Sun Safety for Children

School’s out, the weather is warm and it is time to hit the pool or beach! Children are especially susceptible to the harmful rays of the sun so make sure you follow these tips when heading outside for a day of fun:

·         Wear protective clothing. Make sure your child is wearing long sleeves (if possible) and a hat. Some clothing has UPF (UV protection factor) in them which helps protect from the sun’s rays.

·         Use sunblock. Many people do not know the difference between sunscreen and sunblock. Sunscreen protects your skin from harm caused by UV rays while sunblock actually blocks the UV rays from getting to your skin. Sunblock typically blocks both UVA and UVB rays. It is important to use sunblock on infants and children to prevent skin damage from the sun. These products contain zinc oxide or titanium dioxide. Look for these ingredients when choosing a sunblock. Children’s skin is more delicate than adults and tends to burn more easily. According to the American Cancer Society, babies younger than 6 months should be kept out of direct sunlight and protective measures such as protective clothing, hats and a stroller with a canopy should be used.

·         Wear sunglasses. It is important to wear sunglasses to protect your eyes and your children’s eyes from harmful UVA and UVB rays which can cause damage to vision. Sunglasses also protect skin around the eyes from burning which is more delicate and more prone to damage. You should look for sunglasses for you and your children with a label that says “UV absorption up to 400 nm” or “Meets ANSI UV requirements.” This means the lenses block 99% of UV rays.  Children need smaller versions of real, protective adult sunglasses. Toy sunglasses are not sufficient protection in the sun.

·         Limit exposure during mid day. UV rays are strongest between the hours of 10 am and 4 pm typically. A good way to test the intensity of the sun at a certain time of day is to look at your shadow. If your shadow is shorter than you, the sun’s rays are the strongest and protection is vital. Do not assume because it is cloudy or overcast that the sun’s rays are less powerful! Always use sunblock or sunscreen even on cloudy days. Texas tends to have many more days during the summer of extreme heat and UV danger so it is even more important to limit exposure during the peak hours of the day.

·         Don’t use tanning beds or sun lamps. These give out UVA and UVB rays that cause damage to skin cells. Long term use can cause skin damage and even lead to skin cancer.

Children spend more time outside during the summer months so make sure these sun safety measures become part of your daily routine to keep them protected. Sun protection is especially important for babies who cannot control their level of exposure to sun and depend on parents to provide for their needs. Even if you tend to not wear sunscreen or not take proper sun precautions, make sure you protect your children from the harmful rays of the sun.

For more information and helpful sun safety tips, visit: http://www.cancer.org/Healthy/BeSafeintheSun/index

¿Qué es la Terapia Asistida por Animales?

¿Qué es la Terapia Asistida por Animales?

Terapia Asistida por Animales (TAA por sus siglas) implica el uso de animales terapéuticamente durante la sesión de terapia de un paciente. Uno de los tipos más comunes y conocidas de la TAA es la hipoterapia o equitación terapéutica, pero cualquier animal que ha sido capacitado adecuadamente puede ser utilizado en la TAA. Los animales se pueden utilizar en una variedad de maneras para promover el desarrollo físico, social y emocional en niños y adultos. A continuación se muestra un resumen de cómo beneficia a un paciente trabajar con los animales durante la terapia!

·         Efectos Calmantes: estudios han demostrado que disminuye la presión arterial y la frecuencia cardíaca cuando una persona acaricia a un animal.

·         Beneficios Sensoriales: muchos niños con discapacidades tienen dificultades con los sistemas sensoriales. Esto significa que las sensaciones que se sienten normales para usted y yo sienta muy anormal para ellos. Los animales tienen una variedad de texturas disponibles en sus cuerpos que pueden ser utilizados en la terapia-húmedas nariz, espalda peluda, patas peludas en bruto, etc.

·         Beneficios Emocionales: los animales no juzgan. Un niño con trastorno del habla puede hablar con un animal sin tener miedo de sonar "diferente" o que se burlan de ellos. Los niños que han sufrido abusos o que están teniendo un momento difícil con las emociones también pueden contar sus problemas a un animal sin miedo a ser juzgado.

·         Beneficios Sociales: los animales disfrutan de socializar y estar cerca de gente. Los niños que tienen dificultades para jugar y socializar con otros niños pueden aprender observando a los animales interactúan con otras personas. También utilizamos los animales en la terapia para promover un comportamiento positivo, como tomar turnos y compartir.

·         Habilidades Funcionales: animales, como los humanos, tienen que comer, beber, usar el baño, y arreglarse. También necesitan actividad física y el ejercicio como lo hacen los humanos! Trabajamos en muchas de esas mismas habilidades con nuestros pacientes, por lo que usar los animales para practicar esas habilidades es una manera divertida de reforzar lo que estamos trabajando en la terapia. Los pacientes pueden alimentar a los animales ya sea a mano o con utensilios de cocina, cepillar a los animales, caminar, correr y saltar con los animales, e incluso jugar con la pelota!  A veces, incluso se puede vestir a los animales y trabajar en trucos especiales si el animal ha sido entrenado para hacerlo!

En Medcare, nos asociamos con Faithful Paws para ofrecer Terapia Asistida por Animales a nuestros pacientes en nuestras clínicas. Faithful Paws es una organización voluntaria que es patrocinada por la Iglesia Metodista Unida de Bellaire. Los voluntarios de Faithful Paws y sus mascotas han pasado por una formación especializada para garantizar que los animales y nuestros pacientes están a salvo en todo momento durante las sesiones.

Hay muchos libros y artículos de investigación que se han escrito para mostrar cómo las interacciones entre un paciente y un animal puede ser muy beneficioso para el paciente. También hay varias fundaciones que se especializan en Terapia Asistida por Animales. La siguiente es una breve lista de algunas referencias puede echar un vistazo si usted quiere más información sobre la Terapia Asistida por Animales!

Libros

Terapia Asistida por Animales: Actividades Para Motivar e Inspirar
http://www.amazon.com/Assisted-Therapy-Activities-Motivate-Inspire/dp/0976696584/ref=sr_1_5?ie=UTF8&qid=1337803275&sr=8-5

Manual de Terapia Asistida por Animales

http://www.amazon.com/Handbook-Animal-Assisted-Therapy-Third-Edition/dp/0123814537/ref=sr_1_1?ie=UTF8&qid=1337803275&sr=8-1

Asistida Por Animales Intervenciones Para Personas Con Autismo

http://www.amazon.com/Animal-assisted-Interventions-Individuals-Autism-Pavlides/dp/1843108674/ref=sr_1_7?ie=UTF8&qid=1337803275&sr=8-7

101 Ideas Creativas Para Terapia Asistida Por Animales

http://www.amazon.com/Creative-Ideas-Animal-Assisted-Therapy/dp/0982575580/ref=sr_1_2?ie=UTF8&qid=1337803275&sr=8-2

Sitios Web

Faithful Paws
http://www.faithfulpawshouston.com/

Therapet Fundación
http://www.therapet.com/

What is Animal-Assisted Therapy?

What is Animal-Assisted Therapy?

Animal-Assisted Therapy (AAT for short) involves using animals therapeutically during a patient’s therapy session.  One of the most commonly known types of AAT is hippotherapy or therapeutic horseback riding, but any animal that has been trained properly can be used in AAT.  The animals can be used in a variety of ways to promote physical, social, and emotional development in children and adults.  Below is a summary of how working with animals during therapy may benefit a patient!

·         Calming effects:  studies have proven that blood pressure and heart rate decrease when a person strokes an animal.

·         Sensory benefits:  many children with developmental disabilities have impaired sensory systems.  This means that sensations that feel normal to you and I may feel very abnormal to them.  Animals have a variety of textures available on their bodies that can be used in therapy-wet noses, furry backs, rough paws, etc. 

·         Emotional benefits:  animals are non-judgmental.  A child with speech impairment can talk to an animal without being afraid of sounding “different” or being made fun of.  Children who have suffered abuse or who are having a difficult time with emotions can also tell their problems to an animal without fear of being judged.

·         Social benefits:  animals enjoy socializing and being around people.  Children who have difficulty playing and socializing with other children can learn by watching the animals interact with other people.  We also use the animals in therapy to promote positive behavior such as taking turns and sharing. 

·         Functional skills:  animals, like humans, need to eat, drink, use the restroom, and be groomed.  They also need physical activity and exercise like humans do!  We work on many of those same skills with our patients, so using the animals to practice those skills is a fun way to reinforce what we are working on in therapy.  The patients can feed the animals either by hand or with utensils, brush the animals, walk, run and jump with the animals, and even play catch!  Sometimes, we can even dress the animals and work on special tricks if the animal has been trained to do so!  

At MedCare, we partner with Faithful Paws to provide animal-assisted therapy to our patients in our clinics.  Faithful Paws is a volunteer organization which is sponsored by the Bellaire United Methodist Church.  The Faithful Paws volunteers and their pets have gone through specialized training to ensure that the animals and our patients are safe at all times during the sessions. 

There are many books and research articles that have been written to show how the interactions between a patient and an animal can be very beneficial for the patient.  There are also several foundations that specialize in animal-assisted therapy.  The following is just a brief list of some references you can check out if you’d like more information on animal assisted therapy!

Books

Animal Assisted Therapy: Activities to Motivate and Inspire

http://www.amazon.com/Assisted-Therapy-Activities-Motivate-Inspire/dp/0976696584/ref=sr_1_5?ie=UTF8&qid=1337803275&sr=8-5

Handbook on Animal Assisted Therapy          

http://www.amazon.com/Handbook-Animal-Assisted-Therapy-Third-Edition/dp/0123814537/ref=sr_1_1?ie=UTF8&qid=1337803275&sr=8-1

Animal-Assisted Interventions for Individuals with Autism

http://www.amazon.com/Animal-assisted-Interventions-Individuals-Autism-Pavlides/dp/1843108674/ref=sr_1_7?ie=UTF8&qid=1337803275&sr=8-7

101 Creative Ideas for Animal Assisted Therapy

http://www.amazon.com/Creative-Ideas-Animal-Assisted-Therapy/dp/0982575580/ref=sr_1_2?ie=UTF8&qid=1337803275&sr=8-2

Websites

Faithful Paws Website

http://www.faithfulpawshouston.com/

Therapet Foundation

http://www.therapet.com/

Don't Stress Out About Your Home Program!

"I don't have time for my home program"

Don't stress out about your home program!

We as therapists understand you have a very full schedule whether it be with work, school, doctor's appointments, caring for your home and other children or trying to keep up with care of yourself and day to day struggles.

Home programs are not meant to overburden you and are given with "no judgment" policy!  They are meant to supplement therapy.

Key points to remember about your home program are as follows:

Don't feel you need to lie about completing given activities!

·    We as therapists don't exercise as much as we should or eat as healthy as we should or do all we are supposed to do 100% of time!

·    We will not judge you for not doing it but if we think you are doing the activities that you are not able to, then we cannot accurately judge if they are working or not!

·    We also cannot help you find a way to work them into your schedule if we do not know you are having a hard time finding time.

Don't feel we are wanting you to do our work for us!We promise to always work hard for your child and their progress but realize we see them so few minutes a week that they may make more and/or quicker progress if they can do a few things between sessions.  A lot of kids are seen only 80 minutes per week in therapy yet there are over 10,000 minutes in a week!

Don't avoid a little just because you can't do a lot!If you only have 2 minutes a day but we requested 10 minutes of an activity....2 minutes is GREAT!  We will take it!  Any extra can go a long way for your child.

Don't think it has to be a scheduled out session you need to fit into your schedule!Home programs are most effective and are more likely to be done if it can fit into your daily life.  For example....tummy time does not need to be a 15 minute floor session.  Possible ways to fit in 15 minutes of tummy time are as follows:

·    Carry your child between rooms or between bed and changing table as if they are flying through the air!

·    Have your child lay on your stomach while you lay on your back or lean back in a recliner during bonding time!

·    Roll your child to his/her tummy first thing in the morning while you pick out their clothes and prepare their medications!

Ask your therapist to help you get creative with small ways to incorporate activities that will help your child and easily fit into what you already are doing daily so not to add to your busy busy schedule!

Christine Grover, MS, PT-Home Health Physical Therapist

Why Is My Child's Therapy on Hold?

Time and time again caregivers ask us why their child has to go on hold at the beginning of the month or sometimes in the middle of the month.  When a child is placed on hold for therapy the reasons usually involve a problem with the insurance provider, lack of approval from the patient's physician, or delayed submission of paperwork to get new authorization.  In this blog, we're going to talk about some of the reasons for why patients have to be put on hold and how you as a caregiver may be able to assist us so that we do not have to place your child on hold.

Before we can ever provide therapy services to a patient, we must have doctor's orders stating that the doctor is requesting the patient receive therapy AND authorization from the patient's insurance company stating that the insurance company approves of and will pay for the services being provided.  For our patients who have Medicaid and CHIP, we receive a list from the State on the 1^st of every month and this list allows us to verify eligibility for patients with Medicaid or CHIP.  If a patient's name is on this list, it means that the patient’s Medicaid is not active and therefore we cannot treat the patient until the payor source in reinstated.  If the patient switches insurance providers and the plan changes to an HMO plan (Star, CHIP, Molina, CHC, Evercare, or Superior), then the patient will be placed on hold until authorization from the new plan is obtained.  If a patient switches insurance providers and changes to traditional Medicaid, in most cases the patient will not have to go on hold.  This is because traditional Medicaid gives us immediate authorization.  The Medicaid HMO's, on the other hand, can take anywhere from 72 hours up to 2 weeks to give us authorization. 

When it’s time to renew your child’s Medicaid, you get to pick your plan if you are not eligible for traditional Medicaid.   If you do not pick a plan for your child, the state picks one for you. If you get a list of Medicaid HMO's to choose from, please make sure you are choosing one of the HMOS's that MedCare accepts if you want to continue receiving services with us.  MedCare currently accepts Star, Chip, Molina, Superior, Evercare, and Community Health Choice.  We do not accept Amerigroup.  If your child's name does come up on the Medicaid eligibility list and you feel that the state has provided us with the incorrect information, please dial 211 from any phone.  Once you can provide us with proof that your child does in fact have coverage for the month, we can begin treating right away. 

Another reason a patient can be placed on hold is because the Primary Care Physician (PCP) does not sign the patient’s evaluation.  We create a Plan of Care (POC) every 25 weeks and if a patient has traditional Medicaid, the patient will not go on hold when the POC ends because traditional Medicaid gives us authorization for the new POC immediately.  However, if a patient has an HMO plan the doctor will have to sign off on the evaluation before the HMO provider will give us authorization to start the new POC.  For this reason, we usually schedule re-evaluations at least 4 weeks in advance of the end of the POC so that we have plenty of time to get the paperwork to the doctor and signed before the end of the POC.  There are times, though, when this process can be delayed.   If the patient's PCP goes on vacation, it may take longer than usual to get the paperwork signed, which delays us from sending it to the insurance company for approval.  Another example is if a patient goes on vacation or is out sick for a long period of time and misses their re-evaluation.  The longer the re-evaluation is delayed, the bigger the chances are that the patient will have to go on hold.

So how can you as the caregiver help to avoid having your child's therapy placed on hold?  If your child has a Medicaid HMO and you receive paperwork, make sure that you are completing the paperwork and sending it back in before the due date so that the State does not choose a plan for your child.  Each plan is different, so therapy that is covered under one plan may NOT be covered under another.  The less your child changes insurance plans, the better it is for everyone involved!  Also, if you know that your child will be out of therapy for an extended period of time for any reason, make sure you let your therapists and the schedulers know!  That way, the therapists can make arrangements to complete a re-evaluation if needed before it's too late and the child has to go on hold.

Helpful Hints for Trach Patients

TRACH TIPS FOR PARENTS

It can be a tough transition for parents of a tracheostomy patient to feel comfortable at home taking care of their child. What do you do in an emergency? How do you trouble shoot common problems with the trach? Often times, these subjects are briefing addressed during a hospital stay but it is always best to review trach protocols to be best prepared for these situations.

OBSTRUCTIONS

What symptoms will you see?  Low oxygen saturations, labored breathing, wheezing sound coming from the trach, resistance when you try to suction the trach, blue tinge to lips or around mouth.

What will you do?  Try to suction the trach. If you get resistance or no secretions, assume it is a mucous plug. You can try normal saline drops to the trach to try and loosen the plug or just change the whole trach tube out. If you cannot fit a new trach tube in the stoma, use the next smaller size trach tube.

How can you avoid this?  Keep your child well hydrated and suction the trach frequently. If your child always has thick secretions, use saline drops or nebulizer treatments to loosen and thin secretions so you can suction them out more easily.

DISPLACEMENT

What symptoms will you see?  If your child is on a ventilator, the low pressure alarm will sound. You may hear whistling or the sound of air escaping from the stoma. Blue tinge to lips or around mouth, labored breathing, low oxygen saturation readings.

What will you do?  Replace the trach tube immediately! If a clean trach is not available and the trach that has come out of the stoma should be replaced if not broken. If a new trach is close at hand, you may replace with a new trach but in an emergency situation it is not necessary. Remember, it only take 3 minutes of poor oxygen to the brain to cause brain damage.

How can you avoid this?  Make sure the trach ties are secure (a good rule is if you can fit two fingers under the trach tie but no more). Make sure if your child is active to keep them occupied and do not allow them to pull on the trach or ventilator circuit. Remove any objects in the child’s environment that could snag the ventilator circuit. When transferring you child, make sure you secure the trach and/or vent circuit.

May is Better Speech and Hearing Month!

As a Speech Language Pathologist I am often asked, “How can I get my child to talk?” The first thing I tell parents when asked this question is that children must be given the opportunity to talk. For parents, it is often easy to anticipate what your child wants and just give it to them. Children must learn that in order to get what they want they must communicate their wants to those around them. If a child’s wants are always anticipated or if someone else always talks for them, the child will never learn the need to talk. By not anticipating the wants of your child or talking for them, your child will learn that by using their words they can get what they want and thus learn the power of communication.

Here are a few ways you can encourage communication with your child:

Speak simple – Speak in short, simple terms that your child can understand and imitate easily.  Young children can only process fairly short, concise information. Keeping speech concise and consistent is an important key to good communication with your toddler. For example, instead of asking your child, “Are you still thirsty? Would you like some more grape juice in your cup?”, try “More juice?”. The same point has been made, and it is easier for a young child to process. Also, children model our behavior. Their developmental skills limit their ability to speak in long, complicated sentences. Instead they are more likely to be able to communicate “more juice” with greater ease and consistency.

Talk a lot – During the day, comment on things going on in your child’s environment. During bathtime, mealtime, bedtime, playtime, and any other daily routine, constantly talk to your child about what you are doing and what is going on around them. For example, "Get in tub.", “Go night night.", “You’re playing ball.”, etc. The more children hear words modeled the more likely they will remember and use those words when appropriate. Talk as long as your child shows interest. If they turn away or appear inattentive, stop. Don’t give your child a case of auditory overload.

Gain full attention – When talking to a child it is important to get on their level and gain their full attention. Get your child to look at your face when you say words. One thing I like to do is get a child’s toy and hold it next to my mouth as I name it. I like this strategy for three reasons. One, by bringing the toy up to your mouth your child will want to know what you are doing with the toy and therefore you will have their full attention. Second, by holding up the toy as you name it, your child will be able to see the toy and hear the word you say and will put the two together realizing that the word must be the name for that toy. And third, since your child will be looking at your mouth they will see how you move your mouth to form the word which will help them to form their mouth to say the word. 

Withhold – This technique is similar to environmental sabotage. When you are trying to set up a situation to entice your child to talk, never, ever, ever give them all the pieces of anything at once. Withhold what they want until they communicate their wants. For example, if your child likes to play with puzzles, don’t place all of the pieces on the floor and let them put them in on their terms. Place the pieces in a bag and then withhold the pieces until they tell use a word to let you know they would like another piece. Do this with every piece until your child has completed the puzzle. 

Offer choices – One of the simplest, but most effective ways to get your child to talk is to provide them with a choice and withhold the item they want until they use their speech to request it. A good time to try this is when you know they want a snack. Give your child a snack choice of one you know they really want, and one they probably won’t pick. Hold them up and name both items. When they have indicated which snack they desire label it for them. For example, if you hold up a cookie and cracker, and they point or reach for the cookie, you will say, “cookie.” Do not give it to them until they say cookie or at least attempt to say the word.

Expand – Once your child has started talking and has some words in their repertoire it is time to start expanding on those words and making sentences. When your child says a word, expand on it repeating his word but adding to it. For example, if your child says “car” while playing with a blue car expand on it and say’ “blue car.” Be sure to add adjectives to their words, so they can learn new vocabulary and new descriptive words. Over time you can add different parts of speech in as well to make the sentence a bit more complex and meaningful.

There are many more ways to encourage communication with your child, but I think you get the idea. Use any of these strategies you feel comfortable with, but I encourage you to try each of them. Just remember, stimulating you child’s language development should be fun, not frustrating. If these tactics do not seem to be working or are getting the both of you too frustrated, please consult a speech language pathologist or schedule a speech and language evaluation. And remember, the key is for your child to learn the power of communication.

Connie Paulson, M.A. CCC-SLP