmental Chart Np nd Web 12 Oct 2015
bull Folio MR amp Fewell RR(2000) Peabody Developmental Motor Scales- Second edition Austin TX PRO ED
bull Voress Judith K amp Pearson Nils A (2013) Early Childhood Development Chart-Third edition Austin TX PRO ED
bull Paul Rhea (2007) Language Disorders from Infancy Through Adolescence Assessment amp Intervention Third edition St Louis MA Mosby Inc
bull Prosser L Ohlrich L Curatalo L Alter K amp Damiano D (2012) Feasibility and preliminary effectiveness of a novel mobility training intervention in infants and toddlers with cerebral palsy Developmental Neurorehabilitation 15(4) 259-266
References
Perlman Center
Pediatrics 2013 Sep132(3)e735-46
Enriched environments and motor outcomes in cerebral
palsy systematic review and meta-analysis Morgan C Novak I Badawi N
Key Concepts Supported by Research
Perlman Center
Morgan et al BMC Pediatrics (2015) 1530
Optimizing motor learning in infants at high risk of cerebral palsy
a pilot study Catherine Morgan Iona Novak Russell C Dale and Nadia Badawi
Key Concepts Supported by Research
bull GAME (Goals- Activity- Motor- Enrichment) appears to offer a promising and
feasible new motor intervention for CP
bull Parents coached in simple motor task analysis and appropriate strategies to
enhance development and in setting up motor enriched environments
bull Favorable short-term motor outcomes were noted in standardized testing of
motor ability
bull Parents reported improvements in the COPM performance and satisfaction
bull Important to monitor parents well-being due to higher depression and anxiety
levels more than parents with children without disabilities
Perlman Center
Morgan et al BMC Neurology 2014 1420
GAME (Goals - Activity - Motor Enrichment)protocol of a single blind
randomised controlled trial of motor training parent education and
environmental enrichment for infants at high risk of cerebral palsy Catherine Morgan Iona Novak Russell C Dale Andrea Guzzetta and Nadia Badawi
Key Concepts Supported by Research
RCT of a goal driven motor learning approach with environmental interventions
and parent education
bull Prechtlrsquos Qualitative Assessment of General Movements (GMs) has allowed
earlier diagnosis of high risk CP at 3 months of age
bull Set goals with family educate parents enrich the environment
bull ldquostandard carerdquo- varied approaches to therapy intervention including
neurodevelopmental therapy developmental skills approach group therapy
or motor learning approaches
bull Outcome measures PDMS-2 GMFM COPMAHEMD-IS DASS BSID-III
Perlman Center
Key Elements
bull Shared goal-setting
bull Activity-based intervention
bull Routine-based practice
bull Enriched environment
A Multi-Disciplinary Early Intervention Model
It takes a team
Perlman Center
Patient
PT
DI
OT
Parent
Social
Work
SLP
Neurologist
Primary Care Physician
Rehabilitation doctor
Vision specialist
Other care providers
Orthopedic
ENT Nutrition
Neonatologist
Perlman Center
What is the best way to coordinate the
multidisciplinary team bull Determine the primary team (the team that sees the client and
family the most including a social worker)
bull Include parents in meetings with team discussing parents
priorities and goals (Routine Based Assessments Circle
Conferences)
bull Encourage a parent notebookbinder (contact information for
the team educational materials questions recommendations)
bull Communication with physicians before appointments- make
sure you have all necessary releases on front end
bull Use Technology group emails My Chart EPIC Care
Everywhere
Perlman Center
Parent Resource Binder
Educational Topics
Development
Nutrition
Diagnosis
Role of the Clinician
Multidisciplinary team
Muscle tone
Language development
Sensory Integration
Positioning
Sleep
Financial Resourceshelliphellip
Medical Management
Birth History
Medications
Medical Team
Insurance Information
Appointments
EquipmentVendor
Perlman Center
EMPOWER PARENTS
Perlman Center
We know that CP results in complex problems
How do we address multiple areas
Pain
Cognition
Mobility
Bone development
Language
Seizures
Behavior
Bowel and Bladder
Sleep
Vision
Nutrition
Hearing Novak April 2014
The Evaluation Process
Not just focusing on your clinical
area
You are not just
evaluating the infant
Perlman Center
Perlman Center
The Evaluation Process Holistic Picture
Ongoing Assessment of the Infant
Family-Centered Care
General Assessment
Perlman Center
Multidisciplinary Checklist Tools
Perlman Center
Perlman Multidisciplinary Checklist
Perlman Center
ParentChild Assessment of Routines
Perlman Center
Providing Therapy Services
Clinical
assessment Parents Goals
and Priorities
What are the therapy options to meet the above needs
Perlman Center
Bridging the gap between clinical
assessments and family need
bull Identify Limitations
bull Developmental Delays
bull Medical needs
Clinical Finding
bull Family Routines
bull Family Priorities
bull Overcome Barriers and Obstacles
Family Need
Perlman Center
10 minutes
Perlman Center
bull Considering severity and complexity of diagnosis delays
parentsrsquo level of education acceptance and understanding of
their childrsquos diagnosis
bull Frequency Does the childfamily need weekly treatment once
per month or a burst of therapy every couple of months
bull Most supportive environment group or individual home-based
or clinic-based
bull Referrals for specialized intervention (splinting constraint
therapy adaptive equipment oral-motorfeeding therapy vision
therapy Kinesiotherapy etc)
Develop a Therapy Plan
Perlman Center
Perlman Case Study Examples
Mild delays
Infant has risks for CP
Moderate Delays
Infant presents abnormal motor delays
Severe Delays
Infant presents with significant
neuro-motor impairments
Perlman Center M
ild d
ela
ys-a
t risk
bull Full term
bull Difficult delivery
bull Seizure after delivery
bull Abnormal MRI
bull Mom has degree in child development
Mod
era
te d
ela
ys
bull Full term
bull Seizure activity and HIE following birth
bull Abnormal movements of UELE
bull Abnormal MRI
bull Sensory issues
bull Feeding difficulty S
eve
re d
ela
ys
bull Preemie
bull Difficult pregnancy
bull Ruptured placenta
bull Seizures NICU
bull Tonic posturing
bull Feeding difficulty
bull Family lost another child
Case Studies Patient Medical History
Perlman Center M
ild d
ela
ys-A
t R
isk
bull MRI- basal ganglia
bull Clinic check-ups have been on track
bull Underlying weakness observed by PT
bull Slight catch in Right hamstring
bull 1x every 3-4 weeks
Modera
te d
ela
ys
bull Presents with tonal posturing
bull External support for positioning
bull Sensitive to vestibular movement
bull Home based EI OP equipment planning
bull Group tx
Severe
dela
ys
bull Severe posturing
bull FeedingGI issues
bull Mom needs lots of support
bull Positioning needs
bull Medical needs
bull 2x week group setting (OT PT SLP SW MDs feeding team)
Perlman Center
Build high value
interventions
Perlman Center
bull Therapy to support early parent-infant relationships
bull Build parent confidence
bull Education and training
bull Build opportunities for practice
bull Incorporate into daily routines
Engaging Parents
bull Adapt access to play play is FUN
bull Stimulate exploration inquiry and learning
bull Enrich for cognitive motor sensory and social development
Building Enriched
Environments
bull Goal-oriented intensive motor training (Morgan et al 2015)
bull Build in repetition
bull Scaffold so infant is able to complete at least part of the task
bull Experience-based activities will engage self-initiation of movement
bull Occurs while participating in daily routines (ie at the grocery)
Applying Early Motor Learning
Specific Strategies
Perlman Center
Engaging Parents Education
Topic Lists
Identify parent priorities and begin education based
on parentsrsquo perceived need
child diagnoses
parent support and resources
oral-motor and feeding
seating and positioning
disabilities across the lifespan
gross motor development
patient advocacy
adapted equipment fine motor development
home positioning techniques
financial resources
sensory integration
types of rehabilitation therapy
speech and language
Perlman Center
Engaging Parents Goal Setting
Perlman Center
Educate
Model
Engage
Observe
Connect
Perlman Center
Purposeful Play ishellip
Goal oriented
Activity based
Motivating
In an Enriched environment
Perlman Center
Perlman Center
cognitive
sensory
motor
social
Perlman Center
Building Enriched Environments
Perlman Center
Building Enriched Environments
bull Is the child positioned within
reach to explore the activity
bull Are all senses being utilized
bull Is the child being motivated to
move throughout the
environment
bull Is the environment adapted to
increase access to play
Perlman Center
Building Enriched Environments
bull Can the child have an effect
on the activity within the
environment
bull Is the activity appropriately
challenging the child within the
environment
bull Is the child presented with the
need for problem solving
Perlman Center
Building Enriched Environments
bull Is the child motivated to repeat
the task for motor learning
bull Does the environment support
learning (ie appropriate
noise level social motivators
peer groups developmental
learning supports visual
supports auditory feedback
etc)
Perlman Center
Bridging the gap between the clinic and the
home environment
bull Discipline focused
bull Clinic equipment closet
bull May have group option
Clinic
bull Incorporate into Family Routines
bull Functional activities
bull High Value
bull Adapted environment
Home
Mobility
Early Literacy
Sensory Motor Learning
Social Connections
Perlman Center
Early Learning
Functional MRIs show positive long-term neuro-
cognitive effects of reading to very young
infants
Sensory experiences shape a babyrsquos
knowledge about the world
The average toddler moves 8
out of 10 waking hoursday
Perlman Center
Learning through Experience
Adapting the environment with positioning equipment allows children with disabilities to experience their world and build relationships Allows the child to participate in typical experiences to foster learning
Activities need to promote active engagement
and allow a child to
ndash Actively explore move and participate in play
ndash Assist with self-help routines
ndash Interact and connect with family amp friends
ndash Participate in community activities
ndash Have a means to effectively communicate
ndash Make choices about their wants and need
Perlman Center
Perlman Center
bull Headpointing painting
bull Universal cuffs large pegs splints
bull Switch toys for art activitiesdramatic play-pourer
bull Switch computer access- helpkidzlearncom
bull Fischer Price game with keyboard binder switch
bull Walking in different textures while in standers and walkers
bull Cameramouseorg with dwell click
bull Partner assisted scanning
Alternative amp Adaptive Access to Play
Perlman Center
Change the environment Not the body Adaptations will be critical for success
Gross Motor Fine Motor
Social
Communication
Perlman Center Consider Communication Young children need a reliable form of communication as early as possible
Augmentative Communication is shown to support verbal skills and enhance lives of
birth to three children and their families (Romski et al 2015)
Perlman Center
Holistic approach to AAC intervention should
Build on individual strengths
Focus on participation in real-world contexts
Address psychosocial factors (ie motivation attitude confidence resilience)
Focus on environmental factors to reduce barriers and maximize social supports
In the absence of a holistic approach to communication a child is at risk for failing to engage in social contexts beyond their immediate family or educationalvocational personnel (Light and Mcnaughton 2015)
Augmentative amp Alternative Communication (AAC)
Perlman Center
Early Literacy
Perlman Center
Early Mobility
There is more than one way
Hands Free Matters
Perlman Center
Early Mobility
Should I get a gait trainer if
they are going to walk YES
Are they too young for power NO
Perlman Center
Sensory Motor Learning
Perlman Center
Sensory Motor Learning
Perlman Center
Social Connection
Perlman Center
Total Access to Play
Perlman Center
Perlman defines functional positioning bull Positioning which promotes active movement and participation and
provides an opportunity to positively impact cognitive function
bull Equipment should promote function and participation across the lifespan
Perlman Center
Principles of seating and positioning
bull Obtain a stable base of support
bull Decrease the influence of atypical muscle tone
bull Accommodate fixed deformities and correct flexible deformities
bull Provide the least amount of intervention needed to achieve the greatest level of function
bull There is no one solution or product but typically a combination of tools that provide success
Adapted from Radell (1997) and York and Weimann (1991)
Perlman Center
Key Positioning Components
bull Postural Control Strengthening
bull Range of Motion Weight Bearing
bull Home Activity Programs
Developmental Positioning
bull ADLs-Play Feeding Bathing Sleeping
bull Computer AccessAAC-Integrated Technology
bull Vision Sensory Processing Participation
Upright Positioning
bull EARLY MOBILITY- developmental sequence
bull Gait Trainer Stander amp or Wheelchair
bull Manual wheelchair vs Power Mobility- BOTH
bull Recreational
ldquoTotalrdquo Mobility
bull Body Mechanics Hoyer Lifts Overhead Systems
bull Car Seat ampor Tie Downs
bull Adapted VanRamps
Transfers ampTransportation
Perlman Center
Equipment Plan of Care
Birth to Three
Adapting baby
equipment
Floor Play
StanderWalker
Bath Seat
Car Seat
Braces
Seating for Function
Early ACCESS
Wheelchair
Bed Positioning
Bike amp Swing
Preschool
Stander
Walker
Braces
Bath Seat
Potty Seat
Wheelchair
HiLo seating
AACAccess
Adapted Bed
Car Seat
Transportation
RecreationHEP
School-Age
to Adult
Wheelchair
AACACCESS
Integrated AT
Hilo chair
Standerwalker
Bath chair
Potty chair
Adapted Bed
Car SeatVan
Home modslifts
LeisureWork
Perlman Center
Commercial Products strollers car seats cribs bath seats high chairs
playpen infant swings floor mats nursing pillow ExerSaucers
Perlman Center
Creative Commercial Adaptations
Pool noodles
Snug and Go
Crib Wedges
Bed tableart desk
Laundry baskets
Inflatable bathtub
Inflatable infant pools
Boxesstools
Perlman Center Creative Commercial Adaptations
Laundry basket $400
Pool Noodle x 2 $300
Floor sitterbath support $700
table (BLACK) $800
Garbage can $600
Large pool noodle $300
Stander with anterior support and
Visual adaptation $1700
Perlman Center
Complex Rehab Equipment
Standers
Gait trainers
Bath Support
Car seat
Seating
Feeding tools
AAC
Sensory tools
vibration
Compression garments
NUK brushes
Z Vibe
Modified utensils
Swings
Weight
Head phones
Positioning
Neck supports
Bracing
Bobby pillowU cushion
Benches
Fireflyfriendscom
PlayPaK
Upsee
Go To Seat
Early Literacy
Picture symbols
Voice output switches
Adapted books
Adapted Equipment
Perlman Center
You got this baby Nowhellip Questions
Perlman Center
LETrsquoS PLAY
Hands on Equipment Demonstration
Perlman Center
bull Ulrich B (2010) Opportunities for Early Intervention Based on Theory Basic Neuroscience and Clinical Science Physical Therapy 90(12) 1868-1880
bull McIntyre S Morgan C amp Walker K (2011) Cerebral Palsy Dont Delay Developmental Disabilities Research Reviews 17(2) 114-129
bull Novak I (2014) Evidence-Based Diagnosis Health Care and Rehabilitation for Children with Cerebral Palsy Journal of Child Neurology 29(8) 1141-1156
bull Morgan C Novak I amp Badawi N (2013) Enriched Environments and Motor Outcomes in Cerebral Palsy Systematic Review and Meta-analysis Pediatrics 132 (3)e 735 -e746
bull Morgan C Novak I Dale R Guzzetta A amp Badawi N (2014) GAME (Goals- Activity-Motor Enrichment) protocol of a single blind randomised controlled trial of motor training parent education and environmental enrichment for infants at high risk of cerebral palsy BMC Neurology 14(203)
bull Whittingham K Wee D amp Boyd R (2010) Systematic review of the efficacy of parenting interventions for children with cerebral palsy Child care health and development 37(4) 475-483
bull Morgan C Novak I dale R amp Badawi N (2015) Optimising motor learning in infants at high risk of cerebral palsy a pilot study BMC Pediatrics 15(1) n pag Web
bull Vos R Dallmeijer A Verhoef M et al (2014) Developmental trajectories of receptive and expressive communication in children and young adults with cerebral palsy Developmental Medicine amp Child Neurology 56 951-959
bull Light J and McNaughton D (2015) Designing AAC research and intervention to improve outcomes for individuals with complex communication needs Augmentative and Alternative Communication 31(2) 85-96
bull Romski M Sevcik R Barton-Hulsey A amp Whitmore A (2015) Early Intervention and AAC What a difference 30 years makes Augmentative and Alternative Communication 31 (3) 181-202
References
Perlman Center
bull Novak I Cusick A Lannin N (2009) Occupational therapy home programs for cerebral palsy Double-blind randomised controlled trial Pediatrics 124 e606-e614
bull Gericke T (2006) Postural management for children with cerebral palsy consensus statement Dev Med Child Neurol 48 (4) 244-244
bull McKeever P Rossen B Scott H Robinson-Vincent K amp Wright V (2013) The significance of uprightness parentsrsquo reflections on childrenrsquos responses to a hands-free walker for children Disability amp Society 28(3) 380-392
bull Law M Pollock N Russell D Walter S et al (2011) Focus on function a cluster randomised controlled trial comparing child-versus context-focused intervention for young children with cerebral palsy Dev Med Child Neurol 53 621-629
bull ldquoSensory Processing Developmental Chartrdquo Sensory Processing Developmental Chart Np nd Web 12 Oct 2015
bull Folio MR amp Fewell RR(2000) Peabody Developmental Motor Scales- Second edition Austin TX PRO ED
bull Voress Judith K amp Pearson Nils A (2013) Early Childhood Development Chart-Third edition Austin TX PRO ED
bull Paul Rhea (2007) Language Disorders from Infancy Through Adolescence Assessment amp Intervention Third edition St Louis MA Mosby Inc
bull Prosser L Ohlrich L Curatalo L Alter K amp Damiano D (2012) Feasibility and preliminary effectiveness of a novel mobility training intervention in infants and toddlers with cerebral palsy Developmental Neurorehabilitation 15(4) 259-266
References
Perlman Center
Morgan et al BMC Pediatrics (2015) 1530
Optimizing motor learning in infants at high risk of cerebral palsy
a pilot study Catherine Morgan Iona Novak Russell C Dale and Nadia Badawi
Key Concepts Supported by Research
bull GAME (Goals- Activity- Motor- Enrichment) appears to offer a promising and
feasible new motor intervention for CP
bull Parents coached in simple motor task analysis and appropriate strategies to
enhance development and in setting up motor enriched environments
bull Favorable short-term motor outcomes were noted in standardized testing of
motor ability
bull Parents reported improvements in the COPM performance and satisfaction
bull Important to monitor parents well-being due to higher depression and anxiety
levels more than parents with children without disabilities
Perlman Center
Morgan et al BMC Neurology 2014 1420
GAME (Goals - Activity - Motor Enrichment)protocol of a single blind
randomised controlled trial of motor training parent education and
environmental enrichment for infants at high risk of cerebral palsy Catherine Morgan Iona Novak Russell C Dale Andrea Guzzetta and Nadia Badawi
Key Concepts Supported by Research
RCT of a goal driven motor learning approach with environmental interventions
and parent education
bull Prechtlrsquos Qualitative Assessment of General Movements (GMs) has allowed
earlier diagnosis of high risk CP at 3 months of age
bull Set goals with family educate parents enrich the environment
bull ldquostandard carerdquo- varied approaches to therapy intervention including
neurodevelopmental therapy developmental skills approach group therapy
or motor learning approaches
bull Outcome measures PDMS-2 GMFM COPMAHEMD-IS DASS BSID-III
Perlman Center
Key Elements
bull Shared goal-setting
bull Activity-based intervention
bull Routine-based practice
bull Enriched environment
A Multi-Disciplinary Early Intervention Model
It takes a team
Perlman Center
Patient
PT
DI
OT
Parent
Social
Work
SLP
Neurologist
Primary Care Physician
Rehabilitation doctor
Vision specialist
Other care providers
Orthopedic
ENT Nutrition
Neonatologist
Perlman Center
What is the best way to coordinate the
multidisciplinary team bull Determine the primary team (the team that sees the client and
family the most including a social worker)
bull Include parents in meetings with team discussing parents
priorities and goals (Routine Based Assessments Circle
Conferences)
bull Encourage a parent notebookbinder (contact information for
the team educational materials questions recommendations)
bull Communication with physicians before appointments- make
sure you have all necessary releases on front end
bull Use Technology group emails My Chart EPIC Care
Everywhere
Perlman Center
Parent Resource Binder
Educational Topics
Development
Nutrition
Diagnosis
Role of the Clinician
Multidisciplinary team
Muscle tone
Language development
Sensory Integration
Positioning
Sleep
Financial Resourceshelliphellip
Medical Management
Birth History
Medications
Medical Team
Insurance Information
Appointments
EquipmentVendor
Perlman Center
EMPOWER PARENTS
Perlman Center
We know that CP results in complex problems
How do we address multiple areas
Pain
Cognition
Mobility
Bone development
Language
Seizures
Behavior
Bowel and Bladder
Sleep
Vision
Nutrition
Hearing Novak April 2014
The Evaluation Process
Not just focusing on your clinical
area
You are not just
evaluating the infant
Perlman Center
Perlman Center
The Evaluation Process Holistic Picture
Ongoing Assessment of the Infant
Family-Centered Care
General Assessment
Perlman Center
Multidisciplinary Checklist Tools
Perlman Center
Perlman Multidisciplinary Checklist
Perlman Center
ParentChild Assessment of Routines
Perlman Center
Providing Therapy Services
Clinical
assessment Parents Goals
and Priorities
What are the therapy options to meet the above needs
Perlman Center
Bridging the gap between clinical
assessments and family need
bull Identify Limitations
bull Developmental Delays
bull Medical needs
Clinical Finding
bull Family Routines
bull Family Priorities
bull Overcome Barriers and Obstacles
Family Need
Perlman Center
10 minutes
Perlman Center
bull Considering severity and complexity of diagnosis delays
parentsrsquo level of education acceptance and understanding of
their childrsquos diagnosis
bull Frequency Does the childfamily need weekly treatment once
per month or a burst of therapy every couple of months
bull Most supportive environment group or individual home-based
or clinic-based
bull Referrals for specialized intervention (splinting constraint
therapy adaptive equipment oral-motorfeeding therapy vision
therapy Kinesiotherapy etc)
Develop a Therapy Plan
Perlman Center
Perlman Case Study Examples
Mild delays
Infant has risks for CP
Moderate Delays
Infant presents abnormal motor delays
Severe Delays
Infant presents with significant
neuro-motor impairments
Perlman Center M
ild d
ela
ys-a
t risk
bull Full term
bull Difficult delivery
bull Seizure after delivery
bull Abnormal MRI
bull Mom has degree in child development
Mod
era
te d
ela
ys
bull Full term
bull Seizure activity and HIE following birth
bull Abnormal movements of UELE
bull Abnormal MRI
bull Sensory issues
bull Feeding difficulty S
eve
re d
ela
ys
bull Preemie
bull Difficult pregnancy
bull Ruptured placenta
bull Seizures NICU
bull Tonic posturing
bull Feeding difficulty
bull Family lost another child
Case Studies Patient Medical History
Perlman Center M
ild d
ela
ys-A
t R
isk
bull MRI- basal ganglia
bull Clinic check-ups have been on track
bull Underlying weakness observed by PT
bull Slight catch in Right hamstring
bull 1x every 3-4 weeks
Modera
te d
ela
ys
bull Presents with tonal posturing
bull External support for positioning
bull Sensitive to vestibular movement
bull Home based EI OP equipment planning
bull Group tx
Severe
dela
ys
bull Severe posturing
bull FeedingGI issues
bull Mom needs lots of support
bull Positioning needs
bull Medical needs
bull 2x week group setting (OT PT SLP SW MDs feeding team)
Perlman Center
Build high value
interventions
Perlman Center
bull Therapy to support early parent-infant relationships
bull Build parent confidence
bull Education and training
bull Build opportunities for practice
bull Incorporate into daily routines
Engaging Parents
bull Adapt access to play play is FUN
bull Stimulate exploration inquiry and learning
bull Enrich for cognitive motor sensory and social development
Building Enriched
Environments
bull Goal-oriented intensive motor training (Morgan et al 2015)
bull Build in repetition
bull Scaffold so infant is able to complete at least part of the task
bull Experience-based activities will engage self-initiation of movement
bull Occurs while participating in daily routines (ie at the grocery)
Applying Early Motor Learning
Specific Strategies
Perlman Center
Engaging Parents Education
Topic Lists
Identify parent priorities and begin education based
on parentsrsquo perceived need
child diagnoses
parent support and resources
oral-motor and feeding
seating and positioning
disabilities across the lifespan
gross motor development
patient advocacy
adapted equipment fine motor development
home positioning techniques
financial resources
sensory integration
types of rehabilitation therapy
speech and language
Perlman Center
Engaging Parents Goal Setting
Perlman Center
Educate
Model
Engage
Observe
Connect
Perlman Center
Purposeful Play ishellip
Goal oriented
Activity based
Motivating
In an Enriched environment
Perlman Center
Perlman Center
cognitive
sensory
motor
social
Perlman Center
Building Enriched Environments
Perlman Center
Building Enriched Environments
bull Is the child positioned within
reach to explore the activity
bull Are all senses being utilized
bull Is the child being motivated to
move throughout the
environment
bull Is the environment adapted to
increase access to play
Perlman Center
Building Enriched Environments
bull Can the child have an effect
on the activity within the
environment
bull Is the activity appropriately
challenging the child within the
environment
bull Is the child presented with the
need for problem solving
Perlman Center
Building Enriched Environments
bull Is the child motivated to repeat
the task for motor learning
bull Does the environment support
learning (ie appropriate
noise level social motivators
peer groups developmental
learning supports visual
supports auditory feedback
etc)
Perlman Center
Bridging the gap between the clinic and the
home environment
bull Discipline focused
bull Clinic equipment closet
bull May have group option
Clinic
bull Incorporate into Family Routines
bull Functional activities
bull High Value
bull Adapted environment
Home
Mobility
Early Literacy
Sensory Motor Learning
Social Connections
Perlman Center
Early Learning
Functional MRIs show positive long-term neuro-
cognitive effects of reading to very young
infants
Sensory experiences shape a babyrsquos
knowledge about the world
The average toddler moves 8
out of 10 waking hoursday
Perlman Center
Learning through Experience
Adapting the environment with positioning equipment allows children with disabilities to experience their world and build relationships Allows the child to participate in typical experiences to foster learning
Activities need to promote active engagement
and allow a child to
ndash Actively explore move and participate in play
ndash Assist with self-help routines
ndash Interact and connect with family amp friends
ndash Participate in community activities
ndash Have a means to effectively communicate
ndash Make choices about their wants and need
Perlman Center
Perlman Center
bull Headpointing painting
bull Universal cuffs large pegs splints
bull Switch toys for art activitiesdramatic play-pourer
bull Switch computer access- helpkidzlearncom
bull Fischer Price game with keyboard binder switch
bull Walking in different textures while in standers and walkers
bull Cameramouseorg with dwell click
bull Partner assisted scanning
Alternative amp Adaptive Access to Play
Perlman Center
Change the environment Not the body Adaptations will be critical for success
Gross Motor Fine Motor
Social
Communication
Perlman Center Consider Communication Young children need a reliable form of communication as early as possible
Augmentative Communication is shown to support verbal skills and enhance lives of
birth to three children and their families (Romski et al 2015)
Perlman Center
Holistic approach to AAC intervention should
Build on individual strengths
Focus on participation in real-world contexts
Address psychosocial factors (ie motivation attitude confidence resilience)
Focus on environmental factors to reduce barriers and maximize social supports
In the absence of a holistic approach to communication a child is at risk for failing to engage in social contexts beyond their immediate family or educationalvocational personnel (Light and Mcnaughton 2015)
Augmentative amp Alternative Communication (AAC)
Perlman Center
Early Literacy
Perlman Center
Early Mobility
There is more than one way
Hands Free Matters
Perlman Center
Early Mobility
Should I get a gait trainer if
they are going to walk YES
Are they too young for power NO
Perlman Center
Sensory Motor Learning
Perlman Center
Sensory Motor Learning
Perlman Center
Social Connection
Perlman Center
Total Access to Play
Perlman Center
Perlman defines functional positioning bull Positioning which promotes active movement and participation and
provides an opportunity to positively impact cognitive function
bull Equipment should promote function and participation across the lifespan
Perlman Center
Principles of seating and positioning
bull Obtain a stable base of support
bull Decrease the influence of atypical muscle tone
bull Accommodate fixed deformities and correct flexible deformities
bull Provide the least amount of intervention needed to achieve the greatest level of function
bull There is no one solution or product but typically a combination of tools that provide success
Adapted from Radell (1997) and York and Weimann (1991)
Perlman Center
Key Positioning Components
bull Postural Control Strengthening
bull Range of Motion Weight Bearing
bull Home Activity Programs
Developmental Positioning
bull ADLs-Play Feeding Bathing Sleeping
bull Computer AccessAAC-Integrated Technology
bull Vision Sensory Processing Participation
Upright Positioning
bull EARLY MOBILITY- developmental sequence
bull Gait Trainer Stander amp or Wheelchair
bull Manual wheelchair vs Power Mobility- BOTH
bull Recreational
ldquoTotalrdquo Mobility
bull Body Mechanics Hoyer Lifts Overhead Systems
bull Car Seat ampor Tie Downs
bull Adapted VanRamps
Transfers ampTransportation
Perlman Center
Equipment Plan of Care
Birth to Three
Adapting baby
equipment
Floor Play
StanderWalker
Bath Seat
Car Seat
Braces
Seating for Function
Early ACCESS
Wheelchair
Bed Positioning
Bike amp Swing
Preschool
Stander
Walker
Braces
Bath Seat
Potty Seat
Wheelchair
HiLo seating
AACAccess
Adapted Bed
Car Seat
Transportation
RecreationHEP
School-Age
to Adult
Wheelchair
AACACCESS
Integrated AT
Hilo chair
Standerwalker
Bath chair
Potty chair
Adapted Bed
Car SeatVan
Home modslifts
LeisureWork
Perlman Center
Commercial Products strollers car seats cribs bath seats high chairs
playpen infant swings floor mats nursing pillow ExerSaucers
Perlman Center
Creative Commercial Adaptations
Pool noodles
Snug and Go
Crib Wedges
Bed tableart desk
Laundry baskets
Inflatable bathtub
Inflatable infant pools
Boxesstools
Perlman Center Creative Commercial Adaptations
Laundry basket $400
Pool Noodle x 2 $300
Floor sitterbath support $700
table (BLACK) $800
Garbage can $600
Large pool noodle $300
Stander with anterior support and
Visual adaptation $1700
Perlman Center
Complex Rehab Equipment
Standers
Gait trainers
Bath Support
Car seat
Seating
Feeding tools
AAC
Sensory tools
vibration
Compression garments
NUK brushes
Z Vibe
Modified utensils
Swings
Weight
Head phones
Positioning
Neck supports
Bracing
Bobby pillowU cushion
Benches
Fireflyfriendscom
PlayPaK
Upsee
Go To Seat
Early Literacy
Picture symbols
Voice output switches
Adapted books
Adapted Equipment
Perlman Center
You got this baby Nowhellip Questions
Perlman Center
LETrsquoS PLAY
Hands on Equipment Demonstration
Perlman Center
bull Ulrich B (2010) Opportunities for Early Intervention Based on Theory Basic Neuroscience and Clinical Science Physical Therapy 90(12) 1868-1880
bull McIntyre S Morgan C amp Walker K (2011) Cerebral Palsy Dont Delay Developmental Disabilities Research Reviews 17(2) 114-129
bull Novak I (2014) Evidence-Based Diagnosis Health Care and Rehabilitation for Children with Cerebral Palsy Journal of Child Neurology 29(8) 1141-1156
bull Morgan C Novak I amp Badawi N (2013) Enriched Environments and Motor Outcomes in Cerebral Palsy Systematic Review and Meta-analysis Pediatrics 132 (3)e 735 -e746
bull Morgan C Novak I Dale R Guzzetta A amp Badawi N (2014) GAME (Goals- Activity-Motor Enrichment) protocol of a single blind randomised controlled trial of motor training parent education and environmental enrichment for infants at high risk of cerebral palsy BMC Neurology 14(203)
bull Whittingham K Wee D amp Boyd R (2010) Systematic review of the efficacy of parenting interventions for children with cerebral palsy Child care health and development 37(4) 475-483
bull Morgan C Novak I dale R amp Badawi N (2015) Optimising motor learning in infants at high risk of cerebral palsy a pilot study BMC Pediatrics 15(1) n pag Web
bull Vos R Dallmeijer A Verhoef M et al (2014) Developmental trajectories of receptive and expressive communication in children and young adults with cerebral palsy Developmental Medicine amp Child Neurology 56 951-959
bull Light J and McNaughton D (2015) Designing AAC research and intervention to improve outcomes for individuals with complex communication needs Augmentative and Alternative Communication 31(2) 85-96
bull Romski M Sevcik R Barton-Hulsey A amp Whitmore A (2015) Early Intervention and AAC What a difference 30 years makes Augmentative and Alternative Communication 31 (3) 181-202
References
Perlman Center
bull Novak I Cusick A Lannin N (2009) Occupational therapy home programs for cerebral palsy Double-blind randomised controlled trial Pediatrics 124 e606-e614
bull Gericke T (2006) Postural management for children with cerebral palsy consensus statement Dev Med Child Neurol 48 (4) 244-244
bull McKeever P Rossen B Scott H Robinson-Vincent K amp Wright V (2013) The significance of uprightness parentsrsquo reflections on childrenrsquos responses to a hands-free walker for children Disability amp Society 28(3) 380-392
bull Law M Pollock N Russell D Walter S et al (2011) Focus on function a cluster randomised controlled trial comparing child-versus context-focused intervention for young children with cerebral palsy Dev Med Child Neurol 53 621-629
bull ldquoSensory Processing Developmental Chartrdquo Sensory Processing Developmental Chart Np nd Web 12 Oct 2015
bull Folio MR amp Fewell RR(2000) Peabody Developmental Motor Scales- Second edition Austin TX PRO ED
bull Voress Judith K amp Pearson Nils A (2013) Early Childhood Development Chart-Third edition Austin TX PRO ED
bull Paul Rhea (2007) Language Disorders from Infancy Through Adolescence Assessment amp Intervention Third edition St Louis MA Mosby Inc
bull Prosser L Ohlrich L Curatalo L Alter K amp Damiano D (2012) Feasibility and preliminary effectiveness of a novel mobility training intervention in infants and toddlers with cerebral palsy Developmental Neurorehabilitation 15(4) 259-266
References
Perlman Center
Morgan et al BMC Neurology 2014 1420
GAME (Goals - Activity - Motor Enrichment)protocol of a single blind
randomised controlled trial of motor training parent education and
environmental enrichment for infants at high risk of cerebral palsy Catherine Morgan Iona Novak Russell C Dale Andrea Guzzetta and Nadia Badawi
Key Concepts Supported by Research
RCT of a goal driven motor learning approach with environmental interventions
and parent education
bull Prechtlrsquos Qualitative Assessment of General Movements (GMs) has allowed
earlier diagnosis of high risk CP at 3 months of age
bull Set goals with family educate parents enrich the environment
bull ldquostandard carerdquo- varied approaches to therapy intervention including
neurodevelopmental therapy developmental skills approach group therapy
or motor learning approaches
bull Outcome measures PDMS-2 GMFM COPMAHEMD-IS DASS BSID-III
Perlman Center
Key Elements
bull Shared goal-setting
bull Activity-based intervention
bull Routine-based practice
bull Enriched environment
A Multi-Disciplinary Early Intervention Model
It takes a team
Perlman Center
Patient
PT
DI
OT
Parent
Social
Work
SLP
Neurologist
Primary Care Physician
Rehabilitation doctor
Vision specialist
Other care providers
Orthopedic
ENT Nutrition
Neonatologist
Perlman Center
What is the best way to coordinate the
multidisciplinary team bull Determine the primary team (the team that sees the client and
family the most including a social worker)
bull Include parents in meetings with team discussing parents
priorities and goals (Routine Based Assessments Circle
Conferences)
bull Encourage a parent notebookbinder (contact information for
the team educational materials questions recommendations)
bull Communication with physicians before appointments- make
sure you have all necessary releases on front end
bull Use Technology group emails My Chart EPIC Care
Everywhere
Perlman Center
Parent Resource Binder
Educational Topics
Development
Nutrition
Diagnosis
Role of the Clinician
Multidisciplinary team
Muscle tone
Language development
Sensory Integration
Positioning
Sleep
Financial Resourceshelliphellip
Medical Management
Birth History
Medications
Medical Team
Insurance Information
Appointments
EquipmentVendor
Perlman Center
EMPOWER PARENTS
Perlman Center
We know that CP results in complex problems
How do we address multiple areas
Pain
Cognition
Mobility
Bone development
Language
Seizures
Behavior
Bowel and Bladder
Sleep
Vision
Nutrition
Hearing Novak April 2014
The Evaluation Process
Not just focusing on your clinical
area
You are not just
evaluating the infant
Perlman Center
Perlman Center
The Evaluation Process Holistic Picture
Ongoing Assessment of the Infant
Family-Centered Care
General Assessment
Perlman Center
Multidisciplinary Checklist Tools
Perlman Center
Perlman Multidisciplinary Checklist
Perlman Center
ParentChild Assessment of Routines
Perlman Center
Providing Therapy Services
Clinical
assessment Parents Goals
and Priorities
What are the therapy options to meet the above needs
Perlman Center
Bridging the gap between clinical
assessments and family need
bull Identify Limitations
bull Developmental Delays
bull Medical needs
Clinical Finding
bull Family Routines
bull Family Priorities
bull Overcome Barriers and Obstacles
Family Need
Perlman Center
10 minutes
Perlman Center
bull Considering severity and complexity of diagnosis delays
parentsrsquo level of education acceptance and understanding of
their childrsquos diagnosis
bull Frequency Does the childfamily need weekly treatment once
per month or a burst of therapy every couple of months
bull Most supportive environment group or individual home-based
or clinic-based
bull Referrals for specialized intervention (splinting constraint
therapy adaptive equipment oral-motorfeeding therapy vision
therapy Kinesiotherapy etc)
Develop a Therapy Plan
Perlman Center
Perlman Case Study Examples
Mild delays
Infant has risks for CP
Moderate Delays
Infant presents abnormal motor delays
Severe Delays
Infant presents with significant
neuro-motor impairments
Perlman Center M
ild d
ela
ys-a
t risk
bull Full term
bull Difficult delivery
bull Seizure after delivery
bull Abnormal MRI
bull Mom has degree in child development
Mod
era
te d
ela
ys
bull Full term
bull Seizure activity and HIE following birth
bull Abnormal movements of UELE
bull Abnormal MRI
bull Sensory issues
bull Feeding difficulty S
eve
re d
ela
ys
bull Preemie
bull Difficult pregnancy
bull Ruptured placenta
bull Seizures NICU
bull Tonic posturing
bull Feeding difficulty
bull Family lost another child
Case Studies Patient Medical History
Perlman Center M
ild d
ela
ys-A
t R
isk
bull MRI- basal ganglia
bull Clinic check-ups have been on track
bull Underlying weakness observed by PT
bull Slight catch in Right hamstring
bull 1x every 3-4 weeks
Modera
te d
ela
ys
bull Presents with tonal posturing
bull External support for positioning
bull Sensitive to vestibular movement
bull Home based EI OP equipment planning
bull Group tx
Severe
dela
ys
bull Severe posturing
bull FeedingGI issues
bull Mom needs lots of support
bull Positioning needs
bull Medical needs
bull 2x week group setting (OT PT SLP SW MDs feeding team)
Perlman Center
Build high value
interventions
Perlman Center
bull Therapy to support early parent-infant relationships
bull Build parent confidence
bull Education and training
bull Build opportunities for practice
bull Incorporate into daily routines
Engaging Parents
bull Adapt access to play play is FUN
bull Stimulate exploration inquiry and learning
bull Enrich for cognitive motor sensory and social development
Building Enriched
Environments
bull Goal-oriented intensive motor training (Morgan et al 2015)
bull Build in repetition
bull Scaffold so infant is able to complete at least part of the task
bull Experience-based activities will engage self-initiation of movement
bull Occurs while participating in daily routines (ie at the grocery)
Applying Early Motor Learning
Specific Strategies
Perlman Center
Engaging Parents Education
Topic Lists
Identify parent priorities and begin education based
on parentsrsquo perceived need
child diagnoses
parent support and resources
oral-motor and feeding
seating and positioning
disabilities across the lifespan
gross motor development
patient advocacy
adapted equipment fine motor development
home positioning techniques
financial resources
sensory integration
types of rehabilitation therapy
speech and language
Perlman Center
Engaging Parents Goal Setting
Perlman Center
Educate
Model
Engage
Observe
Connect
Perlman Center
Purposeful Play ishellip
Goal oriented
Activity based
Motivating
In an Enriched environment
Perlman Center
Perlman Center
cognitive
sensory
motor
social
Perlman Center
Building Enriched Environments
Perlman Center
Building Enriched Environments
bull Is the child positioned within
reach to explore the activity
bull Are all senses being utilized
bull Is the child being motivated to
move throughout the
environment
bull Is the environment adapted to
increase access to play
Perlman Center
Building Enriched Environments
bull Can the child have an effect
on the activity within the
environment
bull Is the activity appropriately
challenging the child within the
environment
bull Is the child presented with the
need for problem solving
Perlman Center
Building Enriched Environments
bull Is the child motivated to repeat
the task for motor learning
bull Does the environment support
learning (ie appropriate
noise level social motivators
peer groups developmental
learning supports visual
supports auditory feedback
etc)
Perlman Center
Bridging the gap between the clinic and the
home environment
bull Discipline focused
bull Clinic equipment closet
bull May have group option
Clinic
bull Incorporate into Family Routines
bull Functional activities
bull High Value
bull Adapted environment
Home
Mobility
Early Literacy
Sensory Motor Learning
Social Connections
Perlman Center
Early Learning
Functional MRIs show positive long-term neuro-
cognitive effects of reading to very young
infants
Sensory experiences shape a babyrsquos
knowledge about the world
The average toddler moves 8
out of 10 waking hoursday
Perlman Center
Learning through Experience
Adapting the environment with positioning equipment allows children with disabilities to experience their world and build relationships Allows the child to participate in typical experiences to foster learning
Activities need to promote active engagement
and allow a child to
ndash Actively explore move and participate in play
ndash Assist with self-help routines
ndash Interact and connect with family amp friends
ndash Participate in community activities
ndash Have a means to effectively communicate
ndash Make choices about their wants and need
Perlman Center
Perlman Center
bull Headpointing painting
bull Universal cuffs large pegs splints
bull Switch toys for art activitiesdramatic play-pourer
bull Switch computer access- helpkidzlearncom
bull Fischer Price game with keyboard binder switch
bull Walking in different textures while in standers and walkers
bull Cameramouseorg with dwell click
bull Partner assisted scanning
Alternative amp Adaptive Access to Play
Perlman Center
Change the environment Not the body Adaptations will be critical for success
Gross Motor Fine Motor
Social
Communication
Perlman Center Consider Communication Young children need a reliable form of communication as early as possible
Augmentative Communication is shown to support verbal skills and enhance lives of
birth to three children and their families (Romski et al 2015)
Perlman Center
Holistic approach to AAC intervention should
Build on individual strengths
Focus on participation in real-world contexts
Address psychosocial factors (ie motivation attitude confidence resilience)
Focus on environmental factors to reduce barriers and maximize social supports
In the absence of a holistic approach to communication a child is at risk for failing to engage in social contexts beyond their immediate family or educationalvocational personnel (Light and Mcnaughton 2015)
Augmentative amp Alternative Communication (AAC)
Perlman Center
Early Literacy
Perlman Center
Early Mobility
There is more than one way
Hands Free Matters
Perlman Center
Early Mobility
Should I get a gait trainer if
they are going to walk YES
Are they too young for power NO
Perlman Center
Sensory Motor Learning
Perlman Center
Sensory Motor Learning
Perlman Center
Social Connection
Perlman Center
Total Access to Play
Perlman Center
Perlman defines functional positioning bull Positioning which promotes active movement and participation and
provides an opportunity to positively impact cognitive function
bull Equipment should promote function and participation across the lifespan
Perlman Center
Principles of seating and positioning
bull Obtain a stable base of support
bull Decrease the influence of atypical muscle tone
bull Accommodate fixed deformities and correct flexible deformities
bull Provide the least amount of intervention needed to achieve the greatest level of function
bull There is no one solution or product but typically a combination of tools that provide success
Adapted from Radell (1997) and York and Weimann (1991)
Perlman Center
Key Positioning Components
bull Postural Control Strengthening
bull Range of Motion Weight Bearing
bull Home Activity Programs
Developmental Positioning
bull ADLs-Play Feeding Bathing Sleeping
bull Computer AccessAAC-Integrated Technology
bull Vision Sensory Processing Participation
Upright Positioning
bull EARLY MOBILITY- developmental sequence
bull Gait Trainer Stander amp or Wheelchair
bull Manual wheelchair vs Power Mobility- BOTH
bull Recreational
ldquoTotalrdquo Mobility
bull Body Mechanics Hoyer Lifts Overhead Systems
bull Car Seat ampor Tie Downs
bull Adapted VanRamps
Transfers ampTransportation
Perlman Center
Equipment Plan of Care
Birth to Three
Adapting baby
equipment
Floor Play
StanderWalker
Bath Seat
Car Seat
Braces
Seating for Function
Early ACCESS
Wheelchair
Bed Positioning
Bike amp Swing
Preschool
Stander
Walker
Braces
Bath Seat
Potty Seat
Wheelchair
HiLo seating
AACAccess
Adapted Bed
Car Seat
Transportation
RecreationHEP
School-Age
to Adult
Wheelchair
AACACCESS
Integrated AT
Hilo chair
Standerwalker
Bath chair
Potty chair
Adapted Bed
Car SeatVan
Home modslifts
LeisureWork
Perlman Center
Commercial Products strollers car seats cribs bath seats high chairs
playpen infant swings floor mats nursing pillow ExerSaucers
Perlman Center
Creative Commercial Adaptations
Pool noodles
Snug and Go
Crib Wedges
Bed tableart desk
Laundry baskets
Inflatable bathtub
Inflatable infant pools
Boxesstools
Perlman Center Creative Commercial Adaptations
Laundry basket $400
Pool Noodle x 2 $300
Floor sitterbath support $700
table (BLACK) $800
Garbage can $600
Large pool noodle $300
Stander with anterior support and
Visual adaptation $1700
Perlman Center
Complex Rehab Equipment
Standers
Gait trainers
Bath Support
Car seat
Seating
Feeding tools
AAC
Sensory tools
vibration
Compression garments
NUK brushes
Z Vibe
Modified utensils
Swings
Weight
Head phones
Positioning
Neck supports
Bracing
Bobby pillowU cushion
Benches
Fireflyfriendscom
PlayPaK
Upsee
Go To Seat
Early Literacy
Picture symbols
Voice output switches
Adapted books
Adapted Equipment
Perlman Center
You got this baby Nowhellip Questions
Perlman Center
LETrsquoS PLAY
Hands on Equipment Demonstration
Perlman Center
bull Ulrich B (2010) Opportunities for Early Intervention Based on Theory Basic Neuroscience and Clinical Science Physical Therapy 90(12) 1868-1880
bull McIntyre S Morgan C amp Walker K (2011) Cerebral Palsy Dont Delay Developmental Disabilities Research Reviews 17(2) 114-129
bull Novak I (2014) Evidence-Based Diagnosis Health Care and Rehabilitation for Children with Cerebral Palsy Journal of Child Neurology 29(8) 1141-1156
bull Morgan C Novak I amp Badawi N (2013) Enriched Environments and Motor Outcomes in Cerebral Palsy Systematic Review and Meta-analysis Pediatrics 132 (3)e 735 -e746
bull Morgan C Novak I Dale R Guzzetta A amp Badawi N (2014) GAME (Goals- Activity-Motor Enrichment) protocol of a single blind randomised controlled trial of motor training parent education and environmental enrichment for infants at high risk of cerebral palsy BMC Neurology 14(203)
bull Whittingham K Wee D amp Boyd R (2010) Systematic review of the efficacy of parenting interventions for children with cerebral palsy Child care health and development 37(4) 475-483
bull Morgan C Novak I dale R amp Badawi N (2015) Optimising motor learning in infants at high risk of cerebral palsy a pilot study BMC Pediatrics 15(1) n pag Web
bull Vos R Dallmeijer A Verhoef M et al (2014) Developmental trajectories of receptive and expressive communication in children and young adults with cerebral palsy Developmental Medicine amp Child Neurology 56 951-959
bull Light J and McNaughton D (2015) Designing AAC research and intervention to improve outcomes for individuals with complex communication needs Augmentative and Alternative Communication 31(2) 85-96
bull Romski M Sevcik R Barton-Hulsey A amp Whitmore A (2015) Early Intervention and AAC What a difference 30 years makes Augmentative and Alternative Communication 31 (3) 181-202
References
Perlman Center
bull Novak I Cusick A Lannin N (2009) Occupational therapy home programs for cerebral palsy Double-blind randomised controlled trial Pediatrics 124 e606-e614
bull Gericke T (2006) Postural management for children with cerebral palsy consensus statement Dev Med Child Neurol 48 (4) 244-244
bull McKeever P Rossen B Scott H Robinson-Vincent K amp Wright V (2013) The significance of uprightness parentsrsquo reflections on childrenrsquos responses to a hands-free walker for children Disability amp Society 28(3) 380-392
bull Law M Pollock N Russell D Walter S et al (2011) Focus on function a cluster randomised controlled trial comparing child-versus context-focused intervention for young children with cerebral palsy Dev Med Child Neurol 53 621-629
bull ldquoSensory Processing Developmental Chartrdquo Sensory Processing Developmental Chart Np nd Web 12 Oct 2015
bull Folio MR amp Fewell RR(2000) Peabody Developmental Motor Scales- Second edition Austin TX PRO ED
bull Voress Judith K amp Pearson Nils A (2013) Early Childhood Development Chart-Third edition Austin TX PRO ED
bull Paul Rhea (2007) Language Disorders from Infancy Through Adolescence Assessment amp Intervention Third edition St Louis MA Mosby Inc
bull Prosser L Ohlrich L Curatalo L Alter K amp Damiano D (2012) Feasibility and preliminary effectiveness of a novel mobility training intervention in infants and toddlers with cerebral palsy Developmental Neurorehabilitation 15(4) 259-266
References
Perlman Center
Key Elements
bull Shared goal-setting
bull Activity-based intervention
bull Routine-based practice
bull Enriched environment
A Multi-Disciplinary Early Intervention Model
It takes a team
Perlman Center
Patient
PT
DI
OT
Parent
Social
Work
SLP
Neurologist
Primary Care Physician
Rehabilitation doctor
Vision specialist
Other care providers
Orthopedic
ENT Nutrition
Neonatologist
Perlman Center
What is the best way to coordinate the
multidisciplinary team bull Determine the primary team (the team that sees the client and
family the most including a social worker)
bull Include parents in meetings with team discussing parents
priorities and goals (Routine Based Assessments Circle
Conferences)
bull Encourage a parent notebookbinder (contact information for
the team educational materials questions recommendations)
bull Communication with physicians before appointments- make
sure you have all necessary releases on front end
bull Use Technology group emails My Chart EPIC Care
Everywhere
Perlman Center
Parent Resource Binder
Educational Topics
Development
Nutrition
Diagnosis
Role of the Clinician
Multidisciplinary team
Muscle tone
Language development
Sensory Integration
Positioning
Sleep
Financial Resourceshelliphellip
Medical Management
Birth History
Medications
Medical Team
Insurance Information
Appointments
EquipmentVendor
Perlman Center
EMPOWER PARENTS
Perlman Center
We know that CP results in complex problems
How do we address multiple areas
Pain
Cognition
Mobility
Bone development
Language
Seizures
Behavior
Bowel and Bladder
Sleep
Vision
Nutrition
Hearing Novak April 2014
The Evaluation Process
Not just focusing on your clinical
area
You are not just
evaluating the infant
Perlman Center
Perlman Center
The Evaluation Process Holistic Picture
Ongoing Assessment of the Infant
Family-Centered Care
General Assessment
Perlman Center
Multidisciplinary Checklist Tools
Perlman Center
Perlman Multidisciplinary Checklist
Perlman Center
ParentChild Assessment of Routines
Perlman Center
Providing Therapy Services
Clinical
assessment Parents Goals
and Priorities
What are the therapy options to meet the above needs
Perlman Center
Bridging the gap between clinical
assessments and family need
bull Identify Limitations
bull Developmental Delays
bull Medical needs
Clinical Finding
bull Family Routines
bull Family Priorities
bull Overcome Barriers and Obstacles
Family Need
Perlman Center
10 minutes
Perlman Center
bull Considering severity and complexity of diagnosis delays
parentsrsquo level of education acceptance and understanding of
their childrsquos diagnosis
bull Frequency Does the childfamily need weekly treatment once
per month or a burst of therapy every couple of months
bull Most supportive environment group or individual home-based
or clinic-based
bull Referrals for specialized intervention (splinting constraint
therapy adaptive equipment oral-motorfeeding therapy vision
therapy Kinesiotherapy etc)
Develop a Therapy Plan
Perlman Center
Perlman Case Study Examples
Mild delays
Infant has risks for CP
Moderate Delays
Infant presents abnormal motor delays
Severe Delays
Infant presents with significant
neuro-motor impairments
Perlman Center M
ild d
ela
ys-a
t risk
bull Full term
bull Difficult delivery
bull Seizure after delivery
bull Abnormal MRI
bull Mom has degree in child development
Mod
era
te d
ela
ys
bull Full term
bull Seizure activity and HIE following birth
bull Abnormal movements of UELE
bull Abnormal MRI
bull Sensory issues
bull Feeding difficulty S
eve
re d
ela
ys
bull Preemie
bull Difficult pregnancy
bull Ruptured placenta
bull Seizures NICU
bull Tonic posturing
bull Feeding difficulty
bull Family lost another child
Case Studies Patient Medical History
Perlman Center M
ild d
ela
ys-A
t R
isk
bull MRI- basal ganglia
bull Clinic check-ups have been on track
bull Underlying weakness observed by PT
bull Slight catch in Right hamstring
bull 1x every 3-4 weeks
Modera
te d
ela
ys
bull Presents with tonal posturing
bull External support for positioning
bull Sensitive to vestibular movement
bull Home based EI OP equipment planning
bull Group tx
Severe
dela
ys
bull Severe posturing
bull FeedingGI issues
bull Mom needs lots of support
bull Positioning needs
bull Medical needs
bull 2x week group setting (OT PT SLP SW MDs feeding team)
Perlman Center
Build high value
interventions
Perlman Center
bull Therapy to support early parent-infant relationships
bull Build parent confidence
bull Education and training
bull Build opportunities for practice
bull Incorporate into daily routines
Engaging Parents
bull Adapt access to play play is FUN
bull Stimulate exploration inquiry and learning
bull Enrich for cognitive motor sensory and social development
Building Enriched
Environments
bull Goal-oriented intensive motor training (Morgan et al 2015)
bull Build in repetition
bull Scaffold so infant is able to complete at least part of the task
bull Experience-based activities will engage self-initiation of movement
bull Occurs while participating in daily routines (ie at the grocery)
Applying Early Motor Learning
Specific Strategies
Perlman Center
Engaging Parents Education
Topic Lists
Identify parent priorities and begin education based
on parentsrsquo perceived need
child diagnoses
parent support and resources
oral-motor and feeding
seating and positioning
disabilities across the lifespan
gross motor development
patient advocacy
adapted equipment fine motor development
home positioning techniques
financial resources
sensory integration
types of rehabilitation therapy
speech and language
Perlman Center
Engaging Parents Goal Setting
Perlman Center
Educate
Model
Engage
Observe
Connect
Perlman Center
Purposeful Play ishellip
Goal oriented
Activity based
Motivating
In an Enriched environment
Perlman Center
Perlman Center
cognitive
sensory
motor
social
Perlman Center
Building Enriched Environments
Perlman Center
Building Enriched Environments
bull Is the child positioned within
reach to explore the activity
bull Are all senses being utilized
bull Is the child being motivated to
move throughout the
environment
bull Is the environment adapted to
increase access to play
Perlman Center
Building Enriched Environments
bull Can the child have an effect
on the activity within the
environment
bull Is the activity appropriately
challenging the child within the
environment
bull Is the child presented with the
need for problem solving
Perlman Center
Building Enriched Environments
bull Is the child motivated to repeat
the task for motor learning
bull Does the environment support
learning (ie appropriate
noise level social motivators
peer groups developmental
learning supports visual
supports auditory feedback
etc)
Perlman Center
Bridging the gap between the clinic and the
home environment
bull Discipline focused
bull Clinic equipment closet
bull May have group option
Clinic
bull Incorporate into Family Routines
bull Functional activities
bull High Value
bull Adapted environment
Home
Mobility
Early Literacy
Sensory Motor Learning
Social Connections
Perlman Center
Early Learning
Functional MRIs show positive long-term neuro-
cognitive effects of reading to very young
infants
Sensory experiences shape a babyrsquos
knowledge about the world
The average toddler moves 8
out of 10 waking hoursday
Perlman Center
Learning through Experience
Adapting the environment with positioning equipment allows children with disabilities to experience their world and build relationships Allows the child to participate in typical experiences to foster learning
Activities need to promote active engagement
and allow a child to
ndash Actively explore move and participate in play
ndash Assist with self-help routines
ndash Interact and connect with family amp friends
ndash Participate in community activities
ndash Have a means to effectively communicate
ndash Make choices about their wants and need
Perlman Center
Perlman Center
bull Headpointing painting
bull Universal cuffs large pegs splints
bull Switch toys for art activitiesdramatic play-pourer
bull Switch computer access- helpkidzlearncom
bull Fischer Price game with keyboard binder switch
bull Walking in different textures while in standers and walkers
bull Cameramouseorg with dwell click
bull Partner assisted scanning
Alternative amp Adaptive Access to Play
Perlman Center
Change the environment Not the body Adaptations will be critical for success
Gross Motor Fine Motor
Social
Communication
Perlman Center Consider Communication Young children need a reliable form of communication as early as possible
Augmentative Communication is shown to support verbal skills and enhance lives of
birth to three children and their families (Romski et al 2015)
Perlman Center
Holistic approach to AAC intervention should
Build on individual strengths
Focus on participation in real-world contexts
Address psychosocial factors (ie motivation attitude confidence resilience)
Focus on environmental factors to reduce barriers and maximize social supports
In the absence of a holistic approach to communication a child is at risk for failing to engage in social contexts beyond their immediate family or educationalvocational personnel (Light and Mcnaughton 2015)
Augmentative amp Alternative Communication (AAC)
Perlman Center
Early Literacy
Perlman Center
Early Mobility
There is more than one way
Hands Free Matters
Perlman Center
Early Mobility
Should I get a gait trainer if
they are going to walk YES
Are they too young for power NO
Perlman Center
Sensory Motor Learning
Perlman Center
Sensory Motor Learning
Perlman Center
Social Connection
Perlman Center
Total Access to Play
Perlman Center
Perlman defines functional positioning bull Positioning which promotes active movement and participation and
provides an opportunity to positively impact cognitive function
bull Equipment should promote function and participation across the lifespan
Perlman Center
Principles of seating and positioning
bull Obtain a stable base of support
bull Decrease the influence of atypical muscle tone
bull Accommodate fixed deformities and correct flexible deformities
bull Provide the least amount of intervention needed to achieve the greatest level of function
bull There is no one solution or product but typically a combination of tools that provide success
Adapted from Radell (1997) and York and Weimann (1991)
Perlman Center
Key Positioning Components
bull Postural Control Strengthening
bull Range of Motion Weight Bearing
bull Home Activity Programs
Developmental Positioning
bull ADLs-Play Feeding Bathing Sleeping
bull Computer AccessAAC-Integrated Technology
bull Vision Sensory Processing Participation
Upright Positioning
bull EARLY MOBILITY- developmental sequence
bull Gait Trainer Stander amp or Wheelchair
bull Manual wheelchair vs Power Mobility- BOTH
bull Recreational
ldquoTotalrdquo Mobility
bull Body Mechanics Hoyer Lifts Overhead Systems
bull Car Seat ampor Tie Downs
bull Adapted VanRamps
Transfers ampTransportation
Perlman Center
Equipment Plan of Care
Birth to Three
Adapting baby
equipment
Floor Play
StanderWalker
Bath Seat
Car Seat
Braces
Seating for Function
Early ACCESS
Wheelchair
Bed Positioning
Bike amp Swing
Preschool
Stander
Walker
Braces
Bath Seat
Potty Seat
Wheelchair
HiLo seating
AACAccess
Adapted Bed
Car Seat
Transportation
RecreationHEP
School-Age
to Adult
Wheelchair
AACACCESS
Integrated AT
Hilo chair
Standerwalker
Bath chair
Potty chair
Adapted Bed
Car SeatVan
Home modslifts
LeisureWork
Perlman Center
Commercial Products strollers car seats cribs bath seats high chairs
playpen infant swings floor mats nursing pillow ExerSaucers
Perlman Center
Creative Commercial Adaptations
Pool noodles
Snug and Go
Crib Wedges
Bed tableart desk
Laundry baskets
Inflatable bathtub
Inflatable infant pools
Boxesstools
Perlman Center Creative Commercial Adaptations
Laundry basket $400
Pool Noodle x 2 $300
Floor sitterbath support $700
table (BLACK) $800
Garbage can $600
Large pool noodle $300
Stander with anterior support and
Visual adaptation $1700
Perlman Center
Complex Rehab Equipment
Standers
Gait trainers
Bath Support
Car seat
Seating
Feeding tools
AAC
Sensory tools
vibration
Compression garments
NUK brushes
Z Vibe
Modified utensils
Swings
Weight
Head phones
Positioning
Neck supports
Bracing
Bobby pillowU cushion
Benches
Fireflyfriendscom
PlayPaK
Upsee
Go To Seat
Early Literacy
Picture symbols
Voice output switches
Adapted books
Adapted Equipment
Perlman Center
You got this baby Nowhellip Questions
Perlman Center
LETrsquoS PLAY
Hands on Equipment Demonstration
Perlman Center
bull Ulrich B (2010) Opportunities for Early Intervention Based on Theory Basic Neuroscience and Clinical Science Physical Therapy 90(12) 1868-1880
bull McIntyre S Morgan C amp Walker K (2011) Cerebral Palsy Dont Delay Developmental Disabilities Research Reviews 17(2) 114-129
bull Novak I (2014) Evidence-Based Diagnosis Health Care and Rehabilitation for Children with Cerebral Palsy Journal of Child Neurology 29(8) 1141-1156
bull Morgan C Novak I amp Badawi N (2013) Enriched Environments and Motor Outcomes in Cerebral Palsy Systematic Review and Meta-analysis Pediatrics 132 (3)e 735 -e746
bull Morgan C Novak I Dale R Guzzetta A amp Badawi N (2014) GAME (Goals- Activity-Motor Enrichment) protocol of a single blind randomised controlled trial of motor training parent education and environmental enrichment for infants at high risk of cerebral palsy BMC Neurology 14(203)
bull Whittingham K Wee D amp Boyd R (2010) Systematic review of the efficacy of parenting interventions for children with cerebral palsy Child care health and development 37(4) 475-483
bull Morgan C Novak I dale R amp Badawi N (2015) Optimising motor learning in infants at high risk of cerebral palsy a pilot study BMC Pediatrics 15(1) n pag Web
bull Vos R Dallmeijer A Verhoef M et al (2014) Developmental trajectories of receptive and expressive communication in children and young adults with cerebral palsy Developmental Medicine amp Child Neurology 56 951-959
bull Light J and McNaughton D (2015) Designing AAC research and intervention to improve outcomes for individuals with complex communication needs Augmentative and Alternative Communication 31(2) 85-96
bull Romski M Sevcik R Barton-Hulsey A amp Whitmore A (2015) Early Intervention and AAC What a difference 30 years makes Augmentative and Alternative Communication 31 (3) 181-202
References
Perlman Center
bull Novak I Cusick A Lannin N (2009) Occupational therapy home programs for cerebral palsy Double-blind randomised controlled trial Pediatrics 124 e606-e614
bull Gericke T (2006) Postural management for children with cerebral palsy consensus statement Dev Med Child Neurol 48 (4) 244-244
bull McKeever P Rossen B Scott H Robinson-Vincent K amp Wright V (2013) The significance of uprightness parentsrsquo reflections on childrenrsquos responses to a hands-free walker for children Disability amp Society 28(3) 380-392
bull Law M Pollock N Russell D Walter S et al (2011) Focus on function a cluster randomised controlled trial comparing child-versus context-focused intervention for young children with cerebral palsy Dev Med Child Neurol 53 621-629
bull ldquoSensory Processing Developmental Chartrdquo Sensory Processing Developmental Chart Np nd Web 12 Oct 2015
bull Folio MR amp Fewell RR(2000) Peabody Developmental Motor Scales- Second edition Austin TX PRO ED
bull Voress Judith K amp Pearson Nils A (2013) Early Childhood Development Chart-Third edition Austin TX PRO ED
bull Paul Rhea (2007) Language Disorders from Infancy Through Adolescence Assessment amp Intervention Third edition St Louis MA Mosby Inc
bull Prosser L Ohlrich L Curatalo L Alter K amp Damiano D (2012) Feasibility and preliminary effectiveness of a novel mobility training intervention in infants and toddlers with cerebral palsy Developmental Neurorehabilitation 15(4) 259-266
References
Perlman Center
Patient
PT
DI
OT
Parent
Social
Work
SLP
Neurologist
Primary Care Physician
Rehabilitation doctor
Vision specialist
Other care providers
Orthopedic
ENT Nutrition
Neonatologist
Perlman Center
What is the best way to coordinate the
multidisciplinary team bull Determine the primary team (the team that sees the client and
family the most including a social worker)
bull Include parents in meetings with team discussing parents
priorities and goals (Routine Based Assessments Circle
Conferences)
bull Encourage a parent notebookbinder (contact information for
the team educational materials questions recommendations)
bull Communication with physicians before appointments- make
sure you have all necessary releases on front end
bull Use Technology group emails My Chart EPIC Care
Everywhere
Perlman Center
Parent Resource Binder
Educational Topics
Development
Nutrition
Diagnosis
Role of the Clinician
Multidisciplinary team
Muscle tone
Language development
Sensory Integration
Positioning
Sleep
Financial Resourceshelliphellip
Medical Management
Birth History
Medications
Medical Team
Insurance Information
Appointments
EquipmentVendor
Perlman Center
EMPOWER PARENTS
Perlman Center
We know that CP results in complex problems
How do we address multiple areas
Pain
Cognition
Mobility
Bone development
Language
Seizures
Behavior
Bowel and Bladder
Sleep
Vision
Nutrition
Hearing Novak April 2014
The Evaluation Process
Not just focusing on your clinical
area
You are not just
evaluating the infant
Perlman Center
Perlman Center
The Evaluation Process Holistic Picture
Ongoing Assessment of the Infant
Family-Centered Care
General Assessment
Perlman Center
Multidisciplinary Checklist Tools
Perlman Center
Perlman Multidisciplinary Checklist
Perlman Center
ParentChild Assessment of Routines
Perlman Center
Providing Therapy Services
Clinical
assessment Parents Goals
and Priorities
What are the therapy options to meet the above needs
Perlman Center
Bridging the gap between clinical
assessments and family need
bull Identify Limitations
bull Developmental Delays
bull Medical needs
Clinical Finding
bull Family Routines
bull Family Priorities
bull Overcome Barriers and Obstacles
Family Need
Perlman Center
10 minutes
Perlman Center
bull Considering severity and complexity of diagnosis delays
parentsrsquo level of education acceptance and understanding of
their childrsquos diagnosis
bull Frequency Does the childfamily need weekly treatment once
per month or a burst of therapy every couple of months
bull Most supportive environment group or individual home-based
or clinic-based
bull Referrals for specialized intervention (splinting constraint
therapy adaptive equipment oral-motorfeeding therapy vision
therapy Kinesiotherapy etc)
Develop a Therapy Plan
Perlman Center
Perlman Case Study Examples
Mild delays
Infant has risks for CP
Moderate Delays
Infant presents abnormal motor delays
Severe Delays
Infant presents with significant
neuro-motor impairments
Perlman Center M
ild d
ela
ys-a
t risk
bull Full term
bull Difficult delivery
bull Seizure after delivery
bull Abnormal MRI
bull Mom has degree in child development
Mod
era
te d
ela
ys
bull Full term
bull Seizure activity and HIE following birth
bull Abnormal movements of UELE
bull Abnormal MRI
bull Sensory issues
bull Feeding difficulty S
eve
re d
ela
ys
bull Preemie
bull Difficult pregnancy
bull Ruptured placenta
bull Seizures NICU
bull Tonic posturing
bull Feeding difficulty
bull Family lost another child
Case Studies Patient Medical History
Perlman Center M
ild d
ela
ys-A
t R
isk
bull MRI- basal ganglia
bull Clinic check-ups have been on track
bull Underlying weakness observed by PT
bull Slight catch in Right hamstring
bull 1x every 3-4 weeks
Modera
te d
ela
ys
bull Presents with tonal posturing
bull External support for positioning
bull Sensitive to vestibular movement
bull Home based EI OP equipment planning
bull Group tx
Severe
dela
ys
bull Severe posturing
bull FeedingGI issues
bull Mom needs lots of support
bull Positioning needs
bull Medical needs
bull 2x week group setting (OT PT SLP SW MDs feeding team)
Perlman Center
Build high value
interventions
Perlman Center
bull Therapy to support early parent-infant relationships
bull Build parent confidence
bull Education and training
bull Build opportunities for practice
bull Incorporate into daily routines
Engaging Parents
bull Adapt access to play play is FUN
bull Stimulate exploration inquiry and learning
bull Enrich for cognitive motor sensory and social development
Building Enriched
Environments
bull Goal-oriented intensive motor training (Morgan et al 2015)
bull Build in repetition
bull Scaffold so infant is able to complete at least part of the task
bull Experience-based activities will engage self-initiation of movement
bull Occurs while participating in daily routines (ie at the grocery)
Applying Early Motor Learning
Specific Strategies
Perlman Center
Engaging Parents Education
Topic Lists
Identify parent priorities and begin education based
on parentsrsquo perceived need
child diagnoses
parent support and resources
oral-motor and feeding
seating and positioning
disabilities across the lifespan
gross motor development
patient advocacy
adapted equipment fine motor development
home positioning techniques
financial resources
sensory integration
types of rehabilitation therapy
speech and language
Perlman Center
Engaging Parents Goal Setting
Perlman Center
Educate
Model
Engage
Observe
Connect
Perlman Center
Purposeful Play ishellip
Goal oriented
Activity based
Motivating
In an Enriched environment
Perlman Center
Perlman Center
cognitive
sensory
motor
social
Perlman Center
Building Enriched Environments
Perlman Center
Building Enriched Environments
bull Is the child positioned within
reach to explore the activity
bull Are all senses being utilized
bull Is the child being motivated to
move throughout the
environment
bull Is the environment adapted to
increase access to play
Perlman Center
Building Enriched Environments
bull Can the child have an effect
on the activity within the
environment
bull Is the activity appropriately
challenging the child within the
environment
bull Is the child presented with the
need for problem solving
Perlman Center
Building Enriched Environments
bull Is the child motivated to repeat
the task for motor learning
bull Does the environment support
learning (ie appropriate
noise level social motivators
peer groups developmental
learning supports visual
supports auditory feedback
etc)
Perlman Center
Bridging the gap between the clinic and the
home environment
bull Discipline focused
bull Clinic equipment closet
bull May have group option
Clinic
bull Incorporate into Family Routines
bull Functional activities
bull High Value
bull Adapted environment
Home
Mobility
Early Literacy
Sensory Motor Learning
Social Connections
Perlman Center
Early Learning
Functional MRIs show positive long-term neuro-
cognitive effects of reading to very young
infants
Sensory experiences shape a babyrsquos
knowledge about the world
The average toddler moves 8
out of 10 waking hoursday
Perlman Center
Learning through Experience
Adapting the environment with positioning equipment allows children with disabilities to experience their world and build relationships Allows the child to participate in typical experiences to foster learning
Activities need to promote active engagement
and allow a child to
ndash Actively explore move and participate in play
ndash Assist with self-help routines
ndash Interact and connect with family amp friends
ndash Participate in community activities
ndash Have a means to effectively communicate
ndash Make choices about their wants and need
Perlman Center
Perlman Center
bull Headpointing painting
bull Universal cuffs large pegs splints
bull Switch toys for art activitiesdramatic play-pourer
bull Switch computer access- helpkidzlearncom
bull Fischer Price game with keyboard binder switch
bull Walking in different textures while in standers and walkers
bull Cameramouseorg with dwell click
bull Partner assisted scanning
Alternative amp Adaptive Access to Play
Perlman Center
Change the environment Not the body Adaptations will be critical for success
Gross Motor Fine Motor
Social
Communication
Perlman Center Consider Communication Young children need a reliable form of communication as early as possible
Augmentative Communication is shown to support verbal skills and enhance lives of
birth to three children and their families (Romski et al 2015)
Perlman Center
Holistic approach to AAC intervention should
Build on individual strengths
Focus on participation in real-world contexts
Address psychosocial factors (ie motivation attitude confidence resilience)
Focus on environmental factors to reduce barriers and maximize social supports
In the absence of a holistic approach to communication a child is at risk for failing to engage in social contexts beyond their immediate family or educationalvocational personnel (Light and Mcnaughton 2015)
Augmentative amp Alternative Communication (AAC)
Perlman Center
Early Literacy
Perlman Center
Early Mobility
There is more than one way
Hands Free Matters
Perlman Center
Early Mobility
Should I get a gait trainer if
they are going to walk YES
Are they too young for power NO
Perlman Center
Sensory Motor Learning
Perlman Center
Sensory Motor Learning
Perlman Center
Social Connection
Perlman Center
Total Access to Play
Perlman Center
Perlman defines functional positioning bull Positioning which promotes active movement and participation and
provides an opportunity to positively impact cognitive function
bull Equipment should promote function and participation across the lifespan
Perlman Center
Principles of seating and positioning
bull Obtain a stable base of support
bull Decrease the influence of atypical muscle tone
bull Accommodate fixed deformities and correct flexible deformities
bull Provide the least amount of intervention needed to achieve the greatest level of function
bull There is no one solution or product but typically a combination of tools that provide success
Adapted from Radell (1997) and York and Weimann (1991)
Perlman Center
Key Positioning Components
bull Postural Control Strengthening
bull Range of Motion Weight Bearing
bull Home Activity Programs
Developmental Positioning
bull ADLs-Play Feeding Bathing Sleeping
bull Computer AccessAAC-Integrated Technology
bull Vision Sensory Processing Participation
Upright Positioning
bull EARLY MOBILITY- developmental sequence
bull Gait Trainer Stander amp or Wheelchair
bull Manual wheelchair vs Power Mobility- BOTH
bull Recreational
ldquoTotalrdquo Mobility
bull Body Mechanics Hoyer Lifts Overhead Systems
bull Car Seat ampor Tie Downs
bull Adapted VanRamps
Transfers ampTransportation
Perlman Center
Equipment Plan of Care
Birth to Three
Adapting baby
equipment
Floor Play
StanderWalker
Bath Seat
Car Seat
Braces
Seating for Function
Early ACCESS
Wheelchair
Bed Positioning
Bike amp Swing
Preschool
Stander
Walker
Braces
Bath Seat
Potty Seat
Wheelchair
HiLo seating
AACAccess
Adapted Bed
Car Seat
Transportation
RecreationHEP
School-Age
to Adult
Wheelchair
AACACCESS
Integrated AT
Hilo chair
Standerwalker
Bath chair
Potty chair
Adapted Bed
Car SeatVan
Home modslifts
LeisureWork
Perlman Center
Commercial Products strollers car seats cribs bath seats high chairs
playpen infant swings floor mats nursing pillow ExerSaucers
Perlman Center
Creative Commercial Adaptations
Pool noodles
Snug and Go
Crib Wedges
Bed tableart desk
Laundry baskets
Inflatable bathtub
Inflatable infant pools
Boxesstools
Perlman Center Creative Commercial Adaptations
Laundry basket $400
Pool Noodle x 2 $300
Floor sitterbath support $700
table (BLACK) $800
Garbage can $600
Large pool noodle $300
Stander with anterior support and
Visual adaptation $1700
Perlman Center
Complex Rehab Equipment
Standers
Gait trainers
Bath Support
Car seat
Seating
Feeding tools
AAC
Sensory tools
vibration
Compression garments
NUK brushes
Z Vibe
Modified utensils
Swings
Weight
Head phones
Positioning
Neck supports
Bracing
Bobby pillowU cushion
Benches
Fireflyfriendscom
PlayPaK
Upsee
Go To Seat
Early Literacy
Picture symbols
Voice output switches
Adapted books
Adapted Equipment
Perlman Center
You got this baby Nowhellip Questions
Perlman Center
LETrsquoS PLAY
Hands on Equipment Demonstration
Perlman Center
bull Ulrich B (2010) Opportunities for Early Intervention Based on Theory Basic Neuroscience and Clinical Science Physical Therapy 90(12) 1868-1880
bull McIntyre S Morgan C amp Walker K (2011) Cerebral Palsy Dont Delay Developmental Disabilities Research Reviews 17(2) 114-129
bull Novak I (2014) Evidence-Based Diagnosis Health Care and Rehabilitation for Children with Cerebral Palsy Journal of Child Neurology 29(8) 1141-1156
bull Morgan C Novak I amp Badawi N (2013) Enriched Environments and Motor Outcomes in Cerebral Palsy Systematic Review and Meta-analysis Pediatrics 132 (3)e 735 -e746
bull Morgan C Novak I Dale R Guzzetta A amp Badawi N (2014) GAME (Goals- Activity-Motor Enrichment) protocol of a single blind randomised controlled trial of motor training parent education and environmental enrichment for infants at high risk of cerebral palsy BMC Neurology 14(203)
bull Whittingham K Wee D amp Boyd R (2010) Systematic review of the efficacy of parenting interventions for children with cerebral palsy Child care health and development 37(4) 475-483
bull Morgan C Novak I dale R amp Badawi N (2015) Optimising motor learning in infants at high risk of cerebral palsy a pilot study BMC Pediatrics 15(1) n pag Web
bull Vos R Dallmeijer A Verhoef M et al (2014) Developmental trajectories of receptive and expressive communication in children and young adults with cerebral palsy Developmental Medicine amp Child Neurology 56 951-959
bull Light J and McNaughton D (2015) Designing AAC research and intervention to improve outcomes for individuals with complex communication needs Augmentative and Alternative Communication 31(2) 85-96
bull Romski M Sevcik R Barton-Hulsey A amp Whitmore A (2015) Early Intervention and AAC What a difference 30 years makes Augmentative and Alternative Communication 31 (3) 181-202
References
Perlman Center
bull Novak I Cusick A Lannin N (2009) Occupational therapy home programs for cerebral palsy Double-blind randomised controlled trial Pediatrics 124 e606-e614
bull Gericke T (2006) Postural management for children with cerebral palsy consensus statement Dev Med Child Neurol 48 (4) 244-244
bull McKeever P Rossen B Scott H Robinson-Vincent K amp Wright V (2013) The significance of uprightness parentsrsquo reflections on childrenrsquos responses to a hands-free walker for children Disability amp Society 28(3) 380-392
bull Law M Pollock N Russell D Walter S et al (2011) Focus on function a cluster randomised controlled trial comparing child-versus context-focused intervention for young children with cerebral palsy Dev Med Child Neurol 53 621-629
bull ldquoSensory Processing Developmental Chartrdquo Sensory Processing Developmental Chart Np nd Web 12 Oct 2015
bull Folio MR amp Fewell RR(2000) Peabody Developmental Motor Scales- Second edition Austin TX PRO ED
bull Voress Judith K amp Pearson Nils A (2013) Early Childhood Development Chart-Third edition Austin TX PRO ED
bull Paul Rhea (2007) Language Disorders from Infancy Through Adolescence Assessment amp Intervention Third edition St Louis MA Mosby Inc
bull Prosser L Ohlrich L Curatalo L Alter K amp Damiano D (2012) Feasibility and preliminary effectiveness of a novel mobility training intervention in infants and toddlers with cerebral palsy Developmental Neurorehabilitation 15(4) 259-266
References
Perlman Center
What is the best way to coordinate the
multidisciplinary team bull Determine the primary team (the team that sees the client and
family the most including a social worker)
bull Include parents in meetings with team discussing parents
priorities and goals (Routine Based Assessments Circle
Conferences)
bull Encourage a parent notebookbinder (contact information for
the team educational materials questions recommendations)
bull Communication with physicians before appointments- make
sure you have all necessary releases on front end
bull Use Technology group emails My Chart EPIC Care
Everywhere
Perlman Center
Parent Resource Binder
Educational Topics
Development
Nutrition
Diagnosis
Role of the Clinician
Multidisciplinary team
Muscle tone
Language development
Sensory Integration
Positioning
Sleep
Financial Resourceshelliphellip
Medical Management
Birth History
Medications
Medical Team
Insurance Information
Appointments
EquipmentVendor
Perlman Center
EMPOWER PARENTS
Perlman Center
We know that CP results in complex problems
How do we address multiple areas
Pain
Cognition
Mobility
Bone development
Language
Seizures
Behavior
Bowel and Bladder
Sleep
Vision
Nutrition
Hearing Novak April 2014
The Evaluation Process
Not just focusing on your clinical
area
You are not just
evaluating the infant
Perlman Center
Perlman Center
The Evaluation Process Holistic Picture
Ongoing Assessment of the Infant
Family-Centered Care
General Assessment
Perlman Center
Multidisciplinary Checklist Tools
Perlman Center
Perlman Multidisciplinary Checklist
Perlman Center
ParentChild Assessment of Routines
Perlman Center
Providing Therapy Services
Clinical
assessment Parents Goals
and Priorities
What are the therapy options to meet the above needs
Perlman Center
Bridging the gap between clinical
assessments and family need
bull Identify Limitations
bull Developmental Delays
bull Medical needs
Clinical Finding
bull Family Routines
bull Family Priorities
bull Overcome Barriers and Obstacles
Family Need
Perlman Center
10 minutes
Perlman Center
bull Considering severity and complexity of diagnosis delays
parentsrsquo level of education acceptance and understanding of
their childrsquos diagnosis
bull Frequency Does the childfamily need weekly treatment once
per month or a burst of therapy every couple of months
bull Most supportive environment group or individual home-based
or clinic-based
bull Referrals for specialized intervention (splinting constraint
therapy adaptive equipment oral-motorfeeding therapy vision
therapy Kinesiotherapy etc)
Develop a Therapy Plan
Perlman Center
Perlman Case Study Examples
Mild delays
Infant has risks for CP
Moderate Delays
Infant presents abnormal motor delays
Severe Delays
Infant presents with significant
neuro-motor impairments
Perlman Center M
ild d
ela
ys-a
t risk
bull Full term
bull Difficult delivery
bull Seizure after delivery
bull Abnormal MRI
bull Mom has degree in child development
Mod
era
te d
ela
ys
bull Full term
bull Seizure activity and HIE following birth
bull Abnormal movements of UELE
bull Abnormal MRI
bull Sensory issues
bull Feeding difficulty S
eve
re d
ela
ys
bull Preemie
bull Difficult pregnancy
bull Ruptured placenta
bull Seizures NICU
bull Tonic posturing
bull Feeding difficulty
bull Family lost another child
Case Studies Patient Medical History
Perlman Center M
ild d
ela
ys-A
t R
isk
bull MRI- basal ganglia
bull Clinic check-ups have been on track
bull Underlying weakness observed by PT
bull Slight catch in Right hamstring
bull 1x every 3-4 weeks
Modera
te d
ela
ys
bull Presents with tonal posturing
bull External support for positioning
bull Sensitive to vestibular movement
bull Home based EI OP equipment planning
bull Group tx
Severe
dela
ys
bull Severe posturing
bull FeedingGI issues
bull Mom needs lots of support
bull Positioning needs
bull Medical needs
bull 2x week group setting (OT PT SLP SW MDs feeding team)
Perlman Center
Build high value
interventions
Perlman Center
bull Therapy to support early parent-infant relationships
bull Build parent confidence
bull Education and training
bull Build opportunities for practice
bull Incorporate into daily routines
Engaging Parents
bull Adapt access to play play is FUN
bull Stimulate exploration inquiry and learning
bull Enrich for cognitive motor sensory and social development
Building Enriched
Environments
bull Goal-oriented intensive motor training (Morgan et al 2015)
bull Build in repetition
bull Scaffold so infant is able to complete at least part of the task
bull Experience-based activities will engage self-initiation of movement
bull Occurs while participating in daily routines (ie at the grocery)
Applying Early Motor Learning
Specific Strategies
Perlman Center
Engaging Parents Education
Topic Lists
Identify parent priorities and begin education based
on parentsrsquo perceived need
child diagnoses
parent support and resources
oral-motor and feeding
seating and positioning
disabilities across the lifespan
gross motor development
patient advocacy
adapted equipment fine motor development
home positioning techniques
financial resources
sensory integration
types of rehabilitation therapy
speech and language
Perlman Center
Engaging Parents Goal Setting
Perlman Center
Educate
Model
Engage
Observe
Connect
Perlman Center
Purposeful Play ishellip
Goal oriented
Activity based
Motivating
In an Enriched environment
Perlman Center
Perlman Center
cognitive
sensory
motor
social
Perlman Center
Building Enriched Environments
Perlman Center
Building Enriched Environments
bull Is the child positioned within
reach to explore the activity
bull Are all senses being utilized
bull Is the child being motivated to
move throughout the
environment
bull Is the environment adapted to
increase access to play
Perlman Center
Building Enriched Environments
bull Can the child have an effect
on the activity within the
environment
bull Is the activity appropriately
challenging the child within the
environment
bull Is the child presented with the
need for problem solving
Perlman Center
Building Enriched Environments
bull Is the child motivated to repeat
the task for motor learning
bull Does the environment support
learning (ie appropriate
noise level social motivators
peer groups developmental
learning supports visual
supports auditory feedback
etc)
Perlman Center
Bridging the gap between the clinic and the
home environment
bull Discipline focused
bull Clinic equipment closet
bull May have group option
Clinic
bull Incorporate into Family Routines
bull Functional activities
bull High Value
bull Adapted environment
Home
Mobility
Early Literacy
Sensory Motor Learning
Social Connections
Perlman Center
Early Learning
Functional MRIs show positive long-term neuro-
cognitive effects of reading to very young
infants
Sensory experiences shape a babyrsquos
knowledge about the world
The average toddler moves 8
out of 10 waking hoursday
Perlman Center
Learning through Experience
Adapting the environment with positioning equipment allows children with disabilities to experience their world and build relationships Allows the child to participate in typical experiences to foster learning
Activities need to promote active engagement
and allow a child to
ndash Actively explore move and participate in play
ndash Assist with self-help routines
ndash Interact and connect with family amp friends
ndash Participate in community activities
ndash Have a means to effectively communicate
ndash Make choices about their wants and need
Perlman Center
Perlman Center
bull Headpointing painting
bull Universal cuffs large pegs splints
bull Switch toys for art activitiesdramatic play-pourer
bull Switch computer access- helpkidzlearncom
bull Fischer Price game with keyboard binder switch
bull Walking in different textures while in standers and walkers
bull Cameramouseorg with dwell click
bull Partner assisted scanning
Alternative amp Adaptive Access to Play
Perlman Center
Change the environment Not the body Adaptations will be critical for success
Gross Motor Fine Motor
Social
Communication
Perlman Center Consider Communication Young children need a reliable form of communication as early as possible
Augmentative Communication is shown to support verbal skills and enhance lives of
birth to three children and their families (Romski et al 2015)
Perlman Center
Holistic approach to AAC intervention should
Build on individual strengths
Focus on participation in real-world contexts
Address psychosocial factors (ie motivation attitude confidence resilience)
Focus on environmental factors to reduce barriers and maximize social supports
In the absence of a holistic approach to communication a child is at risk for failing to engage in social contexts beyond their immediate family or educationalvocational personnel (Light and Mcnaughton 2015)
Augmentative amp Alternative Communication (AAC)
Perlman Center
Early Literacy
Perlman Center
Early Mobility
There is more than one way
Hands Free Matters
Perlman Center
Early Mobility
Should I get a gait trainer if
they are going to walk YES
Are they too young for power NO
Perlman Center
Sensory Motor Learning
Perlman Center
Sensory Motor Learning
Perlman Center
Social Connection
Perlman Center
Total Access to Play
Perlman Center
Perlman defines functional positioning bull Positioning which promotes active movement and participation and
provides an opportunity to positively impact cognitive function
bull Equipment should promote function and participation across the lifespan
Perlman Center
Principles of seating and positioning
bull Obtain a stable base of support
bull Decrease the influence of atypical muscle tone
bull Accommodate fixed deformities and correct flexible deformities
bull Provide the least amount of intervention needed to achieve the greatest level of function
bull There is no one solution or product but typically a combination of tools that provide success
Adapted from Radell (1997) and York and Weimann (1991)
Perlman Center
Key Positioning Components
bull Postural Control Strengthening
bull Range of Motion Weight Bearing
bull Home Activity Programs
Developmental Positioning
bull ADLs-Play Feeding Bathing Sleeping
bull Computer AccessAAC-Integrated Technology
bull Vision Sensory Processing Participation
Upright Positioning
bull EARLY MOBILITY- developmental sequence
bull Gait Trainer Stander amp or Wheelchair
bull Manual wheelchair vs Power Mobility- BOTH
bull Recreational
ldquoTotalrdquo Mobility
bull Body Mechanics Hoyer Lifts Overhead Systems
bull Car Seat ampor Tie Downs
bull Adapted VanRamps
Transfers ampTransportation
Perlman Center
Equipment Plan of Care
Birth to Three
Adapting baby
equipment
Floor Play
StanderWalker
Bath Seat
Car Seat
Braces
Seating for Function
Early ACCESS
Wheelchair
Bed Positioning
Bike amp Swing
Preschool
Stander
Walker
Braces
Bath Seat
Potty Seat
Wheelchair
HiLo seating
AACAccess
Adapted Bed
Car Seat
Transportation
RecreationHEP
School-Age
to Adult
Wheelchair
AACACCESS
Integrated AT
Hilo chair
Standerwalker
Bath chair
Potty chair
Adapted Bed
Car SeatVan
Home modslifts
LeisureWork
Perlman Center
Commercial Products strollers car seats cribs bath seats high chairs
playpen infant swings floor mats nursing pillow ExerSaucers
Perlman Center
Creative Commercial Adaptations
Pool noodles
Snug and Go
Crib Wedges
Bed tableart desk
Laundry baskets
Inflatable bathtub
Inflatable infant pools
Boxesstools
Perlman Center Creative Commercial Adaptations
Laundry basket $400
Pool Noodle x 2 $300
Floor sitterbath support $700
table (BLACK) $800
Garbage can $600
Large pool noodle $300
Stander with anterior support and
Visual adaptation $1700
Perlman Center
Complex Rehab Equipment
Standers
Gait trainers
Bath Support
Car seat
Seating
Feeding tools
AAC
Sensory tools
vibration
Compression garments
NUK brushes
Z Vibe
Modified utensils
Swings
Weight
Head phones
Positioning
Neck supports
Bracing
Bobby pillowU cushion
Benches
Fireflyfriendscom
PlayPaK
Upsee
Go To Seat
Early Literacy
Picture symbols
Voice output switches
Adapted books
Adapted Equipment
Perlman Center
You got this baby Nowhellip Questions
Perlman Center
LETrsquoS PLAY
Hands on Equipment Demonstration
Perlman Center
bull Ulrich B (2010) Opportunities for Early Intervention Based on Theory Basic Neuroscience and Clinical Science Physical Therapy 90(12) 1868-1880
bull McIntyre S Morgan C amp Walker K (2011) Cerebral Palsy Dont Delay Developmental Disabilities Research Reviews 17(2) 114-129
bull Novak I (2014) Evidence-Based Diagnosis Health Care and Rehabilitation for Children with Cerebral Palsy Journal of Child Neurology 29(8) 1141-1156
bull Morgan C Novak I amp Badawi N (2013) Enriched Environments and Motor Outcomes in Cerebral Palsy Systematic Review and Meta-analysis Pediatrics 132 (3)e 735 -e746
bull Morgan C Novak I Dale R Guzzetta A amp Badawi N (2014) GAME (Goals- Activity-Motor Enrichment) protocol of a single blind randomised controlled trial of motor training parent education and environmental enrichment for infants at high risk of cerebral palsy BMC Neurology 14(203)
bull Whittingham K Wee D amp Boyd R (2010) Systematic review of the efficacy of parenting interventions for children with cerebral palsy Child care health and development 37(4) 475-483
bull Morgan C Novak I dale R amp Badawi N (2015) Optimising motor learning in infants at high risk of cerebral palsy a pilot study BMC Pediatrics 15(1) n pag Web
bull Vos R Dallmeijer A Verhoef M et al (2014) Developmental trajectories of receptive and expressive communication in children and young adults with cerebral palsy Developmental Medicine amp Child Neurology 56 951-959
bull Light J and McNaughton D (2015) Designing AAC research and intervention to improve outcomes for individuals with complex communication needs Augmentative and Alternative Communication 31(2) 85-96
bull Romski M Sevcik R Barton-Hulsey A amp Whitmore A (2015) Early Intervention and AAC What a difference 30 years makes Augmentative and Alternative Communication 31 (3) 181-202
References
Perlman Center
bull Novak I Cusick A Lannin N (2009) Occupational therapy home programs for cerebral palsy Double-blind randomised controlled trial Pediatrics 124 e606-e614
bull Gericke T (2006) Postural management for children with cerebral palsy consensus statement Dev Med Child Neurol 48 (4) 244-244
bull McKeever P Rossen B Scott H Robinson-Vincent K amp Wright V (2013) The significance of uprightness parentsrsquo reflections on childrenrsquos responses to a hands-free walker for children Disability amp Society 28(3) 380-392
bull Law M Pollock N Russell D Walter S et al (2011) Focus on function a cluster randomised controlled trial comparing child-versus context-focused intervention for young children with cerebral palsy Dev Med Child Neurol 53 621-629
bull ldquoSensory Processing Developmental Chartrdquo Sensory Processing Developmental Chart Np nd Web 12 Oct 2015
bull Folio MR amp Fewell RR(2000) Peabody Developmental Motor Scales- Second edition Austin TX PRO ED
bull Voress Judith K amp Pearson Nils A (2013) Early Childhood Development Chart-Third edition Austin TX PRO ED
bull Paul Rhea (2007) Language Disorders from Infancy Through Adolescence Assessment amp Intervention Third edition St Louis MA Mosby Inc
bull Prosser L Ohlrich L Curatalo L Alter K amp Damiano D (2012) Feasibility and preliminary effectiveness of a novel mobility training intervention in infants and toddlers with cerebral palsy Developmental Neurorehabilitation 15(4) 259-266
References
Perlman Center
Parent Resource Binder
Educational Topics
Development
Nutrition
Diagnosis
Role of the Clinician
Multidisciplinary team
Muscle tone
Language development
Sensory Integration
Positioning
Sleep
Financial Resourceshelliphellip
Medical Management
Birth History
Medications
Medical Team
Insurance Information
Appointments
EquipmentVendor
Perlman Center
EMPOWER PARENTS
Perlman Center
We know that CP results in complex problems
How do we address multiple areas
Pain
Cognition
Mobility
Bone development
Language
Seizures
Behavior
Bowel and Bladder
Sleep
Vision
Nutrition
Hearing Novak April 2014
The Evaluation Process
Not just focusing on your clinical
area
You are not just
evaluating the infant
Perlman Center
Perlman Center
The Evaluation Process Holistic Picture
Ongoing Assessment of the Infant
Family-Centered Care
General Assessment
Perlman Center
Multidisciplinary Checklist Tools
Perlman Center
Perlman Multidisciplinary Checklist
Perlman Center
ParentChild Assessment of Routines
Perlman Center
Providing Therapy Services
Clinical
assessment Parents Goals
and Priorities
What are the therapy options to meet the above needs
Perlman Center
Bridging the gap between clinical
assessments and family need
bull Identify Limitations
bull Developmental Delays
bull Medical needs
Clinical Finding
bull Family Routines
bull Family Priorities
bull Overcome Barriers and Obstacles
Family Need
Perlman Center
10 minutes
Perlman Center
bull Considering severity and complexity of diagnosis delays
parentsrsquo level of education acceptance and understanding of
their childrsquos diagnosis
bull Frequency Does the childfamily need weekly treatment once
per month or a burst of therapy every couple of months
bull Most supportive environment group or individual home-based
or clinic-based
bull Referrals for specialized intervention (splinting constraint
therapy adaptive equipment oral-motorfeeding therapy vision
therapy Kinesiotherapy etc)
Develop a Therapy Plan
Perlman Center
Perlman Case Study Examples
Mild delays
Infant has risks for CP
Moderate Delays
Infant presents abnormal motor delays
Severe Delays
Infant presents with significant
neuro-motor impairments
Perlman Center M
ild d
ela
ys-a
t risk
bull Full term
bull Difficult delivery
bull Seizure after delivery
bull Abnormal MRI
bull Mom has degree in child development
Mod
era
te d
ela
ys
bull Full term
bull Seizure activity and HIE following birth
bull Abnormal movements of UELE
bull Abnormal MRI
bull Sensory issues
bull Feeding difficulty S
eve
re d
ela
ys
bull Preemie
bull Difficult pregnancy
bull Ruptured placenta
bull Seizures NICU
bull Tonic posturing
bull Feeding difficulty
bull Family lost another child
Case Studies Patient Medical History
Perlman Center M
ild d
ela
ys-A
t R
isk
bull MRI- basal ganglia
bull Clinic check-ups have been on track
bull Underlying weakness observed by PT
bull Slight catch in Right hamstring
bull 1x every 3-4 weeks
Modera
te d
ela
ys
bull Presents with tonal posturing
bull External support for positioning
bull Sensitive to vestibular movement
bull Home based EI OP equipment planning
bull Group tx
Severe
dela
ys
bull Severe posturing
bull FeedingGI issues
bull Mom needs lots of support
bull Positioning needs
bull Medical needs
bull 2x week group setting (OT PT SLP SW MDs feeding team)
Perlman Center
Build high value
interventions
Perlman Center
bull Therapy to support early parent-infant relationships
bull Build parent confidence
bull Education and training
bull Build opportunities for practice
bull Incorporate into daily routines
Engaging Parents
bull Adapt access to play play is FUN
bull Stimulate exploration inquiry and learning
bull Enrich for cognitive motor sensory and social development
Building Enriched
Environments
bull Goal-oriented intensive motor training (Morgan et al 2015)
bull Build in repetition
bull Scaffold so infant is able to complete at least part of the task
bull Experience-based activities will engage self-initiation of movement
bull Occurs while participating in daily routines (ie at the grocery)
Applying Early Motor Learning
Specific Strategies
Perlman Center
Engaging Parents Education
Topic Lists
Identify parent priorities and begin education based
on parentsrsquo perceived need
child diagnoses
parent support and resources
oral-motor and feeding
seating and positioning
disabilities across the lifespan
gross motor development
patient advocacy
adapted equipment fine motor development
home positioning techniques
financial resources
sensory integration
types of rehabilitation therapy
speech and language
Perlman Center
Engaging Parents Goal Setting
Perlman Center
Educate
Model
Engage
Observe
Connect
Perlman Center
Purposeful Play ishellip
Goal oriented
Activity based
Motivating
In an Enriched environment
Perlman Center
Perlman Center
cognitive
sensory
motor
social
Perlman Center
Building Enriched Environments
Perlman Center
Building Enriched Environments
bull Is the child positioned within
reach to explore the activity
bull Are all senses being utilized
bull Is the child being motivated to
move throughout the
environment
bull Is the environment adapted to
increase access to play
Perlman Center
Building Enriched Environments
bull Can the child have an effect
on the activity within the
environment
bull Is the activity appropriately
challenging the child within the
environment
bull Is the child presented with the
need for problem solving
Perlman Center
Building Enriched Environments
bull Is the child motivated to repeat
the task for motor learning
bull Does the environment support
learning (ie appropriate
noise level social motivators
peer groups developmental
learning supports visual
supports auditory feedback
etc)
Perlman Center
Bridging the gap between the clinic and the
home environment
bull Discipline focused
bull Clinic equipment closet
bull May have group option
Clinic
bull Incorporate into Family Routines
bull Functional activities
bull High Value
bull Adapted environment
Home
Mobility
Early Literacy
Sensory Motor Learning
Social Connections
Perlman Center
Early Learning
Functional MRIs show positive long-term neuro-
cognitive effects of reading to very young
infants
Sensory experiences shape a babyrsquos
knowledge about the world
The average toddler moves 8
out of 10 waking hoursday
Perlman Center
Learning through Experience
Adapting the environment with positioning equipment allows children with disabilities to experience their world and build relationships Allows the child to participate in typical experiences to foster learning
Activities need to promote active engagement
and allow a child to
ndash Actively explore move and participate in play
ndash Assist with self-help routines
ndash Interact and connect with family amp friends
ndash Participate in community activities
ndash Have a means to effectively communicate
ndash Make choices about their wants and need
Perlman Center
Perlman Center
bull Headpointing painting
bull Universal cuffs large pegs splints
bull Switch toys for art activitiesdramatic play-pourer
bull Switch computer access- helpkidzlearncom
bull Fischer Price game with keyboard binder switch
bull Walking in different textures while in standers and walkers
bull Cameramouseorg with dwell click
bull Partner assisted scanning
Alternative amp Adaptive Access to Play
Perlman Center
Change the environment Not the body Adaptations will be critical for success
Gross Motor Fine Motor
Social
Communication
Perlman Center Consider Communication Young children need a reliable form of communication as early as possible
Augmentative Communication is shown to support verbal skills and enhance lives of
birth to three children and their families (Romski et al 2015)
Perlman Center
Holistic approach to AAC intervention should
Build on individual strengths
Focus on participation in real-world contexts
Address psychosocial factors (ie motivation attitude confidence resilience)
Focus on environmental factors to reduce barriers and maximize social supports
In the absence of a holistic approach to communication a child is at risk for failing to engage in social contexts beyond their immediate family or educationalvocational personnel (Light and Mcnaughton 2015)
Augmentative amp Alternative Communication (AAC)
Perlman Center
Early Literacy
Perlman Center
Early Mobility
There is more than one way
Hands Free Matters
Perlman Center
Early Mobility
Should I get a gait trainer if
they are going to walk YES
Are they too young for power NO
Perlman Center
Sensory Motor Learning
Perlman Center
Sensory Motor Learning
Perlman Center
Social Connection
Perlman Center
Total Access to Play
Perlman Center
Perlman defines functional positioning bull Positioning which promotes active movement and participation and
provides an opportunity to positively impact cognitive function
bull Equipment should promote function and participation across the lifespan
Perlman Center
Principles of seating and positioning
bull Obtain a stable base of support
bull Decrease the influence of atypical muscle tone
bull Accommodate fixed deformities and correct flexible deformities
bull Provide the least amount of intervention needed to achieve the greatest level of function
bull There is no one solution or product but typically a combination of tools that provide success
Adapted from Radell (1997) and York and Weimann (1991)
Perlman Center
Key Positioning Components
bull Postural Control Strengthening
bull Range of Motion Weight Bearing
bull Home Activity Programs
Developmental Positioning
bull ADLs-Play Feeding Bathing Sleeping
bull Computer AccessAAC-Integrated Technology
bull Vision Sensory Processing Participation
Upright Positioning
bull EARLY MOBILITY- developmental sequence
bull Gait Trainer Stander amp or Wheelchair
bull Manual wheelchair vs Power Mobility- BOTH
bull Recreational
ldquoTotalrdquo Mobility
bull Body Mechanics Hoyer Lifts Overhead Systems
bull Car Seat ampor Tie Downs
bull Adapted VanRamps
Transfers ampTransportation
Perlman Center
Equipment Plan of Care
Birth to Three
Adapting baby
equipment
Floor Play
StanderWalker
Bath Seat
Car Seat
Braces
Seating for Function
Early ACCESS
Wheelchair
Bed Positioning
Bike amp Swing
Preschool
Stander
Walker
Braces
Bath Seat
Potty Seat
Wheelchair
HiLo seating
AACAccess
Adapted Bed
Car Seat
Transportation
RecreationHEP
School-Age
to Adult
Wheelchair
AACACCESS
Integrated AT
Hilo chair
Standerwalker
Bath chair
Potty chair
Adapted Bed
Car SeatVan
Home modslifts
LeisureWork
Perlman Center
Commercial Products strollers car seats cribs bath seats high chairs
playpen infant swings floor mats nursing pillow ExerSaucers
Perlman Center
Creative Commercial Adaptations
Pool noodles
Snug and Go
Crib Wedges
Bed tableart desk
Laundry baskets
Inflatable bathtub
Inflatable infant pools
Boxesstools
Perlman Center Creative Commercial Adaptations
Laundry basket $400
Pool Noodle x 2 $300
Floor sitterbath support $700
table (BLACK) $800
Garbage can $600
Large pool noodle $300
Stander with anterior support and
Visual adaptation $1700
Perlman Center
Complex Rehab Equipment
Standers
Gait trainers
Bath Support
Car seat
Seating
Feeding tools
AAC
Sensory tools
vibration
Compression garments
NUK brushes
Z Vibe
Modified utensils
Swings
Weight
Head phones
Positioning
Neck supports
Bracing
Bobby pillowU cushion
Benches
Fireflyfriendscom
PlayPaK
Upsee
Go To Seat
Early Literacy
Picture symbols
Voice output switches
Adapted books
Adapted Equipment
Perlman Center
You got this baby Nowhellip Questions
Perlman Center
LETrsquoS PLAY
Hands on Equipment Demonstration
Perlman Center
bull Ulrich B (2010) Opportunities for Early Intervention Based on Theory Basic Neuroscience and Clinical Science Physical Therapy 90(12) 1868-1880
bull McIntyre S Morgan C amp Walker K (2011) Cerebral Palsy Dont Delay Developmental Disabilities Research Reviews 17(2) 114-129
bull Novak I (2014) Evidence-Based Diagnosis Health Care and Rehabilitation for Children with Cerebral Palsy Journal of Child Neurology 29(8) 1141-1156
bull Morgan C Novak I amp Badawi N (2013) Enriched Environments and Motor Outcomes in Cerebral Palsy Systematic Review and Meta-analysis Pediatrics 132 (3)e 735 -e746
bull Morgan C Novak I Dale R Guzzetta A amp Badawi N (2014) GAME (Goals- Activity-Motor Enrichment) protocol of a single blind randomised controlled trial of motor training parent education and environmental enrichment for infants at high risk of cerebral palsy BMC Neurology 14(203)
bull Whittingham K Wee D amp Boyd R (2010) Systematic review of the efficacy of parenting interventions for children with cerebral palsy Child care health and development 37(4) 475-483
bull Morgan C Novak I dale R amp Badawi N (2015) Optimising motor learning in infants at high risk of cerebral palsy a pilot study BMC Pediatrics 15(1) n pag Web
bull Vos R Dallmeijer A Verhoef M et al (2014) Developmental trajectories of receptive and expressive communication in children and young adults with cerebral palsy Developmental Medicine amp Child Neurology 56 951-959
bull Light J and McNaughton D (2015) Designing AAC research and intervention to improve outcomes for individuals with complex communication needs Augmentative and Alternative Communication 31(2) 85-96
bull Romski M Sevcik R Barton-Hulsey A amp Whitmore A (2015) Early Intervention and AAC What a difference 30 years makes Augmentative and Alternative Communication 31 (3) 181-202
References
Perlman Center
bull Novak I Cusick A Lannin N (2009) Occupational therapy home programs for cerebral palsy Double-blind randomised controlled trial Pediatrics 124 e606-e614
bull Gericke T (2006) Postural management for children with cerebral palsy consensus statement Dev Med Child Neurol 48 (4) 244-244
bull McKeever P Rossen B Scott H Robinson-Vincent K amp Wright V (2013) The significance of uprightness parentsrsquo reflections on childrenrsquos responses to a hands-free walker for children Disability amp Society 28(3) 380-392
bull Law M Pollock N Russell D Walter S et al (2011) Focus on function a cluster randomised controlled trial comparing child-versus context-focused intervention for young children with cerebral palsy Dev Med Child Neurol 53 621-629
bull ldquoSensory Processing Developmental Chartrdquo Sensory Processing Developmental Chart Np nd Web 12 Oct 2015
bull Folio MR amp Fewell RR(2000) Peabody Developmental Motor Scales- Second edition Austin TX PRO ED
bull Voress Judith K amp Pearson Nils A (2013) Early Childhood Development Chart-Third edition Austin TX PRO ED
bull Paul Rhea (2007) Language Disorders from Infancy Through Adolescence Assessment amp Intervention Third edition St Louis MA Mosby Inc
bull Prosser L Ohlrich L Curatalo L Alter K amp Damiano D (2012) Feasibility and preliminary effectiveness of a novel mobility training intervention in infants and toddlers with cerebral palsy Developmental Neurorehabilitation 15(4) 259-266
References
Perlman Center
EMPOWER PARENTS
Perlman Center
We know that CP results in complex problems
How do we address multiple areas
Pain
Cognition
Mobility
Bone development
Language
Seizures
Behavior
Bowel and Bladder
Sleep
Vision
Nutrition
Hearing Novak April 2014
The Evaluation Process
Not just focusing on your clinical
area
You are not just
evaluating the infant
Perlman Center
Perlman Center
The Evaluation Process Holistic Picture
Ongoing Assessment of the Infant
Family-Centered Care
General Assessment
Perlman Center
Multidisciplinary Checklist Tools
Perlman Center
Perlman Multidisciplinary Checklist
Perlman Center
ParentChild Assessment of Routines
Perlman Center
Providing Therapy Services
Clinical
assessment Parents Goals
and Priorities
What are the therapy options to meet the above needs
Perlman Center
Bridging the gap between clinical
assessments and family need
bull Identify Limitations
bull Developmental Delays
bull Medical needs
Clinical Finding
bull Family Routines
bull Family Priorities
bull Overcome Barriers and Obstacles
Family Need
Perlman Center
10 minutes
Perlman Center
bull Considering severity and complexity of diagnosis delays
parentsrsquo level of education acceptance and understanding of
their childrsquos diagnosis
bull Frequency Does the childfamily need weekly treatment once
per month or a burst of therapy every couple of months
bull Most supportive environment group or individual home-based
or clinic-based
bull Referrals for specialized intervention (splinting constraint
therapy adaptive equipment oral-motorfeeding therapy vision
therapy Kinesiotherapy etc)
Develop a Therapy Plan
Perlman Center
Perlman Case Study Examples
Mild delays
Infant has risks for CP
Moderate Delays
Infant presents abnormal motor delays
Severe Delays
Infant presents with significant
neuro-motor impairments
Perlman Center M
ild d
ela
ys-a
t risk
bull Full term
bull Difficult delivery
bull Seizure after delivery
bull Abnormal MRI
bull Mom has degree in child development
Mod
era
te d
ela
ys
bull Full term
bull Seizure activity and HIE following birth
bull Abnormal movements of UELE
bull Abnormal MRI
bull Sensory issues
bull Feeding difficulty S
eve
re d
ela
ys
bull Preemie
bull Difficult pregnancy
bull Ruptured placenta
bull Seizures NICU
bull Tonic posturing
bull Feeding difficulty
bull Family lost another child
Case Studies Patient Medical History
Perlman Center M
ild d
ela
ys-A
t R
isk
bull MRI- basal ganglia
bull Clinic check-ups have been on track
bull Underlying weakness observed by PT
bull Slight catch in Right hamstring
bull 1x every 3-4 weeks
Modera
te d
ela
ys
bull Presents with tonal posturing
bull External support for positioning
bull Sensitive to vestibular movement
bull Home based EI OP equipment planning
bull Group tx
Severe
dela
ys
bull Severe posturing
bull FeedingGI issues
bull Mom needs lots of support
bull Positioning needs
bull Medical needs
bull 2x week group setting (OT PT SLP SW MDs feeding team)
Perlman Center
Build high value
interventions
Perlman Center
bull Therapy to support early parent-infant relationships
bull Build parent confidence
bull Education and training
bull Build opportunities for practice
bull Incorporate into daily routines
Engaging Parents
bull Adapt access to play play is FUN
bull Stimulate exploration inquiry and learning
bull Enrich for cognitive motor sensory and social development
Building Enriched
Environments
bull Goal-oriented intensive motor training (Morgan et al 2015)
bull Build in repetition
bull Scaffold so infant is able to complete at least part of the task
bull Experience-based activities will engage self-initiation of movement
bull Occurs while participating in daily routines (ie at the grocery)
Applying Early Motor Learning
Specific Strategies
Perlman Center
Engaging Parents Education
Topic Lists
Identify parent priorities and begin education based
on parentsrsquo perceived need
child diagnoses
parent support and resources
oral-motor and feeding
seating and positioning
disabilities across the lifespan
gross motor development
patient advocacy
adapted equipment fine motor development
home positioning techniques
financial resources
sensory integration
types of rehabilitation therapy
speech and language
Perlman Center
Engaging Parents Goal Setting
Perlman Center
Educate
Model
Engage
Observe
Connect
Perlman Center
Purposeful Play ishellip
Goal oriented
Activity based
Motivating
In an Enriched environment
Perlman Center
Perlman Center
cognitive
sensory
motor
social
Perlman Center
Building Enriched Environments
Perlman Center
Building Enriched Environments
bull Is the child positioned within
reach to explore the activity
bull Are all senses being utilized
bull Is the child being motivated to
move throughout the
environment
bull Is the environment adapted to
increase access to play
Perlman Center
Building Enriched Environments
bull Can the child have an effect
on the activity within the
environment
bull Is the activity appropriately
challenging the child within the
environment
bull Is the child presented with the
need for problem solving
Perlman Center
Building Enriched Environments
bull Is the child motivated to repeat
the task for motor learning
bull Does the environment support
learning (ie appropriate
noise level social motivators
peer groups developmental
learning supports visual
supports auditory feedback
etc)
Perlman Center
Bridging the gap between the clinic and the
home environment
bull Discipline focused
bull Clinic equipment closet
bull May have group option
Clinic
bull Incorporate into Family Routines
bull Functional activities
bull High Value
bull Adapted environment
Home
Mobility
Early Literacy
Sensory Motor Learning
Social Connections
Perlman Center
Early Learning
Functional MRIs show positive long-term neuro-
cognitive effects of reading to very young
infants
Sensory experiences shape a babyrsquos
knowledge about the world
The average toddler moves 8
out of 10 waking hoursday
Perlman Center
Learning through Experience
Adapting the environment with positioning equipment allows children with disabilities to experience their world and build relationships Allows the child to participate in typical experiences to foster learning
Activities need to promote active engagement
and allow a child to
ndash Actively explore move and participate in play
ndash Assist with self-help routines
ndash Interact and connect with family amp friends
ndash Participate in community activities
ndash Have a means to effectively communicate
ndash Make choices about their wants and need
Perlman Center
Perlman Center
bull Headpointing painting
bull Universal cuffs large pegs splints
bull Switch toys for art activitiesdramatic play-pourer
bull Switch computer access- helpkidzlearncom
bull Fischer Price game with keyboard binder switch
bull Walking in different textures while in standers and walkers
bull Cameramouseorg with dwell click
bull Partner assisted scanning
Alternative amp Adaptive Access to Play
Perlman Center
Change the environment Not the body Adaptations will be critical for success
Gross Motor Fine Motor
Social
Communication
Perlman Center Consider Communication Young children need a reliable form of communication as early as possible
Augmentative Communication is shown to support verbal skills and enhance lives of
birth to three children and their families (Romski et al 2015)
Perlman Center
Holistic approach to AAC intervention should
Build on individual strengths
Focus on participation in real-world contexts
Address psychosocial factors (ie motivation attitude confidence resilience)
Focus on environmental factors to reduce barriers and maximize social supports
In the absence of a holistic approach to communication a child is at risk for failing to engage in social contexts beyond their immediate family or educationalvocational personnel (Light and Mcnaughton 2015)
Augmentative amp Alternative Communication (AAC)
Perlman Center
Early Literacy
Perlman Center
Early Mobility
There is more than one way
Hands Free Matters
Perlman Center
Early Mobility
Should I get a gait trainer if
they are going to walk YES
Are they too young for power NO
Perlman Center
Sensory Motor Learning
Perlman Center
Sensory Motor Learning
Perlman Center
Social Connection
Perlman Center
Total Access to Play
Perlman Center
Perlman defines functional positioning bull Positioning which promotes active movement and participation and
provides an opportunity to positively impact cognitive function
bull Equipment should promote function and participation across the lifespan
Perlman Center
Principles of seating and positioning
bull Obtain a stable base of support
bull Decrease the influence of atypical muscle tone
bull Accommodate fixed deformities and correct flexible deformities
bull Provide the least amount of intervention needed to achieve the greatest level of function
bull There is no one solution or product but typically a combination of tools that provide success
Adapted from Radell (1997) and York and Weimann (1991)
Perlman Center
Key Positioning Components
bull Postural Control Strengthening
bull Range of Motion Weight Bearing
bull Home Activity Programs
Developmental Positioning
bull ADLs-Play Feeding Bathing Sleeping
bull Computer AccessAAC-Integrated Technology
bull Vision Sensory Processing Participation
Upright Positioning
bull EARLY MOBILITY- developmental sequence
bull Gait Trainer Stander amp or Wheelchair
bull Manual wheelchair vs Power Mobility- BOTH
bull Recreational
ldquoTotalrdquo Mobility
bull Body Mechanics Hoyer Lifts Overhead Systems
bull Car Seat ampor Tie Downs
bull Adapted VanRamps
Transfers ampTransportation
Perlman Center
Equipment Plan of Care
Birth to Three
Adapting baby
equipment
Floor Play
StanderWalker
Bath Seat
Car Seat
Braces
Seating for Function
Early ACCESS
Wheelchair
Bed Positioning
Bike amp Swing
Preschool
Stander
Walker
Braces
Bath Seat
Potty Seat
Wheelchair
HiLo seating
AACAccess
Adapted Bed
Car Seat
Transportation
RecreationHEP
School-Age
to Adult
Wheelchair
AACACCESS
Integrated AT
Hilo chair
Standerwalker
Bath chair
Potty chair
Adapted Bed
Car SeatVan
Home modslifts
LeisureWork
Perlman Center
Commercial Products strollers car seats cribs bath seats high chairs
playpen infant swings floor mats nursing pillow ExerSaucers
Perlman Center
Creative Commercial Adaptations
Pool noodles
Snug and Go
Crib Wedges
Bed tableart desk
Laundry baskets
Inflatable bathtub
Inflatable infant pools
Boxesstools
Perlman Center Creative Commercial Adaptations
Laundry basket $400
Pool Noodle x 2 $300
Floor sitterbath support $700
table (BLACK) $800
Garbage can $600
Large pool noodle $300
Stander with anterior support and
Visual adaptation $1700
Perlman Center
Complex Rehab Equipment
Standers
Gait trainers
Bath Support
Car seat
Seating
Feeding tools
AAC
Sensory tools
vibration
Compression garments
NUK brushes
Z Vibe
Modified utensils
Swings
Weight
Head phones
Positioning
Neck supports
Bracing
Bobby pillowU cushion
Benches
Fireflyfriendscom
PlayPaK
Upsee
Go To Seat
Early Literacy
Picture symbols
Voice output switches
Adapted books
Adapted Equipment
Perlman Center
You got this baby Nowhellip Questions
Perlman Center
LETrsquoS PLAY
Hands on Equipment Demonstration
Perlman Center
bull Ulrich B (2010) Opportunities for Early Intervention Based on Theory Basic Neuroscience and Clinical Science Physical Therapy 90(12) 1868-1880
bull McIntyre S Morgan C amp Walker K (2011) Cerebral Palsy Dont Delay Developmental Disabilities Research Reviews 17(2) 114-129
bull Novak I (2014) Evidence-Based Diagnosis Health Care and Rehabilitation for Children with Cerebral Palsy Journal of Child Neurology 29(8) 1141-1156
bull Morgan C Novak I amp Badawi N (2013) Enriched Environments and Motor Outcomes in Cerebral Palsy Systematic Review and Meta-analysis Pediatrics 132 (3)e 735 -e746
bull Morgan C Novak I Dale R Guzzetta A amp Badawi N (2014) GAME (Goals- Activity-Motor Enrichment) protocol of a single blind randomised controlled trial of motor training parent education and environmental enrichment for infants at high risk of cerebral palsy BMC Neurology 14(203)
bull Whittingham K Wee D amp Boyd R (2010) Systematic review of the efficacy of parenting interventions for children with cerebral palsy Child care health and development 37(4) 475-483
bull Morgan C Novak I dale R amp Badawi N (2015) Optimising motor learning in infants at high risk of cerebral palsy a pilot study BMC Pediatrics 15(1) n pag Web
bull Vos R Dallmeijer A Verhoef M et al (2014) Developmental trajectories of receptive and expressive communication in children and young adults with cerebral palsy Developmental Medicine amp Child Neurology 56 951-959
bull Light J and McNaughton D (2015) Designing AAC research and intervention to improve outcomes for individuals with complex communication needs Augmentative and Alternative Communication 31(2) 85-96
bull Romski M Sevcik R Barton-Hulsey A amp Whitmore A (2015) Early Intervention and AAC What a difference 30 years makes Augmentative and Alternative Communication 31 (3) 181-202
References
Perlman Center
bull Novak I Cusick A Lannin N (2009) Occupational therapy home programs for cerebral palsy Double-blind randomised controlled trial Pediatrics 124 e606-e614
bull Gericke T (2006) Postural management for children with cerebral palsy consensus statement Dev Med Child Neurol 48 (4) 244-244
bull McKeever P Rossen B Scott H Robinson-Vincent K amp Wright V (2013) The significance of uprightness parentsrsquo reflections on childrenrsquos responses to a hands-free walker for children Disability amp Society 28(3) 380-392
bull Law M Pollock N Russell D Walter S et al (2011) Focus on function a cluster randomised controlled trial comparing child-versus context-focused intervention for young children with cerebral palsy Dev Med Child Neurol 53 621-629
bull ldquoSensory Processing Developmental Chartrdquo Sensory Processing Developmental Chart Np nd Web 12 Oct 2015
bull Folio MR amp Fewell RR(2000) Peabody Developmental Motor Scales- Second edition Austin TX PRO ED
bull Voress Judith K amp Pearson Nils A (2013) Early Childhood Development Chart-Third edition Austin TX PRO ED
bull Paul Rhea (2007) Language Disorders from Infancy Through Adolescence Assessment amp Intervention Third edition St Louis MA Mosby Inc
bull Prosser L Ohlrich L Curatalo L Alter K amp Damiano D (2012) Feasibility and preliminary effectiveness of a novel mobility training intervention in infants and toddlers with cerebral palsy Developmental Neurorehabilitation 15(4) 259-266
References
Perlman Center
We know that CP results in complex problems
How do we address multiple areas
Pain
Cognition
Mobility
Bone development
Language
Seizures
Behavior
Bowel and Bladder
Sleep
Vision
Nutrition
Hearing Novak April 2014
The Evaluation Process
Not just focusing on your clinical
area
You are not just
evaluating the infant
Perlman Center
Perlman Center
The Evaluation Process Holistic Picture
Ongoing Assessment of the Infant
Family-Centered Care
General Assessment
Perlman Center
Multidisciplinary Checklist Tools
Perlman Center
Perlman Multidisciplinary Checklist
Perlman Center
ParentChild Assessment of Routines
Perlman Center
Providing Therapy Services
Clinical
assessment Parents Goals
and Priorities
What are the therapy options to meet the above needs
Perlman Center
Bridging the gap between clinical
assessments and family need
bull Identify Limitations
bull Developmental Delays
bull Medical needs
Clinical Finding
bull Family Routines
bull Family Priorities
bull Overcome Barriers and Obstacles
Family Need
Perlman Center
10 minutes
Perlman Center
bull Considering severity and complexity of diagnosis delays
parentsrsquo level of education acceptance and understanding of
their childrsquos diagnosis
bull Frequency Does the childfamily need weekly treatment once
per month or a burst of therapy every couple of months
bull Most supportive environment group or individual home-based
or clinic-based
bull Referrals for specialized intervention (splinting constraint
therapy adaptive equipment oral-motorfeeding therapy vision
therapy Kinesiotherapy etc)
Develop a Therapy Plan
Perlman Center
Perlman Case Study Examples
Mild delays
Infant has risks for CP
Moderate Delays
Infant presents abnormal motor delays
Severe Delays
Infant presents with significant
neuro-motor impairments
Perlman Center M
ild d
ela
ys-a
t risk
bull Full term
bull Difficult delivery
bull Seizure after delivery
bull Abnormal MRI
bull Mom has degree in child development
Mod
era
te d
ela
ys
bull Full term
bull Seizure activity and HIE following birth
bull Abnormal movements of UELE
bull Abnormal MRI
bull Sensory issues
bull Feeding difficulty S
eve
re d
ela
ys
bull Preemie
bull Difficult pregnancy
bull Ruptured placenta
bull Seizures NICU
bull Tonic posturing
bull Feeding difficulty
bull Family lost another child
Case Studies Patient Medical History
Perlman Center M
ild d
ela
ys-A
t R
isk
bull MRI- basal ganglia
bull Clinic check-ups have been on track
bull Underlying weakness observed by PT
bull Slight catch in Right hamstring
bull 1x every 3-4 weeks
Modera
te d
ela
ys
bull Presents with tonal posturing
bull External support for positioning
bull Sensitive to vestibular movement
bull Home based EI OP equipment planning
bull Group tx
Severe
dela
ys
bull Severe posturing
bull FeedingGI issues
bull Mom needs lots of support
bull Positioning needs
bull Medical needs
bull 2x week group setting (OT PT SLP SW MDs feeding team)
Perlman Center
Build high value
interventions
Perlman Center
bull Therapy to support early parent-infant relationships
bull Build parent confidence
bull Education and training
bull Build opportunities for practice
bull Incorporate into daily routines
Engaging Parents
bull Adapt access to play play is FUN
bull Stimulate exploration inquiry and learning
bull Enrich for cognitive motor sensory and social development
Building Enriched
Environments
bull Goal-oriented intensive motor training (Morgan et al 2015)
bull Build in repetition
bull Scaffold so infant is able to complete at least part of the task
bull Experience-based activities will engage self-initiation of movement
bull Occurs while participating in daily routines (ie at the grocery)
Applying Early Motor Learning
Specific Strategies
Perlman Center
Engaging Parents Education
Topic Lists
Identify parent priorities and begin education based
on parentsrsquo perceived need
child diagnoses
parent support and resources
oral-motor and feeding
seating and positioning
disabilities across the lifespan
gross motor development
patient advocacy
adapted equipment fine motor development
home positioning techniques
financial resources
sensory integration
types of rehabilitation therapy
speech and language
Perlman Center
Engaging Parents Goal Setting
Perlman Center
Educate
Model
Engage
Observe
Connect
Perlman Center
Purposeful Play ishellip
Goal oriented
Activity based
Motivating
In an Enriched environment
Perlman Center
Perlman Center
cognitive
sensory
motor
social
Perlman Center
Building Enriched Environments
Perlman Center
Building Enriched Environments
bull Is the child positioned within
reach to explore the activity
bull Are all senses being utilized
bull Is the child being motivated to
move throughout the
environment
bull Is the environment adapted to
increase access to play
Perlman Center
Building Enriched Environments
bull Can the child have an effect
on the activity within the
environment
bull Is the activity appropriately
challenging the child within the
environment
bull Is the child presented with the
need for problem solving
Perlman Center
Building Enriched Environments
bull Is the child motivated to repeat
the task for motor learning
bull Does the environment support
learning (ie appropriate
noise level social motivators
peer groups developmental
learning supports visual
supports auditory feedback
etc)
Perlman Center
Bridging the gap between the clinic and the
home environment
bull Discipline focused
bull Clinic equipment closet
bull May have group option
Clinic
bull Incorporate into Family Routines
bull Functional activities
bull High Value
bull Adapted environment
Home
Mobility
Early Literacy
Sensory Motor Learning
Social Connections
Perlman Center
Early Learning
Functional MRIs show positive long-term neuro-
cognitive effects of reading to very young
infants
Sensory experiences shape a babyrsquos
knowledge about the world
The average toddler moves 8
out of 10 waking hoursday
Perlman Center
Learning through Experience
Adapting the environment with positioning equipment allows children with disabilities to experience their world and build relationships Allows the child to participate in typical experiences to foster learning
Activities need to promote active engagement
and allow a child to
ndash Actively explore move and participate in play
ndash Assist with self-help routines
ndash Interact and connect with family amp friends
ndash Participate in community activities
ndash Have a means to effectively communicate
ndash Make choices about their wants and need
Perlman Center
Perlman Center
bull Headpointing painting
bull Universal cuffs large pegs splints
bull Switch toys for art activitiesdramatic play-pourer
bull Switch computer access- helpkidzlearncom
bull Fischer Price game with keyboard binder switch
bull Walking in different textures while in standers and walkers
bull Cameramouseorg with dwell click
bull Partner assisted scanning
Alternative amp Adaptive Access to Play
Perlman Center
Change the environment Not the body Adaptations will be critical for success
Gross Motor Fine Motor
Social
Communication
Perlman Center Consider Communication Young children need a reliable form of communication as early as possible
Augmentative Communication is shown to support verbal skills and enhance lives of
birth to three children and their families (Romski et al 2015)
Perlman Center
Holistic approach to AAC intervention should
Build on individual strengths
Focus on participation in real-world contexts
Address psychosocial factors (ie motivation attitude confidence resilience)
Focus on environmental factors to reduce barriers and maximize social supports
In the absence of a holistic approach to communication a child is at risk for failing to engage in social contexts beyond their immediate family or educationalvocational personnel (Light and Mcnaughton 2015)
Augmentative amp Alternative Communication (AAC)
Perlman Center
Early Literacy
Perlman Center
Early Mobility
There is more than one way
Hands Free Matters
Perlman Center
Early Mobility
Should I get a gait trainer if
they are going to walk YES
Are they too young for power NO
Perlman Center
Sensory Motor Learning
Perlman Center
Sensory Motor Learning
Perlman Center
Social Connection
Perlman Center
Total Access to Play
Perlman Center
Perlman defines functional positioning bull Positioning which promotes active movement and participation and
provides an opportunity to positively impact cognitive function
bull Equipment should promote function and participation across the lifespan
Perlman Center
Principles of seating and positioning
bull Obtain a stable base of support
bull Decrease the influence of atypical muscle tone
bull Accommodate fixed deformities and correct flexible deformities
bull Provide the least amount of intervention needed to achieve the greatest level of function
bull There is no one solution or product but typically a combination of tools that provide success
Adapted from Radell (1997) and York and Weimann (1991)
Perlman Center
Key Positioning Components
bull Postural Control Strengthening
bull Range of Motion Weight Bearing
bull Home Activity Programs
Developmental Positioning
bull ADLs-Play Feeding Bathing Sleeping
bull Computer AccessAAC-Integrated Technology
bull Vision Sensory Processing Participation
Upright Positioning
bull EARLY MOBILITY- developmental sequence
bull Gait Trainer Stander amp or Wheelchair
bull Manual wheelchair vs Power Mobility- BOTH
bull Recreational
ldquoTotalrdquo Mobility
bull Body Mechanics Hoyer Lifts Overhead Systems
bull Car Seat ampor Tie Downs
bull Adapted VanRamps
Transfers ampTransportation
Perlman Center
Equipment Plan of Care
Birth to Three
Adapting baby
equipment
Floor Play
StanderWalker
Bath Seat
Car Seat
Braces
Seating for Function
Early ACCESS
Wheelchair
Bed Positioning
Bike amp Swing
Preschool
Stander
Walker
Braces
Bath Seat
Potty Seat
Wheelchair
HiLo seating
AACAccess
Adapted Bed
Car Seat
Transportation
RecreationHEP
School-Age
to Adult
Wheelchair
AACACCESS
Integrated AT
Hilo chair
Standerwalker
Bath chair
Potty chair
Adapted Bed
Car SeatVan
Home modslifts
LeisureWork
Perlman Center
Commercial Products strollers car seats cribs bath seats high chairs
playpen infant swings floor mats nursing pillow ExerSaucers
Perlman Center
Creative Commercial Adaptations
Pool noodles
Snug and Go
Crib Wedges
Bed tableart desk
Laundry baskets
Inflatable bathtub
Inflatable infant pools
Boxesstools
Perlman Center Creative Commercial Adaptations
Laundry basket $400
Pool Noodle x 2 $300
Floor sitterbath support $700
table (BLACK) $800
Garbage can $600
Large pool noodle $300
Stander with anterior support and
Visual adaptation $1700
Perlman Center
Complex Rehab Equipment
Standers
Gait trainers
Bath Support
Car seat
Seating
Feeding tools
AAC
Sensory tools
vibration
Compression garments
NUK brushes
Z Vibe
Modified utensils
Swings
Weight
Head phones
Positioning
Neck supports
Bracing
Bobby pillowU cushion
Benches
Fireflyfriendscom
PlayPaK
Upsee
Go To Seat
Early Literacy
Picture symbols
Voice output switches
Adapted books
Adapted Equipment
Perlman Center
You got this baby Nowhellip Questions
Perlman Center
LETrsquoS PLAY
Hands on Equipment Demonstration
Perlman Center
bull Ulrich B (2010) Opportunities for Early Intervention Based on Theory Basic Neuroscience and Clinical Science Physical Therapy 90(12) 1868-1880
bull McIntyre S Morgan C amp Walker K (2011) Cerebral Palsy Dont Delay Developmental Disabilities Research Reviews 17(2) 114-129
bull Novak I (2014) Evidence-Based Diagnosis Health Care and Rehabilitation for Children with Cerebral Palsy Journal of Child Neurology 29(8) 1141-1156
bull Morgan C Novak I amp Badawi N (2013) Enriched Environments and Motor Outcomes in Cerebral Palsy Systematic Review and Meta-analysis Pediatrics 132 (3)e 735 -e746
bull Morgan C Novak I Dale R Guzzetta A amp Badawi N (2014) GAME (Goals- Activity-Motor Enrichment) protocol of a single blind randomised controlled trial of motor training parent education and environmental enrichment for infants at high risk of cerebral palsy BMC Neurology 14(203)
bull Whittingham K Wee D amp Boyd R (2010) Systematic review of the efficacy of parenting interventions for children with cerebral palsy Child care health and development 37(4) 475-483
bull Morgan C Novak I dale R amp Badawi N (2015) Optimising motor learning in infants at high risk of cerebral palsy a pilot study BMC Pediatrics 15(1) n pag Web
bull Vos R Dallmeijer A Verhoef M et al (2014) Developmental trajectories of receptive and expressive communication in children and young adults with cerebral palsy Developmental Medicine amp Child Neurology 56 951-959
bull Light J and McNaughton D (2015) Designing AAC research and intervention to improve outcomes for individuals with complex communication needs Augmentative and Alternative Communication 31(2) 85-96
bull Romski M Sevcik R Barton-Hulsey A amp Whitmore A (2015) Early Intervention and AAC What a difference 30 years makes Augmentative and Alternative Communication 31 (3) 181-202
References
Perlman Center
bull Novak I Cusick A Lannin N (2009) Occupational therapy home programs for cerebral palsy Double-blind randomised controlled trial Pediatrics 124 e606-e614
bull Gericke T (2006) Postural management for children with cerebral palsy consensus statement Dev Med Child Neurol 48 (4) 244-244
bull McKeever P Rossen B Scott H Robinson-Vincent K amp Wright V (2013) The significance of uprightness parentsrsquo reflections on childrenrsquos responses to a hands-free walker for children Disability amp Society 28(3) 380-392
bull Law M Pollock N Russell D Walter S et al (2011) Focus on function a cluster randomised controlled trial comparing child-versus context-focused intervention for young children with cerebral palsy Dev Med Child Neurol 53 621-629
bull ldquoSensory Processing Developmental Chartrdquo Sensory Processing Developmental Chart Np nd Web 12 Oct 2015
bull Folio MR amp Fewell RR(2000) Peabody Developmental Motor Scales- Second edition Austin TX PRO ED
bull Voress Judith K amp Pearson Nils A (2013) Early Childhood Development Chart-Third edition Austin TX PRO ED
bull Paul Rhea (2007) Language Disorders from Infancy Through Adolescence Assessment amp Intervention Third edition St Louis MA Mosby Inc
bull Prosser L Ohlrich L Curatalo L Alter K amp Damiano D (2012) Feasibility and preliminary effectiveness of a novel mobility training intervention in infants and toddlers with cerebral palsy Developmental Neurorehabilitation 15(4) 259-266
References
The Evaluation Process
Not just focusing on your clinical
area
You are not just
evaluating the infant
Perlman Center
Perlman Center
The Evaluation Process Holistic Picture
Ongoing Assessment of the Infant
Family-Centered Care
General Assessment
Perlman Center
Multidisciplinary Checklist Tools
Perlman Center
Perlman Multidisciplinary Checklist
Perlman Center
ParentChild Assessment of Routines
Perlman Center
Providing Therapy Services
Clinical
assessment Parents Goals
and Priorities
What are the therapy options to meet the above needs
Perlman Center
Bridging the gap between clinical
assessments and family need
bull Identify Limitations
bull Developmental Delays
bull Medical needs
Clinical Finding
bull Family Routines
bull Family Priorities
bull Overcome Barriers and Obstacles
Family Need
Perlman Center
10 minutes
Perlman Center
bull Considering severity and complexity of diagnosis delays
parentsrsquo level of education acceptance and understanding of
their childrsquos diagnosis
bull Frequency Does the childfamily need weekly treatment once
per month or a burst of therapy every couple of months
bull Most supportive environment group or individual home-based
or clinic-based
bull Referrals for specialized intervention (splinting constraint
therapy adaptive equipment oral-motorfeeding therapy vision
therapy Kinesiotherapy etc)
Develop a Therapy Plan
Perlman Center
Perlman Case Study Examples
Mild delays
Infant has risks for CP
Moderate Delays
Infant presents abnormal motor delays
Severe Delays
Infant presents with significant
neuro-motor impairments
Perlman Center M
ild d
ela
ys-a
t risk
bull Full term
bull Difficult delivery
bull Seizure after delivery
bull Abnormal MRI
bull Mom has degree in child development
Mod
era
te d
ela
ys
bull Full term
bull Seizure activity and HIE following birth
bull Abnormal movements of UELE
bull Abnormal MRI
bull Sensory issues
bull Feeding difficulty S
eve
re d
ela
ys
bull Preemie
bull Difficult pregnancy
bull Ruptured placenta
bull Seizures NICU
bull Tonic posturing
bull Feeding difficulty
bull Family lost another child
Case Studies Patient Medical History
Perlman Center M
ild d
ela
ys-A
t R
isk
bull MRI- basal ganglia
bull Clinic check-ups have been on track
bull Underlying weakness observed by PT
bull Slight catch in Right hamstring
bull 1x every 3-4 weeks
Modera
te d
ela
ys
bull Presents with tonal posturing
bull External support for positioning
bull Sensitive to vestibular movement
bull Home based EI OP equipment planning
bull Group tx
Severe
dela
ys
bull Severe posturing
bull FeedingGI issues
bull Mom needs lots of support
bull Positioning needs
bull Medical needs
bull 2x week group setting (OT PT SLP SW MDs feeding team)
Perlman Center
Build high value
interventions
Perlman Center
bull Therapy to support early parent-infant relationships
bull Build parent confidence
bull Education and training
bull Build opportunities for practice
bull Incorporate into daily routines
Engaging Parents
bull Adapt access to play play is FUN
bull Stimulate exploration inquiry and learning
bull Enrich for cognitive motor sensory and social development
Building Enriched
Environments
bull Goal-oriented intensive motor training (Morgan et al 2015)
bull Build in repetition
bull Scaffold so infant is able to complete at least part of the task
bull Experience-based activities will engage self-initiation of movement
bull Occurs while participating in daily routines (ie at the grocery)
Applying Early Motor Learning
Specific Strategies
Perlman Center
Engaging Parents Education
Topic Lists
Identify parent priorities and begin education based
on parentsrsquo perceived need
child diagnoses
parent support and resources
oral-motor and feeding
seating and positioning
disabilities across the lifespan
gross motor development
patient advocacy
adapted equipment fine motor development
home positioning techniques
financial resources
sensory integration
types of rehabilitation therapy
speech and language
Perlman Center
Engaging Parents Goal Setting
Perlman Center
Educate
Model
Engage
Observe
Connect
Perlman Center
Purposeful Play ishellip
Goal oriented
Activity based
Motivating
In an Enriched environment
Perlman Center
Perlman Center
cognitive
sensory
motor
social
Perlman Center
Building Enriched Environments
Perlman Center
Building Enriched Environments
bull Is the child positioned within
reach to explore the activity
bull Are all senses being utilized
bull Is the child being motivated to
move throughout the
environment
bull Is the environment adapted to
increase access to play
Perlman Center
Building Enriched Environments
bull Can the child have an effect
on the activity within the
environment
bull Is the activity appropriately
challenging the child within the
environment
bull Is the child presented with the
need for problem solving
Perlman Center
Building Enriched Environments
bull Is the child motivated to repeat
the task for motor learning
bull Does the environment support
learning (ie appropriate
noise level social motivators
peer groups developmental
learning supports visual
supports auditory feedback
etc)
Perlman Center
Bridging the gap between the clinic and the
home environment
bull Discipline focused
bull Clinic equipment closet
bull May have group option
Clinic
bull Incorporate into Family Routines
bull Functional activities
bull High Value
bull Adapted environment
Home
Mobility
Early Literacy
Sensory Motor Learning
Social Connections
Perlman Center
Early Learning
Functional MRIs show positive long-term neuro-
cognitive effects of reading to very young
infants
Sensory experiences shape a babyrsquos
knowledge about the world
The average toddler moves 8
out of 10 waking hoursday
Perlman Center
Learning through Experience
Adapting the environment with positioning equipment allows children with disabilities to experience their world and build relationships Allows the child to participate in typical experiences to foster learning
Activities need to promote active engagement
and allow a child to
ndash Actively explore move and participate in play
ndash Assist with self-help routines
ndash Interact and connect with family amp friends
ndash Participate in community activities
ndash Have a means to effectively communicate
ndash Make choices about their wants and need
Perlman Center
Perlman Center
bull Headpointing painting
bull Universal cuffs large pegs splints
bull Switch toys for art activitiesdramatic play-pourer
bull Switch computer access- helpkidzlearncom
bull Fischer Price game with keyboard binder switch
bull Walking in different textures while in standers and walkers
bull Cameramouseorg with dwell click
bull Partner assisted scanning
Alternative amp Adaptive Access to Play
Perlman Center
Change the environment Not the body Adaptations will be critical for success
Gross Motor Fine Motor
Social
Communication
Perlman Center Consider Communication Young children need a reliable form of communication as early as possible
Augmentative Communication is shown to support verbal skills and enhance lives of
birth to three children and their families (Romski et al 2015)
Perlman Center
Holistic approach to AAC intervention should
Build on individual strengths
Focus on participation in real-world contexts
Address psychosocial factors (ie motivation attitude confidence resilience)
Focus on environmental factors to reduce barriers and maximize social supports
In the absence of a holistic approach to communication a child is at risk for failing to engage in social contexts beyond their immediate family or educationalvocational personnel (Light and Mcnaughton 2015)
Augmentative amp Alternative Communication (AAC)
Perlman Center
Early Literacy
Perlman Center
Early Mobility
There is more than one way
Hands Free Matters
Perlman Center
Early Mobility
Should I get a gait trainer if
they are going to walk YES
Are they too young for power NO
Perlman Center
Sensory Motor Learning
Perlman Center
Sensory Motor Learning
Perlman Center
Social Connection
Perlman Center
Total Access to Play
Perlman Center
Perlman defines functional positioning bull Positioning which promotes active movement and participation and
provides an opportunity to positively impact cognitive function
bull Equipment should promote function and participation across the lifespan
Perlman Center
Principles of seating and positioning
bull Obtain a stable base of support
bull Decrease the influence of atypical muscle tone
bull Accommodate fixed deformities and correct flexible deformities
bull Provide the least amount of intervention needed to achieve the greatest level of function
bull There is no one solution or product but typically a combination of tools that provide success
Adapted from Radell (1997) and York and Weimann (1991)
Perlman Center
Key Positioning Components
bull Postural Control Strengthening
bull Range of Motion Weight Bearing
bull Home Activity Programs
Developmental Positioning
bull ADLs-Play Feeding Bathing Sleeping
bull Computer AccessAAC-Integrated Technology
bull Vision Sensory Processing Participation
Upright Positioning
bull EARLY MOBILITY- developmental sequence
bull Gait Trainer Stander amp or Wheelchair
bull Manual wheelchair vs Power Mobility- BOTH
bull Recreational
ldquoTotalrdquo Mobility
bull Body Mechanics Hoyer Lifts Overhead Systems
bull Car Seat ampor Tie Downs
bull Adapted VanRamps
Transfers ampTransportation
Perlman Center
Equipment Plan of Care
Birth to Three
Adapting baby
equipment
Floor Play
StanderWalker
Bath Seat
Car Seat
Braces
Seating for Function
Early ACCESS
Wheelchair
Bed Positioning
Bike amp Swing
Preschool
Stander
Walker
Braces
Bath Seat
Potty Seat
Wheelchair
HiLo seating
AACAccess
Adapted Bed
Car Seat
Transportation
RecreationHEP
School-Age
to Adult
Wheelchair
AACACCESS
Integrated AT
Hilo chair
Standerwalker
Bath chair
Potty chair
Adapted Bed
Car SeatVan
Home modslifts
LeisureWork
Perlman Center
Commercial Products strollers car seats cribs bath seats high chairs
playpen infant swings floor mats nursing pillow ExerSaucers
Perlman Center
Creative Commercial Adaptations
Pool noodles
Snug and Go
Crib Wedges
Bed tableart desk
Laundry baskets
Inflatable bathtub
Inflatable infant pools
Boxesstools
Perlman Center Creative Commercial Adaptations
Laundry basket $400
Pool Noodle x 2 $300
Floor sitterbath support $700
table (BLACK) $800
Garbage can $600
Large pool noodle $300
Stander with anterior support and
Visual adaptation $1700
Perlman Center
Complex Rehab Equipment
Standers
Gait trainers
Bath Support
Car seat
Seating
Feeding tools
AAC
Sensory tools
vibration
Compression garments
NUK brushes
Z Vibe
Modified utensils
Swings
Weight
Head phones
Positioning
Neck supports
Bracing
Bobby pillowU cushion
Benches
Fireflyfriendscom
PlayPaK
Upsee
Go To Seat
Early Literacy
Picture symbols
Voice output switches
Adapted books
Adapted Equipment
Perlman Center
You got this baby Nowhellip Questions
Perlman Center
LETrsquoS PLAY
Hands on Equipment Demonstration
Perlman Center
bull Ulrich B (2010) Opportunities for Early Intervention Based on Theory Basic Neuroscience and Clinical Science Physical Therapy 90(12) 1868-1880
bull McIntyre S Morgan C amp Walker K (2011) Cerebral Palsy Dont Delay Developmental Disabilities Research Reviews 17(2) 114-129
bull Novak I (2014) Evidence-Based Diagnosis Health Care and Rehabilitation for Children with Cerebral Palsy Journal of Child Neurology 29(8) 1141-1156
bull Morgan C Novak I amp Badawi N (2013) Enriched Environments and Motor Outcomes in Cerebral Palsy Systematic Review and Meta-analysis Pediatrics 132 (3)e 735 -e746
bull Morgan C Novak I Dale R Guzzetta A amp Badawi N (2014) GAME (Goals- Activity-Motor Enrichment) protocol of a single blind randomised controlled trial of motor training parent education and environmental enrichment for infants at high risk of cerebral palsy BMC Neurology 14(203)
bull Whittingham K Wee D amp Boyd R (2010) Systematic review of the efficacy of parenting interventions for children with cerebral palsy Child care health and development 37(4) 475-483
bull Morgan C Novak I dale R amp Badawi N (2015) Optimising motor learning in infants at high risk of cerebral palsy a pilot study BMC Pediatrics 15(1) n pag Web
bull Vos R Dallmeijer A Verhoef M et al (2014) Developmental trajectories of receptive and expressive communication in children and young adults with cerebral palsy Developmental Medicine amp Child Neurology 56 951-959
bull Light J and McNaughton D (2015) Designing AAC research and intervention to improve outcomes for individuals with complex communication needs Augmentative and Alternative Communication 31(2) 85-96
bull Romski M Sevcik R Barton-Hulsey A amp Whitmore A (2015) Early Intervention and AAC What a difference 30 years makes Augmentative and Alternative Communication 31 (3) 181-202
References
Perlman Center
bull Novak I Cusick A Lannin N (2009) Occupational therapy home programs for cerebral palsy Double-blind randomised controlled trial Pediatrics 124 e606-e614
bull Gericke T (2006) Postural management for children with cerebral palsy consensus statement Dev Med Child Neurol 48 (4) 244-244
bull McKeever P Rossen B Scott H Robinson-Vincent K amp Wright V (2013) The significance of uprightness parentsrsquo reflections on childrenrsquos responses to a hands-free walker for children Disability amp Society 28(3) 380-392
bull Law M Pollock N Russell D Walter S et al (2011) Focus on function a cluster randomised controlled trial comparing child-versus context-focused intervention for young children with cerebral palsy Dev Med Child Neurol 53 621-629
bull ldquoSensory Processing Developmental Chartrdquo Sensory Processing Developmental Chart Np nd Web 12 Oct 2015
bull Folio MR amp Fewell RR(2000) Peabody Developmental Motor Scales- Second edition Austin TX PRO ED
bull Voress Judith K amp Pearson Nils A (2013) Early Childhood Development Chart-Third edition Austin TX PRO ED
bull Paul Rhea (2007) Language Disorders from Infancy Through Adolescence Assessment amp Intervention Third edition St Louis MA Mosby Inc
bull Prosser L Ohlrich L Curatalo L Alter K amp Damiano D (2012) Feasibility and preliminary effectiveness of a novel mobility training intervention in infants and toddlers with cerebral palsy Developmental Neurorehabilitation 15(4) 259-266
References
Perlman Center
The Evaluation Process Holistic Picture
Ongoing Assessment of the Infant
Family-Centered Care
General Assessment
Perlman Center
Multidisciplinary Checklist Tools
Perlman Center
Perlman Multidisciplinary Checklist
Perlman Center
ParentChild Assessment of Routines
Perlman Center
Providing Therapy Services
Clinical
assessment Parents Goals
and Priorities
What are the therapy options to meet the above needs
Perlman Center
Bridging the gap between clinical
assessments and family need
bull Identify Limitations
bull Developmental Delays
bull Medical needs
Clinical Finding
bull Family Routines
bull Family Priorities
bull Overcome Barriers and Obstacles
Family Need
Perlman Center
10 minutes
Perlman Center
bull Considering severity and complexity of diagnosis delays
parentsrsquo level of education acceptance and understanding of
their childrsquos diagnosis
bull Frequency Does the childfamily need weekly treatment once
per month or a burst of therapy every couple of months
bull Most supportive environment group or individual home-based
or clinic-based
bull Referrals for specialized intervention (splinting constraint
therapy adaptive equipment oral-motorfeeding therapy vision
therapy Kinesiotherapy etc)
Develop a Therapy Plan
Perlman Center
Perlman Case Study Examples
Mild delays
Infant has risks for CP
Moderate Delays
Infant presents abnormal motor delays
Severe Delays
Infant presents with significant
neuro-motor impairments
Perlman Center M
ild d
ela
ys-a
t risk
bull Full term
bull Difficult delivery
bull Seizure after delivery
bull Abnormal MRI
bull Mom has degree in child development
Mod
era
te d
ela
ys
bull Full term
bull Seizure activity and HIE following birth
bull Abnormal movements of UELE
bull Abnormal MRI
bull Sensory issues
bull Feeding difficulty S
eve
re d
ela
ys
bull Preemie
bull Difficult pregnancy
bull Ruptured placenta
bull Seizures NICU
bull Tonic posturing
bull Feeding difficulty
bull Family lost another child
Case Studies Patient Medical History
Perlman Center M
ild d
ela
ys-A
t R
isk
bull MRI- basal ganglia
bull Clinic check-ups have been on track
bull Underlying weakness observed by PT
bull Slight catch in Right hamstring
bull 1x every 3-4 weeks
Modera
te d
ela
ys
bull Presents with tonal posturing
bull External support for positioning
bull Sensitive to vestibular movement
bull Home based EI OP equipment planning
bull Group tx
Severe
dela
ys
bull Severe posturing
bull FeedingGI issues
bull Mom needs lots of support
bull Positioning needs
bull Medical needs
bull 2x week group setting (OT PT SLP SW MDs feeding team)
Perlman Center
Build high value
interventions
Perlman Center
bull Therapy to support early parent-infant relationships
bull Build parent confidence
bull Education and training
bull Build opportunities for practice
bull Incorporate into daily routines
Engaging Parents
bull Adapt access to play play is FUN
bull Stimulate exploration inquiry and learning
bull Enrich for cognitive motor sensory and social development
Building Enriched
Environments
bull Goal-oriented intensive motor training (Morgan et al 2015)
bull Build in repetition
bull Scaffold so infant is able to complete at least part of the task
bull Experience-based activities will engage self-initiation of movement
bull Occurs while participating in daily routines (ie at the grocery)
Applying Early Motor Learning
Specific Strategies
Perlman Center
Engaging Parents Education
Topic Lists
Identify parent priorities and begin education based
on parentsrsquo perceived need
child diagnoses
parent support and resources
oral-motor and feeding
seating and positioning
disabilities across the lifespan
gross motor development
patient advocacy
adapted equipment fine motor development
home positioning techniques
financial resources
sensory integration
types of rehabilitation therapy
speech and language
Perlman Center
Engaging Parents Goal Setting
Perlman Center
Educate
Model
Engage
Observe
Connect
Perlman Center
Purposeful Play ishellip
Goal oriented
Activity based
Motivating
In an Enriched environment
Perlman Center
Perlman Center
cognitive
sensory
motor
social
Perlman Center
Building Enriched Environments
Perlman Center
Building Enriched Environments
bull Is the child positioned within
reach to explore the activity
bull Are all senses being utilized
bull Is the child being motivated to
move throughout the
environment
bull Is the environment adapted to
increase access to play
Perlman Center
Building Enriched Environments
bull Can the child have an effect
on the activity within the
environment
bull Is the activity appropriately
challenging the child within the
environment
bull Is the child presented with the
need for problem solving
Perlman Center
Building Enriched Environments
bull Is the child motivated to repeat
the task for motor learning
bull Does the environment support
learning (ie appropriate
noise level social motivators
peer groups developmental
learning supports visual
supports auditory feedback
etc)
Perlman Center
Bridging the gap between the clinic and the
home environment
bull Discipline focused
bull Clinic equipment closet
bull May have group option
Clinic
bull Incorporate into Family Routines
bull Functional activities
bull High Value
bull Adapted environment
Home
Mobility
Early Literacy
Sensory Motor Learning
Social Connections
Perlman Center
Early Learning
Functional MRIs show positive long-term neuro-
cognitive effects of reading to very young
infants
Sensory experiences shape a babyrsquos
knowledge about the world
The average toddler moves 8
out of 10 waking hoursday
Perlman Center
Learning through Experience
Adapting the environment with positioning equipment allows children with disabilities to experience their world and build relationships Allows the child to participate in typical experiences to foster learning
Activities need to promote active engagement
and allow a child to
ndash Actively explore move and participate in play
ndash Assist with self-help routines
ndash Interact and connect with family amp friends
ndash Participate in community activities
ndash Have a means to effectively communicate
ndash Make choices about their wants and need
Perlman Center
Perlman Center
bull Headpointing painting
bull Universal cuffs large pegs splints
bull Switch toys for art activitiesdramatic play-pourer
bull Switch computer access- helpkidzlearncom
bull Fischer Price game with keyboard binder switch
bull Walking in different textures while in standers and walkers
bull Cameramouseorg with dwell click
bull Partner assisted scanning
Alternative amp Adaptive Access to Play
Perlman Center
Change the environment Not the body Adaptations will be critical for success
Gross Motor Fine Motor
Social
Communication
Perlman Center Consider Communication Young children need a reliable form of communication as early as possible
Augmentative Communication is shown to support verbal skills and enhance lives of
birth to three children and their families (Romski et al 2015)
Perlman Center
Holistic approach to AAC intervention should
Build on individual strengths
Focus on participation in real-world contexts
Address psychosocial factors (ie motivation attitude confidence resilience)
Focus on environmental factors to reduce barriers and maximize social supports
In the absence of a holistic approach to communication a child is at risk for failing to engage in social contexts beyond their immediate family or educationalvocational personnel (Light and Mcnaughton 2015)
Augmentative amp Alternative Communication (AAC)
Perlman Center
Early Literacy
Perlman Center
Early Mobility
There is more than one way
Hands Free Matters
Perlman Center
Early Mobility
Should I get a gait trainer if
they are going to walk YES
Are they too young for power NO
Perlman Center
Sensory Motor Learning
Perlman Center
Sensory Motor Learning
Perlman Center
Social Connection
Perlman Center
Total Access to Play
Perlman Center
Perlman defines functional positioning bull Positioning which promotes active movement and participation and
provides an opportunity to positively impact cognitive function
bull Equipment should promote function and participation across the lifespan
Perlman Center
Principles of seating and positioning
bull Obtain a stable base of support
bull Decrease the influence of atypical muscle tone
bull Accommodate fixed deformities and correct flexible deformities
bull Provide the least amount of intervention needed to achieve the greatest level of function
bull There is no one solution or product but typically a combination of tools that provide success
Adapted from Radell (1997) and York and Weimann (1991)
Perlman Center
Key Positioning Components
bull Postural Control Strengthening
bull Range of Motion Weight Bearing
bull Home Activity Programs
Developmental Positioning
bull ADLs-Play Feeding Bathing Sleeping
bull Computer AccessAAC-Integrated Technology
bull Vision Sensory Processing Participation
Upright Positioning
bull EARLY MOBILITY- developmental sequence
bull Gait Trainer Stander amp or Wheelchair
bull Manual wheelchair vs Power Mobility- BOTH
bull Recreational
ldquoTotalrdquo Mobility
bull Body Mechanics Hoyer Lifts Overhead Systems
bull Car Seat ampor Tie Downs
bull Adapted VanRamps
Transfers ampTransportation
Perlman Center
Equipment Plan of Care
Birth to Three
Adapting baby
equipment
Floor Play
StanderWalker
Bath Seat
Car Seat
Braces
Seating for Function
Early ACCESS
Wheelchair
Bed Positioning
Bike amp Swing
Preschool
Stander
Walker
Braces
Bath Seat
Potty Seat
Wheelchair
HiLo seating
AACAccess
Adapted Bed
Car Seat
Transportation
RecreationHEP
School-Age
to Adult
Wheelchair
AACACCESS
Integrated AT
Hilo chair
Standerwalker
Bath chair
Potty chair
Adapted Bed
Car SeatVan
Home modslifts
LeisureWork
Perlman Center
Commercial Products strollers car seats cribs bath seats high chairs
playpen infant swings floor mats nursing pillow ExerSaucers
Perlman Center
Creative Commercial Adaptations
Pool noodles
Snug and Go
Crib Wedges
Bed tableart desk
Laundry baskets
Inflatable bathtub
Inflatable infant pools
Boxesstools
Perlman Center Creative Commercial Adaptations
Laundry basket $400
Pool Noodle x 2 $300
Floor sitterbath support $700
table (BLACK) $800
Garbage can $600
Large pool noodle $300
Stander with anterior support and
Visual adaptation $1700
Perlman Center
Complex Rehab Equipment
Standers
Gait trainers
Bath Support
Car seat
Seating
Feeding tools
AAC
Sensory tools
vibration
Compression garments
NUK brushes
Z Vibe
Modified utensils
Swings
Weight
Head phones
Positioning
Neck supports
Bracing
Bobby pillowU cushion
Benches
Fireflyfriendscom
PlayPaK
Upsee
Go To Seat
Early Literacy
Picture symbols
Voice output switches
Adapted books
Adapted Equipment
Perlman Center
You got this baby Nowhellip Questions
Perlman Center
LETrsquoS PLAY
Hands on Equipment Demonstration
Perlman Center
bull Ulrich B (2010) Opportunities for Early Intervention Based on Theory Basic Neuroscience and Clinical Science Physical Therapy 90(12) 1868-1880
bull McIntyre S Morgan C amp Walker K (2011) Cerebral Palsy Dont Delay Developmental Disabilities Research Reviews 17(2) 114-129
bull Novak I (2014) Evidence-Based Diagnosis Health Care and Rehabilitation for Children with Cerebral Palsy Journal of Child Neurology 29(8) 1141-1156
bull Morgan C Novak I amp Badawi N (2013) Enriched Environments and Motor Outcomes in Cerebral Palsy Systematic Review and Meta-analysis Pediatrics 132 (3)e 735 -e746
bull Morgan C Novak I Dale R Guzzetta A amp Badawi N (2014) GAME (Goals- Activity-Motor Enrichment) protocol of a single blind randomised controlled trial of motor training parent education and environmental enrichment for infants at high risk of cerebral palsy BMC Neurology 14(203)
bull Whittingham K Wee D amp Boyd R (2010) Systematic review of the efficacy of parenting interventions for children with cerebral palsy Child care health and development 37(4) 475-483
bull Morgan C Novak I dale R amp Badawi N (2015) Optimising motor learning in infants at high risk of cerebral palsy a pilot study BMC Pediatrics 15(1) n pag Web
bull Vos R Dallmeijer A Verhoef M et al (2014) Developmental trajectories of receptive and expressive communication in children and young adults with cerebral palsy Developmental Medicine amp Child Neurology 56 951-959
bull Light J and McNaughton D (2015) Designing AAC research and intervention to improve outcomes for individuals with complex communication needs Augmentative and Alternative Communication 31(2) 85-96
bull Romski M Sevcik R Barton-Hulsey A amp Whitmore A (2015) Early Intervention and AAC What a difference 30 years makes Augmentative and Alternative Communication 31 (3) 181-202
References
Perlman Center
bull Novak I Cusick A Lannin N (2009) Occupational therapy home programs for cerebral palsy Double-blind randomised controlled trial Pediatrics 124 e606-e614
bull Gericke T (2006) Postural management for children with cerebral palsy consensus statement Dev Med Child Neurol 48 (4) 244-244
bull McKeever P Rossen B Scott H Robinson-Vincent K amp Wright V (2013) The significance of uprightness parentsrsquo reflections on childrenrsquos responses to a hands-free walker for children Disability amp Society 28(3) 380-392
bull Law M Pollock N Russell D Walter S et al (2011) Focus on function a cluster randomised controlled trial comparing child-versus context-focused intervention for young children with cerebral palsy Dev Med Child Neurol 53 621-629
bull ldquoSensory Processing Developmental Chartrdquo Sensory Processing Developmental Chart Np nd Web 12 Oct 2015
bull Folio MR amp Fewell RR(2000) Peabody Developmental Motor Scales- Second edition Austin TX PRO ED
bull Voress Judith K amp Pearson Nils A (2013) Early Childhood Development Chart-Third edition Austin TX PRO ED
bull Paul Rhea (2007) Language Disorders from Infancy Through Adolescence Assessment amp Intervention Third edition St Louis MA Mosby Inc
bull Prosser L Ohlrich L Curatalo L Alter K amp Damiano D (2012) Feasibility and preliminary effectiveness of a novel mobility training intervention in infants and toddlers with cerebral palsy Developmental Neurorehabilitation 15(4) 259-266
References
Perlman Center
Multidisciplinary Checklist Tools
Perlman Center
Perlman Multidisciplinary Checklist
Perlman Center
ParentChild Assessment of Routines
Perlman Center
Providing Therapy Services
Clinical
assessment Parents Goals
and Priorities
What are the therapy options to meet the above needs
Perlman Center
Bridging the gap between clinical
assessments and family need
bull Identify Limitations
bull Developmental Delays
bull Medical needs
Clinical Finding
bull Family Routines
bull Family Priorities
bull Overcome Barriers and Obstacles
Family Need
Perlman Center
10 minutes
Perlman Center
bull Considering severity and complexity of diagnosis delays
parentsrsquo level of education acceptance and understanding of
their childrsquos diagnosis
bull Frequency Does the childfamily need weekly treatment once
per month or a burst of therapy every couple of months
bull Most supportive environment group or individual home-based
or clinic-based
bull Referrals for specialized intervention (splinting constraint
therapy adaptive equipment oral-motorfeeding therapy vision
therapy Kinesiotherapy etc)
Develop a Therapy Plan
Perlman Center
Perlman Case Study Examples
Mild delays
Infant has risks for CP
Moderate Delays
Infant presents abnormal motor delays
Severe Delays
Infant presents with significant
neuro-motor impairments
Perlman Center M
ild d
ela
ys-a
t risk
bull Full term
bull Difficult delivery
bull Seizure after delivery
bull Abnormal MRI
bull Mom has degree in child development
Mod
era
te d
ela
ys
bull Full term
bull Seizure activity and HIE following birth
bull Abnormal movements of UELE
bull Abnormal MRI
bull Sensory issues
bull Feeding difficulty S
eve
re d
ela
ys
bull Preemie
bull Difficult pregnancy
bull Ruptured placenta
bull Seizures NICU
bull Tonic posturing
bull Feeding difficulty
bull Family lost another child
Case Studies Patient Medical History
Perlman Center M
ild d
ela
ys-A
t R
isk
bull MRI- basal ganglia
bull Clinic check-ups have been on track
bull Underlying weakness observed by PT
bull Slight catch in Right hamstring
bull 1x every 3-4 weeks
Modera
te d
ela
ys
bull Presents with tonal posturing
bull External support for positioning
bull Sensitive to vestibular movement
bull Home based EI OP equipment planning
bull Group tx
Severe
dela
ys
bull Severe posturing
bull FeedingGI issues
bull Mom needs lots of support
bull Positioning needs
bull Medical needs
bull 2x week group setting (OT PT SLP SW MDs feeding team)
Perlman Center
Build high value
interventions
Perlman Center
bull Therapy to support early parent-infant relationships
bull Build parent confidence
bull Education and training
bull Build opportunities for practice
bull Incorporate into daily routines
Engaging Parents
bull Adapt access to play play is FUN
bull Stimulate exploration inquiry and learning
bull Enrich for cognitive motor sensory and social development
Building Enriched
Environments
bull Goal-oriented intensive motor training (Morgan et al 2015)
bull Build in repetition
bull Scaffold so infant is able to complete at least part of the task
bull Experience-based activities will engage self-initiation of movement
bull Occurs while participating in daily routines (ie at the grocery)
Applying Early Motor Learning
Specific Strategies
Perlman Center
Engaging Parents Education
Topic Lists
Identify parent priorities and begin education based
on parentsrsquo perceived need
child diagnoses
parent support and resources
oral-motor and feeding
seating and positioning
disabilities across the lifespan
gross motor development
patient advocacy
adapted equipment fine motor development
home positioning techniques
financial resources
sensory integration
types of rehabilitation therapy
speech and language
Perlman Center
Engaging Parents Goal Setting
Perlman Center
Educate
Model
Engage
Observe
Connect
Perlman Center
Purposeful Play ishellip
Goal oriented
Activity based
Motivating
In an Enriched environment
Perlman Center
Perlman Center
cognitive
sensory
motor
social
Perlman Center
Building Enriched Environments
Perlman Center
Building Enriched Environments
bull Is the child positioned within
reach to explore the activity
bull Are all senses being utilized
bull Is the child being motivated to
move throughout the
environment
bull Is the environment adapted to
increase access to play
Perlman Center
Building Enriched Environments
bull Can the child have an effect
on the activity within the
environment
bull Is the activity appropriately
challenging the child within the
environment
bull Is the child presented with the
need for problem solving
Perlman Center
Building Enriched Environments
bull Is the child motivated to repeat
the task for motor learning
bull Does the environment support
learning (ie appropriate
noise level social motivators
peer groups developmental
learning supports visual
supports auditory feedback
etc)
Perlman Center
Bridging the gap between the clinic and the
home environment
bull Discipline focused
bull Clinic equipment closet
bull May have group option
Clinic
bull Incorporate into Family Routines
bull Functional activities
bull High Value
bull Adapted environment
Home
Mobility
Early Literacy
Sensory Motor Learning
Social Connections
Perlman Center
Early Learning
Functional MRIs show positive long-term neuro-
cognitive effects of reading to very young
infants
Sensory experiences shape a babyrsquos
knowledge about the world
The average toddler moves 8
out of 10 waking hoursday
Perlman Center
Learning through Experience
Adapting the environment with positioning equipment allows children with disabilities to experience their world and build relationships Allows the child to participate in typical experiences to foster learning
Activities need to promote active engagement
and allow a child to
ndash Actively explore move and participate in play
ndash Assist with self-help routines
ndash Interact and connect with family amp friends
ndash Participate in community activities
ndash Have a means to effectively communicate
ndash Make choices about their wants and need
Perlman Center
Perlman Center
bull Headpointing painting
bull Universal cuffs large pegs splints
bull Switch toys for art activitiesdramatic play-pourer
bull Switch computer access- helpkidzlearncom
bull Fischer Price game with keyboard binder switch
bull Walking in different textures while in standers and walkers
bull Cameramouseorg with dwell click
bull Partner assisted scanning
Alternative amp Adaptive Access to Play
Perlman Center
Change the environment Not the body Adaptations will be critical for success
Gross Motor Fine Motor
Social
Communication
Perlman Center Consider Communication Young children need a reliable form of communication as early as possible
Augmentative Communication is shown to support verbal skills and enhance lives of
birth to three children and their families (Romski et al 2015)
Perlman Center
Holistic approach to AAC intervention should
Build on individual strengths
Focus on participation in real-world contexts
Address psychosocial factors (ie motivation attitude confidence resilience)
Focus on environmental factors to reduce barriers and maximize social supports
In the absence of a holistic approach to communication a child is at risk for failing to engage in social contexts beyond their immediate family or educationalvocational personnel (Light and Mcnaughton 2015)
Augmentative amp Alternative Communication (AAC)
Perlman Center
Early Literacy
Perlman Center
Early Mobility
There is more than one way
Hands Free Matters
Perlman Center
Early Mobility
Should I get a gait trainer if
they are going to walk YES
Are they too young for power NO
Perlman Center
Sensory Motor Learning
Perlman Center
Sensory Motor Learning
Perlman Center
Social Connection
Perlman Center
Total Access to Play
Perlman Center
Perlman defines functional positioning bull Positioning which promotes active movement and participation and
provides an opportunity to positively impact cognitive function
bull Equipment should promote function and participation across the lifespan
Perlman Center
Principles of seating and positioning
bull Obtain a stable base of support
bull Decrease the influence of atypical muscle tone
bull Accommodate fixed deformities and correct flexible deformities
bull Provide the least amount of intervention needed to achieve the greatest level of function
bull There is no one solution or product but typically a combination of tools that provide success
Adapted from Radell (1997) and York and Weimann (1991)
Perlman Center
Key Positioning Components
bull Postural Control Strengthening
bull Range of Motion Weight Bearing
bull Home Activity Programs
Developmental Positioning
bull ADLs-Play Feeding Bathing Sleeping
bull Computer AccessAAC-Integrated Technology
bull Vision Sensory Processing Participation
Upright Positioning
bull EARLY MOBILITY- developmental sequence
bull Gait Trainer Stander amp or Wheelchair
bull Manual wheelchair vs Power Mobility- BOTH
bull Recreational
ldquoTotalrdquo Mobility
bull Body Mechanics Hoyer Lifts Overhead Systems
bull Car Seat ampor Tie Downs
bull Adapted VanRamps
Transfers ampTransportation
Perlman Center
Equipment Plan of Care
Birth to Three
Adapting baby
equipment
Floor Play
StanderWalker
Bath Seat
Car Seat
Braces
Seating for Function
Early ACCESS
Wheelchair
Bed Positioning
Bike amp Swing
Preschool
Stander
Walker
Braces
Bath Seat
Potty Seat
Wheelchair
HiLo seating
AACAccess
Adapted Bed
Car Seat
Transportation
RecreationHEP
School-Age
to Adult
Wheelchair
AACACCESS
Integrated AT
Hilo chair
Standerwalker
Bath chair
Potty chair
Adapted Bed
Car SeatVan
Home modslifts
LeisureWork
Perlman Center
Commercial Products strollers car seats cribs bath seats high chairs
playpen infant swings floor mats nursing pillow ExerSaucers
Perlman Center
Creative Commercial Adaptations
Pool noodles
Snug and Go
Crib Wedges
Bed tableart desk
Laundry baskets
Inflatable bathtub
Inflatable infant pools
Boxesstools
Perlman Center Creative Commercial Adaptations
Laundry basket $400
Pool Noodle x 2 $300
Floor sitterbath support $700
table (BLACK) $800
Garbage can $600
Large pool noodle $300
Stander with anterior support and
Visual adaptation $1700
Perlman Center
Complex Rehab Equipment
Standers
Gait trainers
Bath Support
Car seat
Seating
Feeding tools
AAC
Sensory tools
vibration
Compression garments
NUK brushes
Z Vibe
Modified utensils
Swings
Weight
Head phones
Positioning
Neck supports
Bracing
Bobby pillowU cushion
Benches
Fireflyfriendscom
PlayPaK
Upsee
Go To Seat
Early Literacy
Picture symbols
Voice output switches
Adapted books
Adapted Equipment
Perlman Center
You got this baby Nowhellip Questions
Perlman Center
LETrsquoS PLAY
Hands on Equipment Demonstration
Perlman Center
bull Ulrich B (2010) Opportunities for Early Intervention Based on Theory Basic Neuroscience and Clinical Science Physical Therapy 90(12) 1868-1880
bull McIntyre S Morgan C amp Walker K (2011) Cerebral Palsy Dont Delay Developmental Disabilities Research Reviews 17(2) 114-129
bull Novak I (2014) Evidence-Based Diagnosis Health Care and Rehabilitation for Children with Cerebral Palsy Journal of Child Neurology 29(8) 1141-1156
bull Morgan C Novak I amp Badawi N (2013) Enriched Environments and Motor Outcomes in Cerebral Palsy Systematic Review and Meta-analysis Pediatrics 132 (3)e 735 -e746
bull Morgan C Novak I Dale R Guzzetta A amp Badawi N (2014) GAME (Goals- Activity-Motor Enrichment) protocol of a single blind randomised controlled trial of motor training parent education and environmental enrichment for infants at high risk of cerebral palsy BMC Neurology 14(203)
bull Whittingham K Wee D amp Boyd R (2010) Systematic review of the efficacy of parenting interventions for children with cerebral palsy Child care health and development 37(4) 475-483
bull Morgan C Novak I dale R amp Badawi N (2015) Optimising motor learning in infants at high risk of cerebral palsy a pilot study BMC Pediatrics 15(1) n pag Web
bull Vos R Dallmeijer A Verhoef M et al (2014) Developmental trajectories of receptive and expressive communication in children and young adults with cerebral palsy Developmental Medicine amp Child Neurology 56 951-959
bull Light J and McNaughton D (2015) Designing AAC research and intervention to improve outcomes for individuals with complex communication needs Augmentative and Alternative Communication 31(2) 85-96
bull Romski M Sevcik R Barton-Hulsey A amp Whitmore A (2015) Early Intervention and AAC What a difference 30 years makes Augmentative and Alternative Communication 31 (3) 181-202
References
Perlman Center
bull Novak I Cusick A Lannin N (2009) Occupational therapy home programs for cerebral palsy Double-blind randomised controlled trial Pediatrics 124 e606-e614
bull Gericke T (2006) Postural management for children with cerebral palsy consensus statement Dev Med Child Neurol 48 (4) 244-244
bull McKeever P Rossen B Scott H Robinson-Vincent K amp Wright V (2013) The significance of uprightness parentsrsquo reflections on childrenrsquos responses to a hands-free walker for children Disability amp Society 28(3) 380-392
bull Law M Pollock N Russell D Walter S et al (2011) Focus on function a cluster randomised controlled trial comparing child-versus context-focused intervention for young children with cerebral palsy Dev Med Child Neurol 53 621-629
bull ldquoSensory Processing Developmental Chartrdquo Sensory Processing Developmental Chart Np nd Web 12 Oct 2015
bull Folio MR amp Fewell RR(2000) Peabody Developmental Motor Scales- Second edition Austin TX PRO ED
bull Voress Judith K amp Pearson Nils A (2013) Early Childhood Development Chart-Third edition Austin TX PRO ED
bull Paul Rhea (2007) Language Disorders from Infancy Through Adolescence Assessment amp Intervention Third edition St Louis MA Mosby Inc
bull Prosser L Ohlrich L Curatalo L Alter K amp Damiano D (2012) Feasibility and preliminary effectiveness of a novel mobility training intervention in infants and toddlers with cerebral palsy Developmental Neurorehabilitation 15(4) 259-266
References
Perlman Center
Perlman Multidisciplinary Checklist
Perlman Center
ParentChild Assessment of Routines
Perlman Center
Providing Therapy Services
Clinical
assessment Parents Goals
and Priorities
What are the therapy options to meet the above needs
Perlman Center
Bridging the gap between clinical
assessments and family need
bull Identify Limitations
bull Developmental Delays
bull Medical needs
Clinical Finding
bull Family Routines
bull Family Priorities
bull Overcome Barriers and Obstacles
Family Need
Perlman Center
10 minutes
Perlman Center
bull Considering severity and complexity of diagnosis delays
parentsrsquo level of education acceptance and understanding of
their childrsquos diagnosis
bull Frequency Does the childfamily need weekly treatment once
per month or a burst of therapy every couple of months
bull Most supportive environment group or individual home-based
or clinic-based
bull Referrals for specialized intervention (splinting constraint
therapy adaptive equipment oral-motorfeeding therapy vision
therapy Kinesiotherapy etc)
Develop a Therapy Plan
Perlman Center
Perlman Case Study Examples
Mild delays
Infant has risks for CP
Moderate Delays
Infant presents abnormal motor delays
Severe Delays
Infant presents with significant
neuro-motor impairments
Perlman Center M
ild d
ela
ys-a
t risk
bull Full term
bull Difficult delivery
bull Seizure after delivery
bull Abnormal MRI
bull Mom has degree in child development
Mod
era
te d
ela
ys
bull Full term
bull Seizure activity and HIE following birth
bull Abnormal movements of UELE
bull Abnormal MRI
bull Sensory issues
bull Feeding difficulty S
eve
re d
ela
ys
bull Preemie
bull Difficult pregnancy
bull Ruptured placenta
bull Seizures NICU
bull Tonic posturing
bull Feeding difficulty
bull Family lost another child
Case Studies Patient Medical History
Perlman Center M
ild d
ela
ys-A
t R
isk
bull MRI- basal ganglia
bull Clinic check-ups have been on track
bull Underlying weakness observed by PT
bull Slight catch in Right hamstring
bull 1x every 3-4 weeks
Modera
te d
ela
ys
bull Presents with tonal posturing
bull External support for positioning
bull Sensitive to vestibular movement
bull Home based EI OP equipment planning
bull Group tx
Severe
dela
ys
bull Severe posturing
bull FeedingGI issues
bull Mom needs lots of support
bull Positioning needs
bull Medical needs
bull 2x week group setting (OT PT SLP SW MDs feeding team)
Perlman Center
Build high value
interventions
Perlman Center
bull Therapy to support early parent-infant relationships
bull Build parent confidence
bull Education and training
bull Build opportunities for practice
bull Incorporate into daily routines
Engaging Parents
bull Adapt access to play play is FUN
bull Stimulate exploration inquiry and learning
bull Enrich for cognitive motor sensory and social development
Building Enriched
Environments
bull Goal-oriented intensive motor training (Morgan et al 2015)
bull Build in repetition
bull Scaffold so infant is able to complete at least part of the task
bull Experience-based activities will engage self-initiation of movement
bull Occurs while participating in daily routines (ie at the grocery)
Applying Early Motor Learning
Specific Strategies
Perlman Center
Engaging Parents Education
Topic Lists
Identify parent priorities and begin education based
on parentsrsquo perceived need
child diagnoses
parent support and resources
oral-motor and feeding
seating and positioning
disabilities across the lifespan
gross motor development
patient advocacy
adapted equipment fine motor development
home positioning techniques
financial resources
sensory integration
types of rehabilitation therapy
speech and language
Perlman Center
Engaging Parents Goal Setting
Perlman Center
Educate
Model
Engage
Observe
Connect
Perlman Center
Purposeful Play ishellip
Goal oriented
Activity based
Motivating
In an Enriched environment
Perlman Center
Perlman Center
cognitive
sensory
motor
social
Perlman Center
Building Enriched Environments
Perlman Center
Building Enriched Environments
bull Is the child positioned within
reach to explore the activity
bull Are all senses being utilized
bull Is the child being motivated to
move throughout the
environment
bull Is the environment adapted to
increase access to play
Perlman Center
Building Enriched Environments
bull Can the child have an effect
on the activity within the
environment
bull Is the activity appropriately
challenging the child within the
environment
bull Is the child presented with the
need for problem solving
Perlman Center
Building Enriched Environments
bull Is the child motivated to repeat
the task for motor learning
bull Does the environment support
learning (ie appropriate
noise level social motivators
peer groups developmental
learning supports visual
supports auditory feedback
etc)
Perlman Center
Bridging the gap between the clinic and the
home environment
bull Discipline focused
bull Clinic equipment closet
bull May have group option
Clinic
bull Incorporate into Family Routines
bull Functional activities
bull High Value
bull Adapted environment
Home
Mobility
Early Literacy
Sensory Motor Learning
Social Connections
Perlman Center
Early Learning
Functional MRIs show positive long-term neuro-
cognitive effects of reading to very young
infants
Sensory experiences shape a babyrsquos
knowledge about the world
The average toddler moves 8
out of 10 waking hoursday
Perlman Center
Learning through Experience
Adapting the environment with positioning equipment allows children with disabilities to experience their world and build relationships Allows the child to participate in typical experiences to foster learning
Activities need to promote active engagement
and allow a child to
ndash Actively explore move and participate in play
ndash Assist with self-help routines
ndash Interact and connect with family amp friends
ndash Participate in community activities
ndash Have a means to effectively communicate
ndash Make choices about their wants and need
Perlman Center
Perlman Center
bull Headpointing painting
bull Universal cuffs large pegs splints
bull Switch toys for art activitiesdramatic play-pourer
bull Switch computer access- helpkidzlearncom
bull Fischer Price game with keyboard binder switch
bull Walking in different textures while in standers and walkers
bull Cameramouseorg with dwell click
bull Partner assisted scanning
Alternative amp Adaptive Access to Play
Perlman Center
Change the environment Not the body Adaptations will be critical for success
Gross Motor Fine Motor
Social
Communication
Perlman Center Consider Communication Young children need a reliable form of communication as early as possible
Augmentative Communication is shown to support verbal skills and enhance lives of
birth to three children and their families (Romski et al 2015)
Perlman Center
Holistic approach to AAC intervention should
Build on individual strengths
Focus on participation in real-world contexts
Address psychosocial factors (ie motivation attitude confidence resilience)
Focus on environmental factors to reduce barriers and maximize social supports
In the absence of a holistic approach to communication a child is at risk for failing to engage in social contexts beyond their immediate family or educationalvocational personnel (Light and Mcnaughton 2015)
Augmentative amp Alternative Communication (AAC)
Perlman Center
Early Literacy
Perlman Center
Early Mobility
There is more than one way
Hands Free Matters
Perlman Center
Early Mobility
Should I get a gait trainer if
they are going to walk YES
Are they too young for power NO
Perlman Center
Sensory Motor Learning
Perlman Center
Sensory Motor Learning
Perlman Center
Social Connection
Perlman Center
Total Access to Play
Perlman Center
Perlman defines functional positioning bull Positioning which promotes active movement and participation and
provides an opportunity to positively impact cognitive function
bull Equipment should promote function and participation across the lifespan
Perlman Center
Principles of seating and positioning
bull Obtain a stable base of support
bull Decrease the influence of atypical muscle tone
bull Accommodate fixed deformities and correct flexible deformities
bull Provide the least amount of intervention needed to achieve the greatest level of function
bull There is no one solution or product but typically a combination of tools that provide success
Adapted from Radell (1997) and York and Weimann (1991)
Perlman Center
Key Positioning Components
bull Postural Control Strengthening
bull Range of Motion Weight Bearing
bull Home Activity Programs
Developmental Positioning
bull ADLs-Play Feeding Bathing Sleeping
bull Computer AccessAAC-Integrated Technology
bull Vision Sensory Processing Participation
Upright Positioning
bull EARLY MOBILITY- developmental sequence
bull Gait Trainer Stander amp or Wheelchair
bull Manual wheelchair vs Power Mobility- BOTH
bull Recreational
ldquoTotalrdquo Mobility
bull Body Mechanics Hoyer Lifts Overhead Systems
bull Car Seat ampor Tie Downs
bull Adapted VanRamps
Transfers ampTransportation
Perlman Center
Equipment Plan of Care
Birth to Three
Adapting baby
equipment
Floor Play
StanderWalker
Bath Seat
Car Seat
Braces
Seating for Function
Early ACCESS
Wheelchair
Bed Positioning
Bike amp Swing
Preschool
Stander
Walker
Braces
Bath Seat
Potty Seat
Wheelchair
HiLo seating
AACAccess
Adapted Bed
Car Seat
Transportation
RecreationHEP
School-Age
to Adult
Wheelchair
AACACCESS
Integrated AT
Hilo chair
Standerwalker
Bath chair
Potty chair
Adapted Bed
Car SeatVan
Home modslifts
LeisureWork
Perlman Center
Commercial Products strollers car seats cribs bath seats high chairs
playpen infant swings floor mats nursing pillow ExerSaucers
Perlman Center
Creative Commercial Adaptations
Pool noodles
Snug and Go
Crib Wedges
Bed tableart desk
Laundry baskets
Inflatable bathtub
Inflatable infant pools
Boxesstools
Perlman Center Creative Commercial Adaptations
Laundry basket $400
Pool Noodle x 2 $300
Floor sitterbath support $700
table (BLACK) $800
Garbage can $600
Large pool noodle $300
Stander with anterior support and
Visual adaptation $1700
Perlman Center
Complex Rehab Equipment
Standers
Gait trainers
Bath Support
Car seat
Seating
Feeding tools
AAC
Sensory tools
vibration
Compression garments
NUK brushes
Z Vibe
Modified utensils
Swings
Weight
Head phones
Positioning
Neck supports
Bracing
Bobby pillowU cushion
Benches
Fireflyfriendscom
PlayPaK
Upsee
Go To Seat
Early Literacy
Picture symbols
Voice output switches
Adapted books
Adapted Equipment
Perlman Center
You got this baby Nowhellip Questions
Perlman Center
LETrsquoS PLAY
Hands on Equipment Demonstration
Perlman Center
bull Ulrich B (2010) Opportunities for Early Intervention Based on Theory Basic Neuroscience and Clinical Science Physical Therapy 90(12) 1868-1880
bull McIntyre S Morgan C amp Walker K (2011) Cerebral Palsy Dont Delay Developmental Disabilities Research Reviews 17(2) 114-129
bull Novak I (2014) Evidence-Based Diagnosis Health Care and Rehabilitation for Children with Cerebral Palsy Journal of Child Neurology 29(8) 1141-1156
bull Morgan C Novak I amp Badawi N (2013) Enriched Environments and Motor Outcomes in Cerebral Palsy Systematic Review and Meta-analysis Pediatrics 132 (3)e 735 -e746
bull Morgan C Novak I Dale R Guzzetta A amp Badawi N (2014) GAME (Goals- Activity-Motor Enrichment) protocol of a single blind randomised controlled trial of motor training parent education and environmental enrichment for infants at high risk of cerebral palsy BMC Neurology 14(203)
bull Whittingham K Wee D amp Boyd R (2010) Systematic review of the efficacy of parenting interventions for children with cerebral palsy Child care health and development 37(4) 475-483
bull Morgan C Novak I dale R amp Badawi N (2015) Optimising motor learning in infants at high risk of cerebral palsy a pilot study BMC Pediatrics 15(1) n pag Web
bull Vos R Dallmeijer A Verhoef M et al (2014) Developmental trajectories of receptive and expressive communication in children and young adults with cerebral palsy Developmental Medicine amp Child Neurology 56 951-959
bull Light J and McNaughton D (2015) Designing AAC research and intervention to improve outcomes for individuals with complex communication needs Augmentative and Alternative Communication 31(2) 85-96
bull Romski M Sevcik R Barton-Hulsey A amp Whitmore A (2015) Early Intervention and AAC What a difference 30 years makes Augmentative and Alternative Communication 31 (3) 181-202
References
Perlman Center
bull Novak I Cusick A Lannin N (2009) Occupational therapy home programs for cerebral palsy Double-blind randomised controlled trial Pediatrics 124 e606-e614
bull Gericke T (2006) Postural management for children with cerebral palsy consensus statement Dev Med Child Neurol 48 (4) 244-244
bull McKeever P Rossen B Scott H Robinson-Vincent K amp Wright V (2013) The significance of uprightness parentsrsquo reflections on childrenrsquos responses to a hands-free walker for children Disability amp Society 28(3) 380-392
bull Law M Pollock N Russell D Walter S et al (2011) Focus on function a cluster randomised controlled trial comparing child-versus context-focused intervention for young children with cerebral palsy Dev Med Child Neurol 53 621-629
bull ldquoSensory Processing Developmental Chartrdquo Sensory Processing Developmental Chart Np nd Web 12 Oct 2015
bull Folio MR amp Fewell RR(2000) Peabody Developmental Motor Scales- Second edition Austin TX PRO ED
bull Voress Judith K amp Pearson Nils A (2013) Early Childhood Development Chart-Third edition Austin TX PRO ED
bull Paul Rhea (2007) Language Disorders from Infancy Through Adolescence Assessment amp Intervention Third edition St Louis MA Mosby Inc
bull Prosser L Ohlrich L Curatalo L Alter K amp Damiano D (2012) Feasibility and preliminary effectiveness of a novel mobility training intervention in infants and toddlers with cerebral palsy Developmental Neurorehabilitation 15(4) 259-266
References
Perlman Center
ParentChild Assessment of Routines
Perlman Center
Providing Therapy Services
Clinical
assessment Parents Goals
and Priorities
What are the therapy options to meet the above needs
Perlman Center
Bridging the gap between clinical
assessments and family need
bull Identify Limitations
bull Developmental Delays
bull Medical needs
Clinical Finding
bull Family Routines
bull Family Priorities
bull Overcome Barriers and Obstacles
Family Need
Perlman Center
10 minutes
Perlman Center
bull Considering severity and complexity of diagnosis delays
parentsrsquo level of education acceptance and understanding of
their childrsquos diagnosis
bull Frequency Does the childfamily need weekly treatment once
per month or a burst of therapy every couple of months
bull Most supportive environment group or individual home-based
or clinic-based
bull Referrals for specialized intervention (splinting constraint
therapy adaptive equipment oral-motorfeeding therapy vision
therapy Kinesiotherapy etc)
Develop a Therapy Plan
Perlman Center
Perlman Case Study Examples
Mild delays
Infant has risks for CP
Moderate Delays
Infant presents abnormal motor delays
Severe Delays
Infant presents with significant
neuro-motor impairments
Perlman Center M
ild d
ela
ys-a
t risk
bull Full term
bull Difficult delivery
bull Seizure after delivery
bull Abnormal MRI
bull Mom has degree in child development
Mod
era
te d
ela
ys
bull Full term
bull Seizure activity and HIE following birth
bull Abnormal movements of UELE
bull Abnormal MRI
bull Sensory issues
bull Feeding difficulty S
eve
re d
ela
ys
bull Preemie
bull Difficult pregnancy
bull Ruptured placenta
bull Seizures NICU
bull Tonic posturing
bull Feeding difficulty
bull Family lost another child
Case Studies Patient Medical History
Perlman Center M
ild d
ela
ys-A
t R
isk
bull MRI- basal ganglia
bull Clinic check-ups have been on track
bull Underlying weakness observed by PT
bull Slight catch in Right hamstring
bull 1x every 3-4 weeks
Modera
te d
ela
ys
bull Presents with tonal posturing
bull External support for positioning
bull Sensitive to vestibular movement
bull Home based EI OP equipment planning
bull Group tx
Severe
dela
ys
bull Severe posturing
bull FeedingGI issues
bull Mom needs lots of support
bull Positioning needs
bull Medical needs
bull 2x week group setting (OT PT SLP SW MDs feeding team)
Perlman Center
Build high value
interventions
Perlman Center
bull Therapy to support early parent-infant relationships
bull Build parent confidence
bull Education and training
bull Build opportunities for practice
bull Incorporate into daily routines
Engaging Parents
bull Adapt access to play play is FUN
bull Stimulate exploration inquiry and learning
bull Enrich for cognitive motor sensory and social development
Building Enriched
Environments
bull Goal-oriented intensive motor training (Morgan et al 2015)
bull Build in repetition
bull Scaffold so infant is able to complete at least part of the task
bull Experience-based activities will engage self-initiation of movement
bull Occurs while participating in daily routines (ie at the grocery)
Applying Early Motor Learning
Specific Strategies
Perlman Center
Engaging Parents Education
Topic Lists
Identify parent priorities and begin education based
on parentsrsquo perceived need
child diagnoses
parent support and resources
oral-motor and feeding
seating and positioning
disabilities across the lifespan
gross motor development
patient advocacy
adapted equipment fine motor development
home positioning techniques
financial resources
sensory integration
types of rehabilitation therapy
speech and language
Perlman Center
Engaging Parents Goal Setting
Perlman Center
Educate
Model
Engage
Observe
Connect
Perlman Center
Purposeful Play ishellip
Goal oriented
Activity based
Motivating
In an Enriched environment
Perlman Center
Perlman Center
cognitive
sensory
motor
social
Perlman Center
Building Enriched Environments
Perlman Center
Building Enriched Environments
bull Is the child positioned within
reach to explore the activity
bull Are all senses being utilized
bull Is the child being motivated to
move throughout the
environment
bull Is the environment adapted to
increase access to play
Perlman Center
Building Enriched Environments
bull Can the child have an effect
on the activity within the
environment
bull Is the activity appropriately
challenging the child within the
environment
bull Is the child presented with the
need for problem solving
Perlman Center
Building Enriched Environments
bull Is the child motivated to repeat
the task for motor learning
bull Does the environment support
learning (ie appropriate
noise level social motivators
peer groups developmental
learning supports visual
supports auditory feedback
etc)
Perlman Center
Bridging the gap between the clinic and the
home environment
bull Discipline focused
bull Clinic equipment closet
bull May have group option
Clinic
bull Incorporate into Family Routines
bull Functional activities
bull High Value
bull Adapted environment
Home
Mobility
Early Literacy
Sensory Motor Learning
Social Connections
Perlman Center
Early Learning
Functional MRIs show positive long-term neuro-
cognitive effects of reading to very young
infants
Sensory experiences shape a babyrsquos
knowledge about the world
The average toddler moves 8
out of 10 waking hoursday
Perlman Center
Learning through Experience
Adapting the environment with positioning equipment allows children with disabilities to experience their world and build relationships Allows the child to participate in typical experiences to foster learning
Activities need to promote active engagement
and allow a child to
ndash Actively explore move and participate in play
ndash Assist with self-help routines
ndash Interact and connect with family amp friends
ndash Participate in community activities
ndash Have a means to effectively communicate
ndash Make choices about their wants and need
Perlman Center
Perlman Center
bull Headpointing painting
bull Universal cuffs large pegs splints
bull Switch toys for art activitiesdramatic play-pourer
bull Switch computer access- helpkidzlearncom
bull Fischer Price game with keyboard binder switch
bull Walking in different textures while in standers and walkers
bull Cameramouseorg with dwell click
bull Partner assisted scanning
Alternative amp Adaptive Access to Play
Perlman Center
Change the environment Not the body Adaptations will be critical for success
Gross Motor Fine Motor
Social
Communication
Perlman Center Consider Communication Young children need a reliable form of communication as early as possible
Augmentative Communication is shown to support verbal skills and enhance lives of
birth to three children and their families (Romski et al 2015)
Perlman Center
Holistic approach to AAC intervention should
Build on individual strengths
Focus on participation in real-world contexts
Address psychosocial factors (ie motivation attitude confidence resilience)
Focus on environmental factors to reduce barriers and maximize social supports
In the absence of a holistic approach to communication a child is at risk for failing to engage in social contexts beyond their immediate family or educationalvocational personnel (Light and Mcnaughton 2015)
Augmentative amp Alternative Communication (AAC)
Perlman Center
Early Literacy
Perlman Center
Early Mobility
There is more than one way
Hands Free Matters
Perlman Center
Early Mobility
Should I get a gait trainer if
they are going to walk YES
Are they too young for power NO
Perlman Center
Sensory Motor Learning
Perlman Center
Sensory Motor Learning
Perlman Center
Social Connection
Perlman Center
Total Access to Play
Perlman Center
Perlman defines functional positioning bull Positioning which promotes active movement and participation and
provides an opportunity to positively impact cognitive function
bull Equipment should promote function and participation across the lifespan
Perlman Center
Principles of seating and positioning
bull Obtain a stable base of support
bull Decrease the influence of atypical muscle tone
bull Accommodate fixed deformities and correct flexible deformities
bull Provide the least amount of intervention needed to achieve the greatest level of function
bull There is no one solution or product but typically a combination of tools that provide success
Adapted from Radell (1997) and York and Weimann (1991)
Perlman Center
Key Positioning Components
bull Postural Control Strengthening
bull Range of Motion Weight Bearing
bull Home Activity Programs
Developmental Positioning
bull ADLs-Play Feeding Bathing Sleeping
bull Computer AccessAAC-Integrated Technology
bull Vision Sensory Processing Participation
Upright Positioning
bull EARLY MOBILITY- developmental sequence
bull Gait Trainer Stander amp or Wheelchair
bull Manual wheelchair vs Power Mobility- BOTH
bull Recreational
ldquoTotalrdquo Mobility
bull Body Mechanics Hoyer Lifts Overhead Systems
bull Car Seat ampor Tie Downs
bull Adapted VanRamps
Transfers ampTransportation
Perlman Center
Equipment Plan of Care
Birth to Three
Adapting baby
equipment
Floor Play
StanderWalker
Bath Seat
Car Seat
Braces
Seating for Function
Early ACCESS
Wheelchair
Bed Positioning
Bike amp Swing
Preschool
Stander
Walker
Braces
Bath Seat
Potty Seat
Wheelchair
HiLo seating
AACAccess
Adapted Bed
Car Seat
Transportation
RecreationHEP
School-Age
to Adult
Wheelchair
AACACCESS
Integrated AT
Hilo chair
Standerwalker
Bath chair
Potty chair
Adapted Bed
Car SeatVan
Home modslifts
LeisureWork
Perlman Center
Commercial Products strollers car seats cribs bath seats high chairs
playpen infant swings floor mats nursing pillow ExerSaucers
Perlman Center
Creative Commercial Adaptations
Pool noodles
Snug and Go
Crib Wedges
Bed tableart desk
Laundry baskets
Inflatable bathtub
Inflatable infant pools
Boxesstools
Perlman Center Creative Commercial Adaptations
Laundry basket $400
Pool Noodle x 2 $300
Floor sitterbath support $700
table (BLACK) $800
Garbage can $600
Large pool noodle $300
Stander with anterior support and
Visual adaptation $1700
Perlman Center
Complex Rehab Equipment
Standers
Gait trainers
Bath Support
Car seat
Seating
Feeding tools
AAC
Sensory tools
vibration
Compression garments
NUK brushes
Z Vibe
Modified utensils
Swings
Weight
Head phones
Positioning
Neck supports
Bracing
Bobby pillowU cushion
Benches
Fireflyfriendscom
PlayPaK
Upsee
Go To Seat
Early Literacy
Picture symbols
Voice output switches
Adapted books
Adapted Equipment
Perlman Center
You got this baby Nowhellip Questions
Perlman Center
LETrsquoS PLAY
Hands on Equipment Demonstration
Perlman Center
bull Ulrich B (2010) Opportunities for Early Intervention Based on Theory Basic Neuroscience and Clinical Science Physical Therapy 90(12) 1868-1880
bull McIntyre S Morgan C amp Walker K (2011) Cerebral Palsy Dont Delay Developmental Disabilities Research Reviews 17(2) 114-129
bull Novak I (2014) Evidence-Based Diagnosis Health Care and Rehabilitation for Children with Cerebral Palsy Journal of Child Neurology 29(8) 1141-1156
bull Morgan C Novak I amp Badawi N (2013) Enriched Environments and Motor Outcomes in Cerebral Palsy Systematic Review and Meta-analysis Pediatrics 132 (3)e 735 -e746
bull Morgan C Novak I Dale R Guzzetta A amp Badawi N (2014) GAME (Goals- Activity-Motor Enrichment) protocol of a single blind randomised controlled trial of motor training parent education and environmental enrichment for infants at high risk of cerebral palsy BMC Neurology 14(203)
bull Whittingham K Wee D amp Boyd R (2010) Systematic review of the efficacy of parenting interventions for children with cerebral palsy Child care health and development 37(4) 475-483
bull Morgan C Novak I dale R amp Badawi N (2015) Optimising motor learning in infants at high risk of cerebral palsy a pilot study BMC Pediatrics 15(1) n pag Web
bull Vos R Dallmeijer A Verhoef M et al (2014) Developmental trajectories of receptive and expressive communication in children and young adults with cerebral palsy Developmental Medicine amp Child Neurology 56 951-959
bull Light J and McNaughton D (2015) Designing AAC research and intervention to improve outcomes for individuals with complex communication needs Augmentative and Alternative Communication 31(2) 85-96
bull Romski M Sevcik R Barton-Hulsey A amp Whitmore A (2015) Early Intervention and AAC What a difference 30 years makes Augmentative and Alternative Communication 31 (3) 181-202
References
Perlman Center
bull Novak I Cusick A Lannin N (2009) Occupational therapy home programs for cerebral palsy Double-blind randomised controlled trial Pediatrics 124 e606-e614
bull Gericke T (2006) Postural management for children with cerebral palsy consensus statement Dev Med Child Neurol 48 (4) 244-244
bull McKeever P Rossen B Scott H Robinson-Vincent K amp Wright V (2013) The significance of uprightness parentsrsquo reflections on childrenrsquos responses to a hands-free walker for children Disability amp Society 28(3) 380-392
bull Law M Pollock N Russell D Walter S et al (2011) Focus on function a cluster randomised controlled trial comparing child-versus context-focused intervention for young children with cerebral palsy Dev Med Child Neurol 53 621-629
bull ldquoSensory Processing Developmental Chartrdquo Sensory Processing Developmental Chart Np nd Web 12 Oct 2015
bull Folio MR amp Fewell RR(2000) Peabody Developmental Motor Scales- Second edition Austin TX PRO ED
bull Voress Judith K amp Pearson Nils A (2013) Early Childhood Development Chart-Third edition Austin TX PRO ED
bull Paul Rhea (2007) Language Disorders from Infancy Through Adolescence Assessment amp Intervention Third edition St Louis MA Mosby Inc
bull Prosser L Ohlrich L Curatalo L Alter K amp Damiano D (2012) Feasibility and preliminary effectiveness of a novel mobility training intervention in infants and toddlers with cerebral palsy Developmental Neurorehabilitation 15(4) 259-266
References
Perlman Center
Providing Therapy Services
Clinical
assessment Parents Goals
and Priorities
What are the therapy options to meet the above needs
Perlman Center
Bridging the gap between clinical
assessments and family need
bull Identify Limitations
bull Developmental Delays
bull Medical needs
Clinical Finding
bull Family Routines
bull Family Priorities
bull Overcome Barriers and Obstacles
Family Need
Perlman Center
10 minutes
Perlman Center
bull Considering severity and complexity of diagnosis delays
parentsrsquo level of education acceptance and understanding of
their childrsquos diagnosis
bull Frequency Does the childfamily need weekly treatment once
per month or a burst of therapy every couple of months
bull Most supportive environment group or individual home-based
or clinic-based
bull Referrals for specialized intervention (splinting constraint
therapy adaptive equipment oral-motorfeeding therapy vision
therapy Kinesiotherapy etc)
Develop a Therapy Plan
Perlman Center
Perlman Case Study Examples
Mild delays
Infant has risks for CP
Moderate Delays
Infant presents abnormal motor delays
Severe Delays
Infant presents with significant
neuro-motor impairments
Perlman Center M
ild d
ela
ys-a
t risk
bull Full term
bull Difficult delivery
bull Seizure after delivery
bull Abnormal MRI
bull Mom has degree in child development
Mod
era
te d
ela
ys
bull Full term
bull Seizure activity and HIE following birth
bull Abnormal movements of UELE
bull Abnormal MRI
bull Sensory issues
bull Feeding difficulty S
eve
re d
ela
ys
bull Preemie
bull Difficult pregnancy
bull Ruptured placenta
bull Seizures NICU
bull Tonic posturing
bull Feeding difficulty
bull Family lost another child
Case Studies Patient Medical History
Perlman Center M
ild d
ela
ys-A
t R
isk
bull MRI- basal ganglia
bull Clinic check-ups have been on track
bull Underlying weakness observed by PT
bull Slight catch in Right hamstring
bull 1x every 3-4 weeks
Modera
te d
ela
ys
bull Presents with tonal posturing
bull External support for positioning
bull Sensitive to vestibular movement
bull Home based EI OP equipment planning
bull Group tx
Severe
dela
ys
bull Severe posturing
bull FeedingGI issues
bull Mom needs lots of support
bull Positioning needs
bull Medical needs
bull 2x week group setting (OT PT SLP SW MDs feeding team)
Perlman Center
Build high value
interventions
Perlman Center
bull Therapy to support early parent-infant relationships
bull Build parent confidence
bull Education and training
bull Build opportunities for practice
bull Incorporate into daily routines
Engaging Parents
bull Adapt access to play play is FUN
bull Stimulate exploration inquiry and learning
bull Enrich for cognitive motor sensory and social development
Building Enriched
Environments
bull Goal-oriented intensive motor training (Morgan et al 2015)
bull Build in repetition
bull Scaffold so infant is able to complete at least part of the task
bull Experience-based activities will engage self-initiation of movement
bull Occurs while participating in daily routines (ie at the grocery)
Applying Early Motor Learning
Specific Strategies
Perlman Center
Engaging Parents Education
Topic Lists
Identify parent priorities and begin education based
on parentsrsquo perceived need
child diagnoses
parent support and resources
oral-motor and feeding
seating and positioning
disabilities across the lifespan
gross motor development
patient advocacy
adapted equipment fine motor development
home positioning techniques
financial resources
sensory integration
types of rehabilitation therapy
speech and language
Perlman Center
Engaging Parents Goal Setting
Perlman Center
Educate
Model
Engage
Observe
Connect
Perlman Center
Purposeful Play ishellip
Goal oriented
Activity based
Motivating
In an Enriched environment
Perlman Center
Perlman Center
cognitive
sensory
motor
social
Perlman Center
Building Enriched Environments
Perlman Center
Building Enriched Environments
bull Is the child positioned within
reach to explore the activity
bull Are all senses being utilized
bull Is the child being motivated to
move throughout the
environment
bull Is the environment adapted to
increase access to play
Perlman Center
Building Enriched Environments
bull Can the child have an effect
on the activity within the
environment
bull Is the activity appropriately
challenging the child within the
environment
bull Is the child presented with the
need for problem solving
Perlman Center
Building Enriched Environments
bull Is the child motivated to repeat
the task for motor learning
bull Does the environment support
learning (ie appropriate
noise level social motivators
peer groups developmental
learning supports visual
supports auditory feedback
etc)
Perlman Center
Bridging the gap between the clinic and the
home environment
bull Discipline focused
bull Clinic equipment closet
bull May have group option
Clinic
bull Incorporate into Family Routines
bull Functional activities
bull High Value
bull Adapted environment
Home
Mobility
Early Literacy
Sensory Motor Learning
Social Connections
Perlman Center
Early Learning
Functional MRIs show positive long-term neuro-
cognitive effects of reading to very young
infants
Sensory experiences shape a babyrsquos
knowledge about the world
The average toddler moves 8
out of 10 waking hoursday
Perlman Center
Learning through Experience
Adapting the environment with positioning equipment allows children with disabilities to experience their world and build relationships Allows the child to participate in typical experiences to foster learning
Activities need to promote active engagement
and allow a child to
ndash Actively explore move and participate in play
ndash Assist with self-help routines
ndash Interact and connect with family amp friends
ndash Participate in community activities
ndash Have a means to effectively communicate
ndash Make choices about their wants and need
Perlman Center
Perlman Center
bull Headpointing painting
bull Universal cuffs large pegs splints
bull Switch toys for art activitiesdramatic play-pourer
bull Switch computer access- helpkidzlearncom
bull Fischer Price game with keyboard binder switch
bull Walking in different textures while in standers and walkers
bull Cameramouseorg with dwell click
bull Partner assisted scanning
Alternative amp Adaptive Access to Play
Perlman Center
Change the environment Not the body Adaptations will be critical for success
Gross Motor Fine Motor
Social
Communication
Perlman Center Consider Communication Young children need a reliable form of communication as early as possible
Augmentative Communication is shown to support verbal skills and enhance lives of
birth to three children and their families (Romski et al 2015)
Perlman Center
Holistic approach to AAC intervention should
Build on individual strengths
Focus on participation in real-world contexts
Address psychosocial factors (ie motivation attitude confidence resilience)
Focus on environmental factors to reduce barriers and maximize social supports
In the absence of a holistic approach to communication a child is at risk for failing to engage in social contexts beyond their immediate family or educationalvocational personnel (Light and Mcnaughton 2015)
Augmentative amp Alternative Communication (AAC)
Perlman Center
Early Literacy
Perlman Center
Early Mobility
There is more than one way
Hands Free Matters
Perlman Center
Early Mobility
Should I get a gait trainer if
they are going to walk YES
Are they too young for power NO
Perlman Center
Sensory Motor Learning
Perlman Center
Sensory Motor Learning
Perlman Center
Social Connection
Perlman Center
Total Access to Play
Perlman Center
Perlman defines functional positioning bull Positioning which promotes active movement and participation and
provides an opportunity to positively impact cognitive function
bull Equipment should promote function and participation across the lifespan
Perlman Center
Principles of seating and positioning
bull Obtain a stable base of support
bull Decrease the influence of atypical muscle tone
bull Accommodate fixed deformities and correct flexible deformities
bull Provide the least amount of intervention needed to achieve the greatest level of function
bull There is no one solution or product but typically a combination of tools that provide success
Adapted from Radell (1997) and York and Weimann (1991)
Perlman Center
Key Positioning Components
bull Postural Control Strengthening
bull Range of Motion Weight Bearing
bull Home Activity Programs
Developmental Positioning
bull ADLs-Play Feeding Bathing Sleeping
bull Computer AccessAAC-Integrated Technology
bull Vision Sensory Processing Participation
Upright Positioning
bull EARLY MOBILITY- developmental sequence
bull Gait Trainer Stander amp or Wheelchair
bull Manual wheelchair vs Power Mobility- BOTH
bull Recreational
ldquoTotalrdquo Mobility
bull Body Mechanics Hoyer Lifts Overhead Systems
bull Car Seat ampor Tie Downs
bull Adapted VanRamps
Transfers ampTransportation
Perlman Center
Equipment Plan of Care
Birth to Three
Adapting baby
equipment
Floor Play
StanderWalker
Bath Seat
Car Seat
Braces
Seating for Function
Early ACCESS
Wheelchair
Bed Positioning
Bike amp Swing
Preschool
Stander
Walker
Braces
Bath Seat
Potty Seat
Wheelchair
HiLo seating
AACAccess
Adapted Bed
Car Seat
Transportation
RecreationHEP
School-Age
to Adult
Wheelchair
AACACCESS
Integrated AT
Hilo chair
Standerwalker
Bath chair
Potty chair
Adapted Bed
Car SeatVan
Home modslifts
LeisureWork
Perlman Center
Commercial Products strollers car seats cribs bath seats high chairs
playpen infant swings floor mats nursing pillow ExerSaucers
Perlman Center
Creative Commercial Adaptations
Pool noodles
Snug and Go
Crib Wedges
Bed tableart desk
Laundry baskets
Inflatable bathtub
Inflatable infant pools
Boxesstools
Perlman Center Creative Commercial Adaptations
Laundry basket $400
Pool Noodle x 2 $300
Floor sitterbath support $700
table (BLACK) $800
Garbage can $600
Large pool noodle $300
Stander with anterior support and
Visual adaptation $1700
Perlman Center
Complex Rehab Equipment
Standers
Gait trainers
Bath Support
Car seat
Seating
Feeding tools
AAC
Sensory tools
vibration
Compression garments
NUK brushes
Z Vibe
Modified utensils
Swings
Weight
Head phones
Positioning
Neck supports
Bracing
Bobby pillowU cushion
Benches
Fireflyfriendscom
PlayPaK
Upsee
Go To Seat
Early Literacy
Picture symbols
Voice output switches
Adapted books
Adapted Equipment
Perlman Center
You got this baby Nowhellip Questions
Perlman Center
LETrsquoS PLAY
Hands on Equipment Demonstration
Perlman Center
bull Ulrich B (2010) Opportunities for Early Intervention Based on Theory Basic Neuroscience and Clinical Science Physical Therapy 90(12) 1868-1880
bull McIntyre S Morgan C amp Walker K (2011) Cerebral Palsy Dont Delay Developmental Disabilities Research Reviews 17(2) 114-129
bull Novak I (2014) Evidence-Based Diagnosis Health Care and Rehabilitation for Children with Cerebral Palsy Journal of Child Neurology 29(8) 1141-1156
bull Morgan C Novak I amp Badawi N (2013) Enriched Environments and Motor Outcomes in Cerebral Palsy Systematic Review and Meta-analysis Pediatrics 132 (3)e 735 -e746
bull Morgan C Novak I Dale R Guzzetta A amp Badawi N (2014) GAME (Goals- Activity-Motor Enrichment) protocol of a single blind randomised controlled trial of motor training parent education and environmental enrichment for infants at high risk of cerebral palsy BMC Neurology 14(203)
bull Whittingham K Wee D amp Boyd R (2010) Systematic review of the efficacy of parenting interventions for children with cerebral palsy Child care health and development 37(4) 475-483
bull Morgan C Novak I dale R amp Badawi N (2015) Optimising motor learning in infants at high risk of cerebral palsy a pilot study BMC Pediatrics 15(1) n pag Web
bull Vos R Dallmeijer A Verhoef M et al (2014) Developmental trajectories of receptive and expressive communication in children and young adults with cerebral palsy Developmental Medicine amp Child Neurology 56 951-959
bull Light J and McNaughton D (2015) Designing AAC research and intervention to improve outcomes for individuals with complex communication needs Augmentative and Alternative Communication 31(2) 85-96
bull Romski M Sevcik R Barton-Hulsey A amp Whitmore A (2015) Early Intervention and AAC What a difference 30 years makes Augmentative and Alternative Communication 31 (3) 181-202
References
Perlman Center
bull Novak I Cusick A Lannin N (2009) Occupational therapy home programs for cerebral palsy Double-blind randomised controlled trial Pediatrics 124 e606-e614
bull Gericke T (2006) Postural management for children with cerebral palsy consensus statement Dev Med Child Neurol 48 (4) 244-244
bull McKeever P Rossen B Scott H Robinson-Vincent K amp Wright V (2013) The significance of uprightness parentsrsquo reflections on childrenrsquos responses to a hands-free walker for children Disability amp Society 28(3) 380-392
bull Law M Pollock N Russell D Walter S et al (2011) Focus on function a cluster randomised controlled trial comparing child-versus context-focused intervention for young children with cerebral palsy Dev Med Child Neurol 53 621-629
bull ldquoSensory Processing Developmental Chartrdquo Sensory Processing Developmental Chart Np nd Web 12 Oct 2015
bull Folio MR amp Fewell RR(2000) Peabody Developmental Motor Scales- Second edition Austin TX PRO ED
bull Voress Judith K amp Pearson Nils A (2013) Early Childhood Development Chart-Third edition Austin TX PRO ED
bull Paul Rhea (2007) Language Disorders from Infancy Through Adolescence Assessment amp Intervention Third edition St Louis MA Mosby Inc
bull Prosser L Ohlrich L Curatalo L Alter K amp Damiano D (2012) Feasibility and preliminary effectiveness of a novel mobility training intervention in infants and toddlers with cerebral palsy Developmental Neurorehabilitation 15(4) 259-266
References
Perlman Center
Bridging the gap between clinical
assessments and family need
bull Identify Limitations
bull Developmental Delays
bull Medical needs
Clinical Finding
bull Family Routines
bull Family Priorities
bull Overcome Barriers and Obstacles
Family Need
Perlman Center
10 minutes
Perlman Center
bull Considering severity and complexity of diagnosis delays
parentsrsquo level of education acceptance and understanding of
their childrsquos diagnosis
bull Frequency Does the childfamily need weekly treatment once
per month or a burst of therapy every couple of months
bull Most supportive environment group or individual home-based
or clinic-based
bull Referrals for specialized intervention (splinting constraint
therapy adaptive equipment oral-motorfeeding therapy vision
therapy Kinesiotherapy etc)
Develop a Therapy Plan
Perlman Center
Perlman Case Study Examples
Mild delays
Infant has risks for CP
Moderate Delays
Infant presents abnormal motor delays
Severe Delays
Infant presents with significant
neuro-motor impairments
Perlman Center M
ild d
ela
ys-a
t risk
bull Full term
bull Difficult delivery
bull Seizure after delivery
bull Abnormal MRI
bull Mom has degree in child development
Mod
era
te d
ela
ys
bull Full term
bull Seizure activity and HIE following birth
bull Abnormal movements of UELE
bull Abnormal MRI
bull Sensory issues
bull Feeding difficulty S
eve
re d
ela
ys
bull Preemie
bull Difficult pregnancy
bull Ruptured placenta
bull Seizures NICU
bull Tonic posturing
bull Feeding difficulty
bull Family lost another child
Case Studies Patient Medical History
Perlman Center M
ild d
ela
ys-A
t R
isk
bull MRI- basal ganglia
bull Clinic check-ups have been on track
bull Underlying weakness observed by PT
bull Slight catch in Right hamstring
bull 1x every 3-4 weeks
Modera
te d
ela
ys
bull Presents with tonal posturing
bull External support for positioning
bull Sensitive to vestibular movement
bull Home based EI OP equipment planning
bull Group tx
Severe
dela
ys
bull Severe posturing
bull FeedingGI issues
bull Mom needs lots of support
bull Positioning needs
bull Medical needs
bull 2x week group setting (OT PT SLP SW MDs feeding team)
Perlman Center
Build high value
interventions
Perlman Center
bull Therapy to support early parent-infant relationships
bull Build parent confidence
bull Education and training
bull Build opportunities for practice
bull Incorporate into daily routines
Engaging Parents
bull Adapt access to play play is FUN
bull Stimulate exploration inquiry and learning
bull Enrich for cognitive motor sensory and social development
Building Enriched
Environments
bull Goal-oriented intensive motor training (Morgan et al 2015)
bull Build in repetition
bull Scaffold so infant is able to complete at least part of the task
bull Experience-based activities will engage self-initiation of movement
bull Occurs while participating in daily routines (ie at the grocery)
Applying Early Motor Learning
Specific Strategies
Perlman Center
Engaging Parents Education
Topic Lists
Identify parent priorities and begin education based
on parentsrsquo perceived need
child diagnoses
parent support and resources
oral-motor and feeding
seating and positioning
disabilities across the lifespan
gross motor development
patient advocacy
adapted equipment fine motor development
home positioning techniques
financial resources
sensory integration
types of rehabilitation therapy
speech and language
Perlman Center
Engaging Parents Goal Setting
Perlman Center
Educate
Model
Engage
Observe
Connect
Perlman Center
Purposeful Play ishellip
Goal oriented
Activity based
Motivating
In an Enriched environment
Perlman Center
Perlman Center
cognitive
sensory
motor
social
Perlman Center
Building Enriched Environments
Perlman Center
Building Enriched Environments
bull Is the child positioned within
reach to explore the activity
bull Are all senses being utilized
bull Is the child being motivated to
move throughout the
environment
bull Is the environment adapted to
increase access to play
Perlman Center
Building Enriched Environments
bull Can the child have an effect
on the activity within the
environment
bull Is the activity appropriately
challenging the child within the
environment
bull Is the child presented with the
need for problem solving
Perlman Center
Building Enriched Environments
bull Is the child motivated to repeat
the task for motor learning
bull Does the environment support
learning (ie appropriate
noise level social motivators
peer groups developmental
learning supports visual
supports auditory feedback
etc)
Perlman Center
Bridging the gap between the clinic and the
home environment
bull Discipline focused
bull Clinic equipment closet
bull May have group option
Clinic
bull Incorporate into Family Routines
bull Functional activities
bull High Value
bull Adapted environment
Home
Mobility
Early Literacy
Sensory Motor Learning
Social Connections
Perlman Center
Early Learning
Functional MRIs show positive long-term neuro-
cognitive effects of reading to very young
infants
Sensory experiences shape a babyrsquos
knowledge about the world
The average toddler moves 8
out of 10 waking hoursday
Perlman Center
Learning through Experience
Adapting the environment with positioning equipment allows children with disabilities to experience their world and build relationships Allows the child to participate in typical experiences to foster learning
Activities need to promote active engagement
and allow a child to
ndash Actively explore move and participate in play
ndash Assist with self-help routines
ndash Interact and connect with family amp friends
ndash Participate in community activities
ndash Have a means to effectively communicate
ndash Make choices about their wants and need
Perlman Center
Perlman Center
bull Headpointing painting
bull Universal cuffs large pegs splints
bull Switch toys for art activitiesdramatic play-pourer
bull Switch computer access- helpkidzlearncom
bull Fischer Price game with keyboard binder switch
bull Walking in different textures while in standers and walkers
bull Cameramouseorg with dwell click
bull Partner assisted scanning
Alternative amp Adaptive Access to Play
Perlman Center
Change the environment Not the body Adaptations will be critical for success
Gross Motor Fine Motor
Social
Communication
Perlman Center Consider Communication Young children need a reliable form of communication as early as possible
Augmentative Communication is shown to support verbal skills and enhance lives of
birth to three children and their families (Romski et al 2015)
Perlman Center
Holistic approach to AAC intervention should
Build on individual strengths
Focus on participation in real-world contexts
Address psychosocial factors (ie motivation attitude confidence resilience)
Focus on environmental factors to reduce barriers and maximize social supports
In the absence of a holistic approach to communication a child is at risk for failing to engage in social contexts beyond their immediate family or educationalvocational personnel (Light and Mcnaughton 2015)
Augmentative amp Alternative Communication (AAC)
Perlman Center
Early Literacy
Perlman Center
Early Mobility
There is more than one way
Hands Free Matters
Perlman Center
Early Mobility
Should I get a gait trainer if
they are going to walk YES
Are they too young for power NO
Perlman Center
Sensory Motor Learning
Perlman Center
Sensory Motor Learning
Perlman Center
Social Connection
Perlman Center
Total Access to Play
Perlman Center
Perlman defines functional positioning bull Positioning which promotes active movement and participation and
provides an opportunity to positively impact cognitive function
bull Equipment should promote function and participation across the lifespan
Perlman Center
Principles of seating and positioning
bull Obtain a stable base of support
bull Decrease the influence of atypical muscle tone
bull Accommodate fixed deformities and correct flexible deformities
bull Provide the least amount of intervention needed to achieve the greatest level of function
bull There is no one solution or product but typically a combination of tools that provide success
Adapted from Radell (1997) and York and Weimann (1991)
Perlman Center
Key Positioning Components
bull Postural Control Strengthening
bull Range of Motion Weight Bearing
bull Home Activity Programs
Developmental Positioning
bull ADLs-Play Feeding Bathing Sleeping
bull Computer AccessAAC-Integrated Technology
bull Vision Sensory Processing Participation
Upright Positioning
bull EARLY MOBILITY- developmental sequence
bull Gait Trainer Stander amp or Wheelchair
bull Manual wheelchair vs Power Mobility- BOTH
bull Recreational
ldquoTotalrdquo Mobility
bull Body Mechanics Hoyer Lifts Overhead Systems
bull Car Seat ampor Tie Downs
bull Adapted VanRamps
Transfers ampTransportation
Perlman Center
Equipment Plan of Care
Birth to Three
Adapting baby
equipment
Floor Play
StanderWalker
Bath Seat
Car Seat
Braces
Seating for Function
Early ACCESS
Wheelchair
Bed Positioning
Bike amp Swing
Preschool
Stander
Walker
Braces
Bath Seat
Potty Seat
Wheelchair
HiLo seating
AACAccess
Adapted Bed
Car Seat
Transportation
RecreationHEP
School-Age
to Adult
Wheelchair
AACACCESS
Integrated AT
Hilo chair
Standerwalker
Bath chair
Potty chair
Adapted Bed
Car SeatVan
Home modslifts
LeisureWork
Perlman Center
Commercial Products strollers car seats cribs bath seats high chairs
playpen infant swings floor mats nursing pillow ExerSaucers
Perlman Center
Creative Commercial Adaptations
Pool noodles
Snug and Go
Crib Wedges
Bed tableart desk
Laundry baskets
Inflatable bathtub
Inflatable infant pools
Boxesstools
Perlman Center Creative Commercial Adaptations
Laundry basket $400
Pool Noodle x 2 $300
Floor sitterbath support $700
table (BLACK) $800
Garbage can $600
Large pool noodle $300
Stander with anterior support and
Visual adaptation $1700
Perlman Center
Complex Rehab Equipment
Standers
Gait trainers
Bath Support
Car seat
Seating
Feeding tools
AAC
Sensory tools
vibration
Compression garments
NUK brushes
Z Vibe
Modified utensils
Swings
Weight
Head phones
Positioning
Neck supports
Bracing
Bobby pillowU cushion
Benches
Fireflyfriendscom
PlayPaK
Upsee
Go To Seat
Early Literacy
Picture symbols
Voice output switches
Adapted books
Adapted Equipment
Perlman Center
You got this baby Nowhellip Questions
Perlman Center
LETrsquoS PLAY
Hands on Equipment Demonstration
Perlman Center
bull Ulrich B (2010) Opportunities for Early Intervention Based on Theory Basic Neuroscience and Clinical Science Physical Therapy 90(12) 1868-1880
bull McIntyre S Morgan C amp Walker K (2011) Cerebral Palsy Dont Delay Developmental Disabilities Research Reviews 17(2) 114-129
bull Novak I (2014) Evidence-Based Diagnosis Health Care and Rehabilitation for Children with Cerebral Palsy Journal of Child Neurology 29(8) 1141-1156
bull Morgan C Novak I amp Badawi N (2013) Enriched Environments and Motor Outcomes in Cerebral Palsy Systematic Review and Meta-analysis Pediatrics 132 (3)e 735 -e746
bull Morgan C Novak I Dale R Guzzetta A amp Badawi N (2014) GAME (Goals- Activity-Motor Enrichment) protocol of a single blind randomised controlled trial of motor training parent education and environmental enrichment for infants at high risk of cerebral palsy BMC Neurology 14(203)
bull Whittingham K Wee D amp Boyd R (2010) Systematic review of the efficacy of parenting interventions for children with cerebral palsy Child care health and development 37(4) 475-483
bull Morgan C Novak I dale R amp Badawi N (2015) Optimising motor learning in infants at high risk of cerebral palsy a pilot study BMC Pediatrics 15(1) n pag Web
bull Vos R Dallmeijer A Verhoef M et al (2014) Developmental trajectories of receptive and expressive communication in children and young adults with cerebral palsy Developmental Medicine amp Child Neurology 56 951-959
bull Light J and McNaughton D (2015) Designing AAC research and intervention to improve outcomes for individuals with complex communication needs Augmentative and Alternative Communication 31(2) 85-96
bull Romski M Sevcik R Barton-Hulsey A amp Whitmore A (2015) Early Intervention and AAC What a difference 30 years makes Augmentative and Alternative Communication 31 (3) 181-202
References
Perlman Center
bull Novak I Cusick A Lannin N (2009) Occupational therapy home programs for cerebral palsy Double-blind randomised controlled trial Pediatrics 124 e606-e614
bull Gericke T (2006) Postural management for children with cerebral palsy consensus statement Dev Med Child Neurol 48 (4) 244-244
bull McKeever P Rossen B Scott H Robinson-Vincent K amp Wright V (2013) The significance of uprightness parentsrsquo reflections on childrenrsquos responses to a hands-free walker for children Disability amp Society 28(3) 380-392
bull Law M Pollock N Russell D Walter S et al (2011) Focus on function a cluster randomised controlled trial comparing child-versus context-focused intervention for young children with cerebral palsy Dev Med Child Neurol 53 621-629
bull ldquoSensory Processing Developmental Chartrdquo Sensory Processing Developmental Chart Np nd Web 12 Oct 2015
bull Folio MR amp Fewell RR(2000) Peabody Developmental Motor Scales- Second edition Austin TX PRO ED
bull Voress Judith K amp Pearson Nils A (2013) Early Childhood Development Chart-Third edition Austin TX PRO ED
bull Paul Rhea (2007) Language Disorders from Infancy Through Adolescence Assessment amp Intervention Third edition St Louis MA Mosby Inc
bull Prosser L Ohlrich L Curatalo L Alter K amp Damiano D (2012) Feasibility and preliminary effectiveness of a novel mobility training intervention in infants and toddlers with cerebral palsy Developmental Neurorehabilitation 15(4) 259-266
References
Perlman Center
10 minutes
Perlman Center
bull Considering severity and complexity of diagnosis delays
parentsrsquo level of education acceptance and understanding of
their childrsquos diagnosis
bull Frequency Does the childfamily need weekly treatment once
per month or a burst of therapy every couple of months
bull Most supportive environment group or individual home-based
or clinic-based
bull Referrals for specialized intervention (splinting constraint
therapy adaptive equipment oral-motorfeeding therapy vision
therapy Kinesiotherapy etc)
Develop a Therapy Plan
Perlman Center
Perlman Case Study Examples
Mild delays
Infant has risks for CP
Moderate Delays
Infant presents abnormal motor delays
Severe Delays
Infant presents with significant
neuro-motor impairments
Perlman Center M
ild d
ela
ys-a
t risk
bull Full term
bull Difficult delivery
bull Seizure after delivery
bull Abnormal MRI
bull Mom has degree in child development
Mod
era
te d
ela
ys
bull Full term
bull Seizure activity and HIE following birth
bull Abnormal movements of UELE
bull Abnormal MRI
bull Sensory issues
bull Feeding difficulty S
eve
re d
ela
ys
bull Preemie
bull Difficult pregnancy
bull Ruptured placenta
bull Seizures NICU
bull Tonic posturing
bull Feeding difficulty
bull Family lost another child
Case Studies Patient Medical History
Perlman Center M
ild d
ela
ys-A
t R
isk
bull MRI- basal ganglia
bull Clinic check-ups have been on track
bull Underlying weakness observed by PT
bull Slight catch in Right hamstring
bull 1x every 3-4 weeks
Modera
te d
ela
ys
bull Presents with tonal posturing
bull External support for positioning
bull Sensitive to vestibular movement
bull Home based EI OP equipment planning
bull Group tx
Severe
dela
ys
bull Severe posturing
bull FeedingGI issues
bull Mom needs lots of support
bull Positioning needs
bull Medical needs
bull 2x week group setting (OT PT SLP SW MDs feeding team)
Perlman Center
Build high value
interventions
Perlman Center
bull Therapy to support early parent-infant relationships
bull Build parent confidence
bull Education and training
bull Build opportunities for practice
bull Incorporate into daily routines
Engaging Parents
bull Adapt access to play play is FUN
bull Stimulate exploration inquiry and learning
bull Enrich for cognitive motor sensory and social development
Building Enriched
Environments
bull Goal-oriented intensive motor training (Morgan et al 2015)
bull Build in repetition
bull Scaffold so infant is able to complete at least part of the task
bull Experience-based activities will engage self-initiation of movement
bull Occurs while participating in daily routines (ie at the grocery)
Applying Early Motor Learning
Specific Strategies
Perlman Center
Engaging Parents Education
Topic Lists
Identify parent priorities and begin education based
on parentsrsquo perceived need
child diagnoses
parent support and resources
oral-motor and feeding
seating and positioning
disabilities across the lifespan
gross motor development
patient advocacy
adapted equipment fine motor development
home positioning techniques
financial resources
sensory integration
types of rehabilitation therapy
speech and language
Perlman Center
Engaging Parents Goal Setting
Perlman Center
Educate
Model
Engage
Observe
Connect
Perlman Center
Purposeful Play ishellip
Goal oriented
Activity based
Motivating
In an Enriched environment
Perlman Center
Perlman Center
cognitive
sensory
motor
social
Perlman Center
Building Enriched Environments
Perlman Center
Building Enriched Environments
bull Is the child positioned within
reach to explore the activity
bull Are all senses being utilized
bull Is the child being motivated to
move throughout the
environment
bull Is the environment adapted to
increase access to play
Perlman Center
Building Enriched Environments
bull Can the child have an effect
on the activity within the
environment
bull Is the activity appropriately
challenging the child within the
environment
bull Is the child presented with the
need for problem solving
Perlman Center
Building Enriched Environments
bull Is the child motivated to repeat
the task for motor learning
bull Does the environment support
learning (ie appropriate
noise level social motivators
peer groups developmental
learning supports visual
supports auditory feedback
etc)
Perlman Center
Bridging the gap between the clinic and the
home environment
bull Discipline focused
bull Clinic equipment closet
bull May have group option
Clinic
bull Incorporate into Family Routines
bull Functional activities
bull High Value
bull Adapted environment
Home
Mobility
Early Literacy
Sensory Motor Learning
Social Connections
Perlman Center
Early Learning
Functional MRIs show positive long-term neuro-
cognitive effects of reading to very young
infants
Sensory experiences shape a babyrsquos
knowledge about the world
The average toddler moves 8
out of 10 waking hoursday
Perlman Center
Learning through Experience
Adapting the environment with positioning equipment allows children with disabilities to experience their world and build relationships Allows the child to participate in typical experiences to foster learning
Activities need to promote active engagement
and allow a child to
ndash Actively explore move and participate in play
ndash Assist with self-help routines
ndash Interact and connect with family amp friends
ndash Participate in community activities
ndash Have a means to effectively communicate
ndash Make choices about their wants and need
Perlman Center
Perlman Center
bull Headpointing painting
bull Universal cuffs large pegs splints
bull Switch toys for art activitiesdramatic play-pourer
bull Switch computer access- helpkidzlearncom
bull Fischer Price game with keyboard binder switch
bull Walking in different textures while in standers and walkers
bull Cameramouseorg with dwell click
bull Partner assisted scanning
Alternative amp Adaptive Access to Play
Perlman Center
Change the environment Not the body Adaptations will be critical for success
Gross Motor Fine Motor
Social
Communication
Perlman Center Consider Communication Young children need a reliable form of communication as early as possible
Augmentative Communication is shown to support verbal skills and enhance lives of
birth to three children and their families (Romski et al 2015)
Perlman Center
Holistic approach to AAC intervention should
Build on individual strengths
Focus on participation in real-world contexts
Address psychosocial factors (ie motivation attitude confidence resilience)
Focus on environmental factors to reduce barriers and maximize social supports
In the absence of a holistic approach to communication a child is at risk for failing to engage in social contexts beyond their immediate family or educationalvocational personnel (Light and Mcnaughton 2015)
Augmentative amp Alternative Communication (AAC)
Perlman Center
Early Literacy
Perlman Center
Early Mobility
There is more than one way
Hands Free Matters
Perlman Center
Early Mobility
Should I get a gait trainer if
they are going to walk YES
Are they too young for power NO
Perlman Center
Sensory Motor Learning
Perlman Center
Sensory Motor Learning
Perlman Center
Social Connection
Perlman Center
Total Access to Play
Perlman Center
Perlman defines functional positioning bull Positioning which promotes active movement and participation and
provides an opportunity to positively impact cognitive function
bull Equipment should promote function and participation across the lifespan
Perlman Center
Principles of seating and positioning
bull Obtain a stable base of support
bull Decrease the influence of atypical muscle tone
bull Accommodate fixed deformities and correct flexible deformities
bull Provide the least amount of intervention needed to achieve the greatest level of function
bull There is no one solution or product but typically a combination of tools that provide success
Adapted from Radell (1997) and York and Weimann (1991)
Perlman Center
Key Positioning Components
bull Postural Control Strengthening
bull Range of Motion Weight Bearing
bull Home Activity Programs
Developmental Positioning
bull ADLs-Play Feeding Bathing Sleeping
bull Computer AccessAAC-Integrated Technology
bull Vision Sensory Processing Participation
Upright Positioning
bull EARLY MOBILITY- developmental sequence
bull Gait Trainer Stander amp or Wheelchair
bull Manual wheelchair vs Power Mobility- BOTH
bull Recreational
ldquoTotalrdquo Mobility
bull Body Mechanics Hoyer Lifts Overhead Systems
bull Car Seat ampor Tie Downs
bull Adapted VanRamps
Transfers ampTransportation
Perlman Center
Equipment Plan of Care
Birth to Three
Adapting baby
equipment
Floor Play
StanderWalker
Bath Seat
Car Seat
Braces
Seating for Function
Early ACCESS
Wheelchair
Bed Positioning
Bike amp Swing
Preschool
Stander
Walker
Braces
Bath Seat
Potty Seat
Wheelchair
HiLo seating
AACAccess
Adapted Bed
Car Seat
Transportation
RecreationHEP
School-Age
to Adult
Wheelchair
AACACCESS
Integrated AT
Hilo chair
Standerwalker
Bath chair
Potty chair
Adapted Bed
Car SeatVan
Home modslifts
LeisureWork
Perlman Center
Commercial Products strollers car seats cribs bath seats high chairs
playpen infant swings floor mats nursing pillow ExerSaucers
Perlman Center
Creative Commercial Adaptations
Pool noodles
Snug and Go
Crib Wedges
Bed tableart desk
Laundry baskets
Inflatable bathtub
Inflatable infant pools
Boxesstools
Perlman Center Creative Commercial Adaptations
Laundry basket $400
Pool Noodle x 2 $300
Floor sitterbath support $700
table (BLACK) $800
Garbage can $600
Large pool noodle $300
Stander with anterior support and
Visual adaptation $1700
Perlman Center
Complex Rehab Equipment
Standers
Gait trainers
Bath Support
Car seat
Seating
Feeding tools
AAC
Sensory tools
vibration
Compression garments
NUK brushes
Z Vibe
Modified utensils
Swings
Weight
Head phones
Positioning
Neck supports
Bracing
Bobby pillowU cushion
Benches
Fireflyfriendscom
PlayPaK
Upsee
Go To Seat
Early Literacy
Picture symbols
Voice output switches
Adapted books
Adapted Equipment
Perlman Center
You got this baby Nowhellip Questions
Perlman Center
LETrsquoS PLAY
Hands on Equipment Demonstration
Perlman Center
bull Ulrich B (2010) Opportunities for Early Intervention Based on Theory Basic Neuroscience and Clinical Science Physical Therapy 90(12) 1868-1880
bull McIntyre S Morgan C amp Walker K (2011) Cerebral Palsy Dont Delay Developmental Disabilities Research Reviews 17(2) 114-129
bull Novak I (2014) Evidence-Based Diagnosis Health Care and Rehabilitation for Children with Cerebral Palsy Journal of Child Neurology 29(8) 1141-1156
bull Morgan C Novak I amp Badawi N (2013) Enriched Environments and Motor Outcomes in Cerebral Palsy Systematic Review and Meta-analysis Pediatrics 132 (3)e 735 -e746
bull Morgan C Novak I Dale R Guzzetta A amp Badawi N (2014) GAME (Goals- Activity-Motor Enrichment) protocol of a single blind randomised controlled trial of motor training parent education and environmental enrichment for infants at high risk of cerebral palsy BMC Neurology 14(203)
bull Whittingham K Wee D amp Boyd R (2010) Systematic review of the efficacy of parenting interventions for children with cerebral palsy Child care health and development 37(4) 475-483
bull Morgan C Novak I dale R amp Badawi N (2015) Optimising motor learning in infants at high risk of cerebral palsy a pilot study BMC Pediatrics 15(1) n pag Web
bull Vos R Dallmeijer A Verhoef M et al (2014) Developmental trajectories of receptive and expressive communication in children and young adults with cerebral palsy Developmental Medicine amp Child Neurology 56 951-959
bull Light J and McNaughton D (2015) Designing AAC research and intervention to improve outcomes for individuals with complex communication needs Augmentative and Alternative Communication 31(2) 85-96
bull Romski M Sevcik R Barton-Hulsey A amp Whitmore A (2015) Early Intervention and AAC What a difference 30 years makes Augmentative and Alternative Communication 31 (3) 181-202
References
Perlman Center
bull Novak I Cusick A Lannin N (2009) Occupational therapy home programs for cerebral palsy Double-blind randomised controlled trial Pediatrics 124 e606-e614
bull Gericke T (2006) Postural management for children with cerebral palsy consensus statement Dev Med Child Neurol 48 (4) 244-244
bull McKeever P Rossen B Scott H Robinson-Vincent K amp Wright V (2013) The significance of uprightness parentsrsquo reflections on childrenrsquos responses to a hands-free walker for children Disability amp Society 28(3) 380-392
bull Law M Pollock N Russell D Walter S et al (2011) Focus on function a cluster randomised controlled trial comparing child-versus context-focused intervention for young children with cerebral palsy Dev Med Child Neurol 53 621-629
bull ldquoSensory Processing Developmental Chartrdquo Sensory Processing Developmental Chart Np nd Web 12 Oct 2015
bull Folio MR amp Fewell RR(2000) Peabody Developmental Motor Scales- Second edition Austin TX PRO ED
bull Voress Judith K amp Pearson Nils A (2013) Early Childhood Development Chart-Third edition Austin TX PRO ED
bull Paul Rhea (2007) Language Disorders from Infancy Through Adolescence Assessment amp Intervention Third edition St Louis MA Mosby Inc
bull Prosser L Ohlrich L Curatalo L Alter K amp Damiano D (2012) Feasibility and preliminary effectiveness of a novel mobility training intervention in infants and toddlers with cerebral palsy Developmental Neurorehabilitation 15(4) 259-266
References
Perlman Center
bull Considering severity and complexity of diagnosis delays
parentsrsquo level of education acceptance and understanding of
their childrsquos diagnosis
bull Frequency Does the childfamily need weekly treatment once
per month or a burst of therapy every couple of months
bull Most supportive environment group or individual home-based
or clinic-based
bull Referrals for specialized intervention (splinting constraint
therapy adaptive equipment oral-motorfeeding therapy vision
therapy Kinesiotherapy etc)
Develop a Therapy Plan
Perlman Center
Perlman Case Study Examples
Mild delays
Infant has risks for CP
Moderate Delays
Infant presents abnormal motor delays
Severe Delays
Infant presents with significant
neuro-motor impairments
Perlman Center M
ild d
ela
ys-a
t risk
bull Full term
bull Difficult delivery
bull Seizure after delivery
bull Abnormal MRI
bull Mom has degree in child development
Mod
era
te d
ela
ys
bull Full term
bull Seizure activity and HIE following birth
bull Abnormal movements of UELE
bull Abnormal MRI
bull Sensory issues
bull Feeding difficulty S
eve
re d
ela
ys
bull Preemie
bull Difficult pregnancy
bull Ruptured placenta
bull Seizures NICU
bull Tonic posturing
bull Feeding difficulty
bull Family lost another child
Case Studies Patient Medical History
Perlman Center M
ild d
ela
ys-A
t R
isk
bull MRI- basal ganglia
bull Clinic check-ups have been on track
bull Underlying weakness observed by PT
bull Slight catch in Right hamstring
bull 1x every 3-4 weeks
Modera
te d
ela
ys
bull Presents with tonal posturing
bull External support for positioning
bull Sensitive to vestibular movement
bull Home based EI OP equipment planning
bull Group tx
Severe
dela
ys
bull Severe posturing
bull FeedingGI issues
bull Mom needs lots of support
bull Positioning needs
bull Medical needs
bull 2x week group setting (OT PT SLP SW MDs feeding team)
Perlman Center
Build high value
interventions
Perlman Center
bull Therapy to support early parent-infant relationships
bull Build parent confidence
bull Education and training
bull Build opportunities for practice
bull Incorporate into daily routines
Engaging Parents
bull Adapt access to play play is FUN
bull Stimulate exploration inquiry and learning
bull Enrich for cognitive motor sensory and social development
Building Enriched
Environments
bull Goal-oriented intensive motor training (Morgan et al 2015)
bull Build in repetition
bull Scaffold so infant is able to complete at least part of the task
bull Experience-based activities will engage self-initiation of movement
bull Occurs while participating in daily routines (ie at the grocery)
Applying Early Motor Learning
Specific Strategies
Perlman Center
Engaging Parents Education
Topic Lists
Identify parent priorities and begin education based
on parentsrsquo perceived need
child diagnoses
parent support and resources
oral-motor and feeding
seating and positioning
disabilities across the lifespan
gross motor development
patient advocacy
adapted equipment fine motor development
home positioning techniques
financial resources
sensory integration
types of rehabilitation therapy
speech and language
Perlman Center
Engaging Parents Goal Setting
Perlman Center
Educate
Model
Engage
Observe
Connect
Perlman Center
Purposeful Play ishellip
Goal oriented
Activity based
Motivating
In an Enriched environment
Perlman Center
Perlman Center
cognitive
sensory
motor
social
Perlman Center
Building Enriched Environments
Perlman Center
Building Enriched Environments
bull Is the child positioned within
reach to explore the activity
bull Are all senses being utilized
bull Is the child being motivated to
move throughout the
environment
bull Is the environment adapted to
increase access to play
Perlman Center
Building Enriched Environments
bull Can the child have an effect
on the activity within the
environment
bull Is the activity appropriately
challenging the child within the
environment
bull Is the child presented with the
need for problem solving
Perlman Center
Building Enriched Environments
bull Is the child motivated to repeat
the task for motor learning
bull Does the environment support
learning (ie appropriate
noise level social motivators
peer groups developmental
learning supports visual
supports auditory feedback
etc)
Perlman Center
Bridging the gap between the clinic and the
home environment
bull Discipline focused
bull Clinic equipment closet
bull May have group option
Clinic
bull Incorporate into Family Routines
bull Functional activities
bull High Value
bull Adapted environment
Home
Mobility
Early Literacy
Sensory Motor Learning
Social Connections
Perlman Center
Early Learning
Functional MRIs show positive long-term neuro-
cognitive effects of reading to very young
infants
Sensory experiences shape a babyrsquos
knowledge about the world
The average toddler moves 8
out of 10 waking hoursday
Perlman Center
Learning through Experience
Adapting the environment with positioning equipment allows children with disabilities to experience their world and build relationships Allows the child to participate in typical experiences to foster learning
Activities need to promote active engagement
and allow a child to
ndash Actively explore move and participate in play
ndash Assist with self-help routines
ndash Interact and connect with family amp friends
ndash Participate in community activities
ndash Have a means to effectively communicate
ndash Make choices about their wants and need
Perlman Center
Perlman Center
bull Headpointing painting
bull Universal cuffs large pegs splints
bull Switch toys for art activitiesdramatic play-pourer
bull Switch computer access- helpkidzlearncom
bull Fischer Price game with keyboard binder switch
bull Walking in different textures while in standers and walkers
bull Cameramouseorg with dwell click
bull Partner assisted scanning
Alternative amp Adaptive Access to Play
Perlman Center
Change the environment Not the body Adaptations will be critical for success
Gross Motor Fine Motor
Social
Communication
Perlman Center Consider Communication Young children need a reliable form of communication as early as possible
Augmentative Communication is shown to support verbal skills and enhance lives of
birth to three children and their families (Romski et al 2015)
Perlman Center
Holistic approach to AAC intervention should
Build on individual strengths
Focus on participation in real-world contexts
Address psychosocial factors (ie motivation attitude confidence resilience)
Focus on environmental factors to reduce barriers and maximize social supports
In the absence of a holistic approach to communication a child is at risk for failing to engage in social contexts beyond their immediate family or educationalvocational personnel (Light and Mcnaughton 2015)
Augmentative amp Alternative Communication (AAC)
Perlman Center
Early Literacy
Perlman Center
Early Mobility
There is more than one way
Hands Free Matters
Perlman Center
Early Mobility
Should I get a gait trainer if
they are going to walk YES
Are they too young for power NO
Perlman Center
Sensory Motor Learning
Perlman Center
Sensory Motor Learning
Perlman Center
Social Connection
Perlman Center
Total Access to Play
Perlman Center
Perlman defines functional positioning bull Positioning which promotes active movement and participation and
provides an opportunity to positively impact cognitive function
bull Equipment should promote function and participation across the lifespan
Perlman Center
Principles of seating and positioning
bull Obtain a stable base of support
bull Decrease the influence of atypical muscle tone
bull Accommodate fixed deformities and correct flexible deformities
bull Provide the least amount of intervention needed to achieve the greatest level of function
bull There is no one solution or product but typically a combination of tools that provide success
Adapted from Radell (1997) and York and Weimann (1991)
Perlman Center
Key Positioning Components
bull Postural Control Strengthening
bull Range of Motion Weight Bearing
bull Home Activity Programs
Developmental Positioning
bull ADLs-Play Feeding Bathing Sleeping
bull Computer AccessAAC-Integrated Technology
bull Vision Sensory Processing Participation
Upright Positioning
bull EARLY MOBILITY- developmental sequence
bull Gait Trainer Stander amp or Wheelchair
bull Manual wheelchair vs Power Mobility- BOTH
bull Recreational
ldquoTotalrdquo Mobility
bull Body Mechanics Hoyer Lifts Overhead Systems
bull Car Seat ampor Tie Downs
bull Adapted VanRamps
Transfers ampTransportation
Perlman Center
Equipment Plan of Care
Birth to Three
Adapting baby
equipment
Floor Play
StanderWalker
Bath Seat
Car Seat
Braces
Seating for Function
Early ACCESS
Wheelchair
Bed Positioning
Bike amp Swing
Preschool
Stander
Walker
Braces
Bath Seat
Potty Seat
Wheelchair
HiLo seating
AACAccess
Adapted Bed
Car Seat
Transportation
RecreationHEP
School-Age
to Adult
Wheelchair
AACACCESS
Integrated AT
Hilo chair
Standerwalker
Bath chair
Potty chair
Adapted Bed
Car SeatVan
Home modslifts
LeisureWork
Perlman Center
Commercial Products strollers car seats cribs bath seats high chairs
playpen infant swings floor mats nursing pillow ExerSaucers
Perlman Center
Creative Commercial Adaptations
Pool noodles
Snug and Go
Crib Wedges
Bed tableart desk
Laundry baskets
Inflatable bathtub
Inflatable infant pools
Boxesstools
Perlman Center Creative Commercial Adaptations
Laundry basket $400
Pool Noodle x 2 $300
Floor sitterbath support $700
table (BLACK) $800
Garbage can $600
Large pool noodle $300
Stander with anterior support and
Visual adaptation $1700
Perlman Center
Complex Rehab Equipment
Standers
Gait trainers
Bath Support
Car seat
Seating
Feeding tools
AAC
Sensory tools
vibration
Compression garments
NUK brushes
Z Vibe
Modified utensils
Swings
Weight
Head phones
Positioning
Neck supports
Bracing
Bobby pillowU cushion
Benches
Fireflyfriendscom
PlayPaK
Upsee
Go To Seat
Early Literacy
Picture symbols
Voice output switches
Adapted books
Adapted Equipment
Perlman Center
You got this baby Nowhellip Questions
Perlman Center
LETrsquoS PLAY
Hands on Equipment Demonstration
Perlman Center
bull Ulrich B (2010) Opportunities for Early Intervention Based on Theory Basic Neuroscience and Clinical Science Physical Therapy 90(12) 1868-1880
bull McIntyre S Morgan C amp Walker K (2011) Cerebral Palsy Dont Delay Developmental Disabilities Research Reviews 17(2) 114-129
bull Novak I (2014) Evidence-Based Diagnosis Health Care and Rehabilitation for Children with Cerebral Palsy Journal of Child Neurology 29(8) 1141-1156
bull Morgan C Novak I amp Badawi N (2013) Enriched Environments and Motor Outcomes in Cerebral Palsy Systematic Review and Meta-analysis Pediatrics 132 (3)e 735 -e746
bull Morgan C Novak I Dale R Guzzetta A amp Badawi N (2014) GAME (Goals- Activity-Motor Enrichment) protocol of a single blind randomised controlled trial of motor training parent education and environmental enrichment for infants at high risk of cerebral palsy BMC Neurology 14(203)
bull Whittingham K Wee D amp Boyd R (2010) Systematic review of the efficacy of parenting interventions for children with cerebral palsy Child care health and development 37(4) 475-483
bull Morgan C Novak I dale R amp Badawi N (2015) Optimising motor learning in infants at high risk of cerebral palsy a pilot study BMC Pediatrics 15(1) n pag Web
bull Vos R Dallmeijer A Verhoef M et al (2014) Developmental trajectories of receptive and expressive communication in children and young adults with cerebral palsy Developmental Medicine amp Child Neurology 56 951-959
bull Light J and McNaughton D (2015) Designing AAC research and intervention to improve outcomes for individuals with complex communication needs Augmentative and Alternative Communication 31(2) 85-96
bull Romski M Sevcik R Barton-Hulsey A amp Whitmore A (2015) Early Intervention and AAC What a difference 30 years makes Augmentative and Alternative Communication 31 (3) 181-202
References
Perlman Center
bull Novak I Cusick A Lannin N (2009) Occupational therapy home programs for cerebral palsy Double-blind randomised controlled trial Pediatrics 124 e606-e614
bull Gericke T (2006) Postural management for children with cerebral palsy consensus statement Dev Med Child Neurol 48 (4) 244-244
bull McKeever P Rossen B Scott H Robinson-Vincent K amp Wright V (2013) The significance of uprightness parentsrsquo reflections on childrenrsquos responses to a hands-free walker for children Disability amp Society 28(3) 380-392
bull Law M Pollock N Russell D Walter S et al (2011) Focus on function a cluster randomised controlled trial comparing child-versus context-focused intervention for young children with cerebral palsy Dev Med Child Neurol 53 621-629
bull ldquoSensory Processing Developmental Chartrdquo Sensory Processing Developmental Chart Np nd Web 12 Oct 2015
bull Folio MR amp Fewell RR(2000) Peabody Developmental Motor Scales- Second edition Austin TX PRO ED
bull Voress Judith K amp Pearson Nils A (2013) Early Childhood Development Chart-Third edition Austin TX PRO ED
bull Paul Rhea (2007) Language Disorders from Infancy Through Adolescence Assessment amp Intervention Third edition St Louis MA Mosby Inc
bull Prosser L Ohlrich L Curatalo L Alter K amp Damiano D (2012) Feasibility and preliminary effectiveness of a novel mobility training intervention in infants and toddlers with cerebral palsy Developmental Neurorehabilitation 15(4) 259-266
References
Perlman Center
Perlman Case Study Examples
Mild delays
Infant has risks for CP
Moderate Delays
Infant presents abnormal motor delays
Severe Delays
Infant presents with significant
neuro-motor impairments
Perlman Center M
ild d
ela
ys-a
t risk
bull Full term
bull Difficult delivery
bull Seizure after delivery
bull Abnormal MRI
bull Mom has degree in child development
Mod
era
te d
ela
ys
bull Full term
bull Seizure activity and HIE following birth
bull Abnormal movements of UELE
bull Abnormal MRI
bull Sensory issues
bull Feeding difficulty S
eve
re d
ela
ys
bull Preemie
bull Difficult pregnancy
bull Ruptured placenta
bull Seizures NICU
bull Tonic posturing
bull Feeding difficulty
bull Family lost another child
Case Studies Patient Medical History
Perlman Center M
ild d
ela
ys-A
t R
isk
bull MRI- basal ganglia
bull Clinic check-ups have been on track
bull Underlying weakness observed by PT
bull Slight catch in Right hamstring
bull 1x every 3-4 weeks
Modera
te d
ela
ys
bull Presents with tonal posturing
bull External support for positioning
bull Sensitive to vestibular movement
bull Home based EI OP equipment planning
bull Group tx
Severe
dela
ys
bull Severe posturing
bull FeedingGI issues
bull Mom needs lots of support
bull Positioning needs
bull Medical needs
bull 2x week group setting (OT PT SLP SW MDs feeding team)
Perlman Center
Build high value
interventions
Perlman Center
bull Therapy to support early parent-infant relationships
bull Build parent confidence
bull Education and training
bull Build opportunities for practice
bull Incorporate into daily routines
Engaging Parents
bull Adapt access to play play is FUN
bull Stimulate exploration inquiry and learning
bull Enrich for cognitive motor sensory and social development
Building Enriched
Environments
bull Goal-oriented intensive motor training (Morgan et al 2015)
bull Build in repetition
bull Scaffold so infant is able to complete at least part of the task
bull Experience-based activities will engage self-initiation of movement
bull Occurs while participating in daily routines (ie at the grocery)
Applying Early Motor Learning
Specific Strategies
Perlman Center
Engaging Parents Education
Topic Lists
Identify parent priorities and begin education based
on parentsrsquo perceived need
child diagnoses
parent support and resources
oral-motor and feeding
seating and positioning
disabilities across the lifespan
gross motor development
patient advocacy
adapted equipment fine motor development
home positioning techniques
financial resources
sensory integration
types of rehabilitation therapy
speech and language
Perlman Center
Engaging Parents Goal Setting
Perlman Center
Educate
Model
Engage
Observe
Connect
Perlman Center
Purposeful Play ishellip
Goal oriented
Activity based
Motivating
In an Enriched environment
Perlman Center
Perlman Center
cognitive
sensory
motor
social
Perlman Center
Building Enriched Environments
Perlman Center
Building Enriched Environments
bull Is the child positioned within
reach to explore the activity
bull Are all senses being utilized
bull Is the child being motivated to
move throughout the
environment
bull Is the environment adapted to
increase access to play
Perlman Center
Building Enriched Environments
bull Can the child have an effect
on the activity within the
environment
bull Is the activity appropriately
challenging the child within the
environment
bull Is the child presented with the
need for problem solving
Perlman Center
Building Enriched Environments
bull Is the child motivated to repeat
the task for motor learning
bull Does the environment support
learning (ie appropriate
noise level social motivators
peer groups developmental
learning supports visual
supports auditory feedback
etc)
Perlman Center
Bridging the gap between the clinic and the
home environment
bull Discipline focused
bull Clinic equipment closet
bull May have group option
Clinic
bull Incorporate into Family Routines
bull Functional activities
bull High Value
bull Adapted environment
Home
Mobility
Early Literacy
Sensory Motor Learning
Social Connections
Perlman Center
Early Learning
Functional MRIs show positive long-term neuro-
cognitive effects of reading to very young
infants
Sensory experiences shape a babyrsquos
knowledge about the world
The average toddler moves 8
out of 10 waking hoursday
Perlman Center
Learning through Experience
Adapting the environment with positioning equipment allows children with disabilities to experience their world and build relationships Allows the child to participate in typical experiences to foster learning
Activities need to promote active engagement
and allow a child to
ndash Actively explore move and participate in play
ndash Assist with self-help routines
ndash Interact and connect with family amp friends
ndash Participate in community activities
ndash Have a means to effectively communicate
ndash Make choices about their wants and need
Perlman Center
Perlman Center
bull Headpointing painting
bull Universal cuffs large pegs splints
bull Switch toys for art activitiesdramatic play-pourer
bull Switch computer access- helpkidzlearncom
bull Fischer Price game with keyboard binder switch
bull Walking in different textures while in standers and walkers
bull Cameramouseorg with dwell click
bull Partner assisted scanning
Alternative amp Adaptive Access to Play
Perlman Center
Change the environment Not the body Adaptations will be critical for success
Gross Motor Fine Motor
Social
Communication
Perlman Center Consider Communication Young children need a reliable form of communication as early as possible
Augmentative Communication is shown to support verbal skills and enhance lives of
birth to three children and their families (Romski et al 2015)
Perlman Center
Holistic approach to AAC intervention should
Build on individual strengths
Focus on participation in real-world contexts
Address psychosocial factors (ie motivation attitude confidence resilience)
Focus on environmental factors to reduce barriers and maximize social supports
In the absence of a holistic approach to communication a child is at risk for failing to engage in social contexts beyond their immediate family or educationalvocational personnel (Light and Mcnaughton 2015)
Augmentative amp Alternative Communication (AAC)
Perlman Center
Early Literacy
Perlman Center
Early Mobility
There is more than one way
Hands Free Matters
Perlman Center
Early Mobility
Should I get a gait trainer if
they are going to walk YES
Are they too young for power NO
Perlman Center
Sensory Motor Learning
Perlman Center
Sensory Motor Learning
Perlman Center
Social Connection
Perlman Center
Total Access to Play
Perlman Center
Perlman defines functional positioning bull Positioning which promotes active movement and participation and
provides an opportunity to positively impact cognitive function
bull Equipment should promote function and participation across the lifespan
Perlman Center
Principles of seating and positioning
bull Obtain a stable base of support
bull Decrease the influence of atypical muscle tone
bull Accommodate fixed deformities and correct flexible deformities
bull Provide the least amount of intervention needed to achieve the greatest level of function
bull There is no one solution or product but typically a combination of tools that provide success
Adapted from Radell (1997) and York and Weimann (1991)
Perlman Center
Key Positioning Components
bull Postural Control Strengthening
bull Range of Motion Weight Bearing
bull Home Activity Programs
Developmental Positioning
bull ADLs-Play Feeding Bathing Sleeping
bull Computer AccessAAC-Integrated Technology
bull Vision Sensory Processing Participation
Upright Positioning
bull EARLY MOBILITY- developmental sequence
bull Gait Trainer Stander amp or Wheelchair
bull Manual wheelchair vs Power Mobility- BOTH
bull Recreational
ldquoTotalrdquo Mobility
bull Body Mechanics Hoyer Lifts Overhead Systems
bull Car Seat ampor Tie Downs
bull Adapted VanRamps
Transfers ampTransportation
Perlman Center
Equipment Plan of Care
Birth to Three
Adapting baby
equipment
Floor Play
StanderWalker
Bath Seat
Car Seat
Braces
Seating for Function
Early ACCESS
Wheelchair
Bed Positioning
Bike amp Swing
Preschool
Stander
Walker
Braces
Bath Seat
Potty Seat
Wheelchair
HiLo seating
AACAccess
Adapted Bed
Car Seat
Transportation
RecreationHEP
School-Age
to Adult
Wheelchair
AACACCESS
Integrated AT
Hilo chair
Standerwalker
Bath chair
Potty chair
Adapted Bed
Car SeatVan
Home modslifts
LeisureWork
Perlman Center
Commercial Products strollers car seats cribs bath seats high chairs
playpen infant swings floor mats nursing pillow ExerSaucers
Perlman Center
Creative Commercial Adaptations
Pool noodles
Snug and Go
Crib Wedges
Bed tableart desk
Laundry baskets
Inflatable bathtub
Inflatable infant pools
Boxesstools
Perlman Center Creative Commercial Adaptations
Laundry basket $400
Pool Noodle x 2 $300
Floor sitterbath support $700
table (BLACK) $800
Garbage can $600
Large pool noodle $300
Stander with anterior support and
Visual adaptation $1700
Perlman Center
Complex Rehab Equipment
Standers
Gait trainers
Bath Support
Car seat
Seating
Feeding tools
AAC
Sensory tools
vibration
Compression garments
NUK brushes
Z Vibe
Modified utensils
Swings
Weight
Head phones
Positioning
Neck supports
Bracing
Bobby pillowU cushion
Benches
Fireflyfriendscom
PlayPaK
Upsee
Go To Seat
Early Literacy
Picture symbols
Voice output switches
Adapted books
Adapted Equipment
Perlman Center
You got this baby Nowhellip Questions
Perlman Center
LETrsquoS PLAY
Hands on Equipment Demonstration
Perlman Center
bull Ulrich B (2010) Opportunities for Early Intervention Based on Theory Basic Neuroscience and Clinical Science Physical Therapy 90(12) 1868-1880
bull McIntyre S Morgan C amp Walker K (2011) Cerebral Palsy Dont Delay Developmental Disabilities Research Reviews 17(2) 114-129
bull Novak I (2014) Evidence-Based Diagnosis Health Care and Rehabilitation for Children with Cerebral Palsy Journal of Child Neurology 29(8) 1141-1156
bull Morgan C Novak I amp Badawi N (2013) Enriched Environments and Motor Outcomes in Cerebral Palsy Systematic Review and Meta-analysis Pediatrics 132 (3)e 735 -e746
bull Morgan C Novak I Dale R Guzzetta A amp Badawi N (2014) GAME (Goals- Activity-Motor Enrichment) protocol of a single blind randomised controlled trial of motor training parent education and environmental enrichment for infants at high risk of cerebral palsy BMC Neurology 14(203)
bull Whittingham K Wee D amp Boyd R (2010) Systematic review of the efficacy of parenting interventions for children with cerebral palsy Child care health and development 37(4) 475-483
bull Morgan C Novak I dale R amp Badawi N (2015) Optimising motor learning in infants at high risk of cerebral palsy a pilot study BMC Pediatrics 15(1) n pag Web
bull Vos R Dallmeijer A Verhoef M et al (2014) Developmental trajectories of receptive and expressive communication in children and young adults with cerebral palsy Developmental Medicine amp Child Neurology 56 951-959
bull Light J and McNaughton D (2015) Designing AAC research and intervention to improve outcomes for individuals with complex communication needs Augmentative and Alternative Communication 31(2) 85-96
bull Romski M Sevcik R Barton-Hulsey A amp Whitmore A (2015) Early Intervention and AAC What a difference 30 years makes Augmentative and Alternative Communication 31 (3) 181-202
References
Perlman Center
bull Novak I Cusick A Lannin N (2009) Occupational therapy home programs for cerebral palsy Double-blind randomised controlled trial Pediatrics 124 e606-e614
bull Gericke T (2006) Postural management for children with cerebral palsy consensus statement Dev Med Child Neurol 48 (4) 244-244
bull McKeever P Rossen B Scott H Robinson-Vincent K amp Wright V (2013) The significance of uprightness parentsrsquo reflections on childrenrsquos responses to a hands-free walker for children Disability amp Society 28(3) 380-392
bull Law M Pollock N Russell D Walter S et al (2011) Focus on function a cluster randomised controlled trial comparing child-versus context-focused intervention for young children with cerebral palsy Dev Med Child Neurol 53 621-629
bull ldquoSensory Processing Developmental Chartrdquo Sensory Processing Developmental Chart Np nd Web 12 Oct 2015
bull Folio MR amp Fewell RR(2000) Peabody Developmental Motor Scales- Second edition Austin TX PRO ED
bull Voress Judith K amp Pearson Nils A (2013) Early Childhood Development Chart-Third edition Austin TX PRO ED
bull Paul Rhea (2007) Language Disorders from Infancy Through Adolescence Assessment amp Intervention Third edition St Louis MA Mosby Inc
bull Prosser L Ohlrich L Curatalo L Alter K amp Damiano D (2012) Feasibility and preliminary effectiveness of a novel mobility training intervention in infants and toddlers with cerebral palsy Developmental Neurorehabilitation 15(4) 259-266
References
Perlman Center M
ild d
ela
ys-a
t risk
bull Full term
bull Difficult delivery
bull Seizure after delivery
bull Abnormal MRI
bull Mom has degree in child development
Mod
era
te d
ela
ys
bull Full term
bull Seizure activity and HIE following birth
bull Abnormal movements of UELE
bull Abnormal MRI
bull Sensory issues
bull Feeding difficulty S
eve
re d
ela
ys
bull Preemie
bull Difficult pregnancy
bull Ruptured placenta
bull Seizures NICU
bull Tonic posturing
bull Feeding difficulty
bull Family lost another child
Case Studies Patient Medical History
Perlman Center M
ild d
ela
ys-A
t R
isk
bull MRI- basal ganglia
bull Clinic check-ups have been on track
bull Underlying weakness observed by PT
bull Slight catch in Right hamstring
bull 1x every 3-4 weeks
Modera
te d
ela
ys
bull Presents with tonal posturing
bull External support for positioning
bull Sensitive to vestibular movement
bull Home based EI OP equipment planning
bull Group tx
Severe
dela
ys
bull Severe posturing
bull FeedingGI issues
bull Mom needs lots of support
bull Positioning needs
bull Medical needs
bull 2x week group setting (OT PT SLP SW MDs feeding team)
Perlman Center
Build high value
interventions
Perlman Center
bull Therapy to support early parent-infant relationships
bull Build parent confidence
bull Education and training
bull Build opportunities for practice
bull Incorporate into daily routines
Engaging Parents
bull Adapt access to play play is FUN
bull Stimulate exploration inquiry and learning
bull Enrich for cognitive motor sensory and social development
Building Enriched
Environments
bull Goal-oriented intensive motor training (Morgan et al 2015)
bull Build in repetition
bull Scaffold so infant is able to complete at least part of the task
bull Experience-based activities will engage self-initiation of movement
bull Occurs while participating in daily routines (ie at the grocery)
Applying Early Motor Learning
Specific Strategies
Perlman Center
Engaging Parents Education
Topic Lists
Identify parent priorities and begin education based
on parentsrsquo perceived need
child diagnoses
parent support and resources
oral-motor and feeding
seating and positioning
disabilities across the lifespan
gross motor development
patient advocacy
adapted equipment fine motor development
home positioning techniques
financial resources
sensory integration
types of rehabilitation therapy
speech and language
Perlman Center
Engaging Parents Goal Setting
Perlman Center
Educate
Model
Engage
Observe
Connect
Perlman Center
Purposeful Play ishellip
Goal oriented
Activity based
Motivating
In an Enriched environment
Perlman Center
Perlman Center
cognitive
sensory
motor
social
Perlman Center
Building Enriched Environments
Perlman Center
Building Enriched Environments
bull Is the child positioned within
reach to explore the activity
bull Are all senses being utilized
bull Is the child being motivated to
move throughout the
environment
bull Is the environment adapted to
increase access to play
Perlman Center
Building Enriched Environments
bull Can the child have an effect
on the activity within the
environment
bull Is the activity appropriately
challenging the child within the
environment
bull Is the child presented with the
need for problem solving
Perlman Center
Building Enriched Environments
bull Is the child motivated to repeat
the task for motor learning
bull Does the environment support
learning (ie appropriate
noise level social motivators
peer groups developmental
learning supports visual
supports auditory feedback
etc)
Perlman Center
Bridging the gap between the clinic and the
home environment
bull Discipline focused
bull Clinic equipment closet
bull May have group option
Clinic
bull Incorporate into Family Routines
bull Functional activities
bull High Value
bull Adapted environment
Home
Mobility
Early Literacy
Sensory Motor Learning
Social Connections
Perlman Center
Early Learning
Functional MRIs show positive long-term neuro-
cognitive effects of reading to very young
infants
Sensory experiences shape a babyrsquos
knowledge about the world
The average toddler moves 8
out of 10 waking hoursday
Perlman Center
Learning through Experience
Adapting the environment with positioning equipment allows children with disabilities to experience their world and build relationships Allows the child to participate in typical experiences to foster learning
Activities need to promote active engagement
and allow a child to
ndash Actively explore move and participate in play
ndash Assist with self-help routines
ndash Interact and connect with family amp friends
ndash Participate in community activities
ndash Have a means to effectively communicate
ndash Make choices about their wants and need
Perlman Center
Perlman Center
bull Headpointing painting
bull Universal cuffs large pegs splints
bull Switch toys for art activitiesdramatic play-pourer
bull Switch computer access- helpkidzlearncom
bull Fischer Price game with keyboard binder switch
bull Walking in different textures while in standers and walkers
bull Cameramouseorg with dwell click
bull Partner assisted scanning
Alternative amp Adaptive Access to Play
Perlman Center
Change the environment Not the body Adaptations will be critical for success
Gross Motor Fine Motor
Social
Communication
Perlman Center Consider Communication Young children need a reliable form of communication as early as possible
Augmentative Communication is shown to support verbal skills and enhance lives of
birth to three children and their families (Romski et al 2015)
Perlman Center
Holistic approach to AAC intervention should
Build on individual strengths
Focus on participation in real-world contexts
Address psychosocial factors (ie motivation attitude confidence resilience)
Focus on environmental factors to reduce barriers and maximize social supports
In the absence of a holistic approach to communication a child is at risk for failing to engage in social contexts beyond their immediate family or educationalvocational personnel (Light and Mcnaughton 2015)
Augmentative amp Alternative Communication (AAC)
Perlman Center
Early Literacy
Perlman Center
Early Mobility
There is more than one way
Hands Free Matters
Perlman Center
Early Mobility
Should I get a gait trainer if
they are going to walk YES
Are they too young for power NO
Perlman Center
Sensory Motor Learning
Perlman Center
Sensory Motor Learning
Perlman Center
Social Connection
Perlman Center
Total Access to Play
Perlman Center
Perlman defines functional positioning bull Positioning which promotes active movement and participation and
provides an opportunity to positively impact cognitive function
bull Equipment should promote function and participation across the lifespan
Perlman Center
Principles of seating and positioning
bull Obtain a stable base of support
bull Decrease the influence of atypical muscle tone
bull Accommodate fixed deformities and correct flexible deformities
bull Provide the least amount of intervention needed to achieve the greatest level of function
bull There is no one solution or product but typically a combination of tools that provide success
Adapted from Radell (1997) and York and Weimann (1991)
Perlman Center
Key Positioning Components
bull Postural Control Strengthening
bull Range of Motion Weight Bearing
bull Home Activity Programs
Developmental Positioning
bull ADLs-Play Feeding Bathing Sleeping
bull Computer AccessAAC-Integrated Technology
bull Vision Sensory Processing Participation
Upright Positioning
bull EARLY MOBILITY- developmental sequence
bull Gait Trainer Stander amp or Wheelchair
bull Manual wheelchair vs Power Mobility- BOTH
bull Recreational
ldquoTotalrdquo Mobility
bull Body Mechanics Hoyer Lifts Overhead Systems
bull Car Seat ampor Tie Downs
bull Adapted VanRamps
Transfers ampTransportation
Perlman Center
Equipment Plan of Care
Birth to Three
Adapting baby
equipment
Floor Play
StanderWalker
Bath Seat
Car Seat
Braces
Seating for Function
Early ACCESS
Wheelchair
Bed Positioning
Bike amp Swing
Preschool
Stander
Walker
Braces
Bath Seat
Potty Seat
Wheelchair
HiLo seating
AACAccess
Adapted Bed
Car Seat
Transportation
RecreationHEP
School-Age
to Adult
Wheelchair
AACACCESS
Integrated AT
Hilo chair
Standerwalker
Bath chair
Potty chair
Adapted Bed
Car SeatVan
Home modslifts
LeisureWork
Perlman Center
Commercial Products strollers car seats cribs bath seats high chairs
playpen infant swings floor mats nursing pillow ExerSaucers
Perlman Center
Creative Commercial Adaptations
Pool noodles
Snug and Go
Crib Wedges
Bed tableart desk
Laundry baskets
Inflatable bathtub
Inflatable infant pools
Boxesstools
Perlman Center Creative Commercial Adaptations
Laundry basket $400
Pool Noodle x 2 $300
Floor sitterbath support $700
table (BLACK) $800
Garbage can $600
Large pool noodle $300
Stander with anterior support and
Visual adaptation $1700
Perlman Center
Complex Rehab Equipment
Standers
Gait trainers
Bath Support
Car seat
Seating
Feeding tools
AAC
Sensory tools
vibration
Compression garments
NUK brushes
Z Vibe
Modified utensils
Swings
Weight
Head phones
Positioning
Neck supports
Bracing
Bobby pillowU cushion
Benches
Fireflyfriendscom
PlayPaK
Upsee
Go To Seat
Early Literacy
Picture symbols
Voice output switches
Adapted books
Adapted Equipment
Perlman Center
You got this baby Nowhellip Questions
Perlman Center
LETrsquoS PLAY
Hands on Equipment Demonstration
Perlman Center
bull Ulrich B (2010) Opportunities for Early Intervention Based on Theory Basic Neuroscience and Clinical Science Physical Therapy 90(12) 1868-1880
bull McIntyre S Morgan C amp Walker K (2011) Cerebral Palsy Dont Delay Developmental Disabilities Research Reviews 17(2) 114-129
bull Novak I (2014) Evidence-Based Diagnosis Health Care and Rehabilitation for Children with Cerebral Palsy Journal of Child Neurology 29(8) 1141-1156
bull Morgan C Novak I amp Badawi N (2013) Enriched Environments and Motor Outcomes in Cerebral Palsy Systematic Review and Meta-analysis Pediatrics 132 (3)e 735 -e746
bull Morgan C Novak I Dale R Guzzetta A amp Badawi N (2014) GAME (Goals- Activity-Motor Enrichment) protocol of a single blind randomised controlled trial of motor training parent education and environmental enrichment for infants at high risk of cerebral palsy BMC Neurology 14(203)
bull Whittingham K Wee D amp Boyd R (2010) Systematic review of the efficacy of parenting interventions for children with cerebral palsy Child care health and development 37(4) 475-483
bull Morgan C Novak I dale R amp Badawi N (2015) Optimising motor learning in infants at high risk of cerebral palsy a pilot study BMC Pediatrics 15(1) n pag Web
bull Vos R Dallmeijer A Verhoef M et al (2014) Developmental trajectories of receptive and expressive communication in children and young adults with cerebral palsy Developmental Medicine amp Child Neurology 56 951-959
bull Light J and McNaughton D (2015) Designing AAC research and intervention to improve outcomes for individuals with complex communication needs Augmentative and Alternative Communication 31(2) 85-96
bull Romski M Sevcik R Barton-Hulsey A amp Whitmore A (2015) Early Intervention and AAC What a difference 30 years makes Augmentative and Alternative Communication 31 (3) 181-202
References
Perlman Center
bull Novak I Cusick A Lannin N (2009) Occupational therapy home programs for cerebral palsy Double-blind randomised controlled trial Pediatrics 124 e606-e614
bull Gericke T (2006) Postural management for children with cerebral palsy consensus statement Dev Med Child Neurol 48 (4) 244-244
bull McKeever P Rossen B Scott H Robinson-Vincent K amp Wright V (2013) The significance of uprightness parentsrsquo reflections on childrenrsquos responses to a hands-free walker for children Disability amp Society 28(3) 380-392
bull Law M Pollock N Russell D Walter S et al (2011) Focus on function a cluster randomised controlled trial comparing child-versus context-focused intervention for young children with cerebral palsy Dev Med Child Neurol 53 621-629
bull ldquoSensory Processing Developmental Chartrdquo Sensory Processing Developmental Chart Np nd Web 12 Oct 2015
bull Folio MR amp Fewell RR(2000) Peabody Developmental Motor Scales- Second edition Austin TX PRO ED
bull Voress Judith K amp Pearson Nils A (2013) Early Childhood Development Chart-Third edition Austin TX PRO ED
bull Paul Rhea (2007) Language Disorders from Infancy Through Adolescence Assessment amp Intervention Third edition St Louis MA Mosby Inc
bull Prosser L Ohlrich L Curatalo L Alter K amp Damiano D (2012) Feasibility and preliminary effectiveness of a novel mobility training intervention in infants and toddlers with cerebral palsy Developmental Neurorehabilitation 15(4) 259-266
References
Perlman Center M
ild d
ela
ys-A
t R
isk
bull MRI- basal ganglia
bull Clinic check-ups have been on track
bull Underlying weakness observed by PT
bull Slight catch in Right hamstring
bull 1x every 3-4 weeks
Modera
te d
ela
ys
bull Presents with tonal posturing
bull External support for positioning
bull Sensitive to vestibular movement
bull Home based EI OP equipment planning
bull Group tx
Severe
dela
ys
bull Severe posturing
bull FeedingGI issues
bull Mom needs lots of support
bull Positioning needs
bull Medical needs
bull 2x week group setting (OT PT SLP SW MDs feeding team)
Perlman Center
Build high value
interventions
Perlman Center
bull Therapy to support early parent-infant relationships
bull Build parent confidence
bull Education and training
bull Build opportunities for practice
bull Incorporate into daily routines
Engaging Parents
bull Adapt access to play play is FUN
bull Stimulate exploration inquiry and learning
bull Enrich for cognitive motor sensory and social development
Building Enriched
Environments
bull Goal-oriented intensive motor training (Morgan et al 2015)
bull Build in repetition
bull Scaffold so infant is able to complete at least part of the task
bull Experience-based activities will engage self-initiation of movement
bull Occurs while participating in daily routines (ie at the grocery)
Applying Early Motor Learning
Specific Strategies
Perlman Center
Engaging Parents Education
Topic Lists
Identify parent priorities and begin education based
on parentsrsquo perceived need
child diagnoses
parent support and resources
oral-motor and feeding
seating and positioning
disabilities across the lifespan
gross motor development
patient advocacy
adapted equipment fine motor development
home positioning techniques
financial resources
sensory integration
types of rehabilitation therapy
speech and language
Perlman Center
Engaging Parents Goal Setting
Perlman Center
Educate
Model
Engage
Observe
Connect
Perlman Center
Purposeful Play ishellip
Goal oriented
Activity based
Motivating
In an Enriched environment
Perlman Center
Perlman Center
cognitive
sensory
motor
social
Perlman Center
Building Enriched Environments
Perlman Center
Building Enriched Environments
bull Is the child positioned within
reach to explore the activity
bull Are all senses being utilized
bull Is the child being motivated to
move throughout the
environment
bull Is the environment adapted to
increase access to play
Perlman Center
Building Enriched Environments
bull Can the child have an effect
on the activity within the
environment
bull Is the activity appropriately
challenging the child within the
environment
bull Is the child presented with the
need for problem solving
Perlman Center
Building Enriched Environments
bull Is the child motivated to repeat
the task for motor learning
bull Does the environment support
learning (ie appropriate
noise level social motivators
peer groups developmental
learning supports visual
supports auditory feedback
etc)
Perlman Center
Bridging the gap between the clinic and the
home environment
bull Discipline focused
bull Clinic equipment closet
bull May have group option
Clinic
bull Incorporate into Family Routines
bull Functional activities
bull High Value
bull Adapted environment
Home
Mobility
Early Literacy
Sensory Motor Learning
Social Connections
Perlman Center
Early Learning
Functional MRIs show positive long-term neuro-
cognitive effects of reading to very young
infants
Sensory experiences shape a babyrsquos
knowledge about the world
The average toddler moves 8
out of 10 waking hoursday
Perlman Center
Learning through Experience
Adapting the environment with positioning equipment allows children with disabilities to experience their world and build relationships Allows the child to participate in typical experiences to foster learning
Activities need to promote active engagement
and allow a child to
ndash Actively explore move and participate in play
ndash Assist with self-help routines
ndash Interact and connect with family amp friends
ndash Participate in community activities
ndash Have a means to effectively communicate
ndash Make choices about their wants and need
Perlman Center
Perlman Center
bull Headpointing painting
bull Universal cuffs large pegs splints
bull Switch toys for art activitiesdramatic play-pourer
bull Switch computer access- helpkidzlearncom
bull Fischer Price game with keyboard binder switch
bull Walking in different textures while in standers and walkers
bull Cameramouseorg with dwell click
bull Partner assisted scanning
Alternative amp Adaptive Access to Play
Perlman Center
Change the environment Not the body Adaptations will be critical for success
Gross Motor Fine Motor
Social
Communication
Perlman Center Consider Communication Young children need a reliable form of communication as early as possible
Augmentative Communication is shown to support verbal skills and enhance lives of
birth to three children and their families (Romski et al 2015)
Perlman Center
Holistic approach to AAC intervention should
Build on individual strengths
Focus on participation in real-world contexts
Address psychosocial factors (ie motivation attitude confidence resilience)
Focus on environmental factors to reduce barriers and maximize social supports
In the absence of a holistic approach to communication a child is at risk for failing to engage in social contexts beyond their immediate family or educationalvocational personnel (Light and Mcnaughton 2015)
Augmentative amp Alternative Communication (AAC)
Perlman Center
Early Literacy
Perlman Center
Early Mobility
There is more than one way
Hands Free Matters
Perlman Center
Early Mobility
Should I get a gait trainer if
they are going to walk YES
Are they too young for power NO
Perlman Center
Sensory Motor Learning
Perlman Center
Sensory Motor Learning
Perlman Center
Social Connection
Perlman Center
Total Access to Play
Perlman Center
Perlman defines functional positioning bull Positioning which promotes active movement and participation and
provides an opportunity to positively impact cognitive function
bull Equipment should promote function and participation across the lifespan
Perlman Center
Principles of seating and positioning
bull Obtain a stable base of support
bull Decrease the influence of atypical muscle tone
bull Accommodate fixed deformities and correct flexible deformities
bull Provide the least amount of intervention needed to achieve the greatest level of function
bull There is no one solution or product but typically a combination of tools that provide success
Adapted from Radell (1997) and York and Weimann (1991)
Perlman Center
Key Positioning Components
bull Postural Control Strengthening
bull Range of Motion Weight Bearing
bull Home Activity Programs
Developmental Positioning
bull ADLs-Play Feeding Bathing Sleeping
bull Computer AccessAAC-Integrated Technology
bull Vision Sensory Processing Participation
Upright Positioning
bull EARLY MOBILITY- developmental sequence
bull Gait Trainer Stander amp or Wheelchair
bull Manual wheelchair vs Power Mobility- BOTH
bull Recreational
ldquoTotalrdquo Mobility
bull Body Mechanics Hoyer Lifts Overhead Systems
bull Car Seat ampor Tie Downs
bull Adapted VanRamps
Transfers ampTransportation
Perlman Center
Equipment Plan of Care
Birth to Three
Adapting baby
equipment
Floor Play
StanderWalker
Bath Seat
Car Seat
Braces
Seating for Function
Early ACCESS
Wheelchair
Bed Positioning
Bike amp Swing
Preschool
Stander
Walker
Braces
Bath Seat
Potty Seat
Wheelchair
HiLo seating
AACAccess
Adapted Bed
Car Seat
Transportation
RecreationHEP
School-Age
to Adult
Wheelchair
AACACCESS
Integrated AT
Hilo chair
Standerwalker
Bath chair
Potty chair
Adapted Bed
Car SeatVan
Home modslifts
LeisureWork
Perlman Center
Commercial Products strollers car seats cribs bath seats high chairs
playpen infant swings floor mats nursing pillow ExerSaucers
Perlman Center
Creative Commercial Adaptations
Pool noodles
Snug and Go
Crib Wedges
Bed tableart desk
Laundry baskets
Inflatable bathtub
Inflatable infant pools
Boxesstools
Perlman Center Creative Commercial Adaptations
Laundry basket $400
Pool Noodle x 2 $300
Floor sitterbath support $700
table (BLACK) $800
Garbage can $600
Large pool noodle $300
Stander with anterior support and
Visual adaptation $1700
Perlman Center
Complex Rehab Equipment
Standers
Gait trainers
Bath Support
Car seat
Seating
Feeding tools
AAC
Sensory tools
vibration
Compression garments
NUK brushes
Z Vibe
Modified utensils
Swings
Weight
Head phones
Positioning
Neck supports
Bracing
Bobby pillowU cushion
Benches
Fireflyfriendscom
PlayPaK
Upsee
Go To Seat
Early Literacy
Picture symbols
Voice output switches
Adapted books
Adapted Equipment
Perlman Center
You got this baby Nowhellip Questions
Perlman Center
LETrsquoS PLAY
Hands on Equipment Demonstration
Perlman Center
bull Ulrich B (2010) Opportunities for Early Intervention Based on Theory Basic Neuroscience and Clinical Science Physical Therapy 90(12) 1868-1880
bull McIntyre S Morgan C amp Walker K (2011) Cerebral Palsy Dont Delay Developmental Disabilities Research Reviews 17(2) 114-129
bull Novak I (2014) Evidence-Based Diagnosis Health Care and Rehabilitation for Children with Cerebral Palsy Journal of Child Neurology 29(8) 1141-1156
bull Morgan C Novak I amp Badawi N (2013) Enriched Environments and Motor Outcomes in Cerebral Palsy Systematic Review and Meta-analysis Pediatrics 132 (3)e 735 -e746
bull Morgan C Novak I Dale R Guzzetta A amp Badawi N (2014) GAME (Goals- Activity-Motor Enrichment) protocol of a single blind randomised controlled trial of motor training parent education and environmental enrichment for infants at high risk of cerebral palsy BMC Neurology 14(203)
bull Whittingham K Wee D amp Boyd R (2010) Systematic review of the efficacy of parenting interventions for children with cerebral palsy Child care health and development 37(4) 475-483
bull Morgan C Novak I dale R amp Badawi N (2015) Optimising motor learning in infants at high risk of cerebral palsy a pilot study BMC Pediatrics 15(1) n pag Web
bull Vos R Dallmeijer A Verhoef M et al (2014) Developmental trajectories of receptive and expressive communication in children and young adults with cerebral palsy Developmental Medicine amp Child Neurology 56 951-959
bull Light J and McNaughton D (2015) Designing AAC research and intervention to improve outcomes for individuals with complex communication needs Augmentative and Alternative Communication 31(2) 85-96
bull Romski M Sevcik R Barton-Hulsey A amp Whitmore A (2015) Early Intervention and AAC What a difference 30 years makes Augmentative and Alternative Communication 31 (3) 181-202
References
Perlman Center
bull Novak I Cusick A Lannin N (2009) Occupational therapy home programs for cerebral palsy Double-blind randomised controlled trial Pediatrics 124 e606-e614
bull Gericke T (2006) Postural management for children with cerebral palsy consensus statement Dev Med Child Neurol 48 (4) 244-244
bull McKeever P Rossen B Scott H Robinson-Vincent K amp Wright V (2013) The significance of uprightness parentsrsquo reflections on childrenrsquos responses to a hands-free walker for children Disability amp Society 28(3) 380-392
bull Law M Pollock N Russell D Walter S et al (2011) Focus on function a cluster randomised controlled trial comparing child-versus context-focused intervention for young children with cerebral palsy Dev Med Child Neurol 53 621-629
bull ldquoSensory Processing Developmental Chartrdquo Sensory Processing Developmental Chart Np nd Web 12 Oct 2015
bull Folio MR amp Fewell RR(2000) Peabody Developmental Motor Scales- Second edition Austin TX PRO ED
bull Voress Judith K amp Pearson Nils A (2013) Early Childhood Development Chart-Third edition Austin TX PRO ED
bull Paul Rhea (2007) Language Disorders from Infancy Through Adolescence Assessment amp Intervention Third edition St Louis MA Mosby Inc
bull Prosser L Ohlrich L Curatalo L Alter K amp Damiano D (2012) Feasibility and preliminary effectiveness of a novel mobility training intervention in infants and toddlers with cerebral palsy Developmental Neurorehabilitation 15(4) 259-266
References
Perlman Center
Build high value
interventions
Perlman Center
bull Therapy to support early parent-infant relationships
bull Build parent confidence
bull Education and training
bull Build opportunities for practice
bull Incorporate into daily routines
Engaging Parents
bull Adapt access to play play is FUN
bull Stimulate exploration inquiry and learning
bull Enrich for cognitive motor sensory and social development
Building Enriched
Environments
bull Goal-oriented intensive motor training (Morgan et al 2015)
bull Build in repetition
bull Scaffold so infant is able to complete at least part of the task
bull Experience-based activities will engage self-initiation of movement
bull Occurs while participating in daily routines (ie at the grocery)
Applying Early Motor Learning
Specific Strategies
Perlman Center
Engaging Parents Education
Topic Lists
Identify parent priorities and begin education based
on parentsrsquo perceived need
child diagnoses
parent support and resources
oral-motor and feeding
seating and positioning
disabilities across the lifespan
gross motor development
patient advocacy
adapted equipment fine motor development
home positioning techniques
financial resources
sensory integration
types of rehabilitation therapy
speech and language
Perlman Center
Engaging Parents Goal Setting
Perlman Center
Educate
Model
Engage
Observe
Connect
Perlman Center
Purposeful Play ishellip
Goal oriented
Activity based
Motivating
In an Enriched environment
Perlman Center
Perlman Center
cognitive
sensory
motor
social
Perlman Center
Building Enriched Environments
Perlman Center
Building Enriched Environments
bull Is the child positioned within
reach to explore the activity
bull Are all senses being utilized
bull Is the child being motivated to
move throughout the
environment
bull Is the environment adapted to
increase access to play
Perlman Center
Building Enriched Environments
bull Can the child have an effect
on the activity within the
environment
bull Is the activity appropriately
challenging the child within the
environment
bull Is the child presented with the
need for problem solving
Perlman Center
Building Enriched Environments
bull Is the child motivated to repeat
the task for motor learning
bull Does the environment support
learning (ie appropriate
noise level social motivators
peer groups developmental
learning supports visual
supports auditory feedback
etc)
Perlman Center
Bridging the gap between the clinic and the
home environment
bull Discipline focused
bull Clinic equipment closet
bull May have group option
Clinic
bull Incorporate into Family Routines
bull Functional activities
bull High Value
bull Adapted environment
Home
Mobility
Early Literacy
Sensory Motor Learning
Social Connections
Perlman Center
Early Learning
Functional MRIs show positive long-term neuro-
cognitive effects of reading to very young
infants
Sensory experiences shape a babyrsquos
knowledge about the world
The average toddler moves 8
out of 10 waking hoursday
Perlman Center
Learning through Experience
Adapting the environment with positioning equipment allows children with disabilities to experience their world and build relationships Allows the child to participate in typical experiences to foster learning
Activities need to promote active engagement
and allow a child to
ndash Actively explore move and participate in play
ndash Assist with self-help routines
ndash Interact and connect with family amp friends
ndash Participate in community activities
ndash Have a means to effectively communicate
ndash Make choices about their wants and need
Perlman Center
Perlman Center
bull Headpointing painting
bull Universal cuffs large pegs splints
bull Switch toys for art activitiesdramatic play-pourer
bull Switch computer access- helpkidzlearncom
bull Fischer Price game with keyboard binder switch
bull Walking in different textures while in standers and walkers
bull Cameramouseorg with dwell click
bull Partner assisted scanning
Alternative amp Adaptive Access to Play
Perlman Center
Change the environment Not the body Adaptations will be critical for success
Gross Motor Fine Motor
Social
Communication
Perlman Center Consider Communication Young children need a reliable form of communication as early as possible
Augmentative Communication is shown to support verbal skills and enhance lives of
birth to three children and their families (Romski et al 2015)
Perlman Center
Holistic approach to AAC intervention should
Build on individual strengths
Focus on participation in real-world contexts
Address psychosocial factors (ie motivation attitude confidence resilience)
Focus on environmental factors to reduce barriers and maximize social supports
In the absence of a holistic approach to communication a child is at risk for failing to engage in social contexts beyond their immediate family or educationalvocational personnel (Light and Mcnaughton 2015)
Augmentative amp Alternative Communication (AAC)
Perlman Center
Early Literacy
Perlman Center
Early Mobility
There is more than one way
Hands Free Matters
Perlman Center
Early Mobility
Should I get a gait trainer if
they are going to walk YES
Are they too young for power NO
Perlman Center
Sensory Motor Learning
Perlman Center
Sensory Motor Learning
Perlman Center
Social Connection
Perlman Center
Total Access to Play
Perlman Center
Perlman defines functional positioning bull Positioning which promotes active movement and participation and
provides an opportunity to positively impact cognitive function
bull Equipment should promote function and participation across the lifespan
Perlman Center
Principles of seating and positioning
bull Obtain a stable base of support
bull Decrease the influence of atypical muscle tone
bull Accommodate fixed deformities and correct flexible deformities
bull Provide the least amount of intervention needed to achieve the greatest level of function
bull There is no one solution or product but typically a combination of tools that provide success
Adapted from Radell (1997) and York and Weimann (1991)
Perlman Center
Key Positioning Components
bull Postural Control Strengthening
bull Range of Motion Weight Bearing
bull Home Activity Programs
Developmental Positioning
bull ADLs-Play Feeding Bathing Sleeping
bull Computer AccessAAC-Integrated Technology
bull Vision Sensory Processing Participation
Upright Positioning
bull EARLY MOBILITY- developmental sequence
bull Gait Trainer Stander amp or Wheelchair
bull Manual wheelchair vs Power Mobility- BOTH
bull Recreational
ldquoTotalrdquo Mobility
bull Body Mechanics Hoyer Lifts Overhead Systems
bull Car Seat ampor Tie Downs
bull Adapted VanRamps
Transfers ampTransportation
Perlman Center
Equipment Plan of Care
Birth to Three
Adapting baby
equipment
Floor Play
StanderWalker
Bath Seat
Car Seat
Braces
Seating for Function
Early ACCESS
Wheelchair
Bed Positioning
Bike amp Swing
Preschool
Stander
Walker
Braces
Bath Seat
Potty Seat
Wheelchair
HiLo seating
AACAccess
Adapted Bed
Car Seat
Transportation
RecreationHEP
School-Age
to Adult
Wheelchair
AACACCESS
Integrated AT
Hilo chair
Standerwalker
Bath chair
Potty chair
Adapted Bed
Car SeatVan
Home modslifts
LeisureWork
Perlman Center
Commercial Products strollers car seats cribs bath seats high chairs
playpen infant swings floor mats nursing pillow ExerSaucers
Perlman Center
Creative Commercial Adaptations
Pool noodles
Snug and Go
Crib Wedges
Bed tableart desk
Laundry baskets
Inflatable bathtub
Inflatable infant pools
Boxesstools
Perlman Center Creative Commercial Adaptations
Laundry basket $400
Pool Noodle x 2 $300
Floor sitterbath support $700
table (BLACK) $800
Garbage can $600
Large pool noodle $300
Stander with anterior support and
Visual adaptation $1700
Perlman Center
Complex Rehab Equipment
Standers
Gait trainers
Bath Support
Car seat
Seating
Feeding tools
AAC
Sensory tools
vibration
Compression garments
NUK brushes
Z Vibe
Modified utensils
Swings
Weight
Head phones
Positioning
Neck supports
Bracing
Bobby pillowU cushion
Benches
Fireflyfriendscom
PlayPaK
Upsee
Go To Seat
Early Literacy
Picture symbols
Voice output switches
Adapted books
Adapted Equipment
Perlman Center
You got this baby Nowhellip Questions
Perlman Center
LETrsquoS PLAY
Hands on Equipment Demonstration
Perlman Center
bull Ulrich B (2010) Opportunities for Early Intervention Based on Theory Basic Neuroscience and Clinical Science Physical Therapy 90(12) 1868-1880
bull McIntyre S Morgan C amp Walker K (2011) Cerebral Palsy Dont Delay Developmental Disabilities Research Reviews 17(2) 114-129
bull Novak I (2014) Evidence-Based Diagnosis Health Care and Rehabilitation for Children with Cerebral Palsy Journal of Child Neurology 29(8) 1141-1156
bull Morgan C Novak I amp Badawi N (2013) Enriched Environments and Motor Outcomes in Cerebral Palsy Systematic Review and Meta-analysis Pediatrics 132 (3)e 735 -e746
bull Morgan C Novak I Dale R Guzzetta A amp Badawi N (2014) GAME (Goals- Activity-Motor Enrichment) protocol of a single blind randomised controlled trial of motor training parent education and environmental enrichment for infants at high risk of cerebral palsy BMC Neurology 14(203)
bull Whittingham K Wee D amp Boyd R (2010) Systematic review of the efficacy of parenting interventions for children with cerebral palsy Child care health and development 37(4) 475-483
bull Morgan C Novak I dale R amp Badawi N (2015) Optimising motor learning in infants at high risk of cerebral palsy a pilot study BMC Pediatrics 15(1) n pag Web
bull Vos R Dallmeijer A Verhoef M et al (2014) Developmental trajectories of receptive and expressive communication in children and young adults with cerebral palsy Developmental Medicine amp Child Neurology 56 951-959
bull Light J and McNaughton D (2015) Designing AAC research and intervention to improve outcomes for individuals with complex communication needs Augmentative and Alternative Communication 31(2) 85-96
bull Romski M Sevcik R Barton-Hulsey A amp Whitmore A (2015) Early Intervention and AAC What a difference 30 years makes Augmentative and Alternative Communication 31 (3) 181-202
References
Perlman Center
bull Novak I Cusick A Lannin N (2009) Occupational therapy home programs for cerebral palsy Double-blind randomised controlled trial Pediatrics 124 e606-e614
bull Gericke T (2006) Postural management for children with cerebral palsy consensus statement Dev Med Child Neurol 48 (4) 244-244
bull McKeever P Rossen B Scott H Robinson-Vincent K amp Wright V (2013) The significance of uprightness parentsrsquo reflections on childrenrsquos responses to a hands-free walker for children Disability amp Society 28(3) 380-392
bull Law M Pollock N Russell D Walter S et al (2011) Focus on function a cluster randomised controlled trial comparing child-versus context-focused intervention for young children with cerebral palsy Dev Med Child Neurol 53 621-629
bull ldquoSensory Processing Developmental Chartrdquo Sensory Processing Developmental Chart Np nd Web 12 Oct 2015
bull Folio MR amp Fewell RR(2000) Peabody Developmental Motor Scales- Second edition Austin TX PRO ED
bull Voress Judith K amp Pearson Nils A (2013) Early Childhood Development Chart-Third edition Austin TX PRO ED
bull Paul Rhea (2007) Language Disorders from Infancy Through Adolescence Assessment amp Intervention Third edition St Louis MA Mosby Inc
bull Prosser L Ohlrich L Curatalo L Alter K amp Damiano D (2012) Feasibility and preliminary effectiveness of a novel mobility training intervention in infants and toddlers with cerebral palsy Developmental Neurorehabilitation 15(4) 259-266
References
Perlman Center
bull Therapy to support early parent-infant relationships
bull Build parent confidence
bull Education and training
bull Build opportunities for practice
bull Incorporate into daily routines
Engaging Parents
bull Adapt access to play play is FUN
bull Stimulate exploration inquiry and learning
bull Enrich for cognitive motor sensory and social development
Building Enriched
Environments
bull Goal-oriented intensive motor training (Morgan et al 2015)
bull Build in repetition
bull Scaffold so infant is able to complete at least part of the task
bull Experience-based activities will engage self-initiation of movement
bull Occurs while participating in daily routines (ie at the grocery)
Applying Early Motor Learning
Specific Strategies
Perlman Center
Engaging Parents Education
Topic Lists
Identify parent priorities and begin education based
on parentsrsquo perceived need
child diagnoses
parent support and resources
oral-motor and feeding
seating and positioning
disabilities across the lifespan
gross motor development
patient advocacy
adapted equipment fine motor development
home positioning techniques
financial resources
sensory integration
types of rehabilitation therapy
speech and language
Perlman Center
Engaging Parents Goal Setting
Perlman Center
Educate
Model
Engage
Observe
Connect
Perlman Center
Purposeful Play ishellip
Goal oriented
Activity based
Motivating
In an Enriched environment
Perlman Center
Perlman Center
cognitive
sensory
motor
social
Perlman Center
Building Enriched Environments
Perlman Center
Building Enriched Environments
bull Is the child positioned within
reach to explore the activity
bull Are all senses being utilized
bull Is the child being motivated to
move throughout the
environment
bull Is the environment adapted to
increase access to play
Perlman Center
Building Enriched Environments
bull Can the child have an effect
on the activity within the
environment
bull Is the activity appropriately
challenging the child within the
environment
bull Is the child presented with the
need for problem solving
Perlman Center
Building Enriched Environments
bull Is the child motivated to repeat
the task for motor learning
bull Does the environment support
learning (ie appropriate
noise level social motivators
peer groups developmental
learning supports visual
supports auditory feedback
etc)
Perlman Center
Bridging the gap between the clinic and the
home environment
bull Discipline focused
bull Clinic equipment closet
bull May have group option
Clinic
bull Incorporate into Family Routines
bull Functional activities
bull High Value
bull Adapted environment
Home
Mobility
Early Literacy
Sensory Motor Learning
Social Connections
Perlman Center
Early Learning
Functional MRIs show positive long-term neuro-
cognitive effects of reading to very young
infants
Sensory experiences shape a babyrsquos
knowledge about the world
The average toddler moves 8
out of 10 waking hoursday
Perlman Center
Learning through Experience
Adapting the environment with positioning equipment allows children with disabilities to experience their world and build relationships Allows the child to participate in typical experiences to foster learning
Activities need to promote active engagement
and allow a child to
ndash Actively explore move and participate in play
ndash Assist with self-help routines
ndash Interact and connect with family amp friends
ndash Participate in community activities
ndash Have a means to effectively communicate
ndash Make choices about their wants and need
Perlman Center
Perlman Center
bull Headpointing painting
bull Universal cuffs large pegs splints
bull Switch toys for art activitiesdramatic play-pourer
bull Switch computer access- helpkidzlearncom
bull Fischer Price game with keyboard binder switch
bull Walking in different textures while in standers and walkers
bull Cameramouseorg with dwell click
bull Partner assisted scanning
Alternative amp Adaptive Access to Play
Perlman Center
Change the environment Not the body Adaptations will be critical for success
Gross Motor Fine Motor
Social
Communication
Perlman Center Consider Communication Young children need a reliable form of communication as early as possible
Augmentative Communication is shown to support verbal skills and enhance lives of
birth to three children and their families (Romski et al 2015)
Perlman Center
Holistic approach to AAC intervention should
Build on individual strengths
Focus on participation in real-world contexts
Address psychosocial factors (ie motivation attitude confidence resilience)
Focus on environmental factors to reduce barriers and maximize social supports
In the absence of a holistic approach to communication a child is at risk for failing to engage in social contexts beyond their immediate family or educationalvocational personnel (Light and Mcnaughton 2015)
Augmentative amp Alternative Communication (AAC)
Perlman Center
Early Literacy
Perlman Center
Early Mobility
There is more than one way
Hands Free Matters
Perlman Center
Early Mobility
Should I get a gait trainer if
they are going to walk YES
Are they too young for power NO
Perlman Center
Sensory Motor Learning
Perlman Center
Sensory Motor Learning
Perlman Center
Social Connection
Perlman Center
Total Access to Play
Perlman Center
Perlman defines functional positioning bull Positioning which promotes active movement and participation and
provides an opportunity to positively impact cognitive function
bull Equipment should promote function and participation across the lifespan
Perlman Center
Principles of seating and positioning
bull Obtain a stable base of support
bull Decrease the influence of atypical muscle tone
bull Accommodate fixed deformities and correct flexible deformities
bull Provide the least amount of intervention needed to achieve the greatest level of function
bull There is no one solution or product but typically a combination of tools that provide success
Adapted from Radell (1997) and York and Weimann (1991)
Perlman Center
Key Positioning Components
bull Postural Control Strengthening
bull Range of Motion Weight Bearing
bull Home Activity Programs
Developmental Positioning
bull ADLs-Play Feeding Bathing Sleeping
bull Computer AccessAAC-Integrated Technology
bull Vision Sensory Processing Participation
Upright Positioning
bull EARLY MOBILITY- developmental sequence
bull Gait Trainer Stander amp or Wheelchair
bull Manual wheelchair vs Power Mobility- BOTH
bull Recreational
ldquoTotalrdquo Mobility
bull Body Mechanics Hoyer Lifts Overhead Systems
bull Car Seat ampor Tie Downs
bull Adapted VanRamps
Transfers ampTransportation
Perlman Center
Equipment Plan of Care
Birth to Three
Adapting baby
equipment
Floor Play
StanderWalker
Bath Seat
Car Seat
Braces
Seating for Function
Early ACCESS
Wheelchair
Bed Positioning
Bike amp Swing
Preschool
Stander
Walker
Braces
Bath Seat
Potty Seat
Wheelchair
HiLo seating
AACAccess
Adapted Bed
Car Seat
Transportation
RecreationHEP
School-Age
to Adult
Wheelchair
AACACCESS
Integrated AT
Hilo chair
Standerwalker
Bath chair
Potty chair
Adapted Bed
Car SeatVan
Home modslifts
LeisureWork
Perlman Center
Commercial Products strollers car seats cribs bath seats high chairs
playpen infant swings floor mats nursing pillow ExerSaucers
Perlman Center
Creative Commercial Adaptations
Pool noodles
Snug and Go
Crib Wedges
Bed tableart desk
Laundry baskets
Inflatable bathtub
Inflatable infant pools
Boxesstools
Perlman Center Creative Commercial Adaptations
Laundry basket $400
Pool Noodle x 2 $300
Floor sitterbath support $700
table (BLACK) $800
Garbage can $600
Large pool noodle $300
Stander with anterior support and
Visual adaptation $1700
Perlman Center
Complex Rehab Equipment
Standers
Gait trainers
Bath Support
Car seat
Seating
Feeding tools
AAC
Sensory tools
vibration
Compression garments
NUK brushes
Z Vibe
Modified utensils
Swings
Weight
Head phones
Positioning
Neck supports
Bracing
Bobby pillowU cushion
Benches
Fireflyfriendscom
PlayPaK
Upsee
Go To Seat
Early Literacy
Picture symbols
Voice output switches
Adapted books
Adapted Equipment
Perlman Center
You got this baby Nowhellip Questions
Perlman Center
LETrsquoS PLAY
Hands on Equipment Demonstration
Perlman Center
bull Ulrich B (2010) Opportunities for Early Intervention Based on Theory Basic Neuroscience and Clinical Science Physical Therapy 90(12) 1868-1880
bull McIntyre S Morgan C amp Walker K (2011) Cerebral Palsy Dont Delay Developmental Disabilities Research Reviews 17(2) 114-129
bull Novak I (2014) Evidence-Based Diagnosis Health Care and Rehabilitation for Children with Cerebral Palsy Journal of Child Neurology 29(8) 1141-1156
bull Morgan C Novak I amp Badawi N (2013) Enriched Environments and Motor Outcomes in Cerebral Palsy Systematic Review and Meta-analysis Pediatrics 132 (3)e 735 -e746
bull Morgan C Novak I Dale R Guzzetta A amp Badawi N (2014) GAME (Goals- Activity-Motor Enrichment) protocol of a single blind randomised controlled trial of motor training parent education and environmental enrichment for infants at high risk of cerebral palsy BMC Neurology 14(203)
bull Whittingham K Wee D amp Boyd R (2010) Systematic review of the efficacy of parenting interventions for children with cerebral palsy Child care health and development 37(4) 475-483
bull Morgan C Novak I dale R amp Badawi N (2015) Optimising motor learning in infants at high risk of cerebral palsy a pilot study BMC Pediatrics 15(1) n pag Web
bull Vos R Dallmeijer A Verhoef M et al (2014) Developmental trajectories of receptive and expressive communication in children and young adults with cerebral palsy Developmental Medicine amp Child Neurology 56 951-959
bull Light J and McNaughton D (2015) Designing AAC research and intervention to improve outcomes for individuals with complex communication needs Augmentative and Alternative Communication 31(2) 85-96
bull Romski M Sevcik R Barton-Hulsey A amp Whitmore A (2015) Early Intervention and AAC What a difference 30 years makes Augmentative and Alternative Communication 31 (3) 181-202
References
Perlman Center
bull Novak I Cusick A Lannin N (2009) Occupational therapy home programs for cerebral palsy Double-blind randomised controlled trial Pediatrics 124 e606-e614
bull Gericke T (2006) Postural management for children with cerebral palsy consensus statement Dev Med Child Neurol 48 (4) 244-244
bull McKeever P Rossen B Scott H Robinson-Vincent K amp Wright V (2013) The significance of uprightness parentsrsquo reflections on childrenrsquos responses to a hands-free walker for children Disability amp Society 28(3) 380-392
bull Law M Pollock N Russell D Walter S et al (2011) Focus on function a cluster randomised controlled trial comparing child-versus context-focused intervention for young children with cerebral palsy Dev Med Child Neurol 53 621-629
bull ldquoSensory Processing Developmental Chartrdquo Sensory Processing Developmental Chart Np nd Web 12 Oct 2015
bull Folio MR amp Fewell RR(2000) Peabody Developmental Motor Scales- Second edition Austin TX PRO ED
bull Voress Judith K amp Pearson Nils A (2013) Early Childhood Development Chart-Third edition Austin TX PRO ED
bull Paul Rhea (2007) Language Disorders from Infancy Through Adolescence Assessment amp Intervention Third edition St Louis MA Mosby Inc
bull Prosser L Ohlrich L Curatalo L Alter K amp Damiano D (2012) Feasibility and preliminary effectiveness of a novel mobility training intervention in infants and toddlers with cerebral palsy Developmental Neurorehabilitation 15(4) 259-266
References
Perlman Center
Engaging Parents Education
Topic Lists
Identify parent priorities and begin education based
on parentsrsquo perceived need
child diagnoses
parent support and resources
oral-motor and feeding
seating and positioning
disabilities across the lifespan
gross motor development
patient advocacy
adapted equipment fine motor development
home positioning techniques
financial resources
sensory integration
types of rehabilitation therapy
speech and language
Perlman Center
Engaging Parents Goal Setting
Perlman Center
Educate
Model
Engage
Observe
Connect
Perlman Center
Purposeful Play ishellip
Goal oriented
Activity based
Motivating
In an Enriched environment
Perlman Center
Perlman Center
cognitive
sensory
motor
social
Perlman Center
Building Enriched Environments
Perlman Center
Building Enriched Environments
bull Is the child positioned within
reach to explore the activity
bull Are all senses being utilized
bull Is the child being motivated to
move throughout the
environment
bull Is the environment adapted to
increase access to play
Perlman Center
Building Enriched Environments
bull Can the child have an effect
on the activity within the
environment
bull Is the activity appropriately
challenging the child within the
environment
bull Is the child presented with the
need for problem solving
Perlman Center
Building Enriched Environments
bull Is the child motivated to repeat
the task for motor learning
bull Does the environment support
learning (ie appropriate
noise level social motivators
peer groups developmental
learning supports visual
supports auditory feedback
etc)
Perlman Center
Bridging the gap between the clinic and the
home environment
bull Discipline focused
bull Clinic equipment closet
bull May have group option
Clinic
bull Incorporate into Family Routines
bull Functional activities
bull High Value
bull Adapted environment
Home
Mobility
Early Literacy
Sensory Motor Learning
Social Connections
Perlman Center
Early Learning
Functional MRIs show positive long-term neuro-
cognitive effects of reading to very young
infants
Sensory experiences shape a babyrsquos
knowledge about the world
The average toddler moves 8
out of 10 waking hoursday
Perlman Center
Learning through Experience
Adapting the environment with positioning equipment allows children with disabilities to experience their world and build relationships Allows the child to participate in typical experiences to foster learning
Activities need to promote active engagement
and allow a child to
ndash Actively explore move and participate in play
ndash Assist with self-help routines
ndash Interact and connect with family amp friends
ndash Participate in community activities
ndash Have a means to effectively communicate
ndash Make choices about their wants and need
Perlman Center
Perlman Center
bull Headpointing painting
bull Universal cuffs large pegs splints
bull Switch toys for art activitiesdramatic play-pourer
bull Switch computer access- helpkidzlearncom
bull Fischer Price game with keyboard binder switch
bull Walking in different textures while in standers and walkers
bull Cameramouseorg with dwell click
bull Partner assisted scanning
Alternative amp Adaptive Access to Play
Perlman Center
Change the environment Not the body Adaptations will be critical for success
Gross Motor Fine Motor
Social
Communication
Perlman Center Consider Communication Young children need a reliable form of communication as early as possible
Augmentative Communication is shown to support verbal skills and enhance lives of
birth to three children and their families (Romski et al 2015)
Perlman Center
Holistic approach to AAC intervention should
Build on individual strengths
Focus on participation in real-world contexts
Address psychosocial factors (ie motivation attitude confidence resilience)
Focus on environmental factors to reduce barriers and maximize social supports
In the absence of a holistic approach to communication a child is at risk for failing to engage in social contexts beyond their immediate family or educationalvocational personnel (Light and Mcnaughton 2015)
Augmentative amp Alternative Communication (AAC)
Perlman Center
Early Literacy
Perlman Center
Early Mobility
There is more than one way
Hands Free Matters
Perlman Center
Early Mobility
Should I get a gait trainer if
they are going to walk YES
Are they too young for power NO
Perlman Center
Sensory Motor Learning
Perlman Center
Sensory Motor Learning
Perlman Center
Social Connection
Perlman Center
Total Access to Play
Perlman Center
Perlman defines functional positioning bull Positioning which promotes active movement and participation and
provides an opportunity to positively impact cognitive function
bull Equipment should promote function and participation across the lifespan
Perlman Center
Principles of seating and positioning
bull Obtain a stable base of support
bull Decrease the influence of atypical muscle tone
bull Accommodate fixed deformities and correct flexible deformities
bull Provide the least amount of intervention needed to achieve the greatest level of function
bull There is no one solution or product but typically a combination of tools that provide success
Adapted from Radell (1997) and York and Weimann (1991)
Perlman Center
Key Positioning Components
bull Postural Control Strengthening
bull Range of Motion Weight Bearing
bull Home Activity Programs
Developmental Positioning
bull ADLs-Play Feeding Bathing Sleeping
bull Computer AccessAAC-Integrated Technology
bull Vision Sensory Processing Participation
Upright Positioning
bull EARLY MOBILITY- developmental sequence
bull Gait Trainer Stander amp or Wheelchair
bull Manual wheelchair vs Power Mobility- BOTH
bull Recreational
ldquoTotalrdquo Mobility
bull Body Mechanics Hoyer Lifts Overhead Systems
bull Car Seat ampor Tie Downs
bull Adapted VanRamps
Transfers ampTransportation
Perlman Center
Equipment Plan of Care
Birth to Three
Adapting baby
equipment
Floor Play
StanderWalker
Bath Seat
Car Seat
Braces
Seating for Function
Early ACCESS
Wheelchair
Bed Positioning
Bike amp Swing
Preschool
Stander
Walker
Braces
Bath Seat
Potty Seat
Wheelchair
HiLo seating
AACAccess
Adapted Bed
Car Seat
Transportation
RecreationHEP
School-Age
to Adult
Wheelchair
AACACCESS
Integrated AT
Hilo chair
Standerwalker
Bath chair
Potty chair
Adapted Bed
Car SeatVan
Home modslifts
LeisureWork
Perlman Center
Commercial Products strollers car seats cribs bath seats high chairs
playpen infant swings floor mats nursing pillow ExerSaucers
Perlman Center
Creative Commercial Adaptations
Pool noodles
Snug and Go
Crib Wedges
Bed tableart desk
Laundry baskets
Inflatable bathtub
Inflatable infant pools
Boxesstools
Perlman Center Creative Commercial Adaptations
Laundry basket $400
Pool Noodle x 2 $300
Floor sitterbath support $700
table (BLACK) $800
Garbage can $600
Large pool noodle $300
Stander with anterior support and
Visual adaptation $1700
Perlman Center
Complex Rehab Equipment
Standers
Gait trainers
Bath Support
Car seat
Seating
Feeding tools
AAC
Sensory tools
vibration
Compression garments
NUK brushes
Z Vibe
Modified utensils
Swings
Weight
Head phones
Positioning
Neck supports
Bracing
Bobby pillowU cushion
Benches
Fireflyfriendscom
PlayPaK
Upsee
Go To Seat
Early Literacy
Picture symbols
Voice output switches
Adapted books
Adapted Equipment
Perlman Center
You got this baby Nowhellip Questions
Perlman Center
LETrsquoS PLAY
Hands on Equipment Demonstration
Perlman Center
bull Ulrich B (2010) Opportunities for Early Intervention Based on Theory Basic Neuroscience and Clinical Science Physical Therapy 90(12) 1868-1880
bull McIntyre S Morgan C amp Walker K (2011) Cerebral Palsy Dont Delay Developmental Disabilities Research Reviews 17(2) 114-129
bull Novak I (2014) Evidence-Based Diagnosis Health Care and Rehabilitation for Children with Cerebral Palsy Journal of Child Neurology 29(8) 1141-1156
bull Morgan C Novak I amp Badawi N (2013) Enriched Environments and Motor Outcomes in Cerebral Palsy Systematic Review and Meta-analysis Pediatrics 132 (3)e 735 -e746
bull Morgan C Novak I Dale R Guzzetta A amp Badawi N (2014) GAME (Goals- Activity-Motor Enrichment) protocol of a single blind randomised controlled trial of motor training parent education and environmental enrichment for infants at high risk of cerebral palsy BMC Neurology 14(203)
bull Whittingham K Wee D amp Boyd R (2010) Systematic review of the efficacy of parenting interventions for children with cerebral palsy Child care health and development 37(4) 475-483
bull Morgan C Novak I dale R amp Badawi N (2015) Optimising motor learning in infants at high risk of cerebral palsy a pilot study BMC Pediatrics 15(1) n pag Web
bull Vos R Dallmeijer A Verhoef M et al (2014) Developmental trajectories of receptive and expressive communication in children and young adults with cerebral palsy Developmental Medicine amp Child Neurology 56 951-959
bull Light J and McNaughton D (2015) Designing AAC research and intervention to improve outcomes for individuals with complex communication needs Augmentative and Alternative Communication 31(2) 85-96
bull Romski M Sevcik R Barton-Hulsey A amp Whitmore A (2015) Early Intervention and AAC What a difference 30 years makes Augmentative and Alternative Communication 31 (3) 181-202
References
Perlman Center
bull Novak I Cusick A Lannin N (2009) Occupational therapy home programs for cerebral palsy Double-blind randomised controlled trial Pediatrics 124 e606-e614
bull Gericke T (2006) Postural management for children with cerebral palsy consensus statement Dev Med Child Neurol 48 (4) 244-244
bull McKeever P Rossen B Scott H Robinson-Vincent K amp Wright V (2013) The significance of uprightness parentsrsquo reflections on childrenrsquos responses to a hands-free walker for children Disability amp Society 28(3) 380-392
bull Law M Pollock N Russell D Walter S et al (2011) Focus on function a cluster randomised controlled trial comparing child-versus context-focused intervention for young children with cerebral palsy Dev Med Child Neurol 53 621-629
bull ldquoSensory Processing Developmental Chartrdquo Sensory Processing Developmental Chart Np nd Web 12 Oct 2015
bull Folio MR amp Fewell RR(2000) Peabody Developmental Motor Scales- Second edition Austin TX PRO ED
bull Voress Judith K amp Pearson Nils A (2013) Early Childhood Development Chart-Third edition Austin TX PRO ED
bull Paul Rhea (2007) Language Disorders from Infancy Through Adolescence Assessment amp Intervention Third edition St Louis MA Mosby Inc
bull Prosser L Ohlrich L Curatalo L Alter K amp Damiano D (2012) Feasibility and preliminary effectiveness of a novel mobility training intervention in infants and toddlers with cerebral palsy Developmental Neurorehabilitation 15(4) 259-266
References
Perlman Center
Engaging Parents Goal Setting
Perlman Center
Educate
Model
Engage
Observe
Connect
Perlman Center
Purposeful Play ishellip
Goal oriented
Activity based
Motivating
In an Enriched environment
Perlman Center
Perlman Center
cognitive
sensory
motor
social
Perlman Center
Building Enriched Environments
Perlman Center
Building Enriched Environments
bull Is the child positioned within
reach to explore the activity
bull Are all senses being utilized
bull Is the child being motivated to
move throughout the
environment
bull Is the environment adapted to
increase access to play
Perlman Center
Building Enriched Environments
bull Can the child have an effect
on the activity within the
environment
bull Is the activity appropriately
challenging the child within the
environment
bull Is the child presented with the
need for problem solving
Perlman Center
Building Enriched Environments
bull Is the child motivated to repeat
the task for motor learning
bull Does the environment support
learning (ie appropriate
noise level social motivators
peer groups developmental
learning supports visual
supports auditory feedback
etc)
Perlman Center
Bridging the gap between the clinic and the
home environment
bull Discipline focused
bull Clinic equipment closet
bull May have group option
Clinic
bull Incorporate into Family Routines
bull Functional activities
bull High Value
bull Adapted environment
Home
Mobility
Early Literacy
Sensory Motor Learning
Social Connections
Perlman Center
Early Learning
Functional MRIs show positive long-term neuro-
cognitive effects of reading to very young
infants
Sensory experiences shape a babyrsquos
knowledge about the world
The average toddler moves 8
out of 10 waking hoursday
Perlman Center
Learning through Experience
Adapting the environment with positioning equipment allows children with disabilities to experience their world and build relationships Allows the child to participate in typical experiences to foster learning
Activities need to promote active engagement
and allow a child to
ndash Actively explore move and participate in play
ndash Assist with self-help routines
ndash Interact and connect with family amp friends
ndash Participate in community activities
ndash Have a means to effectively communicate
ndash Make choices about their wants and need
Perlman Center
Perlman Center
bull Headpointing painting
bull Universal cuffs large pegs splints
bull Switch toys for art activitiesdramatic play-pourer
bull Switch computer access- helpkidzlearncom
bull Fischer Price game with keyboard binder switch
bull Walking in different textures while in standers and walkers
bull Cameramouseorg with dwell click
bull Partner assisted scanning
Alternative amp Adaptive Access to Play
Perlman Center
Change the environment Not the body Adaptations will be critical for success
Gross Motor Fine Motor
Social
Communication
Perlman Center Consider Communication Young children need a reliable form of communication as early as possible
Augmentative Communication is shown to support verbal skills and enhance lives of
birth to three children and their families (Romski et al 2015)
Perlman Center
Holistic approach to AAC intervention should
Build on individual strengths
Focus on participation in real-world contexts
Address psychosocial factors (ie motivation attitude confidence resilience)
Focus on environmental factors to reduce barriers and maximize social supports
In the absence of a holistic approach to communication a child is at risk for failing to engage in social contexts beyond their immediate family or educationalvocational personnel (Light and Mcnaughton 2015)
Augmentative amp Alternative Communication (AAC)
Perlman Center
Early Literacy
Perlman Center
Early Mobility
There is more than one way
Hands Free Matters
Perlman Center
Early Mobility
Should I get a gait trainer if
they are going to walk YES
Are they too young for power NO
Perlman Center
Sensory Motor Learning
Perlman Center
Sensory Motor Learning
Perlman Center
Social Connection
Perlman Center
Total Access to Play
Perlman Center
Perlman defines functional positioning bull Positioning which promotes active movement and participation and
provides an opportunity to positively impact cognitive function
bull Equipment should promote function and participation across the lifespan
Perlman Center
Principles of seating and positioning
bull Obtain a stable base of support
bull Decrease the influence of atypical muscle tone
bull Accommodate fixed deformities and correct flexible deformities
bull Provide the least amount of intervention needed to achieve the greatest level of function
bull There is no one solution or product but typically a combination of tools that provide success
Adapted from Radell (1997) and York and Weimann (1991)
Perlman Center
Key Positioning Components
bull Postural Control Strengthening
bull Range of Motion Weight Bearing
bull Home Activity Programs
Developmental Positioning
bull ADLs-Play Feeding Bathing Sleeping
bull Computer AccessAAC-Integrated Technology
bull Vision Sensory Processing Participation
Upright Positioning
bull EARLY MOBILITY- developmental sequence
bull Gait Trainer Stander amp or Wheelchair
bull Manual wheelchair vs Power Mobility- BOTH
bull Recreational
ldquoTotalrdquo Mobility
bull Body Mechanics Hoyer Lifts Overhead Systems
bull Car Seat ampor Tie Downs
bull Adapted VanRamps
Transfers ampTransportation
Perlman Center
Equipment Plan of Care
Birth to Three
Adapting baby
equipment
Floor Play
StanderWalker
Bath Seat
Car Seat
Braces
Seating for Function
Early ACCESS
Wheelchair
Bed Positioning
Bike amp Swing
Preschool
Stander
Walker
Braces
Bath Seat
Potty Seat
Wheelchair
HiLo seating
AACAccess
Adapted Bed
Car Seat
Transportation
RecreationHEP
School-Age
to Adult
Wheelchair
AACACCESS
Integrated AT
Hilo chair
Standerwalker
Bath chair
Potty chair
Adapted Bed
Car SeatVan
Home modslifts
LeisureWork
Perlman Center
Commercial Products strollers car seats cribs bath seats high chairs
playpen infant swings floor mats nursing pillow ExerSaucers
Perlman Center
Creative Commercial Adaptations
Pool noodles
Snug and Go
Crib Wedges
Bed tableart desk
Laundry baskets
Inflatable bathtub
Inflatable infant pools
Boxesstools
Perlman Center Creative Commercial Adaptations
Laundry basket $400
Pool Noodle x 2 $300
Floor sitterbath support $700
table (BLACK) $800
Garbage can $600
Large pool noodle $300
Stander with anterior support and
Visual adaptation $1700
Perlman Center
Complex Rehab Equipment
Standers
Gait trainers
Bath Support
Car seat
Seating
Feeding tools
AAC
Sensory tools
vibration
Compression garments
NUK brushes
Z Vibe
Modified utensils
Swings
Weight
Head phones
Positioning
Neck supports
Bracing
Bobby pillowU cushion
Benches
Fireflyfriendscom
PlayPaK
Upsee
Go To Seat
Early Literacy
Picture symbols
Voice output switches
Adapted books
Adapted Equipment
Perlman Center
You got this baby Nowhellip Questions
Perlman Center
LETrsquoS PLAY
Hands on Equipment Demonstration
Perlman Center
bull Ulrich B (2010) Opportunities for Early Intervention Based on Theory Basic Neuroscience and Clinical Science Physical Therapy 90(12) 1868-1880
bull McIntyre S Morgan C amp Walker K (2011) Cerebral Palsy Dont Delay Developmental Disabilities Research Reviews 17(2) 114-129
bull Novak I (2014) Evidence-Based Diagnosis Health Care and Rehabilitation for Children with Cerebral Palsy Journal of Child Neurology 29(8) 1141-1156
bull Morgan C Novak I amp Badawi N (2013) Enriched Environments and Motor Outcomes in Cerebral Palsy Systematic Review and Meta-analysis Pediatrics 132 (3)e 735 -e746
bull Morgan C Novak I Dale R Guzzetta A amp Badawi N (2014) GAME (Goals- Activity-Motor Enrichment) protocol of a single blind randomised controlled trial of motor training parent education and environmental enrichment for infants at high risk of cerebral palsy BMC Neurology 14(203)
bull Whittingham K Wee D amp Boyd R (2010) Systematic review of the efficacy of parenting interventions for children with cerebral palsy Child care health and development 37(4) 475-483
bull Morgan C Novak I dale R amp Badawi N (2015) Optimising motor learning in infants at high risk of cerebral palsy a pilot study BMC Pediatrics 15(1) n pag Web
bull Vos R Dallmeijer A Verhoef M et al (2014) Developmental trajectories of receptive and expressive communication in children and young adults with cerebral palsy Developmental Medicine amp Child Neurology 56 951-959
bull Light J and McNaughton D (2015) Designing AAC research and intervention to improve outcomes for individuals with complex communication needs Augmentative and Alternative Communication 31(2) 85-96
bull Romski M Sevcik R Barton-Hulsey A amp Whitmore A (2015) Early Intervention and AAC What a difference 30 years makes Augmentative and Alternative Communication 31 (3) 181-202
References
Perlman Center
bull Novak I Cusick A Lannin N (2009) Occupational therapy home programs for cerebral palsy Double-blind randomised controlled trial Pediatrics 124 e606-e614
bull Gericke T (2006) Postural management for children with cerebral palsy consensus statement Dev Med Child Neurol 48 (4) 244-244
bull McKeever P Rossen B Scott H Robinson-Vincent K amp Wright V (2013) The significance of uprightness parentsrsquo reflections on childrenrsquos responses to a hands-free walker for children Disability amp Society 28(3) 380-392
bull Law M Pollock N Russell D Walter S et al (2011) Focus on function a cluster randomised controlled trial comparing child-versus context-focused intervention for young children with cerebral palsy Dev Med Child Neurol 53 621-629
bull ldquoSensory Processing Developmental Chartrdquo Sensory Processing Developmental Chart Np nd Web 12 Oct 2015
bull Folio MR amp Fewell RR(2000) Peabody Developmental Motor Scales- Second edition Austin TX PRO ED
bull Voress Judith K amp Pearson Nils A (2013) Early Childhood Development Chart-Third edition Austin TX PRO ED
bull Paul Rhea (2007) Language Disorders from Infancy Through Adolescence Assessment amp Intervention Third edition St Louis MA Mosby Inc
bull Prosser L Ohlrich L Curatalo L Alter K amp Damiano D (2012) Feasibility and preliminary effectiveness of a novel mobility training intervention in infants and toddlers with cerebral palsy Developmental Neurorehabilitation 15(4) 259-266
References
Perlman Center
Educate
Model
Engage
Observe
Connect
Perlman Center
Purposeful Play ishellip
Goal oriented
Activity based
Motivating
In an Enriched environment
Perlman Center
Perlman Center
cognitive
sensory
motor
social
Perlman Center
Building Enriched Environments
Perlman Center
Building Enriched Environments
bull Is the child positioned within
reach to explore the activity
bull Are all senses being utilized
bull Is the child being motivated to
move throughout the
environment
bull Is the environment adapted to
increase access to play
Perlman Center
Building Enriched Environments
bull Can the child have an effect
on the activity within the
environment
bull Is the activity appropriately
challenging the child within the
environment
bull Is the child presented with the
need for problem solving
Perlman Center
Building Enriched Environments
bull Is the child motivated to repeat
the task for motor learning
bull Does the environment support
learning (ie appropriate
noise level social motivators
peer groups developmental
learning supports visual
supports auditory feedback
etc)
Perlman Center
Bridging the gap between the clinic and the
home environment
bull Discipline focused
bull Clinic equipment closet
bull May have group option
Clinic
bull Incorporate into Family Routines
bull Functional activities
bull High Value
bull Adapted environment
Home
Mobility
Early Literacy
Sensory Motor Learning
Social Connections
Perlman Center
Early Learning
Functional MRIs show positive long-term neuro-
cognitive effects of reading to very young
infants
Sensory experiences shape a babyrsquos
knowledge about the world
The average toddler moves 8
out of 10 waking hoursday
Perlman Center
Learning through Experience
Adapting the environment with positioning equipment allows children with disabilities to experience their world and build relationships Allows the child to participate in typical experiences to foster learning
Activities need to promote active engagement
and allow a child to
ndash Actively explore move and participate in play
ndash Assist with self-help routines
ndash Interact and connect with family amp friends
ndash Participate in community activities
ndash Have a means to effectively communicate
ndash Make choices about their wants and need
Perlman Center
Perlman Center
bull Headpointing painting
bull Universal cuffs large pegs splints
bull Switch toys for art activitiesdramatic play-pourer
bull Switch computer access- helpkidzlearncom
bull Fischer Price game with keyboard binder switch
bull Walking in different textures while in standers and walkers
bull Cameramouseorg with dwell click
bull Partner assisted scanning
Alternative amp Adaptive Access to Play
Perlman Center
Change the environment Not the body Adaptations will be critical for success
Gross Motor Fine Motor
Social
Communication
Perlman Center Consider Communication Young children need a reliable form of communication as early as possible
Augmentative Communication is shown to support verbal skills and enhance lives of
birth to three children and their families (Romski et al 2015)
Perlman Center
Holistic approach to AAC intervention should
Build on individual strengths
Focus on participation in real-world contexts
Address psychosocial factors (ie motivation attitude confidence resilience)
Focus on environmental factors to reduce barriers and maximize social supports
In the absence of a holistic approach to communication a child is at risk for failing to engage in social contexts beyond their immediate family or educationalvocational personnel (Light and Mcnaughton 2015)
Augmentative amp Alternative Communication (AAC)
Perlman Center
Early Literacy
Perlman Center
Early Mobility
There is more than one way
Hands Free Matters
Perlman Center
Early Mobility
Should I get a gait trainer if
they are going to walk YES
Are they too young for power NO
Perlman Center
Sensory Motor Learning
Perlman Center
Sensory Motor Learning
Perlman Center
Social Connection
Perlman Center
Total Access to Play
Perlman Center
Perlman defines functional positioning bull Positioning which promotes active movement and participation and
provides an opportunity to positively impact cognitive function
bull Equipment should promote function and participation across the lifespan
Perlman Center
Principles of seating and positioning
bull Obtain a stable base of support
bull Decrease the influence of atypical muscle tone
bull Accommodate fixed deformities and correct flexible deformities
bull Provide the least amount of intervention needed to achieve the greatest level of function
bull There is no one solution or product but typically a combination of tools that provide success
Adapted from Radell (1997) and York and Weimann (1991)
Perlman Center
Key Positioning Components
bull Postural Control Strengthening
bull Range of Motion Weight Bearing
bull Home Activity Programs
Developmental Positioning
bull ADLs-Play Feeding Bathing Sleeping
bull Computer AccessAAC-Integrated Technology
bull Vision Sensory Processing Participation
Upright Positioning
bull EARLY MOBILITY- developmental sequence
bull Gait Trainer Stander amp or Wheelchair
bull Manual wheelchair vs Power Mobility- BOTH
bull Recreational
ldquoTotalrdquo Mobility
bull Body Mechanics Hoyer Lifts Overhead Systems
bull Car Seat ampor Tie Downs
bull Adapted VanRamps
Transfers ampTransportation
Perlman Center
Equipment Plan of Care
Birth to Three
Adapting baby
equipment
Floor Play
StanderWalker
Bath Seat
Car Seat
Braces
Seating for Function
Early ACCESS
Wheelchair
Bed Positioning
Bike amp Swing
Preschool
Stander
Walker
Braces
Bath Seat
Potty Seat
Wheelchair
HiLo seating
AACAccess
Adapted Bed
Car Seat
Transportation
RecreationHEP
School-Age
to Adult
Wheelchair
AACACCESS
Integrated AT
Hilo chair
Standerwalker
Bath chair
Potty chair
Adapted Bed
Car SeatVan
Home modslifts
LeisureWork
Perlman Center
Commercial Products strollers car seats cribs bath seats high chairs
playpen infant swings floor mats nursing pillow ExerSaucers
Perlman Center
Creative Commercial Adaptations
Pool noodles
Snug and Go
Crib Wedges
Bed tableart desk
Laundry baskets
Inflatable bathtub
Inflatable infant pools
Boxesstools
Perlman Center Creative Commercial Adaptations
Laundry basket $400
Pool Noodle x 2 $300
Floor sitterbath support $700
table (BLACK) $800
Garbage can $600
Large pool noodle $300
Stander with anterior support and
Visual adaptation $1700
Perlman Center
Complex Rehab Equipment
Standers
Gait trainers
Bath Support
Car seat
Seating
Feeding tools
AAC
Sensory tools
vibration
Compression garments
NUK brushes
Z Vibe
Modified utensils
Swings
Weight
Head phones
Positioning
Neck supports
Bracing
Bobby pillowU cushion
Benches
Fireflyfriendscom
PlayPaK
Upsee
Go To Seat
Early Literacy
Picture symbols
Voice output switches
Adapted books
Adapted Equipment
Perlman Center
You got this baby Nowhellip Questions
Perlman Center
LETrsquoS PLAY
Hands on Equipment Demonstration
Perlman Center
bull Ulrich B (2010) Opportunities for Early Intervention Based on Theory Basic Neuroscience and Clinical Science Physical Therapy 90(12) 1868-1880
bull McIntyre S Morgan C amp Walker K (2011) Cerebral Palsy Dont Delay Developmental Disabilities Research Reviews 17(2) 114-129
bull Novak I (2014) Evidence-Based Diagnosis Health Care and Rehabilitation for Children with Cerebral Palsy Journal of Child Neurology 29(8) 1141-1156
bull Morgan C Novak I amp Badawi N (2013) Enriched Environments and Motor Outcomes in Cerebral Palsy Systematic Review and Meta-analysis Pediatrics 132 (3)e 735 -e746
bull Morgan C Novak I Dale R Guzzetta A amp Badawi N (2014) GAME (Goals- Activity-Motor Enrichment) protocol of a single blind randomised controlled trial of motor training parent education and environmental enrichment for infants at high risk of cerebral palsy BMC Neurology 14(203)
bull Whittingham K Wee D amp Boyd R (2010) Systematic review of the efficacy of parenting interventions for children with cerebral palsy Child care health and development 37(4) 475-483
bull Morgan C Novak I dale R amp Badawi N (2015) Optimising motor learning in infants at high risk of cerebral palsy a pilot study BMC Pediatrics 15(1) n pag Web
bull Vos R Dallmeijer A Verhoef M et al (2014) Developmental trajectories of receptive and expressive communication in children and young adults with cerebral palsy Developmental Medicine amp Child Neurology 56 951-959
bull Light J and McNaughton D (2015) Designing AAC research and intervention to improve outcomes for individuals with complex communication needs Augmentative and Alternative Communication 31(2) 85-96
bull Romski M Sevcik R Barton-Hulsey A amp Whitmore A (2015) Early Intervention and AAC What a difference 30 years makes Augmentative and Alternative Communication 31 (3) 181-202
References
Perlman Center
bull Novak I Cusick A Lannin N (2009) Occupational therapy home programs for cerebral palsy Double-blind randomised controlled trial Pediatrics 124 e606-e614
bull Gericke T (2006) Postural management for children with cerebral palsy consensus statement Dev Med Child Neurol 48 (4) 244-244
bull McKeever P Rossen B Scott H Robinson-Vincent K amp Wright V (2013) The significance of uprightness parentsrsquo reflections on childrenrsquos responses to a hands-free walker for children Disability amp Society 28(3) 380-392
bull Law M Pollock N Russell D Walter S et al (2011) Focus on function a cluster randomised controlled trial comparing child-versus context-focused intervention for young children with cerebral palsy Dev Med Child Neurol 53 621-629
bull ldquoSensory Processing Developmental Chartrdquo Sensory Processing Developmental Chart Np nd Web 12 Oct 2015
bull Folio MR amp Fewell RR(2000) Peabody Developmental Motor Scales- Second edition Austin TX PRO ED
bull Voress Judith K amp Pearson Nils A (2013) Early Childhood Development Chart-Third edition Austin TX PRO ED
bull Paul Rhea (2007) Language Disorders from Infancy Through Adolescence Assessment amp Intervention Third edition St Louis MA Mosby Inc
bull Prosser L Ohlrich L Curatalo L Alter K amp Damiano D (2012) Feasibility and preliminary effectiveness of a novel mobility training intervention in infants and toddlers with cerebral palsy Developmental Neurorehabilitation 15(4) 259-266
References
Perlman Center
Purposeful Play ishellip
Goal oriented
Activity based
Motivating
In an Enriched environment
Perlman Center
Perlman Center
cognitive
sensory
motor
social
Perlman Center
Building Enriched Environments
Perlman Center
Building Enriched Environments
bull Is the child positioned within
reach to explore the activity
bull Are all senses being utilized
bull Is the child being motivated to
move throughout the
environment
bull Is the environment adapted to
increase access to play
Perlman Center
Building Enriched Environments
bull Can the child have an effect
on the activity within the
environment
bull Is the activity appropriately
challenging the child within the
environment
bull Is the child presented with the
need for problem solving
Perlman Center
Building Enriched Environments
bull Is the child motivated to repeat
the task for motor learning
bull Does the environment support
learning (ie appropriate
noise level social motivators
peer groups developmental
learning supports visual
supports auditory feedback
etc)
Perlman Center
Bridging the gap between the clinic and the
home environment
bull Discipline focused
bull Clinic equipment closet
bull May have group option
Clinic
bull Incorporate into Family Routines
bull Functional activities
bull High Value
bull Adapted environment
Home
Mobility
Early Literacy
Sensory Motor Learning
Social Connections
Perlman Center
Early Learning
Functional MRIs show positive long-term neuro-
cognitive effects of reading to very young
infants
Sensory experiences shape a babyrsquos
knowledge about the world
The average toddler moves 8
out of 10 waking hoursday
Perlman Center
Learning through Experience
Adapting the environment with positioning equipment allows children with disabilities to experience their world and build relationships Allows the child to participate in typical experiences to foster learning
Activities need to promote active engagement
and allow a child to
ndash Actively explore move and participate in play
ndash Assist with self-help routines
ndash Interact and connect with family amp friends
ndash Participate in community activities
ndash Have a means to effectively communicate
ndash Make choices about their wants and need
Perlman Center
Perlman Center
bull Headpointing painting
bull Universal cuffs large pegs splints
bull Switch toys for art activitiesdramatic play-pourer
bull Switch computer access- helpkidzlearncom
bull Fischer Price game with keyboard binder switch
bull Walking in different textures while in standers and walkers
bull Cameramouseorg with dwell click
bull Partner assisted scanning
Alternative amp Adaptive Access to Play
Perlman Center
Change the environment Not the body Adaptations will be critical for success
Gross Motor Fine Motor
Social
Communication
Perlman Center Consider Communication Young children need a reliable form of communication as early as possible
Augmentative Communication is shown to support verbal skills and enhance lives of
birth to three children and their families (Romski et al 2015)
Perlman Center
Holistic approach to AAC intervention should
Build on individual strengths
Focus on participation in real-world contexts
Address psychosocial factors (ie motivation attitude confidence resilience)
Focus on environmental factors to reduce barriers and maximize social supports
In the absence of a holistic approach to communication a child is at risk for failing to engage in social contexts beyond their immediate family or educationalvocational personnel (Light and Mcnaughton 2015)
Augmentative amp Alternative Communication (AAC)
Perlman Center
Early Literacy
Perlman Center
Early Mobility
There is more than one way
Hands Free Matters
Perlman Center
Early Mobility
Should I get a gait trainer if
they are going to walk YES
Are they too young for power NO
Perlman Center
Sensory Motor Learning
Perlman Center
Sensory Motor Learning
Perlman Center
Social Connection
Perlman Center
Total Access to Play
Perlman Center
Perlman defines functional positioning bull Positioning which promotes active movement and participation and
provides an opportunity to positively impact cognitive function
bull Equipment should promote function and participation across the lifespan
Perlman Center
Principles of seating and positioning
bull Obtain a stable base of support
bull Decrease the influence of atypical muscle tone
bull Accommodate fixed deformities and correct flexible deformities
bull Provide the least amount of intervention needed to achieve the greatest level of function
bull There is no one solution or product but typically a combination of tools that provide success
Adapted from Radell (1997) and York and Weimann (1991)
Perlman Center
Key Positioning Components
bull Postural Control Strengthening
bull Range of Motion Weight Bearing
bull Home Activity Programs
Developmental Positioning
bull ADLs-Play Feeding Bathing Sleeping
bull Computer AccessAAC-Integrated Technology
bull Vision Sensory Processing Participation
Upright Positioning
bull EARLY MOBILITY- developmental sequence
bull Gait Trainer Stander amp or Wheelchair
bull Manual wheelchair vs Power Mobility- BOTH
bull Recreational
ldquoTotalrdquo Mobility
bull Body Mechanics Hoyer Lifts Overhead Systems
bull Car Seat ampor Tie Downs
bull Adapted VanRamps
Transfers ampTransportation
Perlman Center
Equipment Plan of Care
Birth to Three
Adapting baby
equipment
Floor Play
StanderWalker
Bath Seat
Car Seat
Braces
Seating for Function
Early ACCESS
Wheelchair
Bed Positioning
Bike amp Swing
Preschool
Stander
Walker
Braces
Bath Seat
Potty Seat
Wheelchair
HiLo seating
AACAccess
Adapted Bed
Car Seat
Transportation
RecreationHEP
School-Age
to Adult
Wheelchair
AACACCESS
Integrated AT
Hilo chair
Standerwalker
Bath chair
Potty chair
Adapted Bed
Car SeatVan
Home modslifts
LeisureWork
Perlman Center
Commercial Products strollers car seats cribs bath seats high chairs
playpen infant swings floor mats nursing pillow ExerSaucers
Perlman Center
Creative Commercial Adaptations
Pool noodles
Snug and Go
Crib Wedges
Bed tableart desk
Laundry baskets
Inflatable bathtub
Inflatable infant pools
Boxesstools
Perlman Center Creative Commercial Adaptations
Laundry basket $400
Pool Noodle x 2 $300
Floor sitterbath support $700
table (BLACK) $800
Garbage can $600
Large pool noodle $300
Stander with anterior support and
Visual adaptation $1700
Perlman Center
Complex Rehab Equipment
Standers
Gait trainers
Bath Support
Car seat
Seating
Feeding tools
AAC
Sensory tools
vibration
Compression garments
NUK brushes
Z Vibe
Modified utensils
Swings
Weight
Head phones
Positioning
Neck supports
Bracing
Bobby pillowU cushion
Benches
Fireflyfriendscom
PlayPaK
Upsee
Go To Seat
Early Literacy
Picture symbols
Voice output switches
Adapted books
Adapted Equipment
Perlman Center
You got this baby Nowhellip Questions
Perlman Center
LETrsquoS PLAY
Hands on Equipment Demonstration
Perlman Center
bull Ulrich B (2010) Opportunities for Early Intervention Based on Theory Basic Neuroscience and Clinical Science Physical Therapy 90(12) 1868-1880
bull McIntyre S Morgan C amp Walker K (2011) Cerebral Palsy Dont Delay Developmental Disabilities Research Reviews 17(2) 114-129
bull Novak I (2014) Evidence-Based Diagnosis Health Care and Rehabilitation for Children with Cerebral Palsy Journal of Child Neurology 29(8) 1141-1156
bull Morgan C Novak I amp Badawi N (2013) Enriched Environments and Motor Outcomes in Cerebral Palsy Systematic Review and Meta-analysis Pediatrics 132 (3)e 735 -e746
bull Morgan C Novak I Dale R Guzzetta A amp Badawi N (2014) GAME (Goals- Activity-Motor Enrichment) protocol of a single blind randomised controlled trial of motor training parent education and environmental enrichment for infants at high risk of cerebral palsy BMC Neurology 14(203)
bull Whittingham K Wee D amp Boyd R (2010) Systematic review of the efficacy of parenting interventions for children with cerebral palsy Child care health and development 37(4) 475-483
bull Morgan C Novak I dale R amp Badawi N (2015) Optimising motor learning in infants at high risk of cerebral palsy a pilot study BMC Pediatrics 15(1) n pag Web
bull Vos R Dallmeijer A Verhoef M et al (2014) Developmental trajectories of receptive and expressive communication in children and young adults with cerebral palsy Developmental Medicine amp Child Neurology 56 951-959
bull Light J and McNaughton D (2015) Designing AAC research and intervention to improve outcomes for individuals with complex communication needs Augmentative and Alternative Communication 31(2) 85-96
bull Romski M Sevcik R Barton-Hulsey A amp Whitmore A (2015) Early Intervention and AAC What a difference 30 years makes Augmentative and Alternative Communication 31 (3) 181-202
References
Perlman Center
bull Novak I Cusick A Lannin N (2009) Occupational therapy home programs for cerebral palsy Double-blind randomised controlled trial Pediatrics 124 e606-e614
bull Gericke T (2006) Postural management for children with cerebral palsy consensus statement Dev Med Child Neurol 48 (4) 244-244
bull McKeever P Rossen B Scott H Robinson-Vincent K amp Wright V (2013) The significance of uprightness parentsrsquo reflections on childrenrsquos responses to a hands-free walker for children Disability amp Society 28(3) 380-392
bull Law M Pollock N Russell D Walter S et al (2011) Focus on function a cluster randomised controlled trial comparing child-versus context-focused intervention for young children with cerebral palsy Dev Med Child Neurol 53 621-629
bull ldquoSensory Processing Developmental Chartrdquo Sensory Processing Developmental Chart Np nd Web 12 Oct 2015
bull Folio MR amp Fewell RR(2000) Peabody Developmental Motor Scales- Second edition Austin TX PRO ED
bull Voress Judith K amp Pearson Nils A (2013) Early Childhood Development Chart-Third edition Austin TX PRO ED
bull Paul Rhea (2007) Language Disorders from Infancy Through Adolescence Assessment amp Intervention Third edition St Louis MA Mosby Inc
bull Prosser L Ohlrich L Curatalo L Alter K amp Damiano D (2012) Feasibility and preliminary effectiveness of a novel mobility training intervention in infants and toddlers with cerebral palsy Developmental Neurorehabilitation 15(4) 259-266
References
Perlman Center
Perlman Center
cognitive
sensory
motor
social
Perlman Center
Building Enriched Environments
Perlman Center
Building Enriched Environments
bull Is the child positioned within
reach to explore the activity
bull Are all senses being utilized
bull Is the child being motivated to
move throughout the
environment
bull Is the environment adapted to
increase access to play
Perlman Center
Building Enriched Environments
bull Can the child have an effect
on the activity within the
environment
bull Is the activity appropriately
challenging the child within the
environment
bull Is the child presented with the
need for problem solving
Perlman Center
Building Enriched Environments
bull Is the child motivated to repeat
the task for motor learning
bull Does the environment support
learning (ie appropriate
noise level social motivators
peer groups developmental
learning supports visual
supports auditory feedback
etc)
Perlman Center
Bridging the gap between the clinic and the
home environment
bull Discipline focused
bull Clinic equipment closet
bull May have group option
Clinic
bull Incorporate into Family Routines
bull Functional activities
bull High Value
bull Adapted environment
Home
Mobility
Early Literacy
Sensory Motor Learning
Social Connections
Perlman Center
Early Learning
Functional MRIs show positive long-term neuro-
cognitive effects of reading to very young
infants
Sensory experiences shape a babyrsquos
knowledge about the world
The average toddler moves 8
out of 10 waking hoursday
Perlman Center
Learning through Experience
Adapting the environment with positioning equipment allows children with disabilities to experience their world and build relationships Allows the child to participate in typical experiences to foster learning
Activities need to promote active engagement
and allow a child to
ndash Actively explore move and participate in play
ndash Assist with self-help routines
ndash Interact and connect with family amp friends
ndash Participate in community activities
ndash Have a means to effectively communicate
ndash Make choices about their wants and need
Perlman Center
Perlman Center
bull Headpointing painting
bull Universal cuffs large pegs splints
bull Switch toys for art activitiesdramatic play-pourer
bull Switch computer access- helpkidzlearncom
bull Fischer Price game with keyboard binder switch
bull Walking in different textures while in standers and walkers
bull Cameramouseorg with dwell click
bull Partner assisted scanning
Alternative amp Adaptive Access to Play
Perlman Center
Change the environment Not the body Adaptations will be critical for success
Gross Motor Fine Motor
Social
Communication
Perlman Center Consider Communication Young children need a reliable form of communication as early as possible
Augmentative Communication is shown to support verbal skills and enhance lives of
birth to three children and their families (Romski et al 2015)
Perlman Center
Holistic approach to AAC intervention should
Build on individual strengths
Focus on participation in real-world contexts
Address psychosocial factors (ie motivation attitude confidence resilience)
Focus on environmental factors to reduce barriers and maximize social supports
In the absence of a holistic approach to communication a child is at risk for failing to engage in social contexts beyond their immediate family or educationalvocational personnel (Light and Mcnaughton 2015)
Augmentative amp Alternative Communication (AAC)
Perlman Center
Early Literacy
Perlman Center
Early Mobility
There is more than one way
Hands Free Matters
Perlman Center
Early Mobility
Should I get a gait trainer if
they are going to walk YES
Are they too young for power NO
Perlman Center
Sensory Motor Learning
Perlman Center
Sensory Motor Learning
Perlman Center
Social Connection
Perlman Center
Total Access to Play
Perlman Center
Perlman defines functional positioning bull Positioning which promotes active movement and participation and
provides an opportunity to positively impact cognitive function
bull Equipment should promote function and participation across the lifespan
Perlman Center
Principles of seating and positioning
bull Obtain a stable base of support
bull Decrease the influence of atypical muscle tone
bull Accommodate fixed deformities and correct flexible deformities
bull Provide the least amount of intervention needed to achieve the greatest level of function
bull There is no one solution or product but typically a combination of tools that provide success
Adapted from Radell (1997) and York and Weimann (1991)
Perlman Center
Key Positioning Components
bull Postural Control Strengthening
bull Range of Motion Weight Bearing
bull Home Activity Programs
Developmental Positioning
bull ADLs-Play Feeding Bathing Sleeping
bull Computer AccessAAC-Integrated Technology
bull Vision Sensory Processing Participation
Upright Positioning
bull EARLY MOBILITY- developmental sequence
bull Gait Trainer Stander amp or Wheelchair
bull Manual wheelchair vs Power Mobility- BOTH
bull Recreational
ldquoTotalrdquo Mobility
bull Body Mechanics Hoyer Lifts Overhead Systems
bull Car Seat ampor Tie Downs
bull Adapted VanRamps
Transfers ampTransportation
Perlman Center
Equipment Plan of Care
Birth to Three
Adapting baby
equipment
Floor Play
StanderWalker
Bath Seat
Car Seat
Braces
Seating for Function
Early ACCESS
Wheelchair
Bed Positioning
Bike amp Swing
Preschool
Stander
Walker
Braces
Bath Seat
Potty Seat
Wheelchair
HiLo seating
AACAccess
Adapted Bed
Car Seat
Transportation
RecreationHEP
School-Age
to Adult
Wheelchair
AACACCESS
Integrated AT
Hilo chair
Standerwalker
Bath chair
Potty chair
Adapted Bed
Car SeatVan
Home modslifts
LeisureWork
Perlman Center
Commercial Products strollers car seats cribs bath seats high chairs
playpen infant swings floor mats nursing pillow ExerSaucers
Perlman Center
Creative Commercial Adaptations
Pool noodles
Snug and Go
Crib Wedges
Bed tableart desk
Laundry baskets
Inflatable bathtub
Inflatable infant pools
Boxesstools
Perlman Center Creative Commercial Adaptations
Laundry basket $400
Pool Noodle x 2 $300
Floor sitterbath support $700
table (BLACK) $800
Garbage can $600
Large pool noodle $300
Stander with anterior support and
Visual adaptation $1700
Perlman Center
Complex Rehab Equipment
Standers
Gait trainers
Bath Support
Car seat
Seating
Feeding tools
AAC
Sensory tools
vibration
Compression garments
NUK brushes
Z Vibe
Modified utensils
Swings
Weight
Head phones
Positioning
Neck supports
Bracing
Bobby pillowU cushion
Benches
Fireflyfriendscom
PlayPaK
Upsee
Go To Seat
Early Literacy
Picture symbols
Voice output switches
Adapted books
Adapted Equipment
Perlman Center
You got this baby Nowhellip Questions
Perlman Center
LETrsquoS PLAY
Hands on Equipment Demonstration
Perlman Center
bull Ulrich B (2010) Opportunities for Early Intervention Based on Theory Basic Neuroscience and Clinical Science Physical Therapy 90(12) 1868-1880
bull McIntyre S Morgan C amp Walker K (2011) Cerebral Palsy Dont Delay Developmental Disabilities Research Reviews 17(2) 114-129
bull Novak I (2014) Evidence-Based Diagnosis Health Care and Rehabilitation for Children with Cerebral Palsy Journal of Child Neurology 29(8) 1141-1156
bull Morgan C Novak I amp Badawi N (2013) Enriched Environments and Motor Outcomes in Cerebral Palsy Systematic Review and Meta-analysis Pediatrics 132 (3)e 735 -e746
bull Morgan C Novak I Dale R Guzzetta A amp Badawi N (2014) GAME (Goals- Activity-Motor Enrichment) protocol of a single blind randomised controlled trial of motor training parent education and environmental enrichment for infants at high risk of cerebral palsy BMC Neurology 14(203)
bull Whittingham K Wee D amp Boyd R (2010) Systematic review of the efficacy of parenting interventions for children with cerebral palsy Child care health and development 37(4) 475-483
bull Morgan C Novak I dale R amp Badawi N (2015) Optimising motor learning in infants at high risk of cerebral palsy a pilot study BMC Pediatrics 15(1) n pag Web
bull Vos R Dallmeijer A Verhoef M et al (2014) Developmental trajectories of receptive and expressive communication in children and young adults with cerebral palsy Developmental Medicine amp Child Neurology 56 951-959
bull Light J and McNaughton D (2015) Designing AAC research and intervention to improve outcomes for individuals with complex communication needs Augmentative and Alternative Communication 31(2) 85-96
bull Romski M Sevcik R Barton-Hulsey A amp Whitmore A (2015) Early Intervention and AAC What a difference 30 years makes Augmentative and Alternative Communication 31 (3) 181-202
References
Perlman Center
bull Novak I Cusick A Lannin N (2009) Occupational therapy home programs for cerebral palsy Double-blind randomised controlled trial Pediatrics 124 e606-e614
bull Gericke T (2006) Postural management for children with cerebral palsy consensus statement Dev Med Child Neurol 48 (4) 244-244
bull McKeever P Rossen B Scott H Robinson-Vincent K amp Wright V (2013) The significance of uprightness parentsrsquo reflections on childrenrsquos responses to a hands-free walker for children Disability amp Society 28(3) 380-392
bull Law M Pollock N Russell D Walter S et al (2011) Focus on function a cluster randomised controlled trial comparing child-versus context-focused intervention for young children with cerebral palsy Dev Med Child Neurol 53 621-629
bull ldquoSensory Processing Developmental Chartrdquo Sensory Processing Developmental Chart Np nd Web 12 Oct 2015
bull Folio MR amp Fewell RR(2000) Peabody Developmental Motor Scales- Second edition Austin TX PRO ED
bull Voress Judith K amp Pearson Nils A (2013) Early Childhood Development Chart-Third edition Austin TX PRO ED
bull Paul Rhea (2007) Language Disorders from Infancy Through Adolescence Assessment amp Intervention Third edition St Louis MA Mosby Inc
bull Prosser L Ohlrich L Curatalo L Alter K amp Damiano D (2012) Feasibility and preliminary effectiveness of a novel mobility training intervention in infants and toddlers with cerebral palsy Developmental Neurorehabilitation 15(4) 259-266
References
Perlman Center
cognitive
sensory
motor
social
Perlman Center
Building Enriched Environments
Perlman Center
Building Enriched Environments
bull Is the child positioned within
reach to explore the activity
bull Are all senses being utilized
bull Is the child being motivated to
move throughout the
environment
bull Is the environment adapted to
increase access to play
Perlman Center
Building Enriched Environments
bull Can the child have an effect
on the activity within the
environment
bull Is the activity appropriately
challenging the child within the
environment
bull Is the child presented with the
need for problem solving
Perlman Center
Building Enriched Environments
bull Is the child motivated to repeat
the task for motor learning
bull Does the environment support
learning (ie appropriate
noise level social motivators
peer groups developmental
learning supports visual
supports auditory feedback
etc)
Perlman Center
Bridging the gap between the clinic and the
home environment
bull Discipline focused
bull Clinic equipment closet
bull May have group option
Clinic
bull Incorporate into Family Routines
bull Functional activities
bull High Value
bull Adapted environment
Home
Mobility
Early Literacy
Sensory Motor Learning
Social Connections
Perlman Center
Early Learning
Functional MRIs show positive long-term neuro-
cognitive effects of reading to very young
infants
Sensory experiences shape a babyrsquos
knowledge about the world
The average toddler moves 8
out of 10 waking hoursday
Perlman Center
Learning through Experience
Adapting the environment with positioning equipment allows children with disabilities to experience their world and build relationships Allows the child to participate in typical experiences to foster learning
Activities need to promote active engagement
and allow a child to
ndash Actively explore move and participate in play
ndash Assist with self-help routines
ndash Interact and connect with family amp friends
ndash Participate in community activities
ndash Have a means to effectively communicate
ndash Make choices about their wants and need
Perlman Center
Perlman Center
bull Headpointing painting
bull Universal cuffs large pegs splints
bull Switch toys for art activitiesdramatic play-pourer
bull Switch computer access- helpkidzlearncom
bull Fischer Price game with keyboard binder switch
bull Walking in different textures while in standers and walkers
bull Cameramouseorg with dwell click
bull Partner assisted scanning
Alternative amp Adaptive Access to Play
Perlman Center
Change the environment Not the body Adaptations will be critical for success
Gross Motor Fine Motor
Social
Communication
Perlman Center Consider Communication Young children need a reliable form of communication as early as possible
Augmentative Communication is shown to support verbal skills and enhance lives of
birth to three children and their families (Romski et al 2015)
Perlman Center
Holistic approach to AAC intervention should
Build on individual strengths
Focus on participation in real-world contexts
Address psychosocial factors (ie motivation attitude confidence resilience)
Focus on environmental factors to reduce barriers and maximize social supports
In the absence of a holistic approach to communication a child is at risk for failing to engage in social contexts beyond their immediate family or educationalvocational personnel (Light and Mcnaughton 2015)
Augmentative amp Alternative Communication (AAC)
Perlman Center
Early Literacy
Perlman Center
Early Mobility
There is more than one way
Hands Free Matters
Perlman Center
Early Mobility
Should I get a gait trainer if
they are going to walk YES
Are they too young for power NO
Perlman Center
Sensory Motor Learning
Perlman Center
Sensory Motor Learning
Perlman Center
Social Connection
Perlman Center
Total Access to Play
Perlman Center
Perlman defines functional positioning bull Positioning which promotes active movement and participation and
provides an opportunity to positively impact cognitive function
bull Equipment should promote function and participation across the lifespan
Perlman Center
Principles of seating and positioning
bull Obtain a stable base of support
bull Decrease the influence of atypical muscle tone
bull Accommodate fixed deformities and correct flexible deformities
bull Provide the least amount of intervention needed to achieve the greatest level of function
bull There is no one solution or product but typically a combination of tools that provide success
Adapted from Radell (1997) and York and Weimann (1991)
Perlman Center
Key Positioning Components
bull Postural Control Strengthening
bull Range of Motion Weight Bearing
bull Home Activity Programs
Developmental Positioning
bull ADLs-Play Feeding Bathing Sleeping
bull Computer AccessAAC-Integrated Technology
bull Vision Sensory Processing Participation
Upright Positioning
bull EARLY MOBILITY- developmental sequence
bull Gait Trainer Stander amp or Wheelchair
bull Manual wheelchair vs Power Mobility- BOTH
bull Recreational
ldquoTotalrdquo Mobility
bull Body Mechanics Hoyer Lifts Overhead Systems
bull Car Seat ampor Tie Downs
bull Adapted VanRamps
Transfers ampTransportation
Perlman Center
Equipment Plan of Care
Birth to Three
Adapting baby
equipment
Floor Play
StanderWalker
Bath Seat
Car Seat
Braces
Seating for Function
Early ACCESS
Wheelchair
Bed Positioning
Bike amp Swing
Preschool
Stander
Walker
Braces
Bath Seat
Potty Seat
Wheelchair
HiLo seating
AACAccess
Adapted Bed
Car Seat
Transportation
RecreationHEP
School-Age
to Adult
Wheelchair
AACACCESS
Integrated AT
Hilo chair
Standerwalker
Bath chair
Potty chair
Adapted Bed
Car SeatVan
Home modslifts
LeisureWork
Perlman Center
Commercial Products strollers car seats cribs bath seats high chairs
playpen infant swings floor mats nursing pillow ExerSaucers
Perlman Center
Creative Commercial Adaptations
Pool noodles
Snug and Go
Crib Wedges
Bed tableart desk
Laundry baskets
Inflatable bathtub
Inflatable infant pools
Boxesstools
Perlman Center Creative Commercial Adaptations
Laundry basket $400
Pool Noodle x 2 $300
Floor sitterbath support $700
table (BLACK) $800
Garbage can $600
Large pool noodle $300
Stander with anterior support and
Visual adaptation $1700
Perlman Center
Complex Rehab Equipment
Standers
Gait trainers
Bath Support
Car seat
Seating
Feeding tools
AAC
Sensory tools
vibration
Compression garments
NUK brushes
Z Vibe
Modified utensils
Swings
Weight
Head phones
Positioning
Neck supports
Bracing
Bobby pillowU cushion
Benches
Fireflyfriendscom
PlayPaK
Upsee
Go To Seat
Early Literacy
Picture symbols
Voice output switches
Adapted books
Adapted Equipment
Perlman Center
You got this baby Nowhellip Questions
Perlman Center
LETrsquoS PLAY
Hands on Equipment Demonstration
Perlman Center
bull Ulrich B (2010) Opportunities for Early Intervention Based on Theory Basic Neuroscience and Clinical Science Physical Therapy 90(12) 1868-1880
bull McIntyre S Morgan C amp Walker K (2011) Cerebral Palsy Dont Delay Developmental Disabilities Research Reviews 17(2) 114-129
bull Novak I (2014) Evidence-Based Diagnosis Health Care and Rehabilitation for Children with Cerebral Palsy Journal of Child Neurology 29(8) 1141-1156
bull Morgan C Novak I amp Badawi N (2013) Enriched Environments and Motor Outcomes in Cerebral Palsy Systematic Review and Meta-analysis Pediatrics 132 (3)e 735 -e746
bull Morgan C Novak I Dale R Guzzetta A amp Badawi N (2014) GAME (Goals- Activity-Motor Enrichment) protocol of a single blind randomised controlled trial of motor training parent education and environmental enrichment for infants at high risk of cerebral palsy BMC Neurology 14(203)
bull Whittingham K Wee D amp Boyd R (2010) Systematic review of the efficacy of parenting interventions for children with cerebral palsy Child care health and development 37(4) 475-483
bull Morgan C Novak I dale R amp Badawi N (2015) Optimising motor learning in infants at high risk of cerebral palsy a pilot study BMC Pediatrics 15(1) n pag Web
bull Vos R Dallmeijer A Verhoef M et al (2014) Developmental trajectories of receptive and expressive communication in children and young adults with cerebral palsy Developmental Medicine amp Child Neurology 56 951-959
bull Light J and McNaughton D (2015) Designing AAC research and intervention to improve outcomes for individuals with complex communication needs Augmentative and Alternative Communication 31(2) 85-96
bull Romski M Sevcik R Barton-Hulsey A amp Whitmore A (2015) Early Intervention and AAC What a difference 30 years makes Augmentative and Alternative Communication 31 (3) 181-202
References
Perlman Center
bull Novak I Cusick A Lannin N (2009) Occupational therapy home programs for cerebral palsy Double-blind randomised controlled trial Pediatrics 124 e606-e614
bull Gericke T (2006) Postural management for children with cerebral palsy consensus statement Dev Med Child Neurol 48 (4) 244-244
bull McKeever P Rossen B Scott H Robinson-Vincent K amp Wright V (2013) The significance of uprightness parentsrsquo reflections on childrenrsquos responses to a hands-free walker for children Disability amp Society 28(3) 380-392
bull Law M Pollock N Russell D Walter S et al (2011) Focus on function a cluster randomised controlled trial comparing child-versus context-focused intervention for young children with cerebral palsy Dev Med Child Neurol 53 621-629
bull ldquoSensory Processing Developmental Chartrdquo Sensory Processing Developmental Chart Np nd Web 12 Oct 2015
bull Folio MR amp Fewell RR(2000) Peabody Developmental Motor Scales- Second edition Austin TX PRO ED
bull Voress Judith K amp Pearson Nils A (2013) Early Childhood Development Chart-Third edition Austin TX PRO ED
bull Paul Rhea (2007) Language Disorders from Infancy Through Adolescence Assessment amp Intervention Third edition St Louis MA Mosby Inc
bull Prosser L Ohlrich L Curatalo L Alter K amp Damiano D (2012) Feasibility and preliminary effectiveness of a novel mobility training intervention in infants and toddlers with cerebral palsy Developmental Neurorehabilitation 15(4) 259-266
References
Perlman Center
Building Enriched Environments
Perlman Center
Building Enriched Environments
bull Is the child positioned within
reach to explore the activity
bull Are all senses being utilized
bull Is the child being motivated to
move throughout the
environment
bull Is the environment adapted to
increase access to play
Perlman Center
Building Enriched Environments
bull Can the child have an effect
on the activity within the
environment
bull Is the activity appropriately
challenging the child within the
environment
bull Is the child presented with the
need for problem solving
Perlman Center
Building Enriched Environments
bull Is the child motivated to repeat
the task for motor learning
bull Does the environment support
learning (ie appropriate
noise level social motivators
peer groups developmental
learning supports visual
supports auditory feedback
etc)
Perlman Center
Bridging the gap between the clinic and the
home environment
bull Discipline focused
bull Clinic equipment closet
bull May have group option
Clinic
bull Incorporate into Family Routines
bull Functional activities
bull High Value
bull Adapted environment
Home
Mobility
Early Literacy
Sensory Motor Learning
Social Connections
Perlman Center
Early Learning
Functional MRIs show positive long-term neuro-
cognitive effects of reading to very young
infants
Sensory experiences shape a babyrsquos
knowledge about the world
The average toddler moves 8
out of 10 waking hoursday
Perlman Center
Learning through Experience
Adapting the environment with positioning equipment allows children with disabilities to experience their world and build relationships Allows the child to participate in typical experiences to foster learning
Activities need to promote active engagement
and allow a child to
ndash Actively explore move and participate in play
ndash Assist with self-help routines
ndash Interact and connect with family amp friends
ndash Participate in community activities
ndash Have a means to effectively communicate
ndash Make choices about their wants and need
Perlman Center
Perlman Center
bull Headpointing painting
bull Universal cuffs large pegs splints
bull Switch toys for art activitiesdramatic play-pourer
bull Switch computer access- helpkidzlearncom
bull Fischer Price game with keyboard binder switch
bull Walking in different textures while in standers and walkers
bull Cameramouseorg with dwell click
bull Partner assisted scanning
Alternative amp Adaptive Access to Play
Perlman Center
Change the environment Not the body Adaptations will be critical for success
Gross Motor Fine Motor
Social
Communication
Perlman Center Consider Communication Young children need a reliable form of communication as early as possible
Augmentative Communication is shown to support verbal skills and enhance lives of
birth to three children and their families (Romski et al 2015)
Perlman Center
Holistic approach to AAC intervention should
Build on individual strengths
Focus on participation in real-world contexts
Address psychosocial factors (ie motivation attitude confidence resilience)
Focus on environmental factors to reduce barriers and maximize social supports
In the absence of a holistic approach to communication a child is at risk for failing to engage in social contexts beyond their immediate family or educationalvocational personnel (Light and Mcnaughton 2015)
Augmentative amp Alternative Communication (AAC)
Perlman Center
Early Literacy
Perlman Center
Early Mobility
There is more than one way
Hands Free Matters
Perlman Center
Early Mobility
Should I get a gait trainer if
they are going to walk YES
Are they too young for power NO
Perlman Center
Sensory Motor Learning
Perlman Center
Sensory Motor Learning
Perlman Center
Social Connection
Perlman Center
Total Access to Play
Perlman Center
Perlman defines functional positioning bull Positioning which promotes active movement and participation and
provides an opportunity to positively impact cognitive function
bull Equipment should promote function and participation across the lifespan
Perlman Center
Principles of seating and positioning
bull Obtain a stable base of support
bull Decrease the influence of atypical muscle tone
bull Accommodate fixed deformities and correct flexible deformities
bull Provide the least amount of intervention needed to achieve the greatest level of function
bull There is no one solution or product but typically a combination of tools that provide success
Adapted from Radell (1997) and York and Weimann (1991)
Perlman Center
Key Positioning Components
bull Postural Control Strengthening
bull Range of Motion Weight Bearing
bull Home Activity Programs
Developmental Positioning
bull ADLs-Play Feeding Bathing Sleeping
bull Computer AccessAAC-Integrated Technology
bull Vision Sensory Processing Participation
Upright Positioning
bull EARLY MOBILITY- developmental sequence
bull Gait Trainer Stander amp or Wheelchair
bull Manual wheelchair vs Power Mobility- BOTH
bull Recreational
ldquoTotalrdquo Mobility
bull Body Mechanics Hoyer Lifts Overhead Systems
bull Car Seat ampor Tie Downs
bull Adapted VanRamps
Transfers ampTransportation
Perlman Center
Equipment Plan of Care
Birth to Three
Adapting baby
equipment
Floor Play
StanderWalker
Bath Seat
Car Seat
Braces
Seating for Function
Early ACCESS
Wheelchair
Bed Positioning
Bike amp Swing
Preschool
Stander
Walker
Braces
Bath Seat
Potty Seat
Wheelchair
HiLo seating
AACAccess
Adapted Bed
Car Seat
Transportation
RecreationHEP
School-Age
to Adult
Wheelchair
AACACCESS
Integrated AT
Hilo chair
Standerwalker
Bath chair
Potty chair
Adapted Bed
Car SeatVan
Home modslifts
LeisureWork
Perlman Center
Commercial Products strollers car seats cribs bath seats high chairs
playpen infant swings floor mats nursing pillow ExerSaucers
Perlman Center
Creative Commercial Adaptations
Pool noodles
Snug and Go
Crib Wedges
Bed tableart desk
Laundry baskets
Inflatable bathtub
Inflatable infant pools
Boxesstools
Perlman Center Creative Commercial Adaptations
Laundry basket $400
Pool Noodle x 2 $300
Floor sitterbath support $700
table (BLACK) $800
Garbage can $600
Large pool noodle $300
Stander with anterior support and
Visual adaptation $1700
Perlman Center
Complex Rehab Equipment
Standers
Gait trainers
Bath Support
Car seat
Seating
Feeding tools
AAC
Sensory tools
vibration
Compression garments
NUK brushes
Z Vibe
Modified utensils
Swings
Weight
Head phones
Positioning
Neck supports
Bracing
Bobby pillowU cushion
Benches
Fireflyfriendscom
PlayPaK
Upsee
Go To Seat
Early Literacy
Picture symbols
Voice output switches
Adapted books
Adapted Equipment
Perlman Center
You got this baby Nowhellip Questions
Perlman Center
LETrsquoS PLAY
Hands on Equipment Demonstration
Perlman Center
bull Ulrich B (2010) Opportunities for Early Intervention Based on Theory Basic Neuroscience and Clinical Science Physical Therapy 90(12) 1868-1880
bull McIntyre S Morgan C amp Walker K (2011) Cerebral Palsy Dont Delay Developmental Disabilities Research Reviews 17(2) 114-129
bull Novak I (2014) Evidence-Based Diagnosis Health Care and Rehabilitation for Children with Cerebral Palsy Journal of Child Neurology 29(8) 1141-1156
bull Morgan C Novak I amp Badawi N (2013) Enriched Environments and Motor Outcomes in Cerebral Palsy Systematic Review and Meta-analysis Pediatrics 132 (3)e 735 -e746
bull Morgan C Novak I Dale R Guzzetta A amp Badawi N (2014) GAME (Goals- Activity-Motor Enrichment) protocol of a single blind randomised controlled trial of motor training parent education and environmental enrichment for infants at high risk of cerebral palsy BMC Neurology 14(203)
bull Whittingham K Wee D amp Boyd R (2010) Systematic review of the efficacy of parenting interventions for children with cerebral palsy Child care health and development 37(4) 475-483
bull Morgan C Novak I dale R amp Badawi N (2015) Optimising motor learning in infants at high risk of cerebral palsy a pilot study BMC Pediatrics 15(1) n pag Web
bull Vos R Dallmeijer A Verhoef M et al (2014) Developmental trajectories of receptive and expressive communication in children and young adults with cerebral palsy Developmental Medicine amp Child Neurology 56 951-959
bull Light J and McNaughton D (2015) Designing AAC research and intervention to improve outcomes for individuals with complex communication needs Augmentative and Alternative Communication 31(2) 85-96
bull Romski M Sevcik R Barton-Hulsey A amp Whitmore A (2015) Early Intervention and AAC What a difference 30 years makes Augmentative and Alternative Communication 31 (3) 181-202
References
Perlman Center
bull Novak I Cusick A Lannin N (2009) Occupational therapy home programs for cerebral palsy Double-blind randomised controlled trial Pediatrics 124 e606-e614
bull Gericke T (2006) Postural management for children with cerebral palsy consensus statement Dev Med Child Neurol 48 (4) 244-244
bull McKeever P Rossen B Scott H Robinson-Vincent K amp Wright V (2013) The significance of uprightness parentsrsquo reflections on childrenrsquos responses to a hands-free walker for children Disability amp Society 28(3) 380-392
bull Law M Pollock N Russell D Walter S et al (2011) Focus on function a cluster randomised controlled trial comparing child-versus context-focused intervention for young children with cerebral palsy Dev Med Child Neurol 53 621-629
bull ldquoSensory Processing Developmental Chartrdquo Sensory Processing Developmental Chart Np nd Web 12 Oct 2015
bull Folio MR amp Fewell RR(2000) Peabody Developmental Motor Scales- Second edition Austin TX PRO ED
bull Voress Judith K amp Pearson Nils A (2013) Early Childhood Development Chart-Third edition Austin TX PRO ED
bull Paul Rhea (2007) Language Disorders from Infancy Through Adolescence Assessment amp Intervention Third edition St Louis MA Mosby Inc
bull Prosser L Ohlrich L Curatalo L Alter K amp Damiano D (2012) Feasibility and preliminary effectiveness of a novel mobility training intervention in infants and toddlers with cerebral palsy Developmental Neurorehabilitation 15(4) 259-266
References
Perlman Center
Building Enriched Environments
bull Is the child positioned within
reach to explore the activity
bull Are all senses being utilized
bull Is the child being motivated to
move throughout the
environment
bull Is the environment adapted to
increase access to play
Perlman Center
Building Enriched Environments
bull Can the child have an effect
on the activity within the
environment
bull Is the activity appropriately
challenging the child within the
environment
bull Is the child presented with the
need for problem solving
Perlman Center
Building Enriched Environments
bull Is the child motivated to repeat
the task for motor learning
bull Does the environment support
learning (ie appropriate
noise level social motivators
peer groups developmental
learning supports visual
supports auditory feedback
etc)
Perlman Center
Bridging the gap between the clinic and the
home environment
bull Discipline focused
bull Clinic equipment closet
bull May have group option
Clinic
bull Incorporate into Family Routines
bull Functional activities
bull High Value
bull Adapted environment
Home
Mobility
Early Literacy
Sensory Motor Learning
Social Connections
Perlman Center
Early Learning
Functional MRIs show positive long-term neuro-
cognitive effects of reading to very young
infants
Sensory experiences shape a babyrsquos
knowledge about the world
The average toddler moves 8
out of 10 waking hoursday
Perlman Center
Learning through Experience
Adapting the environment with positioning equipment allows children with disabilities to experience their world and build relationships Allows the child to participate in typical experiences to foster learning
Activities need to promote active engagement
and allow a child to
ndash Actively explore move and participate in play
ndash Assist with self-help routines
ndash Interact and connect with family amp friends
ndash Participate in community activities
ndash Have a means to effectively communicate
ndash Make choices about their wants and need
Perlman Center
Perlman Center
bull Headpointing painting
bull Universal cuffs large pegs splints
bull Switch toys for art activitiesdramatic play-pourer
bull Switch computer access- helpkidzlearncom
bull Fischer Price game with keyboard binder switch
bull Walking in different textures while in standers and walkers
bull Cameramouseorg with dwell click
bull Partner assisted scanning
Alternative amp Adaptive Access to Play
Perlman Center
Change the environment Not the body Adaptations will be critical for success
Gross Motor Fine Motor
Social
Communication
Perlman Center Consider Communication Young children need a reliable form of communication as early as possible
Augmentative Communication is shown to support verbal skills and enhance lives of
birth to three children and their families (Romski et al 2015)
Perlman Center
Holistic approach to AAC intervention should
Build on individual strengths
Focus on participation in real-world contexts
Address psychosocial factors (ie motivation attitude confidence resilience)
Focus on environmental factors to reduce barriers and maximize social supports
In the absence of a holistic approach to communication a child is at risk for failing to engage in social contexts beyond their immediate family or educationalvocational personnel (Light and Mcnaughton 2015)
Augmentative amp Alternative Communication (AAC)
Perlman Center
Early Literacy
Perlman Center
Early Mobility
There is more than one way
Hands Free Matters
Perlman Center
Early Mobility
Should I get a gait trainer if
they are going to walk YES
Are they too young for power NO
Perlman Center
Sensory Motor Learning
Perlman Center
Sensory Motor Learning
Perlman Center
Social Connection
Perlman Center
Total Access to Play
Perlman Center
Perlman defines functional positioning bull Positioning which promotes active movement and participation and
provides an opportunity to positively impact cognitive function
bull Equipment should promote function and participation across the lifespan
Perlman Center
Principles of seating and positioning
bull Obtain a stable base of support
bull Decrease the influence of atypical muscle tone
bull Accommodate fixed deformities and correct flexible deformities
bull Provide the least amount of intervention needed to achieve the greatest level of function
bull There is no one solution or product but typically a combination of tools that provide success
Adapted from Radell (1997) and York and Weimann (1991)
Perlman Center
Key Positioning Components
bull Postural Control Strengthening
bull Range of Motion Weight Bearing
bull Home Activity Programs
Developmental Positioning
bull ADLs-Play Feeding Bathing Sleeping
bull Computer AccessAAC-Integrated Technology
bull Vision Sensory Processing Participation
Upright Positioning
bull EARLY MOBILITY- developmental sequence
bull Gait Trainer Stander amp or Wheelchair
bull Manual wheelchair vs Power Mobility- BOTH
bull Recreational
ldquoTotalrdquo Mobility
bull Body Mechanics Hoyer Lifts Overhead Systems
bull Car Seat ampor Tie Downs
bull Adapted VanRamps
Transfers ampTransportation
Perlman Center
Equipment Plan of Care
Birth to Three
Adapting baby
equipment
Floor Play
StanderWalker
Bath Seat
Car Seat
Braces
Seating for Function
Early ACCESS
Wheelchair
Bed Positioning
Bike amp Swing
Preschool
Stander
Walker
Braces
Bath Seat
Potty Seat
Wheelchair
HiLo seating
AACAccess
Adapted Bed
Car Seat
Transportation
RecreationHEP
School-Age
to Adult
Wheelchair
AACACCESS
Integrated AT
Hilo chair
Standerwalker
Bath chair
Potty chair
Adapted Bed
Car SeatVan
Home modslifts
LeisureWork
Perlman Center
Commercial Products strollers car seats cribs bath seats high chairs
playpen infant swings floor mats nursing pillow ExerSaucers
Perlman Center
Creative Commercial Adaptations
Pool noodles
Snug and Go
Crib Wedges
Bed tableart desk
Laundry baskets
Inflatable bathtub
Inflatable infant pools
Boxesstools
Perlman Center Creative Commercial Adaptations
Laundry basket $400
Pool Noodle x 2 $300
Floor sitterbath support $700
table (BLACK) $800
Garbage can $600
Large pool noodle $300
Stander with anterior support and
Visual adaptation $1700
Perlman Center
Complex Rehab Equipment
Standers
Gait trainers
Bath Support
Car seat
Seating
Feeding tools
AAC
Sensory tools
vibration
Compression garments
NUK brushes
Z Vibe
Modified utensils
Swings
Weight
Head phones
Positioning
Neck supports
Bracing
Bobby pillowU cushion
Benches
Fireflyfriendscom
PlayPaK
Upsee
Go To Seat
Early Literacy
Picture symbols
Voice output switches
Adapted books
Adapted Equipment
Perlman Center
You got this baby Nowhellip Questions
Perlman Center
LETrsquoS PLAY
Hands on Equipment Demonstration
Perlman Center
bull Ulrich B (2010) Opportunities for Early Intervention Based on Theory Basic Neuroscience and Clinical Science Physical Therapy 90(12) 1868-1880
bull McIntyre S Morgan C amp Walker K (2011) Cerebral Palsy Dont Delay Developmental Disabilities Research Reviews 17(2) 114-129
bull Novak I (2014) Evidence-Based Diagnosis Health Care and Rehabilitation for Children with Cerebral Palsy Journal of Child Neurology 29(8) 1141-1156
bull Morgan C Novak I amp Badawi N (2013) Enriched Environments and Motor Outcomes in Cerebral Palsy Systematic Review and Meta-analysis Pediatrics 132 (3)e 735 -e746
bull Morgan C Novak I Dale R Guzzetta A amp Badawi N (2014) GAME (Goals- Activity-Motor Enrichment) protocol of a single blind randomised controlled trial of motor training parent education and environmental enrichment for infants at high risk of cerebral palsy BMC Neurology 14(203)
bull Whittingham K Wee D amp Boyd R (2010) Systematic review of the efficacy of parenting interventions for children with cerebral palsy Child care health and development 37(4) 475-483
bull Morgan C Novak I dale R amp Badawi N (2015) Optimising motor learning in infants at high risk of cerebral palsy a pilot study BMC Pediatrics 15(1) n pag Web
bull Vos R Dallmeijer A Verhoef M et al (2014) Developmental trajectories of receptive and expressive communication in children and young adults with cerebral palsy Developmental Medicine amp Child Neurology 56 951-959
bull Light J and McNaughton D (2015) Designing AAC research and intervention to improve outcomes for individuals with complex communication needs Augmentative and Alternative Communication 31(2) 85-96
bull Romski M Sevcik R Barton-Hulsey A amp Whitmore A (2015) Early Intervention and AAC What a difference 30 years makes Augmentative and Alternative Communication 31 (3) 181-202
References
Perlman Center
bull Novak I Cusick A Lannin N (2009) Occupational therapy home programs for cerebral palsy Double-blind randomised controlled trial Pediatrics 124 e606-e614
bull Gericke T (2006) Postural management for children with cerebral palsy consensus statement Dev Med Child Neurol 48 (4) 244-244
bull McKeever P Rossen B Scott H Robinson-Vincent K amp Wright V (2013) The significance of uprightness parentsrsquo reflections on childrenrsquos responses to a hands-free walker for children Disability amp Society 28(3) 380-392
bull Law M Pollock N Russell D Walter S et al (2011) Focus on function a cluster randomised controlled trial comparing child-versus context-focused intervention for young children with cerebral palsy Dev Med Child Neurol 53 621-629
bull ldquoSensory Processing Developmental Chartrdquo Sensory Processing Developmental Chart Np nd Web 12 Oct 2015
bull Folio MR amp Fewell RR(2000) Peabody Developmental Motor Scales- Second edition Austin TX PRO ED
bull Voress Judith K amp Pearson Nils A (2013) Early Childhood Development Chart-Third edition Austin TX PRO ED
bull Paul Rhea (2007) Language Disorders from Infancy Through Adolescence Assessment amp Intervention Third edition St Louis MA Mosby Inc
bull Prosser L Ohlrich L Curatalo L Alter K amp Damiano D (2012) Feasibility and preliminary effectiveness of a novel mobility training intervention in infants and toddlers with cerebral palsy Developmental Neurorehabilitation 15(4) 259-266
References
Perlman Center
Building Enriched Environments
bull Can the child have an effect
on the activity within the
environment
bull Is the activity appropriately
challenging the child within the
environment
bull Is the child presented with the
need for problem solving
Perlman Center
Building Enriched Environments
bull Is the child motivated to repeat
the task for motor learning
bull Does the environment support
learning (ie appropriate
noise level social motivators
peer groups developmental
learning supports visual
supports auditory feedback
etc)
Perlman Center
Bridging the gap between the clinic and the
home environment
bull Discipline focused
bull Clinic equipment closet
bull May have group option
Clinic
bull Incorporate into Family Routines
bull Functional activities
bull High Value
bull Adapted environment
Home
Mobility
Early Literacy
Sensory Motor Learning
Social Connections
Perlman Center
Early Learning
Functional MRIs show positive long-term neuro-
cognitive effects of reading to very young
infants
Sensory experiences shape a babyrsquos
knowledge about the world
The average toddler moves 8
out of 10 waking hoursday
Perlman Center
Learning through Experience
Adapting the environment with positioning equipment allows children with disabilities to experience their world and build relationships Allows the child to participate in typical experiences to foster learning
Activities need to promote active engagement
and allow a child to
ndash Actively explore move and participate in play
ndash Assist with self-help routines
ndash Interact and connect with family amp friends
ndash Participate in community activities
ndash Have a means to effectively communicate
ndash Make choices about their wants and need
Perlman Center
Perlman Center
bull Headpointing painting
bull Universal cuffs large pegs splints
bull Switch toys for art activitiesdramatic play-pourer
bull Switch computer access- helpkidzlearncom
bull Fischer Price game with keyboard binder switch
bull Walking in different textures while in standers and walkers
bull Cameramouseorg with dwell click
bull Partner assisted scanning
Alternative amp Adaptive Access to Play
Perlman Center
Change the environment Not the body Adaptations will be critical for success
Gross Motor Fine Motor
Social
Communication
Perlman Center Consider Communication Young children need a reliable form of communication as early as possible
Augmentative Communication is shown to support verbal skills and enhance lives of
birth to three children and their families (Romski et al 2015)
Perlman Center
Holistic approach to AAC intervention should
Build on individual strengths
Focus on participation in real-world contexts
Address psychosocial factors (ie motivation attitude confidence resilience)
Focus on environmental factors to reduce barriers and maximize social supports
In the absence of a holistic approach to communication a child is at risk for failing to engage in social contexts beyond their immediate family or educationalvocational personnel (Light and Mcnaughton 2015)
Augmentative amp Alternative Communication (AAC)
Perlman Center
Early Literacy
Perlman Center
Early Mobility
There is more than one way
Hands Free Matters
Perlman Center
Early Mobility
Should I get a gait trainer if
they are going to walk YES
Are they too young for power NO
Perlman Center
Sensory Motor Learning
Perlman Center
Sensory Motor Learning
Perlman Center
Social Connection
Perlman Center
Total Access to Play
Perlman Center
Perlman defines functional positioning bull Positioning which promotes active movement and participation and
provides an opportunity to positively impact cognitive function
bull Equipment should promote function and participation across the lifespan
Perlman Center
Principles of seating and positioning
bull Obtain a stable base of support
bull Decrease the influence of atypical muscle tone
bull Accommodate fixed deformities and correct flexible deformities
bull Provide the least amount of intervention needed to achieve the greatest level of function
bull There is no one solution or product but typically a combination of tools that provide success
Adapted from Radell (1997) and York and Weimann (1991)
Perlman Center
Key Positioning Components
bull Postural Control Strengthening
bull Range of Motion Weight Bearing
bull Home Activity Programs
Developmental Positioning
bull ADLs-Play Feeding Bathing Sleeping
bull Computer AccessAAC-Integrated Technology
bull Vision Sensory Processing Participation
Upright Positioning
bull EARLY MOBILITY- developmental sequence
bull Gait Trainer Stander amp or Wheelchair
bull Manual wheelchair vs Power Mobility- BOTH
bull Recreational
ldquoTotalrdquo Mobility
bull Body Mechanics Hoyer Lifts Overhead Systems
bull Car Seat ampor Tie Downs
bull Adapted VanRamps
Transfers ampTransportation
Perlman Center
Equipment Plan of Care
Birth to Three
Adapting baby
equipment
Floor Play
StanderWalker
Bath Seat
Car Seat
Braces
Seating for Function
Early ACCESS
Wheelchair
Bed Positioning
Bike amp Swing
Preschool
Stander
Walker
Braces
Bath Seat
Potty Seat
Wheelchair
HiLo seating
AACAccess
Adapted Bed
Car Seat
Transportation
RecreationHEP
School-Age
to Adult
Wheelchair
AACACCESS
Integrated AT
Hilo chair
Standerwalker
Bath chair
Potty chair
Adapted Bed
Car SeatVan
Home modslifts
LeisureWork
Perlman Center
Commercial Products strollers car seats cribs bath seats high chairs
playpen infant swings floor mats nursing pillow ExerSaucers
Perlman Center
Creative Commercial Adaptations
Pool noodles
Snug and Go
Crib Wedges
Bed tableart desk
Laundry baskets
Inflatable bathtub
Inflatable infant pools
Boxesstools
Perlman Center Creative Commercial Adaptations
Laundry basket $400
Pool Noodle x 2 $300
Floor sitterbath support $700
table (BLACK) $800
Garbage can $600
Large pool noodle $300
Stander with anterior support and
Visual adaptation $1700
Perlman Center
Complex Rehab Equipment
Standers
Gait trainers
Bath Support
Car seat
Seating
Feeding tools
AAC
Sensory tools
vibration
Compression garments
NUK brushes
Z Vibe
Modified utensils
Swings
Weight
Head phones
Positioning
Neck supports
Bracing
Bobby pillowU cushion
Benches
Fireflyfriendscom
PlayPaK
Upsee
Go To Seat
Early Literacy
Picture symbols
Voice output switches
Adapted books
Adapted Equipment
Perlman Center
You got this baby Nowhellip Questions
Perlman Center
LETrsquoS PLAY
Hands on Equipment Demonstration
Perlman Center
bull Ulrich B (2010) Opportunities for Early Intervention Based on Theory Basic Neuroscience and Clinical Science Physical Therapy 90(12) 1868-1880
bull McIntyre S Morgan C amp Walker K (2011) Cerebral Palsy Dont Delay Developmental Disabilities Research Reviews 17(2) 114-129
bull Novak I (2014) Evidence-Based Diagnosis Health Care and Rehabilitation for Children with Cerebral Palsy Journal of Child Neurology 29(8) 1141-1156
bull Morgan C Novak I amp Badawi N (2013) Enriched Environments and Motor Outcomes in Cerebral Palsy Systematic Review and Meta-analysis Pediatrics 132 (3)e 735 -e746
bull Morgan C Novak I Dale R Guzzetta A amp Badawi N (2014) GAME (Goals- Activity-Motor Enrichment) protocol of a single blind randomised controlled trial of motor training parent education and environmental enrichment for infants at high risk of cerebral palsy BMC Neurology 14(203)
bull Whittingham K Wee D amp Boyd R (2010) Systematic review of the efficacy of parenting interventions for children with cerebral palsy Child care health and development 37(4) 475-483
bull Morgan C Novak I dale R amp Badawi N (2015) Optimising motor learning in infants at high risk of cerebral palsy a pilot study BMC Pediatrics 15(1) n pag Web
bull Vos R Dallmeijer A Verhoef M et al (2014) Developmental trajectories of receptive and expressive communication in children and young adults with cerebral palsy Developmental Medicine amp Child Neurology 56 951-959
bull Light J and McNaughton D (2015) Designing AAC research and intervention to improve outcomes for individuals with complex communication needs Augmentative and Alternative Communication 31(2) 85-96
bull Romski M Sevcik R Barton-Hulsey A amp Whitmore A (2015) Early Intervention and AAC What a difference 30 years makes Augmentative and Alternative Communication 31 (3) 181-202
References
Perlman Center
bull Novak I Cusick A Lannin N (2009) Occupational therapy home programs for cerebral palsy Double-blind randomised controlled trial Pediatrics 124 e606-e614
bull Gericke T (2006) Postural management for children with cerebral palsy consensus statement Dev Med Child Neurol 48 (4) 244-244
bull McKeever P Rossen B Scott H Robinson-Vincent K amp Wright V (2013) The significance of uprightness parentsrsquo reflections on childrenrsquos responses to a hands-free walker for children Disability amp Society 28(3) 380-392
bull Law M Pollock N Russell D Walter S et al (2011) Focus on function a cluster randomised controlled trial comparing child-versus context-focused intervention for young children with cerebral palsy Dev Med Child Neurol 53 621-629
bull ldquoSensory Processing Developmental Chartrdquo Sensory Processing Developmental Chart Np nd Web 12 Oct 2015
bull Folio MR amp Fewell RR(2000) Peabody Developmental Motor Scales- Second edition Austin TX PRO ED
bull Voress Judith K amp Pearson Nils A (2013) Early Childhood Development Chart-Third edition Austin TX PRO ED
bull Paul Rhea (2007) Language Disorders from Infancy Through Adolescence Assessment amp Intervention Third edition St Louis MA Mosby Inc
bull Prosser L Ohlrich L Curatalo L Alter K amp Damiano D (2012) Feasibility and preliminary effectiveness of a novel mobility training intervention in infants and toddlers with cerebral palsy Developmental Neurorehabilitation 15(4) 259-266
References
Perlman Center
Building Enriched Environments
bull Is the child motivated to repeat
the task for motor learning
bull Does the environment support
learning (ie appropriate
noise level social motivators
peer groups developmental
learning supports visual
supports auditory feedback
etc)
Perlman Center
Bridging the gap between the clinic and the
home environment
bull Discipline focused
bull Clinic equipment closet
bull May have group option
Clinic
bull Incorporate into Family Routines
bull Functional activities
bull High Value
bull Adapted environment
Home
Mobility
Early Literacy
Sensory Motor Learning
Social Connections
Perlman Center
Early Learning
Functional MRIs show positive long-term neuro-
cognitive effects of reading to very young
infants
Sensory experiences shape a babyrsquos
knowledge about the world
The average toddler moves 8
out of 10 waking hoursday
Perlman Center
Learning through Experience
Adapting the environment with positioning equipment allows children with disabilities to experience their world and build relationships Allows the child to participate in typical experiences to foster learning
Activities need to promote active engagement
and allow a child to
ndash Actively explore move and participate in play
ndash Assist with self-help routines
ndash Interact and connect with family amp friends
ndash Participate in community activities
ndash Have a means to effectively communicate
ndash Make choices about their wants and need
Perlman Center
Perlman Center
bull Headpointing painting
bull Universal cuffs large pegs splints
bull Switch toys for art activitiesdramatic play-pourer
bull Switch computer access- helpkidzlearncom
bull Fischer Price game with keyboard binder switch
bull Walking in different textures while in standers and walkers
bull Cameramouseorg with dwell click
bull Partner assisted scanning
Alternative amp Adaptive Access to Play
Perlman Center
Change the environment Not the body Adaptations will be critical for success
Gross Motor Fine Motor
Social
Communication
Perlman Center Consider Communication Young children need a reliable form of communication as early as possible
Augmentative Communication is shown to support verbal skills and enhance lives of
birth to three children and their families (Romski et al 2015)
Perlman Center
Holistic approach to AAC intervention should
Build on individual strengths
Focus on participation in real-world contexts
Address psychosocial factors (ie motivation attitude confidence resilience)
Focus on environmental factors to reduce barriers and maximize social supports
In the absence of a holistic approach to communication a child is at risk for failing to engage in social contexts beyond their immediate family or educationalvocational personnel (Light and Mcnaughton 2015)
Augmentative amp Alternative Communication (AAC)
Perlman Center
Early Literacy
Perlman Center
Early Mobility
There is more than one way
Hands Free Matters
Perlman Center
Early Mobility
Should I get a gait trainer if
they are going to walk YES
Are they too young for power NO
Perlman Center
Sensory Motor Learning
Perlman Center
Sensory Motor Learning
Perlman Center
Social Connection
Perlman Center
Total Access to Play
Perlman Center
Perlman defines functional positioning bull Positioning which promotes active movement and participation and
provides an opportunity to positively impact cognitive function
bull Equipment should promote function and participation across the lifespan
Perlman Center
Principles of seating and positioning
bull Obtain a stable base of support
bull Decrease the influence of atypical muscle tone
bull Accommodate fixed deformities and correct flexible deformities
bull Provide the least amount of intervention needed to achieve the greatest level of function
bull There is no one solution or product but typically a combination of tools that provide success
Adapted from Radell (1997) and York and Weimann (1991)
Perlman Center
Key Positioning Components
bull Postural Control Strengthening
bull Range of Motion Weight Bearing
bull Home Activity Programs
Developmental Positioning
bull ADLs-Play Feeding Bathing Sleeping
bull Computer AccessAAC-Integrated Technology
bull Vision Sensory Processing Participation
Upright Positioning
bull EARLY MOBILITY- developmental sequence
bull Gait Trainer Stander amp or Wheelchair
bull Manual wheelchair vs Power Mobility- BOTH
bull Recreational
ldquoTotalrdquo Mobility
bull Body Mechanics Hoyer Lifts Overhead Systems
bull Car Seat ampor Tie Downs
bull Adapted VanRamps
Transfers ampTransportation
Perlman Center
Equipment Plan of Care
Birth to Three
Adapting baby
equipment
Floor Play
StanderWalker
Bath Seat
Car Seat
Braces
Seating for Function
Early ACCESS
Wheelchair
Bed Positioning
Bike amp Swing
Preschool
Stander
Walker
Braces
Bath Seat
Potty Seat
Wheelchair
HiLo seating
AACAccess
Adapted Bed
Car Seat
Transportation
RecreationHEP
School-Age
to Adult
Wheelchair
AACACCESS
Integrated AT
Hilo chair
Standerwalker
Bath chair
Potty chair
Adapted Bed
Car SeatVan
Home modslifts
LeisureWork
Perlman Center
Commercial Products strollers car seats cribs bath seats high chairs
playpen infant swings floor mats nursing pillow ExerSaucers
Perlman Center
Creative Commercial Adaptations
Pool noodles
Snug and Go
Crib Wedges
Bed tableart desk
Laundry baskets
Inflatable bathtub
Inflatable infant pools
Boxesstools
Perlman Center Creative Commercial Adaptations
Laundry basket $400
Pool Noodle x 2 $300
Floor sitterbath support $700
table (BLACK) $800
Garbage can $600
Large pool noodle $300
Stander with anterior support and
Visual adaptation $1700
Perlman Center
Complex Rehab Equipment
Standers
Gait trainers
Bath Support
Car seat
Seating
Feeding tools
AAC
Sensory tools
vibration
Compression garments
NUK brushes
Z Vibe
Modified utensils
Swings
Weight
Head phones
Positioning
Neck supports
Bracing
Bobby pillowU cushion
Benches
Fireflyfriendscom
PlayPaK
Upsee
Go To Seat
Early Literacy
Picture symbols
Voice output switches
Adapted books
Adapted Equipment
Perlman Center
You got this baby Nowhellip Questions
Perlman Center
LETrsquoS PLAY
Hands on Equipment Demonstration
Perlman Center
bull Ulrich B (2010) Opportunities for Early Intervention Based on Theory Basic Neuroscience and Clinical Science Physical Therapy 90(12) 1868-1880
bull McIntyre S Morgan C amp Walker K (2011) Cerebral Palsy Dont Delay Developmental Disabilities Research Reviews 17(2) 114-129
bull Novak I (2014) Evidence-Based Diagnosis Health Care and Rehabilitation for Children with Cerebral Palsy Journal of Child Neurology 29(8) 1141-1156
bull Morgan C Novak I amp Badawi N (2013) Enriched Environments and Motor Outcomes in Cerebral Palsy Systematic Review and Meta-analysis Pediatrics 132 (3)e 735 -e746
bull Morgan C Novak I Dale R Guzzetta A amp Badawi N (2014) GAME (Goals- Activity-Motor Enrichment) protocol of a single blind randomised controlled trial of motor training parent education and environmental enrichment for infants at high risk of cerebral palsy BMC Neurology 14(203)
bull Whittingham K Wee D amp Boyd R (2010) Systematic review of the efficacy of parenting interventions for children with cerebral palsy Child care health and development 37(4) 475-483
bull Morgan C Novak I dale R amp Badawi N (2015) Optimising motor learning in infants at high risk of cerebral palsy a pilot study BMC Pediatrics 15(1) n pag Web
bull Vos R Dallmeijer A Verhoef M et al (2014) Developmental trajectories of receptive and expressive communication in children and young adults with cerebral palsy Developmental Medicine amp Child Neurology 56 951-959
bull Light J and McNaughton D (2015) Designing AAC research and intervention to improve outcomes for individuals with complex communication needs Augmentative and Alternative Communication 31(2) 85-96
bull Romski M Sevcik R Barton-Hulsey A amp Whitmore A (2015) Early Intervention and AAC What a difference 30 years makes Augmentative and Alternative Communication 31 (3) 181-202
References
Perlman Center
bull Novak I Cusick A Lannin N (2009) Occupational therapy home programs for cerebral palsy Double-blind randomised controlled trial Pediatrics 124 e606-e614
bull Gericke T (2006) Postural management for children with cerebral palsy consensus statement Dev Med Child Neurol 48 (4) 244-244
bull McKeever P Rossen B Scott H Robinson-Vincent K amp Wright V (2013) The significance of uprightness parentsrsquo reflections on childrenrsquos responses to a hands-free walker for children Disability amp Society 28(3) 380-392
bull Law M Pollock N Russell D Walter S et al (2011) Focus on function a cluster randomised controlled trial comparing child-versus context-focused intervention for young children with cerebral palsy Dev Med Child Neurol 53 621-629
bull ldquoSensory Processing Developmental Chartrdquo Sensory Processing Developmental Chart Np nd Web 12 Oct 2015
bull Folio MR amp Fewell RR(2000) Peabody Developmental Motor Scales- Second edition Austin TX PRO ED
bull Voress Judith K amp Pearson Nils A (2013) Early Childhood Development Chart-Third edition Austin TX PRO ED
bull Paul Rhea (2007) Language Disorders from Infancy Through Adolescence Assessment amp Intervention Third edition St Louis MA Mosby Inc
bull Prosser L Ohlrich L Curatalo L Alter K amp Damiano D (2012) Feasibility and preliminary effectiveness of a novel mobility training intervention in infants and toddlers with cerebral palsy Developmental Neurorehabilitation 15(4) 259-266
References
Perlman Center
Bridging the gap between the clinic and the
home environment
bull Discipline focused
bull Clinic equipment closet
bull May have group option
Clinic
bull Incorporate into Family Routines
bull Functional activities
bull High Value
bull Adapted environment
Home
Mobility
Early Literacy
Sensory Motor Learning
Social Connections
Perlman Center
Early Learning
Functional MRIs show positive long-term neuro-
cognitive effects of reading to very young
infants
Sensory experiences shape a babyrsquos
knowledge about the world
The average toddler moves 8
out of 10 waking hoursday
Perlman Center
Learning through Experience
Adapting the environment with positioning equipment allows children with disabilities to experience their world and build relationships Allows the child to participate in typical experiences to foster learning
Activities need to promote active engagement
and allow a child to
ndash Actively explore move and participate in play
ndash Assist with self-help routines
ndash Interact and connect with family amp friends
ndash Participate in community activities
ndash Have a means to effectively communicate
ndash Make choices about their wants and need
Perlman Center
Perlman Center
bull Headpointing painting
bull Universal cuffs large pegs splints
bull Switch toys for art activitiesdramatic play-pourer
bull Switch computer access- helpkidzlearncom
bull Fischer Price game with keyboard binder switch
bull Walking in different textures while in standers and walkers
bull Cameramouseorg with dwell click
bull Partner assisted scanning
Alternative amp Adaptive Access to Play
Perlman Center
Change the environment Not the body Adaptations will be critical for success
Gross Motor Fine Motor
Social
Communication
Perlman Center Consider Communication Young children need a reliable form of communication as early as possible
Augmentative Communication is shown to support verbal skills and enhance lives of
birth to three children and their families (Romski et al 2015)
Perlman Center
Holistic approach to AAC intervention should
Build on individual strengths
Focus on participation in real-world contexts
Address psychosocial factors (ie motivation attitude confidence resilience)
Focus on environmental factors to reduce barriers and maximize social supports
In the absence of a holistic approach to communication a child is at risk for failing to engage in social contexts beyond their immediate family or educationalvocational personnel (Light and Mcnaughton 2015)
Augmentative amp Alternative Communication (AAC)
Perlman Center
Early Literacy
Perlman Center
Early Mobility
There is more than one way
Hands Free Matters
Perlman Center
Early Mobility
Should I get a gait trainer if
they are going to walk YES
Are they too young for power NO
Perlman Center
Sensory Motor Learning
Perlman Center
Sensory Motor Learning
Perlman Center
Social Connection
Perlman Center
Total Access to Play
Perlman Center
Perlman defines functional positioning bull Positioning which promotes active movement and participation and
provides an opportunity to positively impact cognitive function
bull Equipment should promote function and participation across the lifespan
Perlman Center
Principles of seating and positioning
bull Obtain a stable base of support
bull Decrease the influence of atypical muscle tone
bull Accommodate fixed deformities and correct flexible deformities
bull Provide the least amount of intervention needed to achieve the greatest level of function
bull There is no one solution or product but typically a combination of tools that provide success
Adapted from Radell (1997) and York and Weimann (1991)
Perlman Center
Key Positioning Components
bull Postural Control Strengthening
bull Range of Motion Weight Bearing
bull Home Activity Programs
Developmental Positioning
bull ADLs-Play Feeding Bathing Sleeping
bull Computer AccessAAC-Integrated Technology
bull Vision Sensory Processing Participation
Upright Positioning
bull EARLY MOBILITY- developmental sequence
bull Gait Trainer Stander amp or Wheelchair
bull Manual wheelchair vs Power Mobility- BOTH
bull Recreational
ldquoTotalrdquo Mobility
bull Body Mechanics Hoyer Lifts Overhead Systems
bull Car Seat ampor Tie Downs
bull Adapted VanRamps
Transfers ampTransportation
Perlman Center
Equipment Plan of Care
Birth to Three
Adapting baby
equipment
Floor Play
StanderWalker
Bath Seat
Car Seat
Braces
Seating for Function
Early ACCESS
Wheelchair
Bed Positioning
Bike amp Swing
Preschool
Stander
Walker
Braces
Bath Seat
Potty Seat
Wheelchair
HiLo seating
AACAccess
Adapted Bed
Car Seat
Transportation
RecreationHEP
School-Age
to Adult
Wheelchair
AACACCESS
Integrated AT
Hilo chair
Standerwalker
Bath chair
Potty chair
Adapted Bed
Car SeatVan
Home modslifts
LeisureWork
Perlman Center
Commercial Products strollers car seats cribs bath seats high chairs
playpen infant swings floor mats nursing pillow ExerSaucers
Perlman Center
Creative Commercial Adaptations
Pool noodles
Snug and Go
Crib Wedges
Bed tableart desk
Laundry baskets
Inflatable bathtub
Inflatable infant pools
Boxesstools
Perlman Center Creative Commercial Adaptations
Laundry basket $400
Pool Noodle x 2 $300
Floor sitterbath support $700
table (BLACK) $800
Garbage can $600
Large pool noodle $300
Stander with anterior support and
Visual adaptation $1700
Perlman Center
Complex Rehab Equipment
Standers
Gait trainers
Bath Support
Car seat
Seating
Feeding tools
AAC
Sensory tools
vibration
Compression garments
NUK brushes
Z Vibe
Modified utensils
Swings
Weight
Head phones
Positioning
Neck supports
Bracing
Bobby pillowU cushion
Benches
Fireflyfriendscom
PlayPaK
Upsee
Go To Seat
Early Literacy
Picture symbols
Voice output switches
Adapted books
Adapted Equipment
Perlman Center
You got this baby Nowhellip Questions
Perlman Center
LETrsquoS PLAY
Hands on Equipment Demonstration
Perlman Center
bull Ulrich B (2010) Opportunities for Early Intervention Based on Theory Basic Neuroscience and Clinical Science Physical Therapy 90(12) 1868-1880
bull McIntyre S Morgan C amp Walker K (2011) Cerebral Palsy Dont Delay Developmental Disabilities Research Reviews 17(2) 114-129
bull Novak I (2014) Evidence-Based Diagnosis Health Care and Rehabilitation for Children with Cerebral Palsy Journal of Child Neurology 29(8) 1141-1156
bull Morgan C Novak I amp Badawi N (2013) Enriched Environments and Motor Outcomes in Cerebral Palsy Systematic Review and Meta-analysis Pediatrics 132 (3)e 735 -e746
bull Morgan C Novak I Dale R Guzzetta A amp Badawi N (2014) GAME (Goals- Activity-Motor Enrichment) protocol of a single blind randomised controlled trial of motor training parent education and environmental enrichment for infants at high risk of cerebral palsy BMC Neurology 14(203)
bull Whittingham K Wee D amp Boyd R (2010) Systematic review of the efficacy of parenting interventions for children with cerebral palsy Child care health and development 37(4) 475-483
bull Morgan C Novak I dale R amp Badawi N (2015) Optimising motor learning in infants at high risk of cerebral palsy a pilot study BMC Pediatrics 15(1) n pag Web
bull Vos R Dallmeijer A Verhoef M et al (2014) Developmental trajectories of receptive and expressive communication in children and young adults with cerebral palsy Developmental Medicine amp Child Neurology 56 951-959
bull Light J and McNaughton D (2015) Designing AAC research and intervention to improve outcomes for individuals with complex communication needs Augmentative and Alternative Communication 31(2) 85-96
bull Romski M Sevcik R Barton-Hulsey A amp Whitmore A (2015) Early Intervention and AAC What a difference 30 years makes Augmentative and Alternative Communication 31 (3) 181-202
References
Perlman Center
bull Novak I Cusick A Lannin N (2009) Occupational therapy home programs for cerebral palsy Double-blind randomised controlled trial Pediatrics 124 e606-e614
bull Gericke T (2006) Postural management for children with cerebral palsy consensus statement Dev Med Child Neurol 48 (4) 244-244
bull McKeever P Rossen B Scott H Robinson-Vincent K amp Wright V (2013) The significance of uprightness parentsrsquo reflections on childrenrsquos responses to a hands-free walker for children Disability amp Society 28(3) 380-392
bull Law M Pollock N Russell D Walter S et al (2011) Focus on function a cluster randomised controlled trial comparing child-versus context-focused intervention for young children with cerebral palsy Dev Med Child Neurol 53 621-629
bull ldquoSensory Processing Developmental Chartrdquo Sensory Processing Developmental Chart Np nd Web 12 Oct 2015
bull Folio MR amp Fewell RR(2000) Peabody Developmental Motor Scales- Second edition Austin TX PRO ED
bull Voress Judith K amp Pearson Nils A (2013) Early Childhood Development Chart-Third edition Austin TX PRO ED
bull Paul Rhea (2007) Language Disorders from Infancy Through Adolescence Assessment amp Intervention Third edition St Louis MA Mosby Inc
bull Prosser L Ohlrich L Curatalo L Alter K amp Damiano D (2012) Feasibility and preliminary effectiveness of a novel mobility training intervention in infants and toddlers with cerebral palsy Developmental Neurorehabilitation 15(4) 259-266
References
Mobility
Early Literacy
Sensory Motor Learning
Social Connections
Perlman Center
Early Learning
Functional MRIs show positive long-term neuro-
cognitive effects of reading to very young
infants
Sensory experiences shape a babyrsquos
knowledge about the world
The average toddler moves 8
out of 10 waking hoursday
Perlman Center
Learning through Experience
Adapting the environment with positioning equipment allows children with disabilities to experience their world and build relationships Allows the child to participate in typical experiences to foster learning
Activities need to promote active engagement
and allow a child to
ndash Actively explore move and participate in play
ndash Assist with self-help routines
ndash Interact and connect with family amp friends
ndash Participate in community activities
ndash Have a means to effectively communicate
ndash Make choices about their wants and need
Perlman Center
Perlman Center
bull Headpointing painting
bull Universal cuffs large pegs splints
bull Switch toys for art activitiesdramatic play-pourer
bull Switch computer access- helpkidzlearncom
bull Fischer Price game with keyboard binder switch
bull Walking in different textures while in standers and walkers
bull Cameramouseorg with dwell click
bull Partner assisted scanning
Alternative amp Adaptive Access to Play
Perlman Center
Change the environment Not the body Adaptations will be critical for success
Gross Motor Fine Motor
Social
Communication
Perlman Center Consider Communication Young children need a reliable form of communication as early as possible
Augmentative Communication is shown to support verbal skills and enhance lives of
birth to three children and their families (Romski et al 2015)
Perlman Center
Holistic approach to AAC intervention should
Build on individual strengths
Focus on participation in real-world contexts
Address psychosocial factors (ie motivation attitude confidence resilience)
Focus on environmental factors to reduce barriers and maximize social supports
In the absence of a holistic approach to communication a child is at risk for failing to engage in social contexts beyond their immediate family or educationalvocational personnel (Light and Mcnaughton 2015)
Augmentative amp Alternative Communication (AAC)
Perlman Center
Early Literacy
Perlman Center
Early Mobility
There is more than one way
Hands Free Matters
Perlman Center
Early Mobility
Should I get a gait trainer if
they are going to walk YES
Are they too young for power NO
Perlman Center
Sensory Motor Learning
Perlman Center
Sensory Motor Learning
Perlman Center
Social Connection
Perlman Center
Total Access to Play
Perlman Center
Perlman defines functional positioning bull Positioning which promotes active movement and participation and
provides an opportunity to positively impact cognitive function
bull Equipment should promote function and participation across the lifespan
Perlman Center
Principles of seating and positioning
bull Obtain a stable base of support
bull Decrease the influence of atypical muscle tone
bull Accommodate fixed deformities and correct flexible deformities
bull Provide the least amount of intervention needed to achieve the greatest level of function
bull There is no one solution or product but typically a combination of tools that provide success
Adapted from Radell (1997) and York and Weimann (1991)
Perlman Center
Key Positioning Components
bull Postural Control Strengthening
bull Range of Motion Weight Bearing
bull Home Activity Programs
Developmental Positioning
bull ADLs-Play Feeding Bathing Sleeping
bull Computer AccessAAC-Integrated Technology
bull Vision Sensory Processing Participation
Upright Positioning
bull EARLY MOBILITY- developmental sequence
bull Gait Trainer Stander amp or Wheelchair
bull Manual wheelchair vs Power Mobility- BOTH
bull Recreational
ldquoTotalrdquo Mobility
bull Body Mechanics Hoyer Lifts Overhead Systems
bull Car Seat ampor Tie Downs
bull Adapted VanRamps
Transfers ampTransportation
Perlman Center
Equipment Plan of Care
Birth to Three
Adapting baby
equipment
Floor Play
StanderWalker
Bath Seat
Car Seat
Braces
Seating for Function
Early ACCESS
Wheelchair
Bed Positioning
Bike amp Swing
Preschool
Stander
Walker
Braces
Bath Seat
Potty Seat
Wheelchair
HiLo seating
AACAccess
Adapted Bed
Car Seat
Transportation
RecreationHEP
School-Age
to Adult
Wheelchair
AACACCESS
Integrated AT
Hilo chair
Standerwalker
Bath chair
Potty chair
Adapted Bed
Car SeatVan
Home modslifts
LeisureWork
Perlman Center
Commercial Products strollers car seats cribs bath seats high chairs
playpen infant swings floor mats nursing pillow ExerSaucers
Perlman Center
Creative Commercial Adaptations
Pool noodles
Snug and Go
Crib Wedges
Bed tableart desk
Laundry baskets
Inflatable bathtub
Inflatable infant pools
Boxesstools
Perlman Center Creative Commercial Adaptations
Laundry basket $400
Pool Noodle x 2 $300
Floor sitterbath support $700
table (BLACK) $800
Garbage can $600
Large pool noodle $300
Stander with anterior support and
Visual adaptation $1700
Perlman Center
Complex Rehab Equipment
Standers
Gait trainers
Bath Support
Car seat
Seating
Feeding tools
AAC
Sensory tools
vibration
Compression garments
NUK brushes
Z Vibe
Modified utensils
Swings
Weight
Head phones
Positioning
Neck supports
Bracing
Bobby pillowU cushion
Benches
Fireflyfriendscom
PlayPaK
Upsee
Go To Seat
Early Literacy
Picture symbols
Voice output switches
Adapted books
Adapted Equipment
Perlman Center
You got this baby Nowhellip Questions
Perlman Center
LETrsquoS PLAY
Hands on Equipment Demonstration
Perlman Center
bull Ulrich B (2010) Opportunities for Early Intervention Based on Theory Basic Neuroscience and Clinical Science Physical Therapy 90(12) 1868-1880
bull McIntyre S Morgan C amp Walker K (2011) Cerebral Palsy Dont Delay Developmental Disabilities Research Reviews 17(2) 114-129
bull Novak I (2014) Evidence-Based Diagnosis Health Care and Rehabilitation for Children with Cerebral Palsy Journal of Child Neurology 29(8) 1141-1156
bull Morgan C Novak I amp Badawi N (2013) Enriched Environments and Motor Outcomes in Cerebral Palsy Systematic Review and Meta-analysis Pediatrics 132 (3)e 735 -e746
bull Morgan C Novak I Dale R Guzzetta A amp Badawi N (2014) GAME (Goals- Activity-Motor Enrichment) protocol of a single blind randomised controlled trial of motor training parent education and environmental enrichment for infants at high risk of cerebral palsy BMC Neurology 14(203)
bull Whittingham K Wee D amp Boyd R (2010) Systematic review of the efficacy of parenting interventions for children with cerebral palsy Child care health and development 37(4) 475-483
bull Morgan C Novak I dale R amp Badawi N (2015) Optimising motor learning in infants at high risk of cerebral palsy a pilot study BMC Pediatrics 15(1) n pag Web
bull Vos R Dallmeijer A Verhoef M et al (2014) Developmental trajectories of receptive and expressive communication in children and young adults with cerebral palsy Developmental Medicine amp Child Neurology 56 951-959
bull Light J and McNaughton D (2015) Designing AAC research and intervention to improve outcomes for individuals with complex communication needs Augmentative and Alternative Communication 31(2) 85-96
bull Romski M Sevcik R Barton-Hulsey A amp Whitmore A (2015) Early Intervention and AAC What a difference 30 years makes Augmentative and Alternative Communication 31 (3) 181-202
References
Perlman Center
bull Novak I Cusick A Lannin N (2009) Occupational therapy home programs for cerebral palsy Double-blind randomised controlled trial Pediatrics 124 e606-e614
bull Gericke T (2006) Postural management for children with cerebral palsy consensus statement Dev Med Child Neurol 48 (4) 244-244
bull McKeever P Rossen B Scott H Robinson-Vincent K amp Wright V (2013) The significance of uprightness parentsrsquo reflections on childrenrsquos responses to a hands-free walker for children Disability amp Society 28(3) 380-392
bull Law M Pollock N Russell D Walter S et al (2011) Focus on function a cluster randomised controlled trial comparing child-versus context-focused intervention for young children with cerebral palsy Dev Med Child Neurol 53 621-629
bull ldquoSensory Processing Developmental Chartrdquo Sensory Processing Developmental Chart Np nd Web 12 Oct 2015
bull Folio MR amp Fewell RR(2000) Peabody Developmental Motor Scales- Second edition Austin TX PRO ED
bull Voress Judith K amp Pearson Nils A (2013) Early Childhood Development Chart-Third edition Austin TX PRO ED
bull Paul Rhea (2007) Language Disorders from Infancy Through Adolescence Assessment amp Intervention Third edition St Louis MA Mosby Inc
bull Prosser L Ohlrich L Curatalo L Alter K amp Damiano D (2012) Feasibility and preliminary effectiveness of a novel mobility training intervention in infants and toddlers with cerebral palsy Developmental Neurorehabilitation 15(4) 259-266
References
Perlman Center
Learning through Experience
Adapting the environment with positioning equipment allows children with disabilities to experience their world and build relationships Allows the child to participate in typical experiences to foster learning
Activities need to promote active engagement
and allow a child to
ndash Actively explore move and participate in play
ndash Assist with self-help routines
ndash Interact and connect with family amp friends
ndash Participate in community activities
ndash Have a means to effectively communicate
ndash Make choices about their wants and need
Perlman Center
Perlman Center
bull Headpointing painting
bull Universal cuffs large pegs splints
bull Switch toys for art activitiesdramatic play-pourer
bull Switch computer access- helpkidzlearncom
bull Fischer Price game with keyboard binder switch
bull Walking in different textures while in standers and walkers
bull Cameramouseorg with dwell click
bull Partner assisted scanning
Alternative amp Adaptive Access to Play
Perlman Center
Change the environment Not the body Adaptations will be critical for success
Gross Motor Fine Motor
Social
Communication
Perlman Center Consider Communication Young children need a reliable form of communication as early as possible
Augmentative Communication is shown to support verbal skills and enhance lives of
birth to three children and their families (Romski et al 2015)
Perlman Center
Holistic approach to AAC intervention should
Build on individual strengths
Focus on participation in real-world contexts
Address psychosocial factors (ie motivation attitude confidence resilience)
Focus on environmental factors to reduce barriers and maximize social supports
In the absence of a holistic approach to communication a child is at risk for failing to engage in social contexts beyond their immediate family or educationalvocational personnel (Light and Mcnaughton 2015)
Augmentative amp Alternative Communication (AAC)
Perlman Center
Early Literacy
Perlman Center
Early Mobility
There is more than one way
Hands Free Matters
Perlman Center
Early Mobility
Should I get a gait trainer if
they are going to walk YES
Are they too young for power NO
Perlman Center
Sensory Motor Learning
Perlman Center
Sensory Motor Learning
Perlman Center
Social Connection
Perlman Center
Total Access to Play
Perlman Center
Perlman defines functional positioning bull Positioning which promotes active movement and participation and
provides an opportunity to positively impact cognitive function
bull Equipment should promote function and participation across the lifespan
Perlman Center
Principles of seating and positioning
bull Obtain a stable base of support
bull Decrease the influence of atypical muscle tone
bull Accommodate fixed deformities and correct flexible deformities
bull Provide the least amount of intervention needed to achieve the greatest level of function
bull There is no one solution or product but typically a combination of tools that provide success
Adapted from Radell (1997) and York and Weimann (1991)
Perlman Center
Key Positioning Components
bull Postural Control Strengthening
bull Range of Motion Weight Bearing
bull Home Activity Programs
Developmental Positioning
bull ADLs-Play Feeding Bathing Sleeping
bull Computer AccessAAC-Integrated Technology
bull Vision Sensory Processing Participation
Upright Positioning
bull EARLY MOBILITY- developmental sequence
bull Gait Trainer Stander amp or Wheelchair
bull Manual wheelchair vs Power Mobility- BOTH
bull Recreational
ldquoTotalrdquo Mobility
bull Body Mechanics Hoyer Lifts Overhead Systems
bull Car Seat ampor Tie Downs
bull Adapted VanRamps
Transfers ampTransportation
Perlman Center
Equipment Plan of Care
Birth to Three
Adapting baby
equipment
Floor Play
StanderWalker
Bath Seat
Car Seat
Braces
Seating for Function
Early ACCESS
Wheelchair
Bed Positioning
Bike amp Swing
Preschool
Stander
Walker
Braces
Bath Seat
Potty Seat
Wheelchair
HiLo seating
AACAccess
Adapted Bed
Car Seat
Transportation
RecreationHEP
School-Age
to Adult
Wheelchair
AACACCESS
Integrated AT
Hilo chair
Standerwalker
Bath chair
Potty chair
Adapted Bed
Car SeatVan
Home modslifts
LeisureWork
Perlman Center
Commercial Products strollers car seats cribs bath seats high chairs
playpen infant swings floor mats nursing pillow ExerSaucers
Perlman Center
Creative Commercial Adaptations
Pool noodles
Snug and Go
Crib Wedges
Bed tableart desk
Laundry baskets
Inflatable bathtub
Inflatable infant pools
Boxesstools
Perlman Center Creative Commercial Adaptations
Laundry basket $400
Pool Noodle x 2 $300
Floor sitterbath support $700
table (BLACK) $800
Garbage can $600
Large pool noodle $300
Stander with anterior support and
Visual adaptation $1700
Perlman Center
Complex Rehab Equipment
Standers
Gait trainers
Bath Support
Car seat
Seating
Feeding tools
AAC
Sensory tools
vibration
Compression garments
NUK brushes
Z Vibe
Modified utensils
Swings
Weight
Head phones
Positioning
Neck supports
Bracing
Bobby pillowU cushion
Benches
Fireflyfriendscom
PlayPaK
Upsee
Go To Seat
Early Literacy
Picture symbols
Voice output switches
Adapted books
Adapted Equipment
Perlman Center
You got this baby Nowhellip Questions
Perlman Center
LETrsquoS PLAY
Hands on Equipment Demonstration
Perlman Center
bull Ulrich B (2010) Opportunities for Early Intervention Based on Theory Basic Neuroscience and Clinical Science Physical Therapy 90(12) 1868-1880
bull McIntyre S Morgan C amp Walker K (2011) Cerebral Palsy Dont Delay Developmental Disabilities Research Reviews 17(2) 114-129
bull Novak I (2014) Evidence-Based Diagnosis Health Care and Rehabilitation for Children with Cerebral Palsy Journal of Child Neurology 29(8) 1141-1156
bull Morgan C Novak I amp Badawi N (2013) Enriched Environments and Motor Outcomes in Cerebral Palsy Systematic Review and Meta-analysis Pediatrics 132 (3)e 735 -e746
bull Morgan C Novak I Dale R Guzzetta A amp Badawi N (2014) GAME (Goals- Activity-Motor Enrichment) protocol of a single blind randomised controlled trial of motor training parent education and environmental enrichment for infants at high risk of cerebral palsy BMC Neurology 14(203)
bull Whittingham K Wee D amp Boyd R (2010) Systematic review of the efficacy of parenting interventions for children with cerebral palsy Child care health and development 37(4) 475-483
bull Morgan C Novak I dale R amp Badawi N (2015) Optimising motor learning in infants at high risk of cerebral palsy a pilot study BMC Pediatrics 15(1) n pag Web
bull Vos R Dallmeijer A Verhoef M et al (2014) Developmental trajectories of receptive and expressive communication in children and young adults with cerebral palsy Developmental Medicine amp Child Neurology 56 951-959
bull Light J and McNaughton D (2015) Designing AAC research and intervention to improve outcomes for individuals with complex communication needs Augmentative and Alternative Communication 31(2) 85-96
bull Romski M Sevcik R Barton-Hulsey A amp Whitmore A (2015) Early Intervention and AAC What a difference 30 years makes Augmentative and Alternative Communication 31 (3) 181-202
References
Perlman Center
bull Novak I Cusick A Lannin N (2009) Occupational therapy home programs for cerebral palsy Double-blind randomised controlled trial Pediatrics 124 e606-e614
bull Gericke T (2006) Postural management for children with cerebral palsy consensus statement Dev Med Child Neurol 48 (4) 244-244
bull McKeever P Rossen B Scott H Robinson-Vincent K amp Wright V (2013) The significance of uprightness parentsrsquo reflections on childrenrsquos responses to a hands-free walker for children Disability amp Society 28(3) 380-392
bull Law M Pollock N Russell D Walter S et al (2011) Focus on function a cluster randomised controlled trial comparing child-versus context-focused intervention for young children with cerebral palsy Dev Med Child Neurol 53 621-629
bull ldquoSensory Processing Developmental Chartrdquo Sensory Processing Developmental Chart Np nd Web 12 Oct 2015
bull Folio MR amp Fewell RR(2000) Peabody Developmental Motor Scales- Second edition Austin TX PRO ED
bull Voress Judith K amp Pearson Nils A (2013) Early Childhood Development Chart-Third edition Austin TX PRO ED
bull Paul Rhea (2007) Language Disorders from Infancy Through Adolescence Assessment amp Intervention Third edition St Louis MA Mosby Inc
bull Prosser L Ohlrich L Curatalo L Alter K amp Damiano D (2012) Feasibility and preliminary effectiveness of a novel mobility training intervention in infants and toddlers with cerebral palsy Developmental Neurorehabilitation 15(4) 259-266
References
Activities need to promote active engagement
and allow a child to
ndash Actively explore move and participate in play
ndash Assist with self-help routines
ndash Interact and connect with family amp friends
ndash Participate in community activities
ndash Have a means to effectively communicate
ndash Make choices about their wants and need
Perlman Center
Perlman Center
bull Headpointing painting
bull Universal cuffs large pegs splints
bull Switch toys for art activitiesdramatic play-pourer
bull Switch computer access- helpkidzlearncom
bull Fischer Price game with keyboard binder switch
bull Walking in different textures while in standers and walkers
bull Cameramouseorg with dwell click
bull Partner assisted scanning
Alternative amp Adaptive Access to Play
Perlman Center
Change the environment Not the body Adaptations will be critical for success
Gross Motor Fine Motor
Social
Communication
Perlman Center Consider Communication Young children need a reliable form of communication as early as possible
Augmentative Communication is shown to support verbal skills and enhance lives of
birth to three children and their families (Romski et al 2015)
Perlman Center
Holistic approach to AAC intervention should
Build on individual strengths
Focus on participation in real-world contexts
Address psychosocial factors (ie motivation attitude confidence resilience)
Focus on environmental factors to reduce barriers and maximize social supports
In the absence of a holistic approach to communication a child is at risk for failing to engage in social contexts beyond their immediate family or educationalvocational personnel (Light and Mcnaughton 2015)
Augmentative amp Alternative Communication (AAC)
Perlman Center
Early Literacy
Perlman Center
Early Mobility
There is more than one way
Hands Free Matters
Perlman Center
Early Mobility
Should I get a gait trainer if
they are going to walk YES
Are they too young for power NO
Perlman Center
Sensory Motor Learning
Perlman Center
Sensory Motor Learning
Perlman Center
Social Connection
Perlman Center
Total Access to Play
Perlman Center
Perlman defines functional positioning bull Positioning which promotes active movement and participation and
provides an opportunity to positively impact cognitive function
bull Equipment should promote function and participation across the lifespan
Perlman Center
Principles of seating and positioning
bull Obtain a stable base of support
bull Decrease the influence of atypical muscle tone
bull Accommodate fixed deformities and correct flexible deformities
bull Provide the least amount of intervention needed to achieve the greatest level of function
bull There is no one solution or product but typically a combination of tools that provide success
Adapted from Radell (1997) and York and Weimann (1991)
Perlman Center
Key Positioning Components
bull Postural Control Strengthening
bull Range of Motion Weight Bearing
bull Home Activity Programs
Developmental Positioning
bull ADLs-Play Feeding Bathing Sleeping
bull Computer AccessAAC-Integrated Technology
bull Vision Sensory Processing Participation
Upright Positioning
bull EARLY MOBILITY- developmental sequence
bull Gait Trainer Stander amp or Wheelchair
bull Manual wheelchair vs Power Mobility- BOTH
bull Recreational
ldquoTotalrdquo Mobility
bull Body Mechanics Hoyer Lifts Overhead Systems
bull Car Seat ampor Tie Downs
bull Adapted VanRamps
Transfers ampTransportation
Perlman Center
Equipment Plan of Care
Birth to Three
Adapting baby
equipment
Floor Play
StanderWalker
Bath Seat
Car Seat
Braces
Seating for Function
Early ACCESS
Wheelchair
Bed Positioning
Bike amp Swing
Preschool
Stander
Walker
Braces
Bath Seat
Potty Seat
Wheelchair
HiLo seating
AACAccess
Adapted Bed
Car Seat
Transportation
RecreationHEP
School-Age
to Adult
Wheelchair
AACACCESS
Integrated AT
Hilo chair
Standerwalker
Bath chair
Potty chair
Adapted Bed
Car SeatVan
Home modslifts
LeisureWork
Perlman Center
Commercial Products strollers car seats cribs bath seats high chairs
playpen infant swings floor mats nursing pillow ExerSaucers
Perlman Center
Creative Commercial Adaptations
Pool noodles
Snug and Go
Crib Wedges
Bed tableart desk
Laundry baskets
Inflatable bathtub
Inflatable infant pools
Boxesstools
Perlman Center Creative Commercial Adaptations
Laundry basket $400
Pool Noodle x 2 $300
Floor sitterbath support $700
table (BLACK) $800
Garbage can $600
Large pool noodle $300
Stander with anterior support and
Visual adaptation $1700
Perlman Center
Complex Rehab Equipment
Standers
Gait trainers
Bath Support
Car seat
Seating
Feeding tools
AAC
Sensory tools
vibration
Compression garments
NUK brushes
Z Vibe
Modified utensils
Swings
Weight
Head phones
Positioning
Neck supports
Bracing
Bobby pillowU cushion
Benches
Fireflyfriendscom
PlayPaK
Upsee
Go To Seat
Early Literacy
Picture symbols
Voice output switches
Adapted books
Adapted Equipment
Perlman Center
You got this baby Nowhellip Questions
Perlman Center
LETrsquoS PLAY
Hands on Equipment Demonstration
Perlman Center
bull Ulrich B (2010) Opportunities for Early Intervention Based on Theory Basic Neuroscience and Clinical Science Physical Therapy 90(12) 1868-1880
bull McIntyre S Morgan C amp Walker K (2011) Cerebral Palsy Dont Delay Developmental Disabilities Research Reviews 17(2) 114-129
bull Novak I (2014) Evidence-Based Diagnosis Health Care and Rehabilitation for Children with Cerebral Palsy Journal of Child Neurology 29(8) 1141-1156
bull Morgan C Novak I amp Badawi N (2013) Enriched Environments and Motor Outcomes in Cerebral Palsy Systematic Review and Meta-analysis Pediatrics 132 (3)e 735 -e746
bull Morgan C Novak I Dale R Guzzetta A amp Badawi N (2014) GAME (Goals- Activity-Motor Enrichment) protocol of a single blind randomised controlled trial of motor training parent education and environmental enrichment for infants at high risk of cerebral palsy BMC Neurology 14(203)
bull Whittingham K Wee D amp Boyd R (2010) Systematic review of the efficacy of parenting interventions for children with cerebral palsy Child care health and development 37(4) 475-483
bull Morgan C Novak I dale R amp Badawi N (2015) Optimising motor learning in infants at high risk of cerebral palsy a pilot study BMC Pediatrics 15(1) n pag Web
bull Vos R Dallmeijer A Verhoef M et al (2014) Developmental trajectories of receptive and expressive communication in children and young adults with cerebral palsy Developmental Medicine amp Child Neurology 56 951-959
bull Light J and McNaughton D (2015) Designing AAC research and intervention to improve outcomes for individuals with complex communication needs Augmentative and Alternative Communication 31(2) 85-96
bull Romski M Sevcik R Barton-Hulsey A amp Whitmore A (2015) Early Intervention and AAC What a difference 30 years makes Augmentative and Alternative Communication 31 (3) 181-202
References
Perlman Center
bull Novak I Cusick A Lannin N (2009) Occupational therapy home programs for cerebral palsy Double-blind randomised controlled trial Pediatrics 124 e606-e614
bull Gericke T (2006) Postural management for children with cerebral palsy consensus statement Dev Med Child Neurol 48 (4) 244-244
bull McKeever P Rossen B Scott H Robinson-Vincent K amp Wright V (2013) The significance of uprightness parentsrsquo reflections on childrenrsquos responses to a hands-free walker for children Disability amp Society 28(3) 380-392
bull Law M Pollock N Russell D Walter S et al (2011) Focus on function a cluster randomised controlled trial comparing child-versus context-focused intervention for young children with cerebral palsy Dev Med Child Neurol 53 621-629
bull ldquoSensory Processing Developmental Chartrdquo Sensory Processing Developmental Chart Np nd Web 12 Oct 2015
bull Folio MR amp Fewell RR(2000) Peabody Developmental Motor Scales- Second edition Austin TX PRO ED
bull Voress Judith K amp Pearson Nils A (2013) Early Childhood Development Chart-Third edition Austin TX PRO ED
bull Paul Rhea (2007) Language Disorders from Infancy Through Adolescence Assessment amp Intervention Third edition St Louis MA Mosby Inc
bull Prosser L Ohlrich L Curatalo L Alter K amp Damiano D (2012) Feasibility and preliminary effectiveness of a novel mobility training intervention in infants and toddlers with cerebral palsy Developmental Neurorehabilitation 15(4) 259-266
References
Perlman Center
bull Headpointing painting
bull Universal cuffs large pegs splints
bull Switch toys for art activitiesdramatic play-pourer
bull Switch computer access- helpkidzlearncom
bull Fischer Price game with keyboard binder switch
bull Walking in different textures while in standers and walkers
bull Cameramouseorg with dwell click
bull Partner assisted scanning
Alternative amp Adaptive Access to Play
Perlman Center
Change the environment Not the body Adaptations will be critical for success
Gross Motor Fine Motor
Social
Communication
Perlman Center Consider Communication Young children need a reliable form of communication as early as possible
Augmentative Communication is shown to support verbal skills and enhance lives of
birth to three children and their families (Romski et al 2015)
Perlman Center
Holistic approach to AAC intervention should
Build on individual strengths
Focus on participation in real-world contexts
Address psychosocial factors (ie motivation attitude confidence resilience)
Focus on environmental factors to reduce barriers and maximize social supports
In the absence of a holistic approach to communication a child is at risk for failing to engage in social contexts beyond their immediate family or educationalvocational personnel (Light and Mcnaughton 2015)
Augmentative amp Alternative Communication (AAC)
Perlman Center
Early Literacy
Perlman Center
Early Mobility
There is more than one way
Hands Free Matters
Perlman Center
Early Mobility
Should I get a gait trainer if
they are going to walk YES
Are they too young for power NO
Perlman Center
Sensory Motor Learning
Perlman Center
Sensory Motor Learning
Perlman Center
Social Connection
Perlman Center
Total Access to Play
Perlman Center
Perlman defines functional positioning bull Positioning which promotes active movement and participation and
provides an opportunity to positively impact cognitive function
bull Equipment should promote function and participation across the lifespan
Perlman Center
Principles of seating and positioning
bull Obtain a stable base of support
bull Decrease the influence of atypical muscle tone
bull Accommodate fixed deformities and correct flexible deformities
bull Provide the least amount of intervention needed to achieve the greatest level of function
bull There is no one solution or product but typically a combination of tools that provide success
Adapted from Radell (1997) and York and Weimann (1991)
Perlman Center
Key Positioning Components
bull Postural Control Strengthening
bull Range of Motion Weight Bearing
bull Home Activity Programs
Developmental Positioning
bull ADLs-Play Feeding Bathing Sleeping
bull Computer AccessAAC-Integrated Technology
bull Vision Sensory Processing Participation
Upright Positioning
bull EARLY MOBILITY- developmental sequence
bull Gait Trainer Stander amp or Wheelchair
bull Manual wheelchair vs Power Mobility- BOTH
bull Recreational
ldquoTotalrdquo Mobility
bull Body Mechanics Hoyer Lifts Overhead Systems
bull Car Seat ampor Tie Downs
bull Adapted VanRamps
Transfers ampTransportation
Perlman Center
Equipment Plan of Care
Birth to Three
Adapting baby
equipment
Floor Play
StanderWalker
Bath Seat
Car Seat
Braces
Seating for Function
Early ACCESS
Wheelchair
Bed Positioning
Bike amp Swing
Preschool
Stander
Walker
Braces
Bath Seat
Potty Seat
Wheelchair
HiLo seating
AACAccess
Adapted Bed
Car Seat
Transportation
RecreationHEP
School-Age
to Adult
Wheelchair
AACACCESS
Integrated AT
Hilo chair
Standerwalker
Bath chair
Potty chair
Adapted Bed
Car SeatVan
Home modslifts
LeisureWork
Perlman Center
Commercial Products strollers car seats cribs bath seats high chairs
playpen infant swings floor mats nursing pillow ExerSaucers
Perlman Center
Creative Commercial Adaptations
Pool noodles
Snug and Go
Crib Wedges
Bed tableart desk
Laundry baskets
Inflatable bathtub
Inflatable infant pools
Boxesstools
Perlman Center Creative Commercial Adaptations
Laundry basket $400
Pool Noodle x 2 $300
Floor sitterbath support $700
table (BLACK) $800
Garbage can $600
Large pool noodle $300
Stander with anterior support and
Visual adaptation $1700
Perlman Center
Complex Rehab Equipment
Standers
Gait trainers
Bath Support
Car seat
Seating
Feeding tools
AAC
Sensory tools
vibration
Compression garments
NUK brushes
Z Vibe
Modified utensils
Swings
Weight
Head phones
Positioning
Neck supports
Bracing
Bobby pillowU cushion
Benches
Fireflyfriendscom
PlayPaK
Upsee
Go To Seat
Early Literacy
Picture symbols
Voice output switches
Adapted books
Adapted Equipment
Perlman Center
You got this baby Nowhellip Questions
Perlman Center
LETrsquoS PLAY
Hands on Equipment Demonstration
Perlman Center
bull Ulrich B (2010) Opportunities for Early Intervention Based on Theory Basic Neuroscience and Clinical Science Physical Therapy 90(12) 1868-1880
bull McIntyre S Morgan C amp Walker K (2011) Cerebral Palsy Dont Delay Developmental Disabilities Research Reviews 17(2) 114-129
bull Novak I (2014) Evidence-Based Diagnosis Health Care and Rehabilitation for Children with Cerebral Palsy Journal of Child Neurology 29(8) 1141-1156
bull Morgan C Novak I amp Badawi N (2013) Enriched Environments and Motor Outcomes in Cerebral Palsy Systematic Review and Meta-analysis Pediatrics 132 (3)e 735 -e746
bull Morgan C Novak I Dale R Guzzetta A amp Badawi N (2014) GAME (Goals- Activity-Motor Enrichment) protocol of a single blind randomised controlled trial of motor training parent education and environmental enrichment for infants at high risk of cerebral palsy BMC Neurology 14(203)
bull Whittingham K Wee D amp Boyd R (2010) Systematic review of the efficacy of parenting interventions for children with cerebral palsy Child care health and development 37(4) 475-483
bull Morgan C Novak I dale R amp Badawi N (2015) Optimising motor learning in infants at high risk of cerebral palsy a pilot study BMC Pediatrics 15(1) n pag Web
bull Vos R Dallmeijer A Verhoef M et al (2014) Developmental trajectories of receptive and expressive communication in children and young adults with cerebral palsy Developmental Medicine amp Child Neurology 56 951-959
bull Light J and McNaughton D (2015) Designing AAC research and intervention to improve outcomes for individuals with complex communication needs Augmentative and Alternative Communication 31(2) 85-96
bull Romski M Sevcik R Barton-Hulsey A amp Whitmore A (2015) Early Intervention and AAC What a difference 30 years makes Augmentative and Alternative Communication 31 (3) 181-202
References
Perlman Center
bull Novak I Cusick A Lannin N (2009) Occupational therapy home programs for cerebral palsy Double-blind randomised controlled trial Pediatrics 124 e606-e614
bull Gericke T (2006) Postural management for children with cerebral palsy consensus statement Dev Med Child Neurol 48 (4) 244-244
bull McKeever P Rossen B Scott H Robinson-Vincent K amp Wright V (2013) The significance of uprightness parentsrsquo reflections on childrenrsquos responses to a hands-free walker for children Disability amp Society 28(3) 380-392
bull Law M Pollock N Russell D Walter S et al (2011) Focus on function a cluster randomised controlled trial comparing child-versus context-focused intervention for young children with cerebral palsy Dev Med Child Neurol 53 621-629
bull ldquoSensory Processing Developmental Chartrdquo Sensory Processing Developmental Chart Np nd Web 12 Oct 2015
bull Folio MR amp Fewell RR(2000) Peabody Developmental Motor Scales- Second edition Austin TX PRO ED
bull Voress Judith K amp Pearson Nils A (2013) Early Childhood Development Chart-Third edition Austin TX PRO ED
bull Paul Rhea (2007) Language Disorders from Infancy Through Adolescence Assessment amp Intervention Third edition St Louis MA Mosby Inc
bull Prosser L Ohlrich L Curatalo L Alter K amp Damiano D (2012) Feasibility and preliminary effectiveness of a novel mobility training intervention in infants and toddlers with cerebral palsy Developmental Neurorehabilitation 15(4) 259-266
References
Perlman Center
Change the environment Not the body Adaptations will be critical for success
Gross Motor Fine Motor
Social
Communication
Perlman Center Consider Communication Young children need a reliable form of communication as early as possible
Augmentative Communication is shown to support verbal skills and enhance lives of
birth to three children and their families (Romski et al 2015)
Perlman Center
Holistic approach to AAC intervention should
Build on individual strengths
Focus on participation in real-world contexts
Address psychosocial factors (ie motivation attitude confidence resilience)
Focus on environmental factors to reduce barriers and maximize social supports
In the absence of a holistic approach to communication a child is at risk for failing to engage in social contexts beyond their immediate family or educationalvocational personnel (Light and Mcnaughton 2015)
Augmentative amp Alternative Communication (AAC)
Perlman Center
Early Literacy
Perlman Center
Early Mobility
There is more than one way
Hands Free Matters
Perlman Center
Early Mobility
Should I get a gait trainer if
they are going to walk YES
Are they too young for power NO
Perlman Center
Sensory Motor Learning
Perlman Center
Sensory Motor Learning
Perlman Center
Social Connection
Perlman Center
Total Access to Play
Perlman Center
Perlman defines functional positioning bull Positioning which promotes active movement and participation and
provides an opportunity to positively impact cognitive function
bull Equipment should promote function and participation across the lifespan
Perlman Center
Principles of seating and positioning
bull Obtain a stable base of support
bull Decrease the influence of atypical muscle tone
bull Accommodate fixed deformities and correct flexible deformities
bull Provide the least amount of intervention needed to achieve the greatest level of function
bull There is no one solution or product but typically a combination of tools that provide success
Adapted from Radell (1997) and York and Weimann (1991)
Perlman Center
Key Positioning Components
bull Postural Control Strengthening
bull Range of Motion Weight Bearing
bull Home Activity Programs
Developmental Positioning
bull ADLs-Play Feeding Bathing Sleeping
bull Computer AccessAAC-Integrated Technology
bull Vision Sensory Processing Participation
Upright Positioning
bull EARLY MOBILITY- developmental sequence
bull Gait Trainer Stander amp or Wheelchair
bull Manual wheelchair vs Power Mobility- BOTH
bull Recreational
ldquoTotalrdquo Mobility
bull Body Mechanics Hoyer Lifts Overhead Systems
bull Car Seat ampor Tie Downs
bull Adapted VanRamps
Transfers ampTransportation
Perlman Center
Equipment Plan of Care
Birth to Three
Adapting baby
equipment
Floor Play
StanderWalker
Bath Seat
Car Seat
Braces
Seating for Function
Early ACCESS
Wheelchair
Bed Positioning
Bike amp Swing
Preschool
Stander
Walker
Braces
Bath Seat
Potty Seat
Wheelchair
HiLo seating
AACAccess
Adapted Bed
Car Seat
Transportation
RecreationHEP
School-Age
to Adult
Wheelchair
AACACCESS
Integrated AT
Hilo chair
Standerwalker
Bath chair
Potty chair
Adapted Bed
Car SeatVan
Home modslifts
LeisureWork
Perlman Center
Commercial Products strollers car seats cribs bath seats high chairs
playpen infant swings floor mats nursing pillow ExerSaucers
Perlman Center
Creative Commercial Adaptations
Pool noodles
Snug and Go
Crib Wedges
Bed tableart desk
Laundry baskets
Inflatable bathtub
Inflatable infant pools
Boxesstools
Perlman Center Creative Commercial Adaptations
Laundry basket $400
Pool Noodle x 2 $300
Floor sitterbath support $700
table (BLACK) $800
Garbage can $600
Large pool noodle $300
Stander with anterior support and
Visual adaptation $1700
Perlman Center
Complex Rehab Equipment
Standers
Gait trainers
Bath Support
Car seat
Seating
Feeding tools
AAC
Sensory tools
vibration
Compression garments
NUK brushes
Z Vibe
Modified utensils
Swings
Weight
Head phones
Positioning
Neck supports
Bracing
Bobby pillowU cushion
Benches
Fireflyfriendscom
PlayPaK
Upsee
Go To Seat
Early Literacy
Picture symbols
Voice output switches
Adapted books
Adapted Equipment
Perlman Center
You got this baby Nowhellip Questions
Perlman Center
LETrsquoS PLAY
Hands on Equipment Demonstration
Perlman Center
bull Ulrich B (2010) Opportunities for Early Intervention Based on Theory Basic Neuroscience and Clinical Science Physical Therapy 90(12) 1868-1880
bull McIntyre S Morgan C amp Walker K (2011) Cerebral Palsy Dont Delay Developmental Disabilities Research Reviews 17(2) 114-129
bull Novak I (2014) Evidence-Based Diagnosis Health Care and Rehabilitation for Children with Cerebral Palsy Journal of Child Neurology 29(8) 1141-1156
bull Morgan C Novak I amp Badawi N (2013) Enriched Environments and Motor Outcomes in Cerebral Palsy Systematic Review and Meta-analysis Pediatrics 132 (3)e 735 -e746
bull Morgan C Novak I Dale R Guzzetta A amp Badawi N (2014) GAME (Goals- Activity-Motor Enrichment) protocol of a single blind randomised controlled trial of motor training parent education and environmental enrichment for infants at high risk of cerebral palsy BMC Neurology 14(203)
bull Whittingham K Wee D amp Boyd R (2010) Systematic review of the efficacy of parenting interventions for children with cerebral palsy Child care health and development 37(4) 475-483
bull Morgan C Novak I dale R amp Badawi N (2015) Optimising motor learning in infants at high risk of cerebral palsy a pilot study BMC Pediatrics 15(1) n pag Web
bull Vos R Dallmeijer A Verhoef M et al (2014) Developmental trajectories of receptive and expressive communication in children and young adults with cerebral palsy Developmental Medicine amp Child Neurology 56 951-959
bull Light J and McNaughton D (2015) Designing AAC research and intervention to improve outcomes for individuals with complex communication needs Augmentative and Alternative Communication 31(2) 85-96
bull Romski M Sevcik R Barton-Hulsey A amp Whitmore A (2015) Early Intervention and AAC What a difference 30 years makes Augmentative and Alternative Communication 31 (3) 181-202
References
Perlman Center
bull Novak I Cusick A Lannin N (2009) Occupational therapy home programs for cerebral palsy Double-blind randomised controlled trial Pediatrics 124 e606-e614
bull Gericke T (2006) Postural management for children with cerebral palsy consensus statement Dev Med Child Neurol 48 (4) 244-244
bull McKeever P Rossen B Scott H Robinson-Vincent K amp Wright V (2013) The significance of uprightness parentsrsquo reflections on childrenrsquos responses to a hands-free walker for children Disability amp Society 28(3) 380-392
bull Law M Pollock N Russell D Walter S et al (2011) Focus on function a cluster randomised controlled trial comparing child-versus context-focused intervention for young children with cerebral palsy Dev Med Child Neurol 53 621-629
bull ldquoSensory Processing Developmental Chartrdquo Sensory Processing Developmental Chart Np nd Web 12 Oct 2015
bull Folio MR amp Fewell RR(2000) Peabody Developmental Motor Scales- Second edition Austin TX PRO ED
bull Voress Judith K amp Pearson Nils A (2013) Early Childhood Development Chart-Third edition Austin TX PRO ED
bull Paul Rhea (2007) Language Disorders from Infancy Through Adolescence Assessment amp Intervention Third edition St Louis MA Mosby Inc
bull Prosser L Ohlrich L Curatalo L Alter K amp Damiano D (2012) Feasibility and preliminary effectiveness of a novel mobility training intervention in infants and toddlers with cerebral palsy Developmental Neurorehabilitation 15(4) 259-266
References
Perlman Center Consider Communication Young children need a reliable form of communication as early as possible
Augmentative Communication is shown to support verbal skills and enhance lives of
birth to three children and their families (Romski et al 2015)
Perlman Center
Holistic approach to AAC intervention should
Build on individual strengths
Focus on participation in real-world contexts
Address psychosocial factors (ie motivation attitude confidence resilience)
Focus on environmental factors to reduce barriers and maximize social supports
In the absence of a holistic approach to communication a child is at risk for failing to engage in social contexts beyond their immediate family or educationalvocational personnel (Light and Mcnaughton 2015)
Augmentative amp Alternative Communication (AAC)
Perlman Center
Early Literacy
Perlman Center
Early Mobility
There is more than one way
Hands Free Matters
Perlman Center
Early Mobility
Should I get a gait trainer if
they are going to walk YES
Are they too young for power NO
Perlman Center
Sensory Motor Learning
Perlman Center
Sensory Motor Learning
Perlman Center
Social Connection
Perlman Center
Total Access to Play
Perlman Center
Perlman defines functional positioning bull Positioning which promotes active movement and participation and
provides an opportunity to positively impact cognitive function
bull Equipment should promote function and participation across the lifespan
Perlman Center
Principles of seating and positioning
bull Obtain a stable base of support
bull Decrease the influence of atypical muscle tone
bull Accommodate fixed deformities and correct flexible deformities
bull Provide the least amount of intervention needed to achieve the greatest level of function
bull There is no one solution or product but typically a combination of tools that provide success
Adapted from Radell (1997) and York and Weimann (1991)
Perlman Center
Key Positioning Components
bull Postural Control Strengthening
bull Range of Motion Weight Bearing
bull Home Activity Programs
Developmental Positioning
bull ADLs-Play Feeding Bathing Sleeping
bull Computer AccessAAC-Integrated Technology
bull Vision Sensory Processing Participation
Upright Positioning
bull EARLY MOBILITY- developmental sequence
bull Gait Trainer Stander amp or Wheelchair
bull Manual wheelchair vs Power Mobility- BOTH
bull Recreational
ldquoTotalrdquo Mobility
bull Body Mechanics Hoyer Lifts Overhead Systems
bull Car Seat ampor Tie Downs
bull Adapted VanRamps
Transfers ampTransportation
Perlman Center
Equipment Plan of Care
Birth to Three
Adapting baby
equipment
Floor Play
StanderWalker
Bath Seat
Car Seat
Braces
Seating for Function
Early ACCESS
Wheelchair
Bed Positioning
Bike amp Swing
Preschool
Stander
Walker
Braces
Bath Seat
Potty Seat
Wheelchair
HiLo seating
AACAccess
Adapted Bed
Car Seat
Transportation
RecreationHEP
School-Age
to Adult
Wheelchair
AACACCESS
Integrated AT
Hilo chair
Standerwalker
Bath chair
Potty chair
Adapted Bed
Car SeatVan
Home modslifts
LeisureWork
Perlman Center
Commercial Products strollers car seats cribs bath seats high chairs
playpen infant swings floor mats nursing pillow ExerSaucers
Perlman Center
Creative Commercial Adaptations
Pool noodles
Snug and Go
Crib Wedges
Bed tableart desk
Laundry baskets
Inflatable bathtub
Inflatable infant pools
Boxesstools
Perlman Center Creative Commercial Adaptations
Laundry basket $400
Pool Noodle x 2 $300
Floor sitterbath support $700
table (BLACK) $800
Garbage can $600
Large pool noodle $300
Stander with anterior support and
Visual adaptation $1700
Perlman Center
Complex Rehab Equipment
Standers
Gait trainers
Bath Support
Car seat
Seating
Feeding tools
AAC
Sensory tools
vibration
Compression garments
NUK brushes
Z Vibe
Modified utensils
Swings
Weight
Head phones
Positioning
Neck supports
Bracing
Bobby pillowU cushion
Benches
Fireflyfriendscom
PlayPaK
Upsee
Go To Seat
Early Literacy
Picture symbols
Voice output switches
Adapted books
Adapted Equipment
Perlman Center
You got this baby Nowhellip Questions
Perlman Center
LETrsquoS PLAY
Hands on Equipment Demonstration
Perlman Center
bull Ulrich B (2010) Opportunities for Early Intervention Based on Theory Basic Neuroscience and Clinical Science Physical Therapy 90(12) 1868-1880
bull McIntyre S Morgan C amp Walker K (2011) Cerebral Palsy Dont Delay Developmental Disabilities Research Reviews 17(2) 114-129
bull Novak I (2014) Evidence-Based Diagnosis Health Care and Rehabilitation for Children with Cerebral Palsy Journal of Child Neurology 29(8) 1141-1156
bull Morgan C Novak I amp Badawi N (2013) Enriched Environments and Motor Outcomes in Cerebral Palsy Systematic Review and Meta-analysis Pediatrics 132 (3)e 735 -e746
bull Morgan C Novak I Dale R Guzzetta A amp Badawi N (2014) GAME (Goals- Activity-Motor Enrichment) protocol of a single blind randomised controlled trial of motor training parent education and environmental enrichment for infants at high risk of cerebral palsy BMC Neurology 14(203)
bull Whittingham K Wee D amp Boyd R (2010) Systematic review of the efficacy of parenting interventions for children with cerebral palsy Child care health and development 37(4) 475-483
bull Morgan C Novak I dale R amp Badawi N (2015) Optimising motor learning in infants at high risk of cerebral palsy a pilot study BMC Pediatrics 15(1) n pag Web
bull Vos R Dallmeijer A Verhoef M et al (2014) Developmental trajectories of receptive and expressive communication in children and young adults with cerebral palsy Developmental Medicine amp Child Neurology 56 951-959
bull Light J and McNaughton D (2015) Designing AAC research and intervention to improve outcomes for individuals with complex communication needs Augmentative and Alternative Communication 31(2) 85-96
bull Romski M Sevcik R Barton-Hulsey A amp Whitmore A (2015) Early Intervention and AAC What a difference 30 years makes Augmentative and Alternative Communication 31 (3) 181-202
References
Perlman Center
bull Novak I Cusick A Lannin N (2009) Occupational therapy home programs for cerebral palsy Double-blind randomised controlled trial Pediatrics 124 e606-e614
bull Gericke T (2006) Postural management for children with cerebral palsy consensus statement Dev Med Child Neurol 48 (4) 244-244
bull McKeever P Rossen B Scott H Robinson-Vincent K amp Wright V (2013) The significance of uprightness parentsrsquo reflections on childrenrsquos responses to a hands-free walker for children Disability amp Society 28(3) 380-392
bull Law M Pollock N Russell D Walter S et al (2011) Focus on function a cluster randomised controlled trial comparing child-versus context-focused intervention for young children with cerebral palsy Dev Med Child Neurol 53 621-629
bull ldquoSensory Processing Developmental Chartrdquo Sensory Processing Developmental Chart Np nd Web 12 Oct 2015
bull Folio MR amp Fewell RR(2000) Peabody Developmental Motor Scales- Second edition Austin TX PRO ED
bull Voress Judith K amp Pearson Nils A (2013) Early Childhood Development Chart-Third edition Austin TX PRO ED
bull Paul Rhea (2007) Language Disorders from Infancy Through Adolescence Assessment amp Intervention Third edition St Louis MA Mosby Inc
bull Prosser L Ohlrich L Curatalo L Alter K amp Damiano D (2012) Feasibility and preliminary effectiveness of a novel mobility training intervention in infants and toddlers with cerebral palsy Developmental Neurorehabilitation 15(4) 259-266
References
Perlman Center
Holistic approach to AAC intervention should
Build on individual strengths
Focus on participation in real-world contexts
Address psychosocial factors (ie motivation attitude confidence resilience)
Focus on environmental factors to reduce barriers and maximize social supports
In the absence of a holistic approach to communication a child is at risk for failing to engage in social contexts beyond their immediate family or educationalvocational personnel (Light and Mcnaughton 2015)
Augmentative amp Alternative Communication (AAC)
Perlman Center
Early Literacy
Perlman Center
Early Mobility
There is more than one way
Hands Free Matters
Perlman Center
Early Mobility
Should I get a gait trainer if
they are going to walk YES
Are they too young for power NO
Perlman Center
Sensory Motor Learning
Perlman Center
Sensory Motor Learning
Perlman Center
Social Connection
Perlman Center
Total Access to Play
Perlman Center
Perlman defines functional positioning bull Positioning which promotes active movement and participation and
provides an opportunity to positively impact cognitive function
bull Equipment should promote function and participation across the lifespan
Perlman Center
Principles of seating and positioning
bull Obtain a stable base of support
bull Decrease the influence of atypical muscle tone
bull Accommodate fixed deformities and correct flexible deformities
bull Provide the least amount of intervention needed to achieve the greatest level of function
bull There is no one solution or product but typically a combination of tools that provide success
Adapted from Radell (1997) and York and Weimann (1991)
Perlman Center
Key Positioning Components
bull Postural Control Strengthening
bull Range of Motion Weight Bearing
bull Home Activity Programs
Developmental Positioning
bull ADLs-Play Feeding Bathing Sleeping
bull Computer AccessAAC-Integrated Technology
bull Vision Sensory Processing Participation
Upright Positioning
bull EARLY MOBILITY- developmental sequence
bull Gait Trainer Stander amp or Wheelchair
bull Manual wheelchair vs Power Mobility- BOTH
bull Recreational
ldquoTotalrdquo Mobility
bull Body Mechanics Hoyer Lifts Overhead Systems
bull Car Seat ampor Tie Downs
bull Adapted VanRamps
Transfers ampTransportation
Perlman Center
Equipment Plan of Care
Birth to Three
Adapting baby
equipment
Floor Play
StanderWalker
Bath Seat
Car Seat
Braces
Seating for Function
Early ACCESS
Wheelchair
Bed Positioning
Bike amp Swing
Preschool
Stander
Walker
Braces
Bath Seat
Potty Seat
Wheelchair
HiLo seating
AACAccess
Adapted Bed
Car Seat
Transportation
RecreationHEP
School-Age
to Adult
Wheelchair
AACACCESS
Integrated AT
Hilo chair
Standerwalker
Bath chair
Potty chair
Adapted Bed
Car SeatVan
Home modslifts
LeisureWork
Perlman Center
Commercial Products strollers car seats cribs bath seats high chairs
playpen infant swings floor mats nursing pillow ExerSaucers
Perlman Center
Creative Commercial Adaptations
Pool noodles
Snug and Go
Crib Wedges
Bed tableart desk
Laundry baskets
Inflatable bathtub
Inflatable infant pools
Boxesstools
Perlman Center Creative Commercial Adaptations
Laundry basket $400
Pool Noodle x 2 $300
Floor sitterbath support $700
table (BLACK) $800
Garbage can $600
Large pool noodle $300
Stander with anterior support and
Visual adaptation $1700
Perlman Center
Complex Rehab Equipment
Standers
Gait trainers
Bath Support
Car seat
Seating
Feeding tools
AAC
Sensory tools
vibration
Compression garments
NUK brushes
Z Vibe
Modified utensils
Swings
Weight
Head phones
Positioning
Neck supports
Bracing
Bobby pillowU cushion
Benches
Fireflyfriendscom
PlayPaK
Upsee
Go To Seat
Early Literacy
Picture symbols
Voice output switches
Adapted books
Adapted Equipment
Perlman Center
You got this baby Nowhellip Questions
Perlman Center
LETrsquoS PLAY
Hands on Equipment Demonstration
Perlman Center
bull Ulrich B (2010) Opportunities for Early Intervention Based on Theory Basic Neuroscience and Clinical Science Physical Therapy 90(12) 1868-1880
bull McIntyre S Morgan C amp Walker K (2011) Cerebral Palsy Dont Delay Developmental Disabilities Research Reviews 17(2) 114-129
bull Novak I (2014) Evidence-Based Diagnosis Health Care and Rehabilitation for Children with Cerebral Palsy Journal of Child Neurology 29(8) 1141-1156
bull Morgan C Novak I amp Badawi N (2013) Enriched Environments and Motor Outcomes in Cerebral Palsy Systematic Review and Meta-analysis Pediatrics 132 (3)e 735 -e746
bull Morgan C Novak I Dale R Guzzetta A amp Badawi N (2014) GAME (Goals- Activity-Motor Enrichment) protocol of a single blind randomised controlled trial of motor training parent education and environmental enrichment for infants at high risk of cerebral palsy BMC Neurology 14(203)
bull Whittingham K Wee D amp Boyd R (2010) Systematic review of the efficacy of parenting interventions for children with cerebral palsy Child care health and development 37(4) 475-483
bull Morgan C Novak I dale R amp Badawi N (2015) Optimising motor learning in infants at high risk of cerebral palsy a pilot study BMC Pediatrics 15(1) n pag Web
bull Vos R Dallmeijer A Verhoef M et al (2014) Developmental trajectories of receptive and expressive communication in children and young adults with cerebral palsy Developmental Medicine amp Child Neurology 56 951-959
bull Light J and McNaughton D (2015) Designing AAC research and intervention to improve outcomes for individuals with complex communication needs Augmentative and Alternative Communication 31(2) 85-96
bull Romski M Sevcik R Barton-Hulsey A amp Whitmore A (2015) Early Intervention and AAC What a difference 30 years makes Augmentative and Alternative Communication 31 (3) 181-202
References
Perlman Center
bull Novak I Cusick A Lannin N (2009) Occupational therapy home programs for cerebral palsy Double-blind randomised controlled trial Pediatrics 124 e606-e614
bull Gericke T (2006) Postural management for children with cerebral palsy consensus statement Dev Med Child Neurol 48 (4) 244-244
bull McKeever P Rossen B Scott H Robinson-Vincent K amp Wright V (2013) The significance of uprightness parentsrsquo reflections on childrenrsquos responses to a hands-free walker for children Disability amp Society 28(3) 380-392
bull Law M Pollock N Russell D Walter S et al (2011) Focus on function a cluster randomised controlled trial comparing child-versus context-focused intervention for young children with cerebral palsy Dev Med Child Neurol 53 621-629
bull ldquoSensory Processing Developmental Chartrdquo Sensory Processing Developmental Chart Np nd Web 12 Oct 2015
bull Folio MR amp Fewell RR(2000) Peabody Developmental Motor Scales- Second edition Austin TX PRO ED
bull Voress Judith K amp Pearson Nils A (2013) Early Childhood Development Chart-Third edition Austin TX PRO ED
bull Paul Rhea (2007) Language Disorders from Infancy Through Adolescence Assessment amp Intervention Third edition St Louis MA Mosby Inc
bull Prosser L Ohlrich L Curatalo L Alter K amp Damiano D (2012) Feasibility and preliminary effectiveness of a novel mobility training intervention in infants and toddlers with cerebral palsy Developmental Neurorehabilitation 15(4) 259-266
References
Perlman Center
Early Literacy
Perlman Center
Early Mobility
There is more than one way
Hands Free Matters
Perlman Center
Early Mobility
Should I get a gait trainer if
they are going to walk YES
Are they too young for power NO
Perlman Center
Sensory Motor Learning
Perlman Center
Sensory Motor Learning
Perlman Center
Social Connection
Perlman Center
Total Access to Play
Perlman Center
Perlman defines functional positioning bull Positioning which promotes active movement and participation and
provides an opportunity to positively impact cognitive function
bull Equipment should promote function and participation across the lifespan
Perlman Center
Principles of seating and positioning
bull Obtain a stable base of support
bull Decrease the influence of atypical muscle tone
bull Accommodate fixed deformities and correct flexible deformities
bull Provide the least amount of intervention needed to achieve the greatest level of function
bull There is no one solution or product but typically a combination of tools that provide success
Adapted from Radell (1997) and York and Weimann (1991)
Perlman Center
Key Positioning Components
bull Postural Control Strengthening
bull Range of Motion Weight Bearing
bull Home Activity Programs
Developmental Positioning
bull ADLs-Play Feeding Bathing Sleeping
bull Computer AccessAAC-Integrated Technology
bull Vision Sensory Processing Participation
Upright Positioning
bull EARLY MOBILITY- developmental sequence
bull Gait Trainer Stander amp or Wheelchair
bull Manual wheelchair vs Power Mobility- BOTH
bull Recreational
ldquoTotalrdquo Mobility
bull Body Mechanics Hoyer Lifts Overhead Systems
bull Car Seat ampor Tie Downs
bull Adapted VanRamps
Transfers ampTransportation
Perlman Center
Equipment Plan of Care
Birth to Three
Adapting baby
equipment
Floor Play
StanderWalker
Bath Seat
Car Seat
Braces
Seating for Function
Early ACCESS
Wheelchair
Bed Positioning
Bike amp Swing
Preschool
Stander
Walker
Braces
Bath Seat
Potty Seat
Wheelchair
HiLo seating
AACAccess
Adapted Bed
Car Seat
Transportation
RecreationHEP
School-Age
to Adult
Wheelchair
AACACCESS
Integrated AT
Hilo chair
Standerwalker
Bath chair
Potty chair
Adapted Bed
Car SeatVan
Home modslifts
LeisureWork
Perlman Center
Commercial Products strollers car seats cribs bath seats high chairs
playpen infant swings floor mats nursing pillow ExerSaucers
Perlman Center
Creative Commercial Adaptations
Pool noodles
Snug and Go
Crib Wedges
Bed tableart desk
Laundry baskets
Inflatable bathtub
Inflatable infant pools
Boxesstools
Perlman Center Creative Commercial Adaptations
Laundry basket $400
Pool Noodle x 2 $300
Floor sitterbath support $700
table (BLACK) $800
Garbage can $600
Large pool noodle $300
Stander with anterior support and
Visual adaptation $1700
Perlman Center
Complex Rehab Equipment
Standers
Gait trainers
Bath Support
Car seat
Seating
Feeding tools
AAC
Sensory tools
vibration
Compression garments
NUK brushes
Z Vibe
Modified utensils
Swings
Weight
Head phones
Positioning
Neck supports
Bracing
Bobby pillowU cushion
Benches
Fireflyfriendscom
PlayPaK
Upsee
Go To Seat
Early Literacy
Picture symbols
Voice output switches
Adapted books
Adapted Equipment
Perlman Center
You got this baby Nowhellip Questions
Perlman Center
LETrsquoS PLAY
Hands on Equipment Demonstration
Perlman Center
bull Ulrich B (2010) Opportunities for Early Intervention Based on Theory Basic Neuroscience and Clinical Science Physical Therapy 90(12) 1868-1880
bull McIntyre S Morgan C amp Walker K (2011) Cerebral Palsy Dont Delay Developmental Disabilities Research Reviews 17(2) 114-129
bull Novak I (2014) Evidence-Based Diagnosis Health Care and Rehabilitation for Children with Cerebral Palsy Journal of Child Neurology 29(8) 1141-1156
bull Morgan C Novak I amp Badawi N (2013) Enriched Environments and Motor Outcomes in Cerebral Palsy Systematic Review and Meta-analysis Pediatrics 132 (3)e 735 -e746
bull Morgan C Novak I Dale R Guzzetta A amp Badawi N (2014) GAME (Goals- Activity-Motor Enrichment) protocol of a single blind randomised controlled trial of motor training parent education and environmental enrichment for infants at high risk of cerebral palsy BMC Neurology 14(203)
bull Whittingham K Wee D amp Boyd R (2010) Systematic review of the efficacy of parenting interventions for children with cerebral palsy Child care health and development 37(4) 475-483
bull Morgan C Novak I dale R amp Badawi N (2015) Optimising motor learning in infants at high risk of cerebral palsy a pilot study BMC Pediatrics 15(1) n pag Web
bull Vos R Dallmeijer A Verhoef M et al (2014) Developmental trajectories of receptive and expressive communication in children and young adults with cerebral palsy Developmental Medicine amp Child Neurology 56 951-959
bull Light J and McNaughton D (2015) Designing AAC research and intervention to improve outcomes for individuals with complex communication needs Augmentative and Alternative Communication 31(2) 85-96
bull Romski M Sevcik R Barton-Hulsey A amp Whitmore A (2015) Early Intervention and AAC What a difference 30 years makes Augmentative and Alternative Communication 31 (3) 181-202
References
Perlman Center
bull Novak I Cusick A Lannin N (2009) Occupational therapy home programs for cerebral palsy Double-blind randomised controlled trial Pediatrics 124 e606-e614
bull Gericke T (2006) Postural management for children with cerebral palsy consensus statement Dev Med Child Neurol 48 (4) 244-244
bull McKeever P Rossen B Scott H Robinson-Vincent K amp Wright V (2013) The significance of uprightness parentsrsquo reflections on childrenrsquos responses to a hands-free walker for children Disability amp Society 28(3) 380-392
bull Law M Pollock N Russell D Walter S et al (2011) Focus on function a cluster randomised controlled trial comparing child-versus context-focused intervention for young children with cerebral palsy Dev Med Child Neurol 53 621-629
bull ldquoSensory Processing Developmental Chartrdquo Sensory Processing Developmental Chart Np nd Web 12 Oct 2015
bull Folio MR amp Fewell RR(2000) Peabody Developmental Motor Scales- Second edition Austin TX PRO ED
bull Voress Judith K amp Pearson Nils A (2013) Early Childhood Development Chart-Third edition Austin TX PRO ED
bull Paul Rhea (2007) Language Disorders from Infancy Through Adolescence Assessment amp Intervention Third edition St Louis MA Mosby Inc
bull Prosser L Ohlrich L Curatalo L Alter K amp Damiano D (2012) Feasibility and preliminary effectiveness of a novel mobility training intervention in infants and toddlers with cerebral palsy Developmental Neurorehabilitation 15(4) 259-266
References
Perlman Center
Early Mobility
There is more than one way
Hands Free Matters
Perlman Center
Early Mobility
Should I get a gait trainer if
they are going to walk YES
Are they too young for power NO
Perlman Center
Sensory Motor Learning
Perlman Center
Sensory Motor Learning
Perlman Center
Social Connection
Perlman Center
Total Access to Play
Perlman Center
Perlman defines functional positioning bull Positioning which promotes active movement and participation and
provides an opportunity to positively impact cognitive function
bull Equipment should promote function and participation across the lifespan
Perlman Center
Principles of seating and positioning
bull Obtain a stable base of support
bull Decrease the influence of atypical muscle tone
bull Accommodate fixed deformities and correct flexible deformities
bull Provide the least amount of intervention needed to achieve the greatest level of function
bull There is no one solution or product but typically a combination of tools that provide success
Adapted from Radell (1997) and York and Weimann (1991)
Perlman Center
Key Positioning Components
bull Postural Control Strengthening
bull Range of Motion Weight Bearing
bull Home Activity Programs
Developmental Positioning
bull ADLs-Play Feeding Bathing Sleeping
bull Computer AccessAAC-Integrated Technology
bull Vision Sensory Processing Participation
Upright Positioning
bull EARLY MOBILITY- developmental sequence
bull Gait Trainer Stander amp or Wheelchair
bull Manual wheelchair vs Power Mobility- BOTH
bull Recreational
ldquoTotalrdquo Mobility
bull Body Mechanics Hoyer Lifts Overhead Systems
bull Car Seat ampor Tie Downs
bull Adapted VanRamps
Transfers ampTransportation
Perlman Center
Equipment Plan of Care
Birth to Three
Adapting baby
equipment
Floor Play
StanderWalker
Bath Seat
Car Seat
Braces
Seating for Function
Early ACCESS
Wheelchair
Bed Positioning
Bike amp Swing
Preschool
Stander
Walker
Braces
Bath Seat
Potty Seat
Wheelchair
HiLo seating
AACAccess
Adapted Bed
Car Seat
Transportation
RecreationHEP
School-Age
to Adult
Wheelchair
AACACCESS
Integrated AT
Hilo chair
Standerwalker
Bath chair
Potty chair
Adapted Bed
Car SeatVan
Home modslifts
LeisureWork
Perlman Center
Commercial Products strollers car seats cribs bath seats high chairs
playpen infant swings floor mats nursing pillow ExerSaucers
Perlman Center
Creative Commercial Adaptations
Pool noodles
Snug and Go
Crib Wedges
Bed tableart desk
Laundry baskets
Inflatable bathtub
Inflatable infant pools
Boxesstools
Perlman Center Creative Commercial Adaptations
Laundry basket $400
Pool Noodle x 2 $300
Floor sitterbath support $700
table (BLACK) $800
Garbage can $600
Large pool noodle $300
Stander with anterior support and
Visual adaptation $1700
Perlman Center
Complex Rehab Equipment
Standers
Gait trainers
Bath Support
Car seat
Seating
Feeding tools
AAC
Sensory tools
vibration
Compression garments
NUK brushes
Z Vibe
Modified utensils
Swings
Weight
Head phones
Positioning
Neck supports
Bracing
Bobby pillowU cushion
Benches
Fireflyfriendscom
PlayPaK
Upsee
Go To Seat
Early Literacy
Picture symbols
Voice output switches
Adapted books
Adapted Equipment
Perlman Center
You got this baby Nowhellip Questions
Perlman Center
LETrsquoS PLAY
Hands on Equipment Demonstration
Perlman Center
bull Ulrich B (2010) Opportunities for Early Intervention Based on Theory Basic Neuroscience and Clinical Science Physical Therapy 90(12) 1868-1880
bull McIntyre S Morgan C amp Walker K (2011) Cerebral Palsy Dont Delay Developmental Disabilities Research Reviews 17(2) 114-129
bull Novak I (2014) Evidence-Based Diagnosis Health Care and Rehabilitation for Children with Cerebral Palsy Journal of Child Neurology 29(8) 1141-1156
bull Morgan C Novak I amp Badawi N (2013) Enriched Environments and Motor Outcomes in Cerebral Palsy Systematic Review and Meta-analysis Pediatrics 132 (3)e 735 -e746
bull Morgan C Novak I Dale R Guzzetta A amp Badawi N (2014) GAME (Goals- Activity-Motor Enrichment) protocol of a single blind randomised controlled trial of motor training parent education and environmental enrichment for infants at high risk of cerebral palsy BMC Neurology 14(203)
bull Whittingham K Wee D amp Boyd R (2010) Systematic review of the efficacy of parenting interventions for children with cerebral palsy Child care health and development 37(4) 475-483
bull Morgan C Novak I dale R amp Badawi N (2015) Optimising motor learning in infants at high risk of cerebral palsy a pilot study BMC Pediatrics 15(1) n pag Web
bull Vos R Dallmeijer A Verhoef M et al (2014) Developmental trajectories of receptive and expressive communication in children and young adults with cerebral palsy Developmental Medicine amp Child Neurology 56 951-959
bull Light J and McNaughton D (2015) Designing AAC research and intervention to improve outcomes for individuals with complex communication needs Augmentative and Alternative Communication 31(2) 85-96
bull Romski M Sevcik R Barton-Hulsey A amp Whitmore A (2015) Early Intervention and AAC What a difference 30 years makes Augmentative and Alternative Communication 31 (3) 181-202
References
Perlman Center
bull Novak I Cusick A Lannin N (2009) Occupational therapy home programs for cerebral palsy Double-blind randomised controlled trial Pediatrics 124 e606-e614
bull Gericke T (2006) Postural management for children with cerebral palsy consensus statement Dev Med Child Neurol 48 (4) 244-244
bull McKeever P Rossen B Scott H Robinson-Vincent K amp Wright V (2013) The significance of uprightness parentsrsquo reflections on childrenrsquos responses to a hands-free walker for children Disability amp Society 28(3) 380-392
bull Law M Pollock N Russell D Walter S et al (2011) Focus on function a cluster randomised controlled trial comparing child-versus context-focused intervention for young children with cerebral palsy Dev Med Child Neurol 53 621-629
bull ldquoSensory Processing Developmental Chartrdquo Sensory Processing Developmental Chart Np nd Web 12 Oct 2015
bull Folio MR amp Fewell RR(2000) Peabody Developmental Motor Scales- Second edition Austin TX PRO ED
bull Voress Judith K amp Pearson Nils A (2013) Early Childhood Development Chart-Third edition Austin TX PRO ED
bull Paul Rhea (2007) Language Disorders from Infancy Through Adolescence Assessment amp Intervention Third edition St Louis MA Mosby Inc
bull Prosser L Ohlrich L Curatalo L Alter K amp Damiano D (2012) Feasibility and preliminary effectiveness of a novel mobility training intervention in infants and toddlers with cerebral palsy Developmental Neurorehabilitation 15(4) 259-266
References
Perlman Center
Early Mobility
Should I get a gait trainer if
they are going to walk YES
Are they too young for power NO
Perlman Center
Sensory Motor Learning
Perlman Center
Sensory Motor Learning
Perlman Center
Social Connection
Perlman Center
Total Access to Play
Perlman Center
Perlman defines functional positioning bull Positioning which promotes active movement and participation and
provides an opportunity to positively impact cognitive function
bull Equipment should promote function and participation across the lifespan
Perlman Center
Principles of seating and positioning
bull Obtain a stable base of support
bull Decrease the influence of atypical muscle tone
bull Accommodate fixed deformities and correct flexible deformities
bull Provide the least amount of intervention needed to achieve the greatest level of function
bull There is no one solution or product but typically a combination of tools that provide success
Adapted from Radell (1997) and York and Weimann (1991)
Perlman Center
Key Positioning Components
bull Postural Control Strengthening
bull Range of Motion Weight Bearing
bull Home Activity Programs
Developmental Positioning
bull ADLs-Play Feeding Bathing Sleeping
bull Computer AccessAAC-Integrated Technology
bull Vision Sensory Processing Participation
Upright Positioning
bull EARLY MOBILITY- developmental sequence
bull Gait Trainer Stander amp or Wheelchair
bull Manual wheelchair vs Power Mobility- BOTH
bull Recreational
ldquoTotalrdquo Mobility
bull Body Mechanics Hoyer Lifts Overhead Systems
bull Car Seat ampor Tie Downs
bull Adapted VanRamps
Transfers ampTransportation
Perlman Center
Equipment Plan of Care
Birth to Three
Adapting baby
equipment
Floor Play
StanderWalker
Bath Seat
Car Seat
Braces
Seating for Function
Early ACCESS
Wheelchair
Bed Positioning
Bike amp Swing
Preschool
Stander
Walker
Braces
Bath Seat
Potty Seat
Wheelchair
HiLo seating
AACAccess
Adapted Bed
Car Seat
Transportation
RecreationHEP
School-Age
to Adult
Wheelchair
AACACCESS
Integrated AT
Hilo chair
Standerwalker
Bath chair
Potty chair
Adapted Bed
Car SeatVan
Home modslifts
LeisureWork
Perlman Center
Commercial Products strollers car seats cribs bath seats high chairs
playpen infant swings floor mats nursing pillow ExerSaucers
Perlman Center
Creative Commercial Adaptations
Pool noodles
Snug and Go
Crib Wedges
Bed tableart desk
Laundry baskets
Inflatable bathtub
Inflatable infant pools
Boxesstools
Perlman Center Creative Commercial Adaptations
Laundry basket $400
Pool Noodle x 2 $300
Floor sitterbath support $700
table (BLACK) $800
Garbage can $600
Large pool noodle $300
Stander with anterior support and
Visual adaptation $1700
Perlman Center
Complex Rehab Equipment
Standers
Gait trainers
Bath Support
Car seat
Seating
Feeding tools
AAC
Sensory tools
vibration
Compression garments
NUK brushes
Z Vibe
Modified utensils
Swings
Weight
Head phones
Positioning
Neck supports
Bracing
Bobby pillowU cushion
Benches
Fireflyfriendscom
PlayPaK
Upsee
Go To Seat
Early Literacy
Picture symbols
Voice output switches
Adapted books
Adapted Equipment
Perlman Center
You got this baby Nowhellip Questions
Perlman Center
LETrsquoS PLAY
Hands on Equipment Demonstration
Perlman Center
bull Ulrich B (2010) Opportunities for Early Intervention Based on Theory Basic Neuroscience and Clinical Science Physical Therapy 90(12) 1868-1880
bull McIntyre S Morgan C amp Walker K (2011) Cerebral Palsy Dont Delay Developmental Disabilities Research Reviews 17(2) 114-129
bull Novak I (2014) Evidence-Based Diagnosis Health Care and Rehabilitation for Children with Cerebral Palsy Journal of Child Neurology 29(8) 1141-1156
bull Morgan C Novak I amp Badawi N (2013) Enriched Environments and Motor Outcomes in Cerebral Palsy Systematic Review and Meta-analysis Pediatrics 132 (3)e 735 -e746
bull Morgan C Novak I Dale R Guzzetta A amp Badawi N (2014) GAME (Goals- Activity-Motor Enrichment) protocol of a single blind randomised controlled trial of motor training parent education and environmental enrichment for infants at high risk of cerebral palsy BMC Neurology 14(203)
bull Whittingham K Wee D amp Boyd R (2010) Systematic review of the efficacy of parenting interventions for children with cerebral palsy Child care health and development 37(4) 475-483
bull Morgan C Novak I dale R amp Badawi N (2015) Optimising motor learning in infants at high risk of cerebral palsy a pilot study BMC Pediatrics 15(1) n pag Web
bull Vos R Dallmeijer A Verhoef M et al (2014) Developmental trajectories of receptive and expressive communication in children and young adults with cerebral palsy Developmental Medicine amp Child Neurology 56 951-959
bull Light J and McNaughton D (2015) Designing AAC research and intervention to improve outcomes for individuals with complex communication needs Augmentative and Alternative Communication 31(2) 85-96
bull Romski M Sevcik R Barton-Hulsey A amp Whitmore A (2015) Early Intervention and AAC What a difference 30 years makes Augmentative and Alternative Communication 31 (3) 181-202
References
Perlman Center
bull Novak I Cusick A Lannin N (2009) Occupational therapy home programs for cerebral palsy Double-blind randomised controlled trial Pediatrics 124 e606-e614
bull Gericke T (2006) Postural management for children with cerebral palsy consensus statement Dev Med Child Neurol 48 (4) 244-244
bull McKeever P Rossen B Scott H Robinson-Vincent K amp Wright V (2013) The significance of uprightness parentsrsquo reflections on childrenrsquos responses to a hands-free walker for children Disability amp Society 28(3) 380-392
bull Law M Pollock N Russell D Walter S et al (2011) Focus on function a cluster randomised controlled trial comparing child-versus context-focused intervention for young children with cerebral palsy Dev Med Child Neurol 53 621-629
bull ldquoSensory Processing Developmental Chartrdquo Sensory Processing Developmental Chart Np nd Web 12 Oct 2015
bull Folio MR amp Fewell RR(2000) Peabody Developmental Motor Scales- Second edition Austin TX PRO ED
bull Voress Judith K amp Pearson Nils A (2013) Early Childhood Development Chart-Third edition Austin TX PRO ED
bull Paul Rhea (2007) Language Disorders from Infancy Through Adolescence Assessment amp Intervention Third edition St Louis MA Mosby Inc
bull Prosser L Ohlrich L Curatalo L Alter K amp Damiano D (2012) Feasibility and preliminary effectiveness of a novel mobility training intervention in infants and toddlers with cerebral palsy Developmental Neurorehabilitation 15(4) 259-266
References
Perlman Center
Sensory Motor Learning
Perlman Center
Sensory Motor Learning
Perlman Center
Social Connection
Perlman Center
Total Access to Play
Perlman Center
Perlman defines functional positioning bull Positioning which promotes active movement and participation and
provides an opportunity to positively impact cognitive function
bull Equipment should promote function and participation across the lifespan
Perlman Center
Principles of seating and positioning
bull Obtain a stable base of support
bull Decrease the influence of atypical muscle tone
bull Accommodate fixed deformities and correct flexible deformities
bull Provide the least amount of intervention needed to achieve the greatest level of function
bull There is no one solution or product but typically a combination of tools that provide success
Adapted from Radell (1997) and York and Weimann (1991)
Perlman Center
Key Positioning Components
bull Postural Control Strengthening
bull Range of Motion Weight Bearing
bull Home Activity Programs
Developmental Positioning
bull ADLs-Play Feeding Bathing Sleeping
bull Computer AccessAAC-Integrated Technology
bull Vision Sensory Processing Participation
Upright Positioning
bull EARLY MOBILITY- developmental sequence
bull Gait Trainer Stander amp or Wheelchair
bull Manual wheelchair vs Power Mobility- BOTH
bull Recreational
ldquoTotalrdquo Mobility
bull Body Mechanics Hoyer Lifts Overhead Systems
bull Car Seat ampor Tie Downs
bull Adapted VanRamps
Transfers ampTransportation
Perlman Center
Equipment Plan of Care
Birth to Three
Adapting baby
equipment
Floor Play
StanderWalker
Bath Seat
Car Seat
Braces
Seating for Function
Early ACCESS
Wheelchair
Bed Positioning
Bike amp Swing
Preschool
Stander
Walker
Braces
Bath Seat
Potty Seat
Wheelchair
HiLo seating
AACAccess
Adapted Bed
Car Seat
Transportation
RecreationHEP
School-Age
to Adult
Wheelchair
AACACCESS
Integrated AT
Hilo chair
Standerwalker
Bath chair
Potty chair
Adapted Bed
Car SeatVan
Home modslifts
LeisureWork
Perlman Center
Commercial Products strollers car seats cribs bath seats high chairs
playpen infant swings floor mats nursing pillow ExerSaucers
Perlman Center
Creative Commercial Adaptations
Pool noodles
Snug and Go
Crib Wedges
Bed tableart desk
Laundry baskets
Inflatable bathtub
Inflatable infant pools
Boxesstools
Perlman Center Creative Commercial Adaptations
Laundry basket $400
Pool Noodle x 2 $300
Floor sitterbath support $700
table (BLACK) $800
Garbage can $600
Large pool noodle $300
Stander with anterior support and
Visual adaptation $1700
Perlman Center
Complex Rehab Equipment
Standers
Gait trainers
Bath Support
Car seat
Seating
Feeding tools
AAC
Sensory tools
vibration
Compression garments
NUK brushes
Z Vibe
Modified utensils
Swings
Weight
Head phones
Positioning
Neck supports
Bracing
Bobby pillowU cushion
Benches
Fireflyfriendscom
PlayPaK
Upsee
Go To Seat
Early Literacy
Picture symbols
Voice output switches
Adapted books
Adapted Equipment
Perlman Center
You got this baby Nowhellip Questions
Perlman Center
LETrsquoS PLAY
Hands on Equipment Demonstration
Perlman Center
bull Ulrich B (2010) Opportunities for Early Intervention Based on Theory Basic Neuroscience and Clinical Science Physical Therapy 90(12) 1868-1880
bull McIntyre S Morgan C amp Walker K (2011) Cerebral Palsy Dont Delay Developmental Disabilities Research Reviews 17(2) 114-129
bull Novak I (2014) Evidence-Based Diagnosis Health Care and Rehabilitation for Children with Cerebral Palsy Journal of Child Neurology 29(8) 1141-1156
bull Morgan C Novak I amp Badawi N (2013) Enriched Environments and Motor Outcomes in Cerebral Palsy Systematic Review and Meta-analysis Pediatrics 132 (3)e 735 -e746
bull Morgan C Novak I Dale R Guzzetta A amp Badawi N (2014) GAME (Goals- Activity-Motor Enrichment) protocol of a single blind randomised controlled trial of motor training parent education and environmental enrichment for infants at high risk of cerebral palsy BMC Neurology 14(203)
bull Whittingham K Wee D amp Boyd R (2010) Systematic review of the efficacy of parenting interventions for children with cerebral palsy Child care health and development 37(4) 475-483
bull Morgan C Novak I dale R amp Badawi N (2015) Optimising motor learning in infants at high risk of cerebral palsy a pilot study BMC Pediatrics 15(1) n pag Web
bull Vos R Dallmeijer A Verhoef M et al (2014) Developmental trajectories of receptive and expressive communication in children and young adults with cerebral palsy Developmental Medicine amp Child Neurology 56 951-959
bull Light J and McNaughton D (2015) Designing AAC research and intervention to improve outcomes for individuals with complex communication needs Augmentative and Alternative Communication 31(2) 85-96
bull Romski M Sevcik R Barton-Hulsey A amp Whitmore A (2015) Early Intervention and AAC What a difference 30 years makes Augmentative and Alternative Communication 31 (3) 181-202
References
Perlman Center
bull Novak I Cusick A Lannin N (2009) Occupational therapy home programs for cerebral palsy Double-blind randomised controlled trial Pediatrics 124 e606-e614
bull Gericke T (2006) Postural management for children with cerebral palsy consensus statement Dev Med Child Neurol 48 (4) 244-244
bull McKeever P Rossen B Scott H Robinson-Vincent K amp Wright V (2013) The significance of uprightness parentsrsquo reflections on childrenrsquos responses to a hands-free walker for children Disability amp Society 28(3) 380-392
bull Law M Pollock N Russell D Walter S et al (2011) Focus on function a cluster randomised controlled trial comparing child-versus context-focused intervention for young children with cerebral palsy Dev Med Child Neurol 53 621-629
bull ldquoSensory Processing Developmental Chartrdquo Sensory Processing Developmental Chart Np nd Web 12 Oct 2015
bull Folio MR amp Fewell RR(2000) Peabody Developmental Motor Scales- Second edition Austin TX PRO ED
bull Voress Judith K amp Pearson Nils A (2013) Early Childhood Development Chart-Third edition Austin TX PRO ED
bull Paul Rhea (2007) Language Disorders from Infancy Through Adolescence Assessment amp Intervention Third edition St Louis MA Mosby Inc
bull Prosser L Ohlrich L Curatalo L Alter K amp Damiano D (2012) Feasibility and preliminary effectiveness of a novel mobility training intervention in infants and toddlers with cerebral palsy Developmental Neurorehabilitation 15(4) 259-266
References
Perlman Center
Sensory Motor Learning
Perlman Center
Social Connection
Perlman Center
Total Access to Play
Perlman Center
Perlman defines functional positioning bull Positioning which promotes active movement and participation and
provides an opportunity to positively impact cognitive function
bull Equipment should promote function and participation across the lifespan
Perlman Center
Principles of seating and positioning
bull Obtain a stable base of support
bull Decrease the influence of atypical muscle tone
bull Accommodate fixed deformities and correct flexible deformities
bull Provide the least amount of intervention needed to achieve the greatest level of function
bull There is no one solution or product but typically a combination of tools that provide success
Adapted from Radell (1997) and York and Weimann (1991)
Perlman Center
Key Positioning Components
bull Postural Control Strengthening
bull Range of Motion Weight Bearing
bull Home Activity Programs
Developmental Positioning
bull ADLs-Play Feeding Bathing Sleeping
bull Computer AccessAAC-Integrated Technology
bull Vision Sensory Processing Participation
Upright Positioning
bull EARLY MOBILITY- developmental sequence
bull Gait Trainer Stander amp or Wheelchair
bull Manual wheelchair vs Power Mobility- BOTH
bull Recreational
ldquoTotalrdquo Mobility
bull Body Mechanics Hoyer Lifts Overhead Systems
bull Car Seat ampor Tie Downs
bull Adapted VanRamps
Transfers ampTransportation
Perlman Center
Equipment Plan of Care
Birth to Three
Adapting baby
equipment
Floor Play
StanderWalker
Bath Seat
Car Seat
Braces
Seating for Function
Early ACCESS
Wheelchair
Bed Positioning
Bike amp Swing
Preschool
Stander
Walker
Braces
Bath Seat
Potty Seat
Wheelchair
HiLo seating
AACAccess
Adapted Bed
Car Seat
Transportation
RecreationHEP
School-Age
to Adult
Wheelchair
AACACCESS
Integrated AT
Hilo chair
Standerwalker
Bath chair
Potty chair
Adapted Bed
Car SeatVan
Home modslifts
LeisureWork
Perlman Center
Commercial Products strollers car seats cribs bath seats high chairs
playpen infant swings floor mats nursing pillow ExerSaucers
Perlman Center
Creative Commercial Adaptations
Pool noodles
Snug and Go
Crib Wedges
Bed tableart desk
Laundry baskets
Inflatable bathtub
Inflatable infant pools
Boxesstools
Perlman Center Creative Commercial Adaptations
Laundry basket $400
Pool Noodle x 2 $300
Floor sitterbath support $700
table (BLACK) $800
Garbage can $600
Large pool noodle $300
Stander with anterior support and
Visual adaptation $1700
Perlman Center
Complex Rehab Equipment
Standers
Gait trainers
Bath Support
Car seat
Seating
Feeding tools
AAC
Sensory tools
vibration
Compression garments
NUK brushes
Z Vibe
Modified utensils
Swings
Weight
Head phones
Positioning
Neck supports
Bracing
Bobby pillowU cushion
Benches
Fireflyfriendscom
PlayPaK
Upsee
Go To Seat
Early Literacy
Picture symbols
Voice output switches
Adapted books
Adapted Equipment
Perlman Center
You got this baby Nowhellip Questions
Perlman Center
LETrsquoS PLAY
Hands on Equipment Demonstration
Perlman Center
bull Ulrich B (2010) Opportunities for Early Intervention Based on Theory Basic Neuroscience and Clinical Science Physical Therapy 90(12) 1868-1880
bull McIntyre S Morgan C amp Walker K (2011) Cerebral Palsy Dont Delay Developmental Disabilities Research Reviews 17(2) 114-129
bull Novak I (2014) Evidence-Based Diagnosis Health Care and Rehabilitation for Children with Cerebral Palsy Journal of Child Neurology 29(8) 1141-1156
bull Morgan C Novak I amp Badawi N (2013) Enriched Environments and Motor Outcomes in Cerebral Palsy Systematic Review and Meta-analysis Pediatrics 132 (3)e 735 -e746
bull Morgan C Novak I Dale R Guzzetta A amp Badawi N (2014) GAME (Goals- Activity-Motor Enrichment) protocol of a single blind randomised controlled trial of motor training parent education and environmental enrichment for infants at high risk of cerebral palsy BMC Neurology 14(203)
bull Whittingham K Wee D amp Boyd R (2010) Systematic review of the efficacy of parenting interventions for children with cerebral palsy Child care health and development 37(4) 475-483
bull Morgan C Novak I dale R amp Badawi N (2015) Optimising motor learning in infants at high risk of cerebral palsy a pilot study BMC Pediatrics 15(1) n pag Web
bull Vos R Dallmeijer A Verhoef M et al (2014) Developmental trajectories of receptive and expressive communication in children and young adults with cerebral palsy Developmental Medicine amp Child Neurology 56 951-959
bull Light J and McNaughton D (2015) Designing AAC research and intervention to improve outcomes for individuals with complex communication needs Augmentative and Alternative Communication 31(2) 85-96
bull Romski M Sevcik R Barton-Hulsey A amp Whitmore A (2015) Early Intervention and AAC What a difference 30 years makes Augmentative and Alternative Communication 31 (3) 181-202
References
Perlman Center
bull Novak I Cusick A Lannin N (2009) Occupational therapy home programs for cerebral palsy Double-blind randomised controlled trial Pediatrics 124 e606-e614
bull Gericke T (2006) Postural management for children with cerebral palsy consensus statement Dev Med Child Neurol 48 (4) 244-244
bull McKeever P Rossen B Scott H Robinson-Vincent K amp Wright V (2013) The significance of uprightness parentsrsquo reflections on childrenrsquos responses to a hands-free walker for children Disability amp Society 28(3) 380-392
bull Law M Pollock N Russell D Walter S et al (2011) Focus on function a cluster randomised controlled trial comparing child-versus context-focused intervention for young children with cerebral palsy Dev Med Child Neurol 53 621-629
bull ldquoSensory Processing Developmental Chartrdquo Sensory Processing Developmental Chart Np nd Web 12 Oct 2015
bull Folio MR amp Fewell RR(2000) Peabody Developmental Motor Scales- Second edition Austin TX PRO ED
bull Voress Judith K amp Pearson Nils A (2013) Early Childhood Development Chart-Third edition Austin TX PRO ED
bull Paul Rhea (2007) Language Disorders from Infancy Through Adolescence Assessment amp Intervention Third edition St Louis MA Mosby Inc
bull Prosser L Ohlrich L Curatalo L Alter K amp Damiano D (2012) Feasibility and preliminary effectiveness of a novel mobility training intervention in infants and toddlers with cerebral palsy Developmental Neurorehabilitation 15(4) 259-266
References
Perlman Center
Social Connection
Perlman Center
Total Access to Play
Perlman Center
Perlman defines functional positioning bull Positioning which promotes active movement and participation and
provides an opportunity to positively impact cognitive function
bull Equipment should promote function and participation across the lifespan
Perlman Center
Principles of seating and positioning
bull Obtain a stable base of support
bull Decrease the influence of atypical muscle tone
bull Accommodate fixed deformities and correct flexible deformities
bull Provide the least amount of intervention needed to achieve the greatest level of function
bull There is no one solution or product but typically a combination of tools that provide success
Adapted from Radell (1997) and York and Weimann (1991)
Perlman Center
Key Positioning Components
bull Postural Control Strengthening
bull Range of Motion Weight Bearing
bull Home Activity Programs
Developmental Positioning
bull ADLs-Play Feeding Bathing Sleeping
bull Computer AccessAAC-Integrated Technology
bull Vision Sensory Processing Participation
Upright Positioning
bull EARLY MOBILITY- developmental sequence
bull Gait Trainer Stander amp or Wheelchair
bull Manual wheelchair vs Power Mobility- BOTH
bull Recreational
ldquoTotalrdquo Mobility
bull Body Mechanics Hoyer Lifts Overhead Systems
bull Car Seat ampor Tie Downs
bull Adapted VanRamps
Transfers ampTransportation
Perlman Center
Equipment Plan of Care
Birth to Three
Adapting baby
equipment
Floor Play
StanderWalker
Bath Seat
Car Seat
Braces
Seating for Function
Early ACCESS
Wheelchair
Bed Positioning
Bike amp Swing
Preschool
Stander
Walker
Braces
Bath Seat
Potty Seat
Wheelchair
HiLo seating
AACAccess
Adapted Bed
Car Seat
Transportation
RecreationHEP
School-Age
to Adult
Wheelchair
AACACCESS
Integrated AT
Hilo chair
Standerwalker
Bath chair
Potty chair
Adapted Bed
Car SeatVan
Home modslifts
LeisureWork
Perlman Center
Commercial Products strollers car seats cribs bath seats high chairs
playpen infant swings floor mats nursing pillow ExerSaucers
Perlman Center
Creative Commercial Adaptations
Pool noodles
Snug and Go
Crib Wedges
Bed tableart desk
Laundry baskets
Inflatable bathtub
Inflatable infant pools
Boxesstools
Perlman Center Creative Commercial Adaptations
Laundry basket $400
Pool Noodle x 2 $300
Floor sitterbath support $700
table (BLACK) $800
Garbage can $600
Large pool noodle $300
Stander with anterior support and
Visual adaptation $1700
Perlman Center
Complex Rehab Equipment
Standers
Gait trainers
Bath Support
Car seat
Seating
Feeding tools
AAC
Sensory tools
vibration
Compression garments
NUK brushes
Z Vibe
Modified utensils
Swings
Weight
Head phones
Positioning
Neck supports
Bracing
Bobby pillowU cushion
Benches
Fireflyfriendscom
PlayPaK
Upsee
Go To Seat
Early Literacy
Picture symbols
Voice output switches
Adapted books
Adapted Equipment
Perlman Center
You got this baby Nowhellip Questions
Perlman Center
LETrsquoS PLAY
Hands on Equipment Demonstration
Perlman Center
bull Ulrich B (2010) Opportunities for Early Intervention Based on Theory Basic Neuroscience and Clinical Science Physical Therapy 90(12) 1868-1880
bull McIntyre S Morgan C amp Walker K (2011) Cerebral Palsy Dont Delay Developmental Disabilities Research Reviews 17(2) 114-129
bull Novak I (2014) Evidence-Based Diagnosis Health Care and Rehabilitation for Children with Cerebral Palsy Journal of Child Neurology 29(8) 1141-1156
bull Morgan C Novak I amp Badawi N (2013) Enriched Environments and Motor Outcomes in Cerebral Palsy Systematic Review and Meta-analysis Pediatrics 132 (3)e 735 -e746
bull Morgan C Novak I Dale R Guzzetta A amp Badawi N (2014) GAME (Goals- Activity-Motor Enrichment) protocol of a single blind randomised controlled trial of motor training parent education and environmental enrichment for infants at high risk of cerebral palsy BMC Neurology 14(203)
bull Whittingham K Wee D amp Boyd R (2010) Systematic review of the efficacy of parenting interventions for children with cerebral palsy Child care health and development 37(4) 475-483
bull Morgan C Novak I dale R amp Badawi N (2015) Optimising motor learning in infants at high risk of cerebral palsy a pilot study BMC Pediatrics 15(1) n pag Web
bull Vos R Dallmeijer A Verhoef M et al (2014) Developmental trajectories of receptive and expressive communication in children and young adults with cerebral palsy Developmental Medicine amp Child Neurology 56 951-959
bull Light J and McNaughton D (2015) Designing AAC research and intervention to improve outcomes for individuals with complex communication needs Augmentative and Alternative Communication 31(2) 85-96
bull Romski M Sevcik R Barton-Hulsey A amp Whitmore A (2015) Early Intervention and AAC What a difference 30 years makes Augmentative and Alternative Communication 31 (3) 181-202
References
Perlman Center
bull Novak I Cusick A Lannin N (2009) Occupational therapy home programs for cerebral palsy Double-blind randomised controlled trial Pediatrics 124 e606-e614
bull Gericke T (2006) Postural management for children with cerebral palsy consensus statement Dev Med Child Neurol 48 (4) 244-244
bull McKeever P Rossen B Scott H Robinson-Vincent K amp Wright V (2013) The significance of uprightness parentsrsquo reflections on childrenrsquos responses to a hands-free walker for children Disability amp Society 28(3) 380-392
bull Law M Pollock N Russell D Walter S et al (2011) Focus on function a cluster randomised controlled trial comparing child-versus context-focused intervention for young children with cerebral palsy Dev Med Child Neurol 53 621-629
bull ldquoSensory Processing Developmental Chartrdquo Sensory Processing Developmental Chart Np nd Web 12 Oct 2015
bull Folio MR amp Fewell RR(2000) Peabody Developmental Motor Scales- Second edition Austin TX PRO ED
bull Voress Judith K amp Pearson Nils A (2013) Early Childhood Development Chart-Third edition Austin TX PRO ED
bull Paul Rhea (2007) Language Disorders from Infancy Through Adolescence Assessment amp Intervention Third edition St Louis MA Mosby Inc
bull Prosser L Ohlrich L Curatalo L Alter K amp Damiano D (2012) Feasibility and preliminary effectiveness of a novel mobility training intervention in infants and toddlers with cerebral palsy Developmental Neurorehabilitation 15(4) 259-266
References
Perlman Center
Total Access to Play
Perlman Center
Perlman defines functional positioning bull Positioning which promotes active movement and participation and
provides an opportunity to positively impact cognitive function
bull Equipment should promote function and participation across the lifespan
Perlman Center
Principles of seating and positioning
bull Obtain a stable base of support
bull Decrease the influence of atypical muscle tone
bull Accommodate fixed deformities and correct flexible deformities
bull Provide the least amount of intervention needed to achieve the greatest level of function
bull There is no one solution or product but typically a combination of tools that provide success
Adapted from Radell (1997) and York and Weimann (1991)
Perlman Center
Key Positioning Components
bull Postural Control Strengthening
bull Range of Motion Weight Bearing
bull Home Activity Programs
Developmental Positioning
bull ADLs-Play Feeding Bathing Sleeping
bull Computer AccessAAC-Integrated Technology
bull Vision Sensory Processing Participation
Upright Positioning
bull EARLY MOBILITY- developmental sequence
bull Gait Trainer Stander amp or Wheelchair
bull Manual wheelchair vs Power Mobility- BOTH
bull Recreational
ldquoTotalrdquo Mobility
bull Body Mechanics Hoyer Lifts Overhead Systems
bull Car Seat ampor Tie Downs
bull Adapted VanRamps
Transfers ampTransportation
Perlman Center
Equipment Plan of Care
Birth to Three
Adapting baby
equipment
Floor Play
StanderWalker
Bath Seat
Car Seat
Braces
Seating for Function
Early ACCESS
Wheelchair
Bed Positioning
Bike amp Swing
Preschool
Stander
Walker
Braces
Bath Seat
Potty Seat
Wheelchair
HiLo seating
AACAccess
Adapted Bed
Car Seat
Transportation
RecreationHEP
School-Age
to Adult
Wheelchair
AACACCESS
Integrated AT
Hilo chair
Standerwalker
Bath chair
Potty chair
Adapted Bed
Car SeatVan
Home modslifts
LeisureWork
Perlman Center
Commercial Products strollers car seats cribs bath seats high chairs
playpen infant swings floor mats nursing pillow ExerSaucers
Perlman Center
Creative Commercial Adaptations
Pool noodles
Snug and Go
Crib Wedges
Bed tableart desk
Laundry baskets
Inflatable bathtub
Inflatable infant pools
Boxesstools
Perlman Center Creative Commercial Adaptations
Laundry basket $400
Pool Noodle x 2 $300
Floor sitterbath support $700
table (BLACK) $800
Garbage can $600
Large pool noodle $300
Stander with anterior support and
Visual adaptation $1700
Perlman Center
Complex Rehab Equipment
Standers
Gait trainers
Bath Support
Car seat
Seating
Feeding tools
AAC
Sensory tools
vibration
Compression garments
NUK brushes
Z Vibe
Modified utensils
Swings
Weight
Head phones
Positioning
Neck supports
Bracing
Bobby pillowU cushion
Benches
Fireflyfriendscom
PlayPaK
Upsee
Go To Seat
Early Literacy
Picture symbols
Voice output switches
Adapted books
Adapted Equipment
Perlman Center
You got this baby Nowhellip Questions
Perlman Center
LETrsquoS PLAY
Hands on Equipment Demonstration
Perlman Center
bull Ulrich B (2010) Opportunities for Early Intervention Based on Theory Basic Neuroscience and Clinical Science Physical Therapy 90(12) 1868-1880
bull McIntyre S Morgan C amp Walker K (2011) Cerebral Palsy Dont Delay Developmental Disabilities Research Reviews 17(2) 114-129
bull Novak I (2014) Evidence-Based Diagnosis Health Care and Rehabilitation for Children with Cerebral Palsy Journal of Child Neurology 29(8) 1141-1156
bull Morgan C Novak I amp Badawi N (2013) Enriched Environments and Motor Outcomes in Cerebral Palsy Systematic Review and Meta-analysis Pediatrics 132 (3)e 735 -e746
bull Morgan C Novak I Dale R Guzzetta A amp Badawi N (2014) GAME (Goals- Activity-Motor Enrichment) protocol of a single blind randomised controlled trial of motor training parent education and environmental enrichment for infants at high risk of cerebral palsy BMC Neurology 14(203)
bull Whittingham K Wee D amp Boyd R (2010) Systematic review of the efficacy of parenting interventions for children with cerebral palsy Child care health and development 37(4) 475-483
bull Morgan C Novak I dale R amp Badawi N (2015) Optimising motor learning in infants at high risk of cerebral palsy a pilot study BMC Pediatrics 15(1) n pag Web
bull Vos R Dallmeijer A Verhoef M et al (2014) Developmental trajectories of receptive and expressive communication in children and young adults with cerebral palsy Developmental Medicine amp Child Neurology 56 951-959
bull Light J and McNaughton D (2015) Designing AAC research and intervention to improve outcomes for individuals with complex communication needs Augmentative and Alternative Communication 31(2) 85-96
bull Romski M Sevcik R Barton-Hulsey A amp Whitmore A (2015) Early Intervention and AAC What a difference 30 years makes Augmentative and Alternative Communication 31 (3) 181-202
References
Perlman Center
bull Novak I Cusick A Lannin N (2009) Occupational therapy home programs for cerebral palsy Double-blind randomised controlled trial Pediatrics 124 e606-e614
bull Gericke T (2006) Postural management for children with cerebral palsy consensus statement Dev Med Child Neurol 48 (4) 244-244
bull McKeever P Rossen B Scott H Robinson-Vincent K amp Wright V (2013) The significance of uprightness parentsrsquo reflections on childrenrsquos responses to a hands-free walker for children Disability amp Society 28(3) 380-392
bull Law M Pollock N Russell D Walter S et al (2011) Focus on function a cluster randomised controlled trial comparing child-versus context-focused intervention for young children with cerebral palsy Dev Med Child Neurol 53 621-629
bull ldquoSensory Processing Developmental Chartrdquo Sensory Processing Developmental Chart Np nd Web 12 Oct 2015
bull Folio MR amp Fewell RR(2000) Peabody Developmental Motor Scales- Second edition Austin TX PRO ED
bull Voress Judith K amp Pearson Nils A (2013) Early Childhood Development Chart-Third edition Austin TX PRO ED
bull Paul Rhea (2007) Language Disorders from Infancy Through Adolescence Assessment amp Intervention Third edition St Louis MA Mosby Inc
bull Prosser L Ohlrich L Curatalo L Alter K amp Damiano D (2012) Feasibility and preliminary effectiveness of a novel mobility training intervention in infants and toddlers with cerebral palsy Developmental Neurorehabilitation 15(4) 259-266
References
Perlman Center
Perlman defines functional positioning bull Positioning which promotes active movement and participation and
provides an opportunity to positively impact cognitive function
bull Equipment should promote function and participation across the lifespan
Perlman Center
Principles of seating and positioning
bull Obtain a stable base of support
bull Decrease the influence of atypical muscle tone
bull Accommodate fixed deformities and correct flexible deformities
bull Provide the least amount of intervention needed to achieve the greatest level of function
bull There is no one solution or product but typically a combination of tools that provide success
Adapted from Radell (1997) and York and Weimann (1991)
Perlman Center
Key Positioning Components
bull Postural Control Strengthening
bull Range of Motion Weight Bearing
bull Home Activity Programs
Developmental Positioning
bull ADLs-Play Feeding Bathing Sleeping
bull Computer AccessAAC-Integrated Technology
bull Vision Sensory Processing Participation
Upright Positioning
bull EARLY MOBILITY- developmental sequence
bull Gait Trainer Stander amp or Wheelchair
bull Manual wheelchair vs Power Mobility- BOTH
bull Recreational
ldquoTotalrdquo Mobility
bull Body Mechanics Hoyer Lifts Overhead Systems
bull Car Seat ampor Tie Downs
bull Adapted VanRamps
Transfers ampTransportation
Perlman Center
Equipment Plan of Care
Birth to Three
Adapting baby
equipment
Floor Play
StanderWalker
Bath Seat
Car Seat
Braces
Seating for Function
Early ACCESS
Wheelchair
Bed Positioning
Bike amp Swing
Preschool
Stander
Walker
Braces
Bath Seat
Potty Seat
Wheelchair
HiLo seating
AACAccess
Adapted Bed
Car Seat
Transportation
RecreationHEP
School-Age
to Adult
Wheelchair
AACACCESS
Integrated AT
Hilo chair
Standerwalker
Bath chair
Potty chair
Adapted Bed
Car SeatVan
Home modslifts
LeisureWork
Perlman Center
Commercial Products strollers car seats cribs bath seats high chairs
playpen infant swings floor mats nursing pillow ExerSaucers
Perlman Center
Creative Commercial Adaptations
Pool noodles
Snug and Go
Crib Wedges
Bed tableart desk
Laundry baskets
Inflatable bathtub
Inflatable infant pools
Boxesstools
Perlman Center Creative Commercial Adaptations
Laundry basket $400
Pool Noodle x 2 $300
Floor sitterbath support $700
table (BLACK) $800
Garbage can $600
Large pool noodle $300
Stander with anterior support and
Visual adaptation $1700
Perlman Center
Complex Rehab Equipment
Standers
Gait trainers
Bath Support
Car seat
Seating
Feeding tools
AAC
Sensory tools
vibration
Compression garments
NUK brushes
Z Vibe
Modified utensils
Swings
Weight
Head phones
Positioning
Neck supports
Bracing
Bobby pillowU cushion
Benches
Fireflyfriendscom
PlayPaK
Upsee
Go To Seat
Early Literacy
Picture symbols
Voice output switches
Adapted books
Adapted Equipment
Perlman Center
You got this baby Nowhellip Questions
Perlman Center
LETrsquoS PLAY
Hands on Equipment Demonstration
Perlman Center
bull Ulrich B (2010) Opportunities for Early Intervention Based on Theory Basic Neuroscience and Clinical Science Physical Therapy 90(12) 1868-1880
bull McIntyre S Morgan C amp Walker K (2011) Cerebral Palsy Dont Delay Developmental Disabilities Research Reviews 17(2) 114-129
bull Novak I (2014) Evidence-Based Diagnosis Health Care and Rehabilitation for Children with Cerebral Palsy Journal of Child Neurology 29(8) 1141-1156
bull Morgan C Novak I amp Badawi N (2013) Enriched Environments and Motor Outcomes in Cerebral Palsy Systematic Review and Meta-analysis Pediatrics 132 (3)e 735 -e746
bull Morgan C Novak I Dale R Guzzetta A amp Badawi N (2014) GAME (Goals- Activity-Motor Enrichment) protocol of a single blind randomised controlled trial of motor training parent education and environmental enrichment for infants at high risk of cerebral palsy BMC Neurology 14(203)
bull Whittingham K Wee D amp Boyd R (2010) Systematic review of the efficacy of parenting interventions for children with cerebral palsy Child care health and development 37(4) 475-483
bull Morgan C Novak I dale R amp Badawi N (2015) Optimising motor learning in infants at high risk of cerebral palsy a pilot study BMC Pediatrics 15(1) n pag Web
bull Vos R Dallmeijer A Verhoef M et al (2014) Developmental trajectories of receptive and expressive communication in children and young adults with cerebral palsy Developmental Medicine amp Child Neurology 56 951-959
bull Light J and McNaughton D (2015) Designing AAC research and intervention to improve outcomes for individuals with complex communication needs Augmentative and Alternative Communication 31(2) 85-96
bull Romski M Sevcik R Barton-Hulsey A amp Whitmore A (2015) Early Intervention and AAC What a difference 30 years makes Augmentative and Alternative Communication 31 (3) 181-202
References
Perlman Center
bull Novak I Cusick A Lannin N (2009) Occupational therapy home programs for cerebral palsy Double-blind randomised controlled trial Pediatrics 124 e606-e614
bull Gericke T (2006) Postural management for children with cerebral palsy consensus statement Dev Med Child Neurol 48 (4) 244-244
bull McKeever P Rossen B Scott H Robinson-Vincent K amp Wright V (2013) The significance of uprightness parentsrsquo reflections on childrenrsquos responses to a hands-free walker for children Disability amp Society 28(3) 380-392
bull Law M Pollock N Russell D Walter S et al (2011) Focus on function a cluster randomised controlled trial comparing child-versus context-focused intervention for young children with cerebral palsy Dev Med Child Neurol 53 621-629
bull ldquoSensory Processing Developmental Chartrdquo Sensory Processing Developmental Chart Np nd Web 12 Oct 2015
bull Folio MR amp Fewell RR(2000) Peabody Developmental Motor Scales- Second edition Austin TX PRO ED
bull Voress Judith K amp Pearson Nils A (2013) Early Childhood Development Chart-Third edition Austin TX PRO ED
bull Paul Rhea (2007) Language Disorders from Infancy Through Adolescence Assessment amp Intervention Third edition St Louis MA Mosby Inc
bull Prosser L Ohlrich L Curatalo L Alter K amp Damiano D (2012) Feasibility and preliminary effectiveness of a novel mobility training intervention in infants and toddlers with cerebral palsy Developmental Neurorehabilitation 15(4) 259-266
References
Perlman Center
Principles of seating and positioning
bull Obtain a stable base of support
bull Decrease the influence of atypical muscle tone
bull Accommodate fixed deformities and correct flexible deformities
bull Provide the least amount of intervention needed to achieve the greatest level of function
bull There is no one solution or product but typically a combination of tools that provide success
Adapted from Radell (1997) and York and Weimann (1991)
Perlman Center
Key Positioning Components
bull Postural Control Strengthening
bull Range of Motion Weight Bearing
bull Home Activity Programs
Developmental Positioning
bull ADLs-Play Feeding Bathing Sleeping
bull Computer AccessAAC-Integrated Technology
bull Vision Sensory Processing Participation
Upright Positioning
bull EARLY MOBILITY- developmental sequence
bull Gait Trainer Stander amp or Wheelchair
bull Manual wheelchair vs Power Mobility- BOTH
bull Recreational
ldquoTotalrdquo Mobility
bull Body Mechanics Hoyer Lifts Overhead Systems
bull Car Seat ampor Tie Downs
bull Adapted VanRamps
Transfers ampTransportation
Perlman Center
Equipment Plan of Care
Birth to Three
Adapting baby
equipment
Floor Play
StanderWalker
Bath Seat
Car Seat
Braces
Seating for Function
Early ACCESS
Wheelchair
Bed Positioning
Bike amp Swing
Preschool
Stander
Walker
Braces
Bath Seat
Potty Seat
Wheelchair
HiLo seating
AACAccess
Adapted Bed
Car Seat
Transportation
RecreationHEP
School-Age
to Adult
Wheelchair
AACACCESS
Integrated AT
Hilo chair
Standerwalker
Bath chair
Potty chair
Adapted Bed
Car SeatVan
Home modslifts
LeisureWork
Perlman Center
Commercial Products strollers car seats cribs bath seats high chairs
playpen infant swings floor mats nursing pillow ExerSaucers
Perlman Center
Creative Commercial Adaptations
Pool noodles
Snug and Go
Crib Wedges
Bed tableart desk
Laundry baskets
Inflatable bathtub
Inflatable infant pools
Boxesstools
Perlman Center Creative Commercial Adaptations
Laundry basket $400
Pool Noodle x 2 $300
Floor sitterbath support $700
table (BLACK) $800
Garbage can $600
Large pool noodle $300
Stander with anterior support and
Visual adaptation $1700
Perlman Center
Complex Rehab Equipment
Standers
Gait trainers
Bath Support
Car seat
Seating
Feeding tools
AAC
Sensory tools
vibration
Compression garments
NUK brushes
Z Vibe
Modified utensils
Swings
Weight
Head phones
Positioning
Neck supports
Bracing
Bobby pillowU cushion
Benches
Fireflyfriendscom
PlayPaK
Upsee
Go To Seat
Early Literacy
Picture symbols
Voice output switches
Adapted books
Adapted Equipment
Perlman Center
You got this baby Nowhellip Questions
Perlman Center
LETrsquoS PLAY
Hands on Equipment Demonstration
Perlman Center
bull Ulrich B (2010) Opportunities for Early Intervention Based on Theory Basic Neuroscience and Clinical Science Physical Therapy 90(12) 1868-1880
bull McIntyre S Morgan C amp Walker K (2011) Cerebral Palsy Dont Delay Developmental Disabilities Research Reviews 17(2) 114-129
bull Novak I (2014) Evidence-Based Diagnosis Health Care and Rehabilitation for Children with Cerebral Palsy Journal of Child Neurology 29(8) 1141-1156
bull Morgan C Novak I amp Badawi N (2013) Enriched Environments and Motor Outcomes in Cerebral Palsy Systematic Review and Meta-analysis Pediatrics 132 (3)e 735 -e746
bull Morgan C Novak I Dale R Guzzetta A amp Badawi N (2014) GAME (Goals- Activity-Motor Enrichment) protocol of a single blind randomised controlled trial of motor training parent education and environmental enrichment for infants at high risk of cerebral palsy BMC Neurology 14(203)
bull Whittingham K Wee D amp Boyd R (2010) Systematic review of the efficacy of parenting interventions for children with cerebral palsy Child care health and development 37(4) 475-483
bull Morgan C Novak I dale R amp Badawi N (2015) Optimising motor learning in infants at high risk of cerebral palsy a pilot study BMC Pediatrics 15(1) n pag Web
bull Vos R Dallmeijer A Verhoef M et al (2014) Developmental trajectories of receptive and expressive communication in children and young adults with cerebral palsy Developmental Medicine amp Child Neurology 56 951-959
bull Light J and McNaughton D (2015) Designing AAC research and intervention to improve outcomes for individuals with complex communication needs Augmentative and Alternative Communication 31(2) 85-96
bull Romski M Sevcik R Barton-Hulsey A amp Whitmore A (2015) Early Intervention and AAC What a difference 30 years makes Augmentative and Alternative Communication 31 (3) 181-202
References
Perlman Center
bull Novak I Cusick A Lannin N (2009) Occupational therapy home programs for cerebral palsy Double-blind randomised controlled trial Pediatrics 124 e606-e614
bull Gericke T (2006) Postural management for children with cerebral palsy consensus statement Dev Med Child Neurol 48 (4) 244-244
bull McKeever P Rossen B Scott H Robinson-Vincent K amp Wright V (2013) The significance of uprightness parentsrsquo reflections on childrenrsquos responses to a hands-free walker for children Disability amp Society 28(3) 380-392
bull Law M Pollock N Russell D Walter S et al (2011) Focus on function a cluster randomised controlled trial comparing child-versus context-focused intervention for young children with cerebral palsy Dev Med Child Neurol 53 621-629
bull ldquoSensory Processing Developmental Chartrdquo Sensory Processing Developmental Chart Np nd Web 12 Oct 2015
bull Folio MR amp Fewell RR(2000) Peabody Developmental Motor Scales- Second edition Austin TX PRO ED
bull Voress Judith K amp Pearson Nils A (2013) Early Childhood Development Chart-Third edition Austin TX PRO ED
bull Paul Rhea (2007) Language Disorders from Infancy Through Adolescence Assessment amp Intervention Third edition St Louis MA Mosby Inc
bull Prosser L Ohlrich L Curatalo L Alter K amp Damiano D (2012) Feasibility and preliminary effectiveness of a novel mobility training intervention in infants and toddlers with cerebral palsy Developmental Neurorehabilitation 15(4) 259-266
References
Perlman Center
Key Positioning Components
bull Postural Control Strengthening
bull Range of Motion Weight Bearing
bull Home Activity Programs
Developmental Positioning
bull ADLs-Play Feeding Bathing Sleeping
bull Computer AccessAAC-Integrated Technology
bull Vision Sensory Processing Participation
Upright Positioning
bull EARLY MOBILITY- developmental sequence
bull Gait Trainer Stander amp or Wheelchair
bull Manual wheelchair vs Power Mobility- BOTH
bull Recreational
ldquoTotalrdquo Mobility
bull Body Mechanics Hoyer Lifts Overhead Systems
bull Car Seat ampor Tie Downs
bull Adapted VanRamps
Transfers ampTransportation
Perlman Center
Equipment Plan of Care
Birth to Three
Adapting baby
equipment
Floor Play
StanderWalker
Bath Seat
Car Seat
Braces
Seating for Function
Early ACCESS
Wheelchair
Bed Positioning
Bike amp Swing
Preschool
Stander
Walker
Braces
Bath Seat
Potty Seat
Wheelchair
HiLo seating
AACAccess
Adapted Bed
Car Seat
Transportation
RecreationHEP
School-Age
to Adult
Wheelchair
AACACCESS
Integrated AT
Hilo chair
Standerwalker
Bath chair
Potty chair
Adapted Bed
Car SeatVan
Home modslifts
LeisureWork
Perlman Center
Commercial Products strollers car seats cribs bath seats high chairs
playpen infant swings floor mats nursing pillow ExerSaucers
Perlman Center
Creative Commercial Adaptations
Pool noodles
Snug and Go
Crib Wedges
Bed tableart desk
Laundry baskets
Inflatable bathtub
Inflatable infant pools
Boxesstools
Perlman Center Creative Commercial Adaptations
Laundry basket $400
Pool Noodle x 2 $300
Floor sitterbath support $700
table (BLACK) $800
Garbage can $600
Large pool noodle $300
Stander with anterior support and
Visual adaptation $1700
Perlman Center
Complex Rehab Equipment
Standers
Gait trainers
Bath Support
Car seat
Seating
Feeding tools
AAC
Sensory tools
vibration
Compression garments
NUK brushes
Z Vibe
Modified utensils
Swings
Weight
Head phones
Positioning
Neck supports
Bracing
Bobby pillowU cushion
Benches
Fireflyfriendscom
PlayPaK
Upsee
Go To Seat
Early Literacy
Picture symbols
Voice output switches
Adapted books
Adapted Equipment
Perlman Center
You got this baby Nowhellip Questions
Perlman Center
LETrsquoS PLAY
Hands on Equipment Demonstration
Perlman Center
bull Ulrich B (2010) Opportunities for Early Intervention Based on Theory Basic Neuroscience and Clinical Science Physical Therapy 90(12) 1868-1880
bull McIntyre S Morgan C amp Walker K (2011) Cerebral Palsy Dont Delay Developmental Disabilities Research Reviews 17(2) 114-129
bull Novak I (2014) Evidence-Based Diagnosis Health Care and Rehabilitation for Children with Cerebral Palsy Journal of Child Neurology 29(8) 1141-1156
bull Morgan C Novak I amp Badawi N (2013) Enriched Environments and Motor Outcomes in Cerebral Palsy Systematic Review and Meta-analysis Pediatrics 132 (3)e 735 -e746
bull Morgan C Novak I Dale R Guzzetta A amp Badawi N (2014) GAME (Goals- Activity-Motor Enrichment) protocol of a single blind randomised controlled trial of motor training parent education and environmental enrichment for infants at high risk of cerebral palsy BMC Neurology 14(203)
bull Whittingham K Wee D amp Boyd R (2010) Systematic review of the efficacy of parenting interventions for children with cerebral palsy Child care health and development 37(4) 475-483
bull Morgan C Novak I dale R amp Badawi N (2015) Optimising motor learning in infants at high risk of cerebral palsy a pilot study BMC Pediatrics 15(1) n pag Web
bull Vos R Dallmeijer A Verhoef M et al (2014) Developmental trajectories of receptive and expressive communication in children and young adults with cerebral palsy Developmental Medicine amp Child Neurology 56 951-959
bull Light J and McNaughton D (2015) Designing AAC research and intervention to improve outcomes for individuals with complex communication needs Augmentative and Alternative Communication 31(2) 85-96
bull Romski M Sevcik R Barton-Hulsey A amp Whitmore A (2015) Early Intervention and AAC What a difference 30 years makes Augmentative and Alternative Communication 31 (3) 181-202
References
Perlman Center
bull Novak I Cusick A Lannin N (2009) Occupational therapy home programs for cerebral palsy Double-blind randomised controlled trial Pediatrics 124 e606-e614
bull Gericke T (2006) Postural management for children with cerebral palsy consensus statement Dev Med Child Neurol 48 (4) 244-244
bull McKeever P Rossen B Scott H Robinson-Vincent K amp Wright V (2013) The significance of uprightness parentsrsquo reflections on childrenrsquos responses to a hands-free walker for children Disability amp Society 28(3) 380-392
bull Law M Pollock N Russell D Walter S et al (2011) Focus on function a cluster randomised controlled trial comparing child-versus context-focused intervention for young children with cerebral palsy Dev Med Child Neurol 53 621-629
bull ldquoSensory Processing Developmental Chartrdquo Sensory Processing Developmental Chart Np nd Web 12 Oct 2015
bull Folio MR amp Fewell RR(2000) Peabody Developmental Motor Scales- Second edition Austin TX PRO ED
bull Voress Judith K amp Pearson Nils A (2013) Early Childhood Development Chart-Third edition Austin TX PRO ED
bull Paul Rhea (2007) Language Disorders from Infancy Through Adolescence Assessment amp Intervention Third edition St Louis MA Mosby Inc
bull Prosser L Ohlrich L Curatalo L Alter K amp Damiano D (2012) Feasibility and preliminary effectiveness of a novel mobility training intervention in infants and toddlers with cerebral palsy Developmental Neurorehabilitation 15(4) 259-266
References
Perlman Center
Equipment Plan of Care
Birth to Three
Adapting baby
equipment
Floor Play
StanderWalker
Bath Seat
Car Seat
Braces
Seating for Function
Early ACCESS
Wheelchair
Bed Positioning
Bike amp Swing
Preschool
Stander
Walker
Braces
Bath Seat
Potty Seat
Wheelchair
HiLo seating
AACAccess
Adapted Bed
Car Seat
Transportation
RecreationHEP
School-Age
to Adult
Wheelchair
AACACCESS
Integrated AT
Hilo chair
Standerwalker
Bath chair
Potty chair
Adapted Bed
Car SeatVan
Home modslifts
LeisureWork
Perlman Center
Commercial Products strollers car seats cribs bath seats high chairs
playpen infant swings floor mats nursing pillow ExerSaucers
Perlman Center
Creative Commercial Adaptations
Pool noodles
Snug and Go
Crib Wedges
Bed tableart desk
Laundry baskets
Inflatable bathtub
Inflatable infant pools
Boxesstools
Perlman Center Creative Commercial Adaptations
Laundry basket $400
Pool Noodle x 2 $300
Floor sitterbath support $700
table (BLACK) $800
Garbage can $600
Large pool noodle $300
Stander with anterior support and
Visual adaptation $1700
Perlman Center
Complex Rehab Equipment
Standers
Gait trainers
Bath Support
Car seat
Seating
Feeding tools
AAC
Sensory tools
vibration
Compression garments
NUK brushes
Z Vibe
Modified utensils
Swings
Weight
Head phones
Positioning
Neck supports
Bracing
Bobby pillowU cushion
Benches
Fireflyfriendscom
PlayPaK
Upsee
Go To Seat
Early Literacy
Picture symbols
Voice output switches
Adapted books
Adapted Equipment
Perlman Center
You got this baby Nowhellip Questions
Perlman Center
LETrsquoS PLAY
Hands on Equipment Demonstration
Perlman Center
bull Ulrich B (2010) Opportunities for Early Intervention Based on Theory Basic Neuroscience and Clinical Science Physical Therapy 90(12) 1868-1880
bull McIntyre S Morgan C amp Walker K (2011) Cerebral Palsy Dont Delay Developmental Disabilities Research Reviews 17(2) 114-129
bull Novak I (2014) Evidence-Based Diagnosis Health Care and Rehabilitation for Children with Cerebral Palsy Journal of Child Neurology 29(8) 1141-1156
bull Morgan C Novak I amp Badawi N (2013) Enriched Environments and Motor Outcomes in Cerebral Palsy Systematic Review and Meta-analysis Pediatrics 132 (3)e 735 -e746
bull Morgan C Novak I Dale R Guzzetta A amp Badawi N (2014) GAME (Goals- Activity-Motor Enrichment) protocol of a single blind randomised controlled trial of motor training parent education and environmental enrichment for infants at high risk of cerebral palsy BMC Neurology 14(203)
bull Whittingham K Wee D amp Boyd R (2010) Systematic review of the efficacy of parenting interventions for children with cerebral palsy Child care health and development 37(4) 475-483
bull Morgan C Novak I dale R amp Badawi N (2015) Optimising motor learning in infants at high risk of cerebral palsy a pilot study BMC Pediatrics 15(1) n pag Web
bull Vos R Dallmeijer A Verhoef M et al (2014) Developmental trajectories of receptive and expressive communication in children and young adults with cerebral palsy Developmental Medicine amp Child Neurology 56 951-959
bull Light J and McNaughton D (2015) Designing AAC research and intervention to improve outcomes for individuals with complex communication needs Augmentative and Alternative Communication 31(2) 85-96
bull Romski M Sevcik R Barton-Hulsey A amp Whitmore A (2015) Early Intervention and AAC What a difference 30 years makes Augmentative and Alternative Communication 31 (3) 181-202
References
Perlman Center
bull Novak I Cusick A Lannin N (2009) Occupational therapy home programs for cerebral palsy Double-blind randomised controlled trial Pediatrics 124 e606-e614
bull Gericke T (2006) Postural management for children with cerebral palsy consensus statement Dev Med Child Neurol 48 (4) 244-244
bull McKeever P Rossen B Scott H Robinson-Vincent K amp Wright V (2013) The significance of uprightness parentsrsquo reflections on childrenrsquos responses to a hands-free walker for children Disability amp Society 28(3) 380-392
bull Law M Pollock N Russell D Walter S et al (2011) Focus on function a cluster randomised controlled trial comparing child-versus context-focused intervention for young children with cerebral palsy Dev Med Child Neurol 53 621-629
bull ldquoSensory Processing Developmental Chartrdquo Sensory Processing Developmental Chart Np nd Web 12 Oct 2015
bull Folio MR amp Fewell RR(2000) Peabody Developmental Motor Scales- Second edition Austin TX PRO ED
bull Voress Judith K amp Pearson Nils A (2013) Early Childhood Development Chart-Third edition Austin TX PRO ED
bull Paul Rhea (2007) Language Disorders from Infancy Through Adolescence Assessment amp Intervention Third edition St Louis MA Mosby Inc
bull Prosser L Ohlrich L Curatalo L Alter K amp Damiano D (2012) Feasibility and preliminary effectiveness of a novel mobility training intervention in infants and toddlers with cerebral palsy Developmental Neurorehabilitation 15(4) 259-266
References
Perlman Center
Commercial Products strollers car seats cribs bath seats high chairs
playpen infant swings floor mats nursing pillow ExerSaucers
Perlman Center
Creative Commercial Adaptations
Pool noodles
Snug and Go
Crib Wedges
Bed tableart desk
Laundry baskets
Inflatable bathtub
Inflatable infant pools
Boxesstools
Perlman Center Creative Commercial Adaptations
Laundry basket $400
Pool Noodle x 2 $300
Floor sitterbath support $700
table (BLACK) $800
Garbage can $600
Large pool noodle $300
Stander with anterior support and
Visual adaptation $1700
Perlman Center
Complex Rehab Equipment
Standers
Gait trainers
Bath Support
Car seat
Seating
Feeding tools
AAC
Sensory tools
vibration
Compression garments
NUK brushes
Z Vibe
Modified utensils
Swings
Weight
Head phones
Positioning
Neck supports
Bracing
Bobby pillowU cushion
Benches
Fireflyfriendscom
PlayPaK
Upsee
Go To Seat
Early Literacy
Picture symbols
Voice output switches
Adapted books
Adapted Equipment
Perlman Center
You got this baby Nowhellip Questions
Perlman Center
LETrsquoS PLAY
Hands on Equipment Demonstration
Perlman Center
bull Ulrich B (2010) Opportunities for Early Intervention Based on Theory Basic Neuroscience and Clinical Science Physical Therapy 90(12) 1868-1880
bull McIntyre S Morgan C amp Walker K (2011) Cerebral Palsy Dont Delay Developmental Disabilities Research Reviews 17(2) 114-129
bull Novak I (2014) Evidence-Based Diagnosis Health Care and Rehabilitation for Children with Cerebral Palsy Journal of Child Neurology 29(8) 1141-1156
bull Morgan C Novak I amp Badawi N (2013) Enriched Environments and Motor Outcomes in Cerebral Palsy Systematic Review and Meta-analysis Pediatrics 132 (3)e 735 -e746
bull Morgan C Novak I Dale R Guzzetta A amp Badawi N (2014) GAME (Goals- Activity-Motor Enrichment) protocol of a single blind randomised controlled trial of motor training parent education and environmental enrichment for infants at high risk of cerebral palsy BMC Neurology 14(203)
bull Whittingham K Wee D amp Boyd R (2010) Systematic review of the efficacy of parenting interventions for children with cerebral palsy Child care health and development 37(4) 475-483
bull Morgan C Novak I dale R amp Badawi N (2015) Optimising motor learning in infants at high risk of cerebral palsy a pilot study BMC Pediatrics 15(1) n pag Web
bull Vos R Dallmeijer A Verhoef M et al (2014) Developmental trajectories of receptive and expressive communication in children and young adults with cerebral palsy Developmental Medicine amp Child Neurology 56 951-959
bull Light J and McNaughton D (2015) Designing AAC research and intervention to improve outcomes for individuals with complex communication needs Augmentative and Alternative Communication 31(2) 85-96
bull Romski M Sevcik R Barton-Hulsey A amp Whitmore A (2015) Early Intervention and AAC What a difference 30 years makes Augmentative and Alternative Communication 31 (3) 181-202
References
Perlman Center
bull Novak I Cusick A Lannin N (2009) Occupational therapy home programs for cerebral palsy Double-blind randomised controlled trial Pediatrics 124 e606-e614
bull Gericke T (2006) Postural management for children with cerebral palsy consensus statement Dev Med Child Neurol 48 (4) 244-244
bull McKeever P Rossen B Scott H Robinson-Vincent K amp Wright V (2013) The significance of uprightness parentsrsquo reflections on childrenrsquos responses to a hands-free walker for children Disability amp Society 28(3) 380-392
bull Law M Pollock N Russell D Walter S et al (2011) Focus on function a cluster randomised controlled trial comparing child-versus context-focused intervention for young children with cerebral palsy Dev Med Child Neurol 53 621-629
bull ldquoSensory Processing Developmental Chartrdquo Sensory Processing Developmental Chart Np nd Web 12 Oct 2015
bull Folio MR amp Fewell RR(2000) Peabody Developmental Motor Scales- Second edition Austin TX PRO ED
bull Voress Judith K amp Pearson Nils A (2013) Early Childhood Development Chart-Third edition Austin TX PRO ED
bull Paul Rhea (2007) Language Disorders from Infancy Through Adolescence Assessment amp Intervention Third edition St Louis MA Mosby Inc
bull Prosser L Ohlrich L Curatalo L Alter K amp Damiano D (2012) Feasibility and preliminary effectiveness of a novel mobility training intervention in infants and toddlers with cerebral palsy Developmental Neurorehabilitation 15(4) 259-266
References
Perlman Center
Creative Commercial Adaptations
Pool noodles
Snug and Go
Crib Wedges
Bed tableart desk
Laundry baskets
Inflatable bathtub
Inflatable infant pools
Boxesstools
Perlman Center Creative Commercial Adaptations
Laundry basket $400
Pool Noodle x 2 $300
Floor sitterbath support $700
table (BLACK) $800
Garbage can $600
Large pool noodle $300
Stander with anterior support and
Visual adaptation $1700
Perlman Center
Complex Rehab Equipment
Standers
Gait trainers
Bath Support
Car seat
Seating
Feeding tools
AAC
Sensory tools
vibration
Compression garments
NUK brushes
Z Vibe
Modified utensils
Swings
Weight
Head phones
Positioning
Neck supports
Bracing
Bobby pillowU cushion
Benches
Fireflyfriendscom
PlayPaK
Upsee
Go To Seat
Early Literacy
Picture symbols
Voice output switches
Adapted books
Adapted Equipment
Perlman Center
You got this baby Nowhellip Questions
Perlman Center
LETrsquoS PLAY
Hands on Equipment Demonstration
Perlman Center
bull Ulrich B (2010) Opportunities for Early Intervention Based on Theory Basic Neuroscience and Clinical Science Physical Therapy 90(12) 1868-1880
bull McIntyre S Morgan C amp Walker K (2011) Cerebral Palsy Dont Delay Developmental Disabilities Research Reviews 17(2) 114-129
bull Novak I (2014) Evidence-Based Diagnosis Health Care and Rehabilitation for Children with Cerebral Palsy Journal of Child Neurology 29(8) 1141-1156
bull Morgan C Novak I amp Badawi N (2013) Enriched Environments and Motor Outcomes in Cerebral Palsy Systematic Review and Meta-analysis Pediatrics 132 (3)e 735 -e746
bull Morgan C Novak I Dale R Guzzetta A amp Badawi N (2014) GAME (Goals- Activity-Motor Enrichment) protocol of a single blind randomised controlled trial of motor training parent education and environmental enrichment for infants at high risk of cerebral palsy BMC Neurology 14(203)
bull Whittingham K Wee D amp Boyd R (2010) Systematic review of the efficacy of parenting interventions for children with cerebral palsy Child care health and development 37(4) 475-483
bull Morgan C Novak I dale R amp Badawi N (2015) Optimising motor learning in infants at high risk of cerebral palsy a pilot study BMC Pediatrics 15(1) n pag Web
bull Vos R Dallmeijer A Verhoef M et al (2014) Developmental trajectories of receptive and expressive communication in children and young adults with cerebral palsy Developmental Medicine amp Child Neurology 56 951-959
bull Light J and McNaughton D (2015) Designing AAC research and intervention to improve outcomes for individuals with complex communication needs Augmentative and Alternative Communication 31(2) 85-96
bull Romski M Sevcik R Barton-Hulsey A amp Whitmore A (2015) Early Intervention and AAC What a difference 30 years makes Augmentative and Alternative Communication 31 (3) 181-202
References
Perlman Center
bull Novak I Cusick A Lannin N (2009) Occupational therapy home programs for cerebral palsy Double-blind randomised controlled trial Pediatrics 124 e606-e614
bull Gericke T (2006) Postural management for children with cerebral palsy consensus statement Dev Med Child Neurol 48 (4) 244-244
bull McKeever P Rossen B Scott H Robinson-Vincent K amp Wright V (2013) The significance of uprightness parentsrsquo reflections on childrenrsquos responses to a hands-free walker for children Disability amp Society 28(3) 380-392
bull Law M Pollock N Russell D Walter S et al (2011) Focus on function a cluster randomised controlled trial comparing child-versus context-focused intervention for young children with cerebral palsy Dev Med Child Neurol 53 621-629
bull ldquoSensory Processing Developmental Chartrdquo Sensory Processing Developmental Chart Np nd Web 12 Oct 2015
bull Folio MR amp Fewell RR(2000) Peabody Developmental Motor Scales- Second edition Austin TX PRO ED
bull Voress Judith K amp Pearson Nils A (2013) Early Childhood Development Chart-Third edition Austin TX PRO ED
bull Paul Rhea (2007) Language Disorders from Infancy Through Adolescence Assessment amp Intervention Third edition St Louis MA Mosby Inc
bull Prosser L Ohlrich L Curatalo L Alter K amp Damiano D (2012) Feasibility and preliminary effectiveness of a novel mobility training intervention in infants and toddlers with cerebral palsy Developmental Neurorehabilitation 15(4) 259-266
References
Perlman Center Creative Commercial Adaptations
Laundry basket $400
Pool Noodle x 2 $300
Floor sitterbath support $700
table (BLACK) $800
Garbage can $600
Large pool noodle $300
Stander with anterior support and
Visual adaptation $1700
Perlman Center
Complex Rehab Equipment
Standers
Gait trainers
Bath Support
Car seat
Seating
Feeding tools
AAC
Sensory tools
vibration
Compression garments
NUK brushes
Z Vibe
Modified utensils
Swings
Weight
Head phones
Positioning
Neck supports
Bracing
Bobby pillowU cushion
Benches
Fireflyfriendscom
PlayPaK
Upsee
Go To Seat
Early Literacy
Picture symbols
Voice output switches
Adapted books
Adapted Equipment
Perlman Center
You got this baby Nowhellip Questions
Perlman Center
LETrsquoS PLAY
Hands on Equipment Demonstration
Perlman Center
bull Ulrich B (2010) Opportunities for Early Intervention Based on Theory Basic Neuroscience and Clinical Science Physical Therapy 90(12) 1868-1880
bull McIntyre S Morgan C amp Walker K (2011) Cerebral Palsy Dont Delay Developmental Disabilities Research Reviews 17(2) 114-129
bull Novak I (2014) Evidence-Based Diagnosis Health Care and Rehabilitation for Children with Cerebral Palsy Journal of Child Neurology 29(8) 1141-1156
bull Morgan C Novak I amp Badawi N (2013) Enriched Environments and Motor Outcomes in Cerebral Palsy Systematic Review and Meta-analysis Pediatrics 132 (3)e 735 -e746
bull Morgan C Novak I Dale R Guzzetta A amp Badawi N (2014) GAME (Goals- Activity-Motor Enrichment) protocol of a single blind randomised controlled trial of motor training parent education and environmental enrichment for infants at high risk of cerebral palsy BMC Neurology 14(203)
bull Whittingham K Wee D amp Boyd R (2010) Systematic review of the efficacy of parenting interventions for children with cerebral palsy Child care health and development 37(4) 475-483
bull Morgan C Novak I dale R amp Badawi N (2015) Optimising motor learning in infants at high risk of cerebral palsy a pilot study BMC Pediatrics 15(1) n pag Web
bull Vos R Dallmeijer A Verhoef M et al (2014) Developmental trajectories of receptive and expressive communication in children and young adults with cerebral palsy Developmental Medicine amp Child Neurology 56 951-959
bull Light J and McNaughton D (2015) Designing AAC research and intervention to improve outcomes for individuals with complex communication needs Augmentative and Alternative Communication 31(2) 85-96
bull Romski M Sevcik R Barton-Hulsey A amp Whitmore A (2015) Early Intervention and AAC What a difference 30 years makes Augmentative and Alternative Communication 31 (3) 181-202
References
Perlman Center
bull Novak I Cusick A Lannin N (2009) Occupational therapy home programs for cerebral palsy Double-blind randomised controlled trial Pediatrics 124 e606-e614
bull Gericke T (2006) Postural management for children with cerebral palsy consensus statement Dev Med Child Neurol 48 (4) 244-244
bull McKeever P Rossen B Scott H Robinson-Vincent K amp Wright V (2013) The significance of uprightness parentsrsquo reflections on childrenrsquos responses to a hands-free walker for children Disability amp Society 28(3) 380-392
bull Law M Pollock N Russell D Walter S et al (2011) Focus on function a cluster randomised controlled trial comparing child-versus context-focused intervention for young children with cerebral palsy Dev Med Child Neurol 53 621-629
bull ldquoSensory Processing Developmental Chartrdquo Sensory Processing Developmental Chart Np nd Web 12 Oct 2015
bull Folio MR amp Fewell RR(2000) Peabody Developmental Motor Scales- Second edition Austin TX PRO ED
bull Voress Judith K amp Pearson Nils A (2013) Early Childhood Development Chart-Third edition Austin TX PRO ED
bull Paul Rhea (2007) Language Disorders from Infancy Through Adolescence Assessment amp Intervention Third edition St Louis MA Mosby Inc
bull Prosser L Ohlrich L Curatalo L Alter K amp Damiano D (2012) Feasibility and preliminary effectiveness of a novel mobility training intervention in infants and toddlers with cerebral palsy Developmental Neurorehabilitation 15(4) 259-266
References
Perlman Center
Complex Rehab Equipment
Standers
Gait trainers
Bath Support
Car seat
Seating
Feeding tools
AAC
Sensory tools
vibration
Compression garments
NUK brushes
Z Vibe
Modified utensils
Swings
Weight
Head phones
Positioning
Neck supports
Bracing
Bobby pillowU cushion
Benches
Fireflyfriendscom
PlayPaK
Upsee
Go To Seat
Early Literacy
Picture symbols
Voice output switches
Adapted books
Adapted Equipment
Perlman Center
You got this baby Nowhellip Questions
Perlman Center
LETrsquoS PLAY
Hands on Equipment Demonstration
Perlman Center
bull Ulrich B (2010) Opportunities for Early Intervention Based on Theory Basic Neuroscience and Clinical Science Physical Therapy 90(12) 1868-1880
bull McIntyre S Morgan C amp Walker K (2011) Cerebral Palsy Dont Delay Developmental Disabilities Research Reviews 17(2) 114-129
bull Novak I (2014) Evidence-Based Diagnosis Health Care and Rehabilitation for Children with Cerebral Palsy Journal of Child Neurology 29(8) 1141-1156
bull Morgan C Novak I amp Badawi N (2013) Enriched Environments and Motor Outcomes in Cerebral Palsy Systematic Review and Meta-analysis Pediatrics 132 (3)e 735 -e746
bull Morgan C Novak I Dale R Guzzetta A amp Badawi N (2014) GAME (Goals- Activity-Motor Enrichment) protocol of a single blind randomised controlled trial of motor training parent education and environmental enrichment for infants at high risk of cerebral palsy BMC Neurology 14(203)
bull Whittingham K Wee D amp Boyd R (2010) Systematic review of the efficacy of parenting interventions for children with cerebral palsy Child care health and development 37(4) 475-483
bull Morgan C Novak I dale R amp Badawi N (2015) Optimising motor learning in infants at high risk of cerebral palsy a pilot study BMC Pediatrics 15(1) n pag Web
bull Vos R Dallmeijer A Verhoef M et al (2014) Developmental trajectories of receptive and expressive communication in children and young adults with cerebral palsy Developmental Medicine amp Child Neurology 56 951-959
bull Light J and McNaughton D (2015) Designing AAC research and intervention to improve outcomes for individuals with complex communication needs Augmentative and Alternative Communication 31(2) 85-96
bull Romski M Sevcik R Barton-Hulsey A amp Whitmore A (2015) Early Intervention and AAC What a difference 30 years makes Augmentative and Alternative Communication 31 (3) 181-202
References
Perlman Center
bull Novak I Cusick A Lannin N (2009) Occupational therapy home programs for cerebral palsy Double-blind randomised controlled trial Pediatrics 124 e606-e614
bull Gericke T (2006) Postural management for children with cerebral palsy consensus statement Dev Med Child Neurol 48 (4) 244-244
bull McKeever P Rossen B Scott H Robinson-Vincent K amp Wright V (2013) The significance of uprightness parentsrsquo reflections on childrenrsquos responses to a hands-free walker for children Disability amp Society 28(3) 380-392
bull Law M Pollock N Russell D Walter S et al (2011) Focus on function a cluster randomised controlled trial comparing child-versus context-focused intervention for young children with cerebral palsy Dev Med Child Neurol 53 621-629
bull ldquoSensory Processing Developmental Chartrdquo Sensory Processing Developmental Chart Np nd Web 12 Oct 2015
bull Folio MR amp Fewell RR(2000) Peabody Developmental Motor Scales- Second edition Austin TX PRO ED
bull Voress Judith K amp Pearson Nils A (2013) Early Childhood Development Chart-Third edition Austin TX PRO ED
bull Paul Rhea (2007) Language Disorders from Infancy Through Adolescence Assessment amp Intervention Third edition St Louis MA Mosby Inc
bull Prosser L Ohlrich L Curatalo L Alter K amp Damiano D (2012) Feasibility and preliminary effectiveness of a novel mobility training intervention in infants and toddlers with cerebral palsy Developmental Neurorehabilitation 15(4) 259-266
References
Perlman Center
You got this baby Nowhellip Questions
Perlman Center
LETrsquoS PLAY
Hands on Equipment Demonstration
Perlman Center
bull Ulrich B (2010) Opportunities for Early Intervention Based on Theory Basic Neuroscience and Clinical Science Physical Therapy 90(12) 1868-1880
bull McIntyre S Morgan C amp Walker K (2011) Cerebral Palsy Dont Delay Developmental Disabilities Research Reviews 17(2) 114-129
bull Novak I (2014) Evidence-Based Diagnosis Health Care and Rehabilitation for Children with Cerebral Palsy Journal of Child Neurology 29(8) 1141-1156
bull Morgan C Novak I amp Badawi N (2013) Enriched Environments and Motor Outcomes in Cerebral Palsy Systematic Review and Meta-analysis Pediatrics 132 (3)e 735 -e746
bull Morgan C Novak I Dale R Guzzetta A amp Badawi N (2014) GAME (Goals- Activity-Motor Enrichment) protocol of a single blind randomised controlled trial of motor training parent education and environmental enrichment for infants at high risk of cerebral palsy BMC Neurology 14(203)
bull Whittingham K Wee D amp Boyd R (2010) Systematic review of the efficacy of parenting interventions for children with cerebral palsy Child care health and development 37(4) 475-483
bull Morgan C Novak I dale R amp Badawi N (2015) Optimising motor learning in infants at high risk of cerebral palsy a pilot study BMC Pediatrics 15(1) n pag Web
bull Vos R Dallmeijer A Verhoef M et al (2014) Developmental trajectories of receptive and expressive communication in children and young adults with cerebral palsy Developmental Medicine amp Child Neurology 56 951-959
bull Light J and McNaughton D (2015) Designing AAC research and intervention to improve outcomes for individuals with complex communication needs Augmentative and Alternative Communication 31(2) 85-96
bull Romski M Sevcik R Barton-Hulsey A amp Whitmore A (2015) Early Intervention and AAC What a difference 30 years makes Augmentative and Alternative Communication 31 (3) 181-202
References
Perlman Center
bull Novak I Cusick A Lannin N (2009) Occupational therapy home programs for cerebral palsy Double-blind randomised controlled trial Pediatrics 124 e606-e614
bull Gericke T (2006) Postural management for children with cerebral palsy consensus statement Dev Med Child Neurol 48 (4) 244-244
bull McKeever P Rossen B Scott H Robinson-Vincent K amp Wright V (2013) The significance of uprightness parentsrsquo reflections on childrenrsquos responses to a hands-free walker for children Disability amp Society 28(3) 380-392
bull Law M Pollock N Russell D Walter S et al (2011) Focus on function a cluster randomised controlled trial comparing child-versus context-focused intervention for young children with cerebral palsy Dev Med Child Neurol 53 621-629
bull ldquoSensory Processing Developmental Chartrdquo Sensory Processing Developmental Chart Np nd Web 12 Oct 2015
bull Folio MR amp Fewell RR(2000) Peabody Developmental Motor Scales- Second edition Austin TX PRO ED
bull Voress Judith K amp Pearson Nils A (2013) Early Childhood Development Chart-Third edition Austin TX PRO ED
bull Paul Rhea (2007) Language Disorders from Infancy Through Adolescence Assessment amp Intervention Third edition St Louis MA Mosby Inc
bull Prosser L Ohlrich L Curatalo L Alter K amp Damiano D (2012) Feasibility and preliminary effectiveness of a novel mobility training intervention in infants and toddlers with cerebral palsy Developmental Neurorehabilitation 15(4) 259-266
References
Perlman Center
LETrsquoS PLAY
Hands on Equipment Demonstration
Perlman Center
bull Ulrich B (2010) Opportunities for Early Intervention Based on Theory Basic Neuroscience and Clinical Science Physical Therapy 90(12) 1868-1880
bull McIntyre S Morgan C amp Walker K (2011) Cerebral Palsy Dont Delay Developmental Disabilities Research Reviews 17(2) 114-129
bull Novak I (2014) Evidence-Based Diagnosis Health Care and Rehabilitation for Children with Cerebral Palsy Journal of Child Neurology 29(8) 1141-1156
bull Morgan C Novak I amp Badawi N (2013) Enriched Environments and Motor Outcomes in Cerebral Palsy Systematic Review and Meta-analysis Pediatrics 132 (3)e 735 -e746
bull Morgan C Novak I Dale R Guzzetta A amp Badawi N (2014) GAME (Goals- Activity-Motor Enrichment) protocol of a single blind randomised controlled trial of motor training parent education and environmental enrichment for infants at high risk of cerebral palsy BMC Neurology 14(203)
bull Whittingham K Wee D amp Boyd R (2010) Systematic review of the efficacy of parenting interventions for children with cerebral palsy Child care health and development 37(4) 475-483
bull Morgan C Novak I dale R amp Badawi N (2015) Optimising motor learning in infants at high risk of cerebral palsy a pilot study BMC Pediatrics 15(1) n pag Web
bull Vos R Dallmeijer A Verhoef M et al (2014) Developmental trajectories of receptive and expressive communication in children and young adults with cerebral palsy Developmental Medicine amp Child Neurology 56 951-959
bull Light J and McNaughton D (2015) Designing AAC research and intervention to improve outcomes for individuals with complex communication needs Augmentative and Alternative Communication 31(2) 85-96
bull Romski M Sevcik R Barton-Hulsey A amp Whitmore A (2015) Early Intervention and AAC What a difference 30 years makes Augmentative and Alternative Communication 31 (3) 181-202
References
Perlman Center
bull Novak I Cusick A Lannin N (2009) Occupational therapy home programs for cerebral palsy Double-blind randomised controlled trial Pediatrics 124 e606-e614
bull Gericke T (2006) Postural management for children with cerebral palsy consensus statement Dev Med Child Neurol 48 (4) 244-244
bull McKeever P Rossen B Scott H Robinson-Vincent K amp Wright V (2013) The significance of uprightness parentsrsquo reflections on childrenrsquos responses to a hands-free walker for children Disability amp Society 28(3) 380-392
bull Law M Pollock N Russell D Walter S et al (2011) Focus on function a cluster randomised controlled trial comparing child-versus context-focused intervention for young children with cerebral palsy Dev Med Child Neurol 53 621-629
bull ldquoSensory Processing Developmental Chartrdquo Sensory Processing Developmental Chart Np nd Web 12 Oct 2015
bull Folio MR amp Fewell RR(2000) Peabody Developmental Motor Scales- Second edition Austin TX PRO ED
bull Voress Judith K amp Pearson Nils A (2013) Early Childhood Development Chart-Third edition Austin TX PRO ED
bull Paul Rhea (2007) Language Disorders from Infancy Through Adolescence Assessment amp Intervention Third edition St Louis MA Mosby Inc
bull Prosser L Ohlrich L Curatalo L Alter K amp Damiano D (2012) Feasibility and preliminary effectiveness of a novel mobility training intervention in infants and toddlers with cerebral palsy Developmental Neurorehabilitation 15(4) 259-266
References
Perlman Center
bull Ulrich B (2010) Opportunities for Early Intervention Based on Theory Basic Neuroscience and Clinical Science Physical Therapy 90(12) 1868-1880
bull McIntyre S Morgan C amp Walker K (2011) Cerebral Palsy Dont Delay Developmental Disabilities Research Reviews 17(2) 114-129
bull Novak I (2014) Evidence-Based Diagnosis Health Care and Rehabilitation for Children with Cerebral Palsy Journal of Child Neurology 29(8) 1141-1156
bull Morgan C Novak I amp Badawi N (2013) Enriched Environments and Motor Outcomes in Cerebral Palsy Systematic Review and Meta-analysis Pediatrics 132 (3)e 735 -e746
bull Morgan C Novak I Dale R Guzzetta A amp Badawi N (2014) GAME (Goals- Activity-Motor Enrichment) protocol of a single blind randomised controlled trial of motor training parent education and environmental enrichment for infants at high risk of cerebral palsy BMC Neurology 14(203)
bull Whittingham K Wee D amp Boyd R (2010) Systematic review of the efficacy of parenting interventions for children with cerebral palsy Child care health and development 37(4) 475-483
bull Morgan C Novak I dale R amp Badawi N (2015) Optimising motor learning in infants at high risk of cerebral palsy a pilot study BMC Pediatrics 15(1) n pag Web
bull Vos R Dallmeijer A Verhoef M et al (2014) Developmental trajectories of receptive and expressive communication in children and young adults with cerebral palsy Developmental Medicine amp Child Neurology 56 951-959
bull Light J and McNaughton D (2015) Designing AAC research and intervention to improve outcomes for individuals with complex communication needs Augmentative and Alternative Communication 31(2) 85-96
bull Romski M Sevcik R Barton-Hulsey A amp Whitmore A (2015) Early Intervention and AAC What a difference 30 years makes Augmentative and Alternative Communication 31 (3) 181-202
References
Perlman Center
bull Novak I Cusick A Lannin N (2009) Occupational therapy home programs for cerebral palsy Double-blind randomised controlled trial Pediatrics 124 e606-e614
bull Gericke T (2006) Postural management for children with cerebral palsy consensus statement Dev Med Child Neurol 48 (4) 244-244
bull McKeever P Rossen B Scott H Robinson-Vincent K amp Wright V (2013) The significance of uprightness parentsrsquo reflections on childrenrsquos responses to a hands-free walker for children Disability amp Society 28(3) 380-392
bull Law M Pollock N Russell D Walter S et al (2011) Focus on function a cluster randomised controlled trial comparing child-versus context-focused intervention for young children with cerebral palsy Dev Med Child Neurol 53 621-629
bull ldquoSensory Processing Developmental Chartrdquo Sensory Processing Developmental Chart Np nd Web 12 Oct 2015
bull Folio MR amp Fewell RR(2000) Peabody Developmental Motor Scales- Second edition Austin TX PRO ED
bull Voress Judith K amp Pearson Nils A (2013) Early Childhood Development Chart-Third edition Austin TX PRO ED
bull Paul Rhea (2007) Language Disorders from Infancy Through Adolescence Assessment amp Intervention Third edition St Louis MA Mosby Inc
bull Prosser L Ohlrich L Curatalo L Alter K amp Damiano D (2012) Feasibility and preliminary effectiveness of a novel mobility training intervention in infants and toddlers with cerebral palsy Developmental Neurorehabilitation 15(4) 259-266
References
Perlman Center
bull Novak I Cusick A Lannin N (2009) Occupational therapy home programs for cerebral palsy Double-blind randomised controlled trial Pediatrics 124 e606-e614
bull Gericke T (2006) Postural management for children with cerebral palsy consensus statement Dev Med Child Neurol 48 (4) 244-244
bull McKeever P Rossen B Scott H Robinson-Vincent K amp Wright V (2013) The significance of uprightness parentsrsquo reflections on childrenrsquos responses to a hands-free walker for children Disability amp Society 28(3) 380-392
bull Law M Pollock N Russell D Walter S et al (2011) Focus on function a cluster randomised controlled trial comparing child-versus context-focused intervention for young children with cerebral palsy Dev Med Child Neurol 53 621-629
bull ldquoSensory Processing Developmental Chartrdquo Sensory Processing Developmental Chart Np nd Web 12 Oct 2015
bull Folio MR amp Fewell RR(2000) Peabody Developmental Motor Scales- Second edition Austin TX PRO ED
bull Voress Judith K amp Pearson Nils A (2013) Early Childhood Development Chart-Third edition Austin TX PRO ED
bull Paul Rhea (2007) Language Disorders from Infancy Through Adolescence Assessment amp Intervention Third edition St Louis MA Mosby Inc
bull Prosser L Ohlrich L Curatalo L Alter K amp Damiano D (2012) Feasibility and preliminary effectiveness of a novel mobility training intervention in infants and toddlers with cerebral palsy Developmental Neurorehabilitation 15(4) 259-266
References