FAQ’s

Every new patient needs to complete and hand in the PPT4Kids’ New Patient Packet. The English and Spanish clinic packets are provided below.

New Patient Forms

Birth to 12 months
Developing an awareness of the 7 senses (smell, sight, taste, sound, touch, movement and proprioception-internal sense of how the body parts are connected)
 
•    mobiles
•    play mats/busy boards
•    unbreakable mirrors
•    rattles, squeaky/squeeze toys, floating bath toys
•    cloth or hard cardboard books showing photos/pictures of familiar objects/actions
•    pots and pans
•    soft stackable blocks or cups
•    balls

12 months to 3 years
Mastery of greater motor control in all extremities. Climbing, hanging, spinning and activating the vestibular system for orientation of their body in space.
•    simple puzzles and books
•    arts and crafts (finger-paint, play dough, colored paper and crayons, etc.)
•    sand box and digging toys
•    riding toys (trikes, wagons, etc)
•    musical instruments (drums, horns, toy piano, etc.)
•    cassette tape player with musical tapes
•    wading pool and water toys

3 to 5 years
Increased reasoning, story telling and creating cause and effect situations. Moving on mobile surfaces with greater balance and reasoning.
•    Any type of “make-believe” type toys (i.e. dress-up clothes, play food, play money, farms, doll houses, baby dolls and accessories, etc.)
•    Bikes (with helmets), swing sets, climbing frames
•    Paint with brushes, scissors, glue, washable markers
•    CDs, books, puzzles, videos
•    Electronic toys, word matching games, simple board games

5 to 9 years
Greater ability to follow rules and interact in games. Learning to function in team interactions with give and take to master greater level of control.
•    sports equipment (with protective gear)
•    card games, board game
•    jump ropes
•    arts and crafts
•    paper dolls
•    doctor and nurse kits
•    simple computer CDs/games

10 to 14 years
Greater ability to use the motor system with posture as the background for increased very fine control in all extremities. Increased strength and overall reasoning and problem solving.
•    computer games
•    sewing, knitting, needlework
•    microscopes, telescopes
•    sports equipment
•    games
•    hobby collections

“As far as botox I continue to have a little love/not-love (hate is too strong) relationship with it.  My explanation is long but I think it is kind of important to your question.

Why do kids get tight in certain muscles?  I think they are looking for stability overall so they learn to “fix” or hold certain muscles tightly to give themselves more stability when their core is weak (weak core might also be thought of as underlying low muscle tone). Stability is crucial for everyone in order to do basic functional things like hold our heads up, look around, eat, use our hands, and even breathe efficiently.  So before I think about kids muscles as ‘spastic’, I actually think about them as weak – but I start looking at the weakness in the foundation of their bodies first – the core/trunk.  So if they have to use every muscle in their body to participate in an activity, like a weight lifter who grunts and grits his teeth and braces with his whole body, then I have to think about what can I do to provide more stability to the core so they can do what is important to them.  We do this with babies when they are too little – you hold their heads and bodies securely before they learn to hold them up themselves, use little carseat neck and body supports, etc. So I recommend you start there – do you have a SPIO vest, TLSO or Benik vest?  Are you using it whenever Leo is using his body up against gravity (sitting, standing, gait training)?  Is every chair and upright device supportive enough that Leo is not tipping over or dropping his head.  If he can’t hold an upright position himself, his equipment needs to help.  This is crucial so that he doesn’t have to compensate with his other muscles. 

What I see happen with botox and surgical releases of muscles after they become too tight is that you are actually taking away a compensatory strategy that the child has learned to rely on for stability.  If the child doesn’t have the core strength still, what is going to happen after you release/relax the muscles – they will tighten up again because the underlying reason for them to over use them in the first place is still the real issue.  The muscles that kids fix with mostly are what we call 2 joint muscles – they cross over 2 joints, such as the hamstrings, gracilis, rectus femoris, and gastrocnemius muscles in the legs.  These muscles are the most unstable because they can affect movement at 2 joints.  So if they are very unstable, the most effective thing a person can do is to tighten it maximally and just hold it still.  That is not very effective for using them, so we see that the person’s function with those muscles becomes more and more limited – think about walking with what therapists call a “scissored” gait – the child is weak in their core but wants to walk, so he uses everything he has to increase his antigravity control and holds strongly all of those muscles that cross 2 joints – legs crisscross, knees are stiff, ankles are stiff.   

SOOOO if we use botox we can gain flexibility on a temporary basis, but we have to look at the underlying reason for the tightness/fixing, because it will not solve the real need that the child has to be more stable to be more functional.  HOWEVER, the hip joints are very important and very concerning, since they are so often subluxed by these tight fixing patterns (think how 3 of the 4 muscles I listed cross the hip joint and pull on it when a child is fixing with them for stability).  So botox can take those muscles out of the picture temporarily which may buy you some time on keeping the hips positioned better, but it won’t help functionally in the long run if you are not stabilizing and/or strengthening the core.  (Mary P., PT)

Teletherapy is the process of providing ST, PT, or OT services at a distance with the use of real time video conferencing software, similar to Skype or Facetime. We will be using a HIPAA compliant platform.

For a typical teletherapy session, the scheduling department will communicate with the family to coordinate a convenient time for appointments to take place. The family will then receive an email with a link to access the video conferencing software, which is entirely free for families and also compliant with privacy standards (HIPAA). Your child will then engage in a 30, 45, or 60 minute session over real time video directed by your current therapist. Services are delivered with apps, whiteboards, and other applications that can be used by the therapist and child interactively at the same time. 

You only need a device with a built in camera/microphone (Ipad, laptop, or desktop) and internet connection! Our teletherapy platform requires the latest version of Google Chrome or Firefox web browser . At times, a printer may be needed to print out activities for a session. If you have equipment/toys at your house that would be beneficial for a treatment session, the therapist may request that these items be available during a session.

The majority of the time, we require an adult to be present to help guide the child with therapy activities. We also find that parent participation during sessions is incredibly beneficial for the child’s progress and parent education. An adult may not be required during sessions if a child is old enough and able to participate in sessions without supervision.