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CONNECTION? How does it fit in my child’s therapy process

As parents, we often find ourselves making sacrifices to ensure our children receive the best care possible. Whether it's juggling work schedules, rearranging family plans, or managing the daily chaos, we show up to every therapy appointment with the hope that our children will achieve the milestones and goals that brought us here in the first place.

However, the path to progress isn’t always straightforward. At our pediatric therapy practice, we recognize that building a strong, trusting relationship with each one of the kids that we get to work with. This is not just a “nice-to-have”—it’s essential for achieving meaningful progress in therapy. Here’s why connection is so vital to our approach:

As occupational therapy practitioners (OTPs), we understand that our role goes beyond merely guiding children through therapeutic activities. We focus on supporting their participation in activities of daily living (ADLs), play, leisure, and social interactions (AOTA, 2024). Each child’s unique developmental, health, sensory, and learning needs influence their progress in therapy, and it is through attunement and looking at them with a holistic lens that we can best tailor their individualized needs and the ones from your family so they can more adaptively participate in daily activities. We do detective work!

Our expertise in sensory integration helps children develop a more organized nervous system. We also ensure a safe and supportive environment where children can actively participate in sessions and everyday activities - whether it's joining a birthday party, participating in a baseball team, or enjoying a playdate with friends. This holistic approach supports their growth and development in a meaningful way, contributing to their overall well-being, confidence, and success.

The Role of Relationship in Therapy

A solid, trusting relationship between therapist and child is crucial for facilitating adaptive responses. Dysregulated children need adults who will engage and stay attuned with them when they are overwhelmed, rather than just managing their behaviors. By focusing on this connection, we help children feel more secure, which improves their ability to participate in day-to-day activities. Attunement allows us to understand and address their sensory needs, emotions, and experiences, creating a calming and supportive environment.

Research highlights the importance of therapeutic relationships in supporting children’s progress. Studies have shown that children who feel heard and understood are more likely to achieve their goals (Shea & Jackson, 2015; O’Connor et al., 2021). The quality of the relationship between the therapist and the family directly impacts the effectiveness of therapy and driving meaningful change (Gagné-Trudel et al., 2024; King et al., 2021). Lastly, building meaningful relationships allows them to learn and develop adaptive sensory-motor and emotional skills (Stackhouse et al., 2023). When children are less stressed and more secure, they are better able to recognize their bodies, physical reactions and emotional states.

Trust the Process

Building a strong connection with your child’s therapist takes time, but it’s crucial. It’s natural to wonder how this focus on connection fits into your child’s therapy goals. However, developing a solid therapeutic relationship is not just an extra—it’s a key part of helping your child make progress. A therapist who listens and understands your child deeply can make a big difference in their overall success.

We are committed to supporting your child’s journey and believe in the power of collaboration. Your insights and intuition as parents are crucial, and by working together, we can create a positive impact on your child's life. Don't hesitate to reach out with any questions or concerns. Observing your child's sensory responses and fostering a safe and supportive environment can support their well-being. Let’s continue this journey together.

Citations

American Occupational Therapy Association. (2014). Occupational therapy practice framework: Domain and process (3rd ed.). American Journal of Occupational Therapy, 68(Suppl. 1), S1–S48. https://doi.org/10.5014/ajot.2014.682006

Gagné-Trudel, S., Therriault, P. Y., & Cantin, N. (2024). Exploring Therapeutic Relationships in Pediatric Occupational Therapy: A Meta-Ethnography. Canadian journal of occupational therapy. Revue canadienne d'ergotherapie, 91(1), 78–87. https://doi.org/10.1177/00084174231186078

King, G., Chiarello, L. A., Ideishi, R., Ziviani, J., Phoenix, M., McLarnon, M. J. W., Pinto, M., Thompson, L., & Smart, E. (2021). The complexities and synergies of engagement: an ethnographic study of engagement in outpatient pediatric rehabilitation sessions. Disability and rehabilitation, 43(16), 2353–2365. https://doi.org/10.1080/09638288.2019.1700562

O'Connor D., Lynch H., Boyle B. (2021). A qualitative study of child participation in decision-making: Exploring rights-based approaches in pediatric occupational therapy. PLoS ONE, 16(12), 1–20. https://doi.org/10.1371/journal.pone.0260975

Shea C.-K., Jackson N. (2015). Client perception of a client-centered and occupation-based intervention for at-risk youth. Scandinavian Journal of Occupational Therapy, 22(3), 173–180. 10.3109/11038128.2014.958873

Stackhouse, T. M., Burke, H. K., Hacker, C. G., Burke, L. M., Hui, C. E., Osten, B., & Lane, S. J. (2023). Integrated Occupational Therapy Camp for Children with Regulation/Sensory Processing Differences: Preliminary Evaluation. Canadian journal of occupational therapy. Revue canadienne d'ergotherapie, 90(1), 25–33. https://doi.org/10.1177/00084174221129941

About the author: 

Jackeline Yagual, MSOT, OTR/L is a bilingual Pediatric Occupational Therapist who completed her masters and undergraduate degrees at the University of Southern Indiana. She is originally from Ecuador and grew up sharing her parent's passion for their family business which specializes in creating developmentally appropriate and sensory based environments for children. She moved to Evansville to further her education and commitment to helping children through up to date sensory integration practices. She is very compassionate and attentive to families and strives to support caregivers in the process!

Disclaimer: The information provided in this blog post is intended to offer general insights into sensory-based occupational therapy and its potential benefits for children. Individualized care and professional assessment by a qualified sensory-based Occupational Therapist (OT) are essential to understanding and addressing the specific needs of each child. The content presented here should not be considered a substitute for personalized guidance from a healthcare professional. For personalized guidance, individualized care, and a thorough assessment of your child's needs, consult with a qualified sensory-based Occupational Therapist (OT) and email us at info@forefronttherapy.org or jackie@forefronttherapy.org

Why do nonspeaking kids need speech?

To the parents or physicians who may be interested in a deeper understanding of why non-speaking children need speech and language skilled services. If a child is non-speaking, why do they need help with speaking? Speech and language therapy goes beyond the area of expressive language, verbal output, or articulation, the clarity of speech sounds. Speech and language pathologists' scope of practice is wider than one might think. Speech and language pathologists are educated and specialized in treating and evaluating 9 areas of development. The list is not comprehensive and is continuously evolving. The areas include; fluency, speech production, language, cognition, voice, resonance, feeding and swallowing, auditory habilitation and rehabilitation, as well as potential etiologies of communication and swallowing disorders. 

A child who is non-speaking, would be evaluated and treated for the areas of receptive language, the ability to comprehend and respond to language, and expressive language, the ability to communicate through sounds and words. Other areas within the scope of practice may be evaluated as well. A non-speaking child may communicate verbally through grunts and/or vocalizations “uhh” and babbling “mamama”. Various non-speaking children only communicate through vocalizations. A non-speaking child may also communicate receptively through pointing or pulling the caregiver towards their specific wants and needs. A child who is typically developing, is able to communicate wants and needs both receptively and expressively by approximately 13 months to 18 months of age. A child who is non-speaking may become frustrated when they are unable to communicate wants and needs verbally. A speech and language pathologist is able to provide specialized treatment plans, intervention, and education to aid this child and his/her family in achieving individualized goals. 

A treatment plan for a child who is non-speaking may include developing play skills and connections through play, fostering desire to communicate, imitation of sounds within the environment, requesting for objects with American Sign Language, or utilizing augmentative and alternative communication. Augmentative and alternative communication (AAC) is an area of clinical practice that supplements an impairment of speech-language production and/or comprehension. 

The opportunities for a child who is non-speaking are vast. The best environment for facilitation of language is within play. Explore the environment with your child whether it’s the playground, living room, or outdoors, search for opportunities to foster language development. If your child is non-speaking or concerns about early language skills arise, discuss a speech and language referral with your primary care provider. 

References:

Communication milestones: 13 to 18 months (2024) American Speech-Language-Hearing Association. Available at: https://www.asha.org/public/developmental-milestones/communication-milestones-13-to-18-months/ (Accessed: 29 August 2024). 

‘Scope of practice in speech-language pathology’ (2016) SCOPE OF PRACTICE IN SPEECH LANGUAGE PATHOLOGY, pp. 16–17. doi:10.1044/policy.sp2016-00343. 

Augmentative and alternative communication (AAC) (2024) Augmentative and Alternative Communication (AAC). Available at: https://www.asha.org/practice-portal/professional-issues/augmentative-and-alternative-communication/ (Accessed: 29 August 2024).

About the author:

Hope Hansen, MS, CCC-SLP is a Speech Language Pathologist (SLP) who received her Masters of Science in Speech Language Pathology as well as her Bachelor's of Science degree in Communication Disorders from Murray State University. Hope has clinical experience in inpatient rehabilitation and outpatient pediatric settings. She is passionate about treating all areas within the scope of practice of a SLP. From articulation and language to augmentative and alternative communication. Hope is dedicated to family-centered therapy and evidence-based intervention. She strives to provide ultimate care and build successful interpersonal relationships with her patients. Hope enjoys spending time with her family, friends, and dog, being involved in her church community, exercising, and traveling.

Spinning out of Control

Dizziness is caused by many factors. Physical therapy can help decipher the cause and provide treatment options! You do not have to feel like you are spinning out of control! 

Dizziness can be caused by vestibular system dysfunction. 

The vestibular system sits in your inner ear and maintains your balance and equilibrium by sensing your head position relative to your body. Crystals inside your inner ear alert your brain to changes in position. This is the system causing you to feel unsteady when you ride a roller coaster, for example.

Dizziness can be caused by weakness of the eye muscles or other visual changes. 

Our eyes help orient us in space and work to confirm equilibrium. It does this along with it's partners--the vestibular and musculoskeletal systems. If an individual is getting poor info from one of these three systems, the eyes jump to correct the problem. 

Dizziness can be caused by dysautonomia. 

Dysautonomia is an umbrella term relating to dysfunction of the autonomic nervous system. The autonomic nervous system controls many processes of our body like breathing, digestion, and heart rate. Dysautonomia also includes syndromes such as Long Covid, POTS, and inappropriate sinus tachycardia. 

Dizziness can be caused by decreased activity and poor proprioception. 

When activity levels are high, our musculoskeletal and vestibular systems work together to keep you upright. As we age, we lose some of our vestibular agility, and oftentimes, become more sedentary. It takes less to disrupt balance and equilibrium because we do not challenge it on a daily basis. 

How can physical therapy help dizziness?

  • Together, we train the vestibular system by challenging vision, balance, and musculoskeletal systems. 

  • We improve lower extremity strength to promote healthy walking patterns and transfer abilities. 

  • We incorporate dual-task training to help balance while distracted or completing other tasks

  • We retrain the nervous system to tolerate activity without significant changes in heart rate.

About the author:

Dr. Hannah Brooks, PT, DPT, OCS, LAT, ATC is a Doctor of Physical Therapy with undergraduate and graduate degrees from the University of Evansville. After completing the Forefront Therapy/Arcadia University Orthopedic Residency, Hannah successfully passed her board certification and is a Board Certified Orthopedic Clinical Specialist. She is originally from the St. Louis area but fell in love with the charm of Evansville while studying at the University of Evansville. Hannah is also a licensed certified athletic trainer and holds certifications in SFMA Level 1. Hannah has developed a love for working with the older adult in various forms throughout her Orthopedic, Neurologic, and Balance/Vestibular passions! She loves being on a Forefront team that is so invested and mission focused in working with the entire Tri-State community!

Get Moving to Boost Learning: How Movement Enhances Your Child’s Focus and Fun

Movement isn’t just a way to burn off excess energy; it's a secret ingredient that fuels your child's brain and emotions. Movement inspires motivation, heightens focus, and increases participation. Understanding how movement influences sensory systems can empower parents and teachers to create more effective learning environments.

Our sensory systems are our body's ways of receiving and responding to information from the environment and play a crucial role in how we process and respond to stimuli. Some children experience sensory processing differences, which can affect their ability to engage with the world around them.

Two of the main sensory system’s that impact learning are the vestibular system and the proprioceptive system. The vestibular system is located in the inner ear. This system helps us sense movement, balance, and spatial orientation. It influences our ability to focus and maintain attention. Our proprioceptive system is connected to our muscles and joints, this system provides information about body position and movement. Engaging in activities that require heavy work (i.e. pushing or pulling) can help children develop better body awareness and improve their ability to stay organized and attentive. When the vestibular and proprioceptive systems are well-regulated, children are more likely to stay engaged in learning tasks. 

The following are some practical tips that can be incorporated into the classroom or at home to improve attention and motivation:


  • Schedule short, consistent breaks throughout the day for movement activities and exercise. A mini dance party, stretching, or even a quick walk can help children refresh their brain and stay engaged in learning tasks.

  • Design activities that combine movement with learning. For example, create a math game that involves jumping to different numbers or use an obstacle course to hunt for letters. Learning becomes fun when it's paired with action!

  • Incorporate heavy work into daily tasks and in between tasks. At home, let your child carry grocery bags or push a loaded laundry basket. At school, they can help deliver books or rearrange desks. These tasks not only strengthen their bodies but also keep them engaged.

  • Be an investigator; pay attention to how different types of movement affect your child’s behavior and learning. Adjust activities based on their responses to ensure they are both motivational and beneficial.


When kids are actively involved in learning through movement, they don’t just grasp concepts faster they also remember them longer. By blending sensory motor activities into everyday routines, you can help your child excel academically, socially, and emotionally. So let’s get moving!

About the author:

Kyle Courtney M.S. OTR/L is an occupational therapist with a Bachelor’s of Science In Exercise Science, Minor in Psychology, and Master’s of Science in Occupational Therapy from The University of Southern Indiana. Kyle grew up in Evansville, Indiana and graduated from Reitz Memorial High School.  Kyle moved to Atlanta, GA, in 2017 to provide pediatrics in outpatient settings with corresponding hippotherapy services. Kyle’s approach focuses on learning through structured play and interactive activities to assist in the development of fine motor skills, coordination, sensory integration, social skills, and self-care. He knows that kids tend to excel when they are enjoying themselves and thrives in making as great of an atmosphere as possible. In his free time, he enjoys spending time outdoors, playing board games, attending sporting events, attending concerts, and exploring new restaurants.

To Kegel or Not to Kegel

Over the past few years more people have become aware of pelvic health thanks to social media. You have probably seen social media posts stating everything from “Kegels will fix all your pelvic floor problems” to “Kegels should never be done.” This can make things confusing to say the least! I want to take some time to explain more about pelvic health physical therapy. 

First of all, pelvic health physical therapists have specialty training in the pelvis and pelvic floor muscles. This is something we don’t learn about in school and do further training after we graduate. Second, both men and women have a pelvic floor and can benefit from pelvic floor therapy, although it is more common for women to have issues. Our pelvic floor PTs at Forefront Therapy have experience in treating pelvic floor dysfunction in men, women, and children. Pelvic floor therapy can be helpful for all kinds of conditions including, urinary or fecal incontinence, urinary urgency or frequency, constipation, pelvic girdle pain, pregnancy and postpartum, pain with intercourse, pain or difficulty with tampon insertion, diastasis recti, or pain in the hips or back. Some pelvic floor PTs may not be able to treat your low back or hips, so it is always good to check before having PT. At Forefront Therapy our pelvic floor PTs have extensive orthopedic and pelvic health knowledge, but this is not the case everywhere. 

So what is a Kegel, is it good or bad, and does it fix leakage? A Kegel is a pelvic floor muscle contraction. Kegels might be helpful for leakage, but they are not the best exercise for the pelvic floor. In some situations they might even increase leakage and other pelvic floor issues! You first need to find out if your pelvic floor is tense and can’t relax or if it’s weak. If it’s tense, then PT will include learning how to relax those muscles throughout the day, we can do internal or external pelvic floor muscle releases, and we check to see if nearby joints are moving appropriately. Tense muscles are typically weak, so strengthening will be a part of the rehab process as well. 

To strengthen the pelvic floor, you need to learn how to use it appropriately with your daily activities, whether this is changing positions, lifting something from the ground, or exercising. We will strengthen the pelvic floor muscles throughout their whole range of shortening and lengthening. Kegels only focus on strengthening during shortening, so other exercises are needed as well. Pelvic floor PT will also include strengthening the hip muscles. The hip and pelvic floor work well together and help each other out. One of the pelvic floor muscles is even part of the hip (the obturator internus), which is why pelvic floor PT needs to include the hip also. Exercises will be performed in a variety of positions including laying down, sitting, on your hands and knees, standing, and on one leg. We can also do a running assessment and discuss running mechanics if this is one of your goals.  

Pelvic floor PT can be helpful in treating a variety of conditions and it might be the missing piece to getting back to living the life you want! Give us a call today if you want to schedule an appointment with one of our amazing pelvic floor PTs!

About the author:

Dr. Tonya Barringer, PT, DPT, WCS is a Doctor of Physical Therapy with undergraduate and graduate degrees from the University of Evansville. Along with general orthopedics and neurological care, she is passionate about women’s health and pelvic floor therapy. Tonya has been successfully certified for the treatment for men and women with pelvic floor dysfunction through Herman & Wallace Pelvic Rehabilitation Institute.  She most recently passed her Board Specialty Certification Exam in Women's Health Physical Therapy through the APTA and is officially a Board Certified Specialist Women's Health Physical Therapy.

A Runner’s Guide to Warming Up Effectively

Runners are just different.

To many, pounding the pavement mile after mile seems like a death sentence, but to a runner, those treks achieve amazing ends–faster mile times, mental clarity and better health.

Whether it be a 400-meter sprint or a 10k jog through the woods, runners all want the same thing…to keep running. Here lies the question to be answered: How can we both run faster and do so with fewer injuries?

After all, The best ability is availability.

I haven’t a clue who deserves credit for those words, but they deserve both a medal and a pat on the back. Practically speaking, we can accomplish faster miles and fewer injuries with a well-structured warm-up routine.

Warming up may not appear super exciting, but it’s crucial to improve three things…

1. Your performance

2. Your mental engagement

3. Your injury risk

And you shouldn’t need to pack a lunch for an effective warm-up. In fact, 5 or 10 good minutes is all most folks need. Without further ado, here are 3 principles to warm-up up effectively.

Principle #1 Raise Your Heart Rate

I know, it seems obvious, but I can’t tell you how many times I’ve asked a runner, “What’s your warm-up like?” Tongue in cheek, the answer often amounts to tying one’s shoes and making sure his or her watch is charged. “I just started running,” they might say.

Step 1 of an effective warm-up is to do exactly that, warm up. I recommend completing 3-5 minutes of steady state exercise–boosting the heart rate above 100 beats per minute.

Examples of exercises fitting the bill include the following:

● Stationary Cycling

● Jumping Rope

● Jogging Slowly

Principle #2 Leave the Sagittal Plane

Running is inherently “forward and backward” movement. This is true of the literal distance you cover, but consider your anatomy as well. Your hips, knees, and ankles; when we run, they all primarily move in this same plane of motion–that is, they bend forward and backward. In the physical therapy world, we call this moving within the sagittal plane.

Conversely, there is very little twisting or side-to-side movement associated with running. Or at least, there shouldn’t be.

That said, runners should be competent in both rotating and side-bending the anatomy. This reduces injury risk, but it also primes the muscular pump–vital if your goal is to run fast.

Examples of exercises fitting the bill include the following:

● Monster Walks

● Lateral Lunges

● Fire Hydrants

● Side Plank + Leg Raises

Principle #3 Stretch Sparingly

Perhaps the only controversial principle on this list is to stretch sparingly. Don’t get me wrong; static stretching does have its place, but it’s typically not before a run. In fact, static stretching often has adverse effects on performance.

Holding a static stretch has been shown to reduce a muscle’s ability to produce force for a period of time after. If you’re looking to scratch this stretchy itch, I recommend grabbing a foam roller to make your quads, hamstrings and calves happy and healthy.

Happy Running.

-Brian

About the author:

Dr. Brian Grant, PT, DPT, OCS, CSCS is a Doctor of Physical Therapy with undergraduate and graduate degrees from the University of Evansville. Brian has successfully completed the 12-month Orthopedic Physical Therapy Residency at Forefront Therapy in collaboration with Arcadia University and is a Board Certified Orthopedic Clinical Specialist.. Brian has thorough experience and passion working with individuals with orthopedic, sports, and neurological conditions. He has been accredited through the National Strength and Conditioning Association as a Certified Strength & Conditioning Specialist. Brian has also taken a regional leadership role as Vice President of the Southwest District, American Physical Therapy Association Indiana Chapter. A native of Evansville, he continues to serve as a local swim coach with Harrison High School and has immense pride and passion for his community!

Disclaimer: The information provided in this blog post is intended to offer general insights into occupational therapy and its potential benefits. Individualized care and professional assessment by a qualified sensory-based Occupational Therapist (OT) are essential to understanding and addressing the specific needs of each individual. The content presented here should not be considered a substitute for personalized guidance from a healthcare professional. For personalized guidance, individualized care, and a thorough assessment of your needs, consult with a qualified sensory-based Occupational Therapist (OT) and email us at info@forefronttherapy.org.