Therapeutic Preschool

Pediatric Dynamic Movement Intervention (DMI) therapy is a specialized treatment aimed at improving the gross motor skills, movement control, and overall functional mobility of children with developmental delays.  DMI therapy is designed to promote and enhance the natural ability of children to develop motor skills through structured, targeted interventions.

What is Dynamic Movement Intervention (DMI)?

Dynamic Movement Intervention (DMI) is a cutting-edge therapeutic approach focusing on improving strength, coordination, balance, and motor planning in children with developmental delays. DMI therapy is based on neuroplasticity principles—the brain’s ability to reorganize itself by forming new neural connections. This means that with consistent and well-targeted interventions, children with motor impairments could make significant gains in motor function.

Without disruption or intervention, unhealthy habits (the types of learned patterns of movement a child relies on rather than reflexive movements) become engrained in the child’s behavior repertoire. Neuroplasticity is defined as the ability of the brain to form and reorganize synaptic connections, especially in response to learning, experience, or following an injury. Neuroplasticity is at its height in young children. Without novelty and challenge, well-established habits always dominate. Due to this natural neuroplasticity, it is often better to start children young with any kind of therapeutic care.

The primary theory behind DMI is the use of the body's automatic postural responses.  In DMI therapy, we place the child in a position where gravity provides information requiring a response. We then wait for the child to complete the movement, with gradually less assistance over time.

Who Needs DMI Therapy?

DMI is beneficial for children with and without a specific diagnosis. However, those with specific diagnoses include, but are not limited to:

Cerebral Palsy: Children with cerebral palsy often struggle with motor control, muscle tone, and balance, all of which can be targeted by DMI therapy.

Developmental Delays: Children experiencing delays in reaching motor milestones (such as crawling, walking, or standing) may benefit from DMI’s movement-based approach.

Genetic Disorders: Certain genetic conditions that affect motor development, such as Down syndrome or muscular dystrophy, may be candidates for DMI.

Spina Bifida: This congenital condition affecting the spinal cord can cause motor deficits, and DMI can be useful in strengthening movement capabilities.

Brain Injuries: Traumatic or acquired brain injuries in children that result in impaired motor functions can be addressed through DMI therapy.

Other symptoms of a child who could benefit from DMI include:

• Difficulty with postural control (e.g., sitting, standing, or balancing)
• Delayed or atypical motor development (not crawling or walking at the expected age)
• Limited muscle tone or spasticity
• Challenges in coordination and movement precision
• Fatigue or weakness during movement activities

This is not an exhaustive list. There are many other conditions that may benefit from Dynamic Movement Intervention. DMI therapy is typically recommended for children who have developmental motor disorders or neuromuscular challenges that affect their ability to move, balance, or coordinate their body movements.

Identifying the Need for DMI

The need for DMI therapy is typically identified by healthcare professionals such as neurologists, rehabilitation specialists or physical therapists, often after a comprehensive evaluation of the child’s motor function. Parents may also notice signs that their child is not reaching developmental motor milestones and seek medical advice.

Any physical therapy diagnosis can result in the use of DMI, and this is often very useful for children under 1 to help with head control, children under 2 to help with standing, walking, and posture control, and children 5 and under with more involved diagnoses. Early identification and intervention are extremely beneficial in maximizing the effectiveness of DMI therapy and improving the child’s functional outcomes.

Youth sports are a cornerstone of childhood, offering numerous benefits such as physical fitness, teamwork, and discipline. However, with the increasing intensity and competitiveness in youth sports, injuries among young children are becoming more prevalent.

According to the National SAFE KIDS Campaign and the American Academy of Pediatrics: More than 3.5 million children (about twice the population of Nebraska) ages 14 and younger get hurt annually playing sports or participating in recreational activities. There are a few steps that parents can take to potentially prevent injuries in sporting activities and keep the fun on the field!

Ensure Proper Conditioning and Training

1. Pre-Participation Physical Exam: Before starting any sport, have your child undergo a physical exam to ensure they are fit to participate.
2. Proper Training: Enroll your child in programs with certified coaches who emphasize proper techniques and conditioning.
3. Strength and Flexibility: Encourage exercises that build strength and flexibility. Strength training should be age-appropriate, focusing on technique rather than heavy weights.

Use Appropriate Equipment

–Protective Gear: Ensure your child uses sport-specific protective gear such as helmets, mouthguards, pads, and appropriate footwear. All equipment should fit well and be in good condition.
–Regular Checks: Inspect equipment regularly for wear and tear. Replace damaged gear promptly to maintain safety standards.

Promote Safe Playing Techniques

1. Warm-Up and Cool-Down: Encourage a proper warm-up before and cool-down after practices and games to prevent muscle injuries.
2. Teach Safe Techniques: Ensure coaches emphasize and teach safe playing techniques, particularly in contact sports. Children should understand the rules of the game and the importance of fair play.
3. Avoid Overuse: Limit repetitive movements that can lead to overuse injuries. Ensure your child gets sufficient rest and recovery time between practices and games.

Encourage Open Communication

-Listen to Your Child: Encourage your child to speak up about any pain or discomfort. Ignoring pain can lead to more severe injuries.
-Monitor for Signs of Fatigue: Watch for signs of fatigue or burnout, which can increase the risk of injury. Ensure your child gets adequate rest and maintains a healthy balance between sports and other activities.

Foster a Balanced Approach

-Limit Specialization: Avoid having your child specialize in one sport or activity at a young age. Encourage participation in various activities from soccer to piano lessons to promote physical development and reduce the risk of overuse injuries.
-Adequate Rest: Ensure your child gets enough rest, including off-season breaks, to allow their body to recover and grow stronger.

Educate on Nutrition and Hydration

-Balanced Diet: Provide a balanced diet rich in vitamins and minerals to support your child’s physical activity. Include a variety of fruits, vegetables, lean proteins, and whole grains.
-Stay Hydrated: Teach your child the importance of staying hydrated before, during, and after physical activities. Encourage them to drink water regularly, especially in hot and humid conditions.

Work with Healthcare Providers

1. Regular Check-Ups: Schedule regular check-ups with a healthcare provider to monitor your child’s overall health and development.
2. Follow Medical Advice: If your child is recovering from an injury, strictly follow the healthcare provider’s advice regarding rehabilitation and when it is safe to return to sports. Stay Informed and Involved
3. Educate Yourself: Stay informed about the risks associated with your child’s sport and the best practices for injury prevention.
4. Active Participation: Be actively involved in your child’s sports activities. Attend practices and games to observe the coaching methods and the environment.

Preventing injuries in youth sports requires a proactive approach from parents. Through these efforts, parents can help their children enjoy the benefits of sports while minimizing the risks. Sometimes, even with parents’ and coaches’ best intentions, injuries can occur.

Common Youth Sports Injuries

Injuries in youth sports can range from minor bruises to severe fractures. Here are some of the most common injuries:

1. Sprains and Strains: These occur when ligaments (sprains) or muscles (strains) are overstretched or torn. Common sites include the ankle, knee, and wrist.
2. Fractures: Broken bones are a frequent result of high-impact sports or falls. The wrist, arm, and collarbone are often affected.
3. Overuse Injuries: Conditions like shin splints and stress fractures arise from repetitive motion. They are particularly common in sports requiring long periods of training, such as running and swimming.
4. Concussions: Head injuries are serious and can occur in contact sports like football, soccer, and basketball. They require immediate medical attention.

The Role of Physical Therapy

Physical therapy plays a critical role in the recovery and rehabilitation of young athletes. Here’s why it’s frequently prescribed:

1. Personalized Rehabilitation Plans: Physical therapists develop customized treatment plans tailored to the specific injury and the child’s needs. This ensures a targeted approach to healing.
2. Pain Management: Techniques such as ice therapy, heat therapy, and electrical stimulation help manage pain effectively, promoting a quicker return to normal activities.
3. Improving Mobility and Strength: Therapists use exercises to enhance flexibility, strength, and range of motion. This is crucial for preventing future injuries.
4. Education and Prevention: Physical therapists educate young athletes and their families on proper techniques, warm-up exercises, and ways to prevent re-injury.

Frequency of Physical Therapy Prescription

The prescription of physical therapy varies depending on the severity and type of injury. However, statistics indicate a growing reliance on physical therapy for youth sports injuries:

Research shows that nearly 30-50% of youth athletes with moderate to severe injuries are prescribed physical therapy as part of their treatment plan. This percentage highlights the critical role physical therapy plays in the comprehensive recovery process for young athletes.

Youth sports injuries are an unfortunate but common aspect of an active childhood. While they can be alarming, the right approach to treatment, including the strategic use of physical therapy, can significantly enhance recovery outcomes. By focusing on personalized rehabilitation, pain management, and preventative education, physical therapy helps young athletes get back on their feet—stronger and more resilient than before.

As the world of youth sports continues to grow, understanding and mitigating the impact of sports injuries through effective therapeutic interventions will remain crucial in safeguarding the health and well-being of young athletes. By fostering awareness and providing appropriate care, we can ensure that youth sports remain a positive and enriching experience for all children.

Once a child has been diagnosed with a Pediatric Feeding Disorder due to oral dysphagia or sensory processing disorder or, if diagnosed by a psychologist, ARFID (Avoidant/Restrictive Food Intake Disorder), they will likely be referred for treatment. Eating is a learned behavior. It is only instinctive for the first 6 months of life. Older children must either teach themselves, or be taught (Toomey). Treatment for a feeding disorder can be completed by a Speech-Language Pathologist (SLP), Occupational Therapist (OT), Board-Certified Behavior Analyst (BCBA), Dietician, or Psychologist. All of these disciplines have overlapping and unique approaches to treatment, so a Pediatric Feeding team that involves more than one specialist may be best for your child. As an SLP who is part of a feeding team that involves an OT and BCBA, some approaches to treatment that I utilize alongside the team include the Food Chaining Approach, The Sequential Oral Sensory approach (SOS), and the Escape Extinction approach.

Food Chaining has become recently popular due to a book written by Fraker and Cox called Food Chaining: The Proven 6 Step Plan To Stop Picky Eating, Solve Feeding Problems, and Expand Your Child’s Diet. To summarize this approach, clinicians and parents would “chain” from food that children currently enjoy by changing 1 aspect of the food at a time: either color, texture, flavor, or shape. For example, if a child enjoys cheetos, you might “chain” to orange veggie sticks (changing flavor), then to green veggie sticks (change in color), then to green veggie chips (change in shape), then to zucchini cut in a circle and placed on the chip (change of texture), then remove the chip. The child is now eating zucchini, and it was introduced slowly in a non-threatening manner! In this procedure, food is not forced on children- they are able to touch and explore it themselves, the clinician models eating it, and children are encouraged to take a bite, but they decide if they would like to try it or not. Using food chaining, children will slowly and positively increase their repertoire of acceptable food.

The Sequential Oral Sensory (SOS) approach was developed by Dr. Kay Toomey, a psychologist who specializes in Pediatric Feeding Disorders. This procedure includes another slow process of children having repeat exposures to foods prior to being forced to take a bite. For example, a child would tolerate a new food, let’s say apple slices, on their plate without expectation of eating it. Once that is tolerated, the apple will slowly and systematically move closer to their mouth, again without expectation of eating. They will touch it first with a fork or toy, then their hand, then put it on their arm, then their cheek, then kiss it, then lick it, then take a bite and spit it out, then chew, and finally swallow the apple slice. This could take a couple of days or even weeks. The idea is to allow children to have positive interactions with the food so that eating is enjoyable and they control what is placed in their mouth according to their comfort level. Eventually the child will be able to more quickly and independently follow the above steps with a new food to independently increase their diet. Children will gain confidence and learn that new foods aren’t as scary as they once thought.

The Escape Extinction approach is an effective, evidence based approach used to aid with feeding problems across all ages and is often utilized in ABA therapy by a BCBA or Behavior Technicians under the guidance of a BCBA. Eating novel food items and non-preferred food items is broken down into easier steps to aid your child with succeeding in their feeding journey. Keeping the presentation of bites and the bite sizes predictable decreases anxiety and allows the child to feel more in control during meal times. We never move up in bite size until we are certain your child is able to handle the bite at that size and has the skills needed to properly lateralize the food item, masticate the bite, and take consecutive bites. Furthermore, this approach reinforces appropriate feeding behavior while extinguishing inappropriate or disruptive feeding behaviors by not allowing the child to escape from taking bites by using a non-removal of the spoon. Often times, children will spit out food, swallow food without chewing, pack bites, turn head away from the bite, or engage in aggression. When these behaviors occur, we do not remove the bite from their lips until the bite has been taken, and provide prompts and reinforcement for taking bites and chewing appropriately.

Children enrolled in the feeding program Metro EHS Pediatric Therapy are evaluated and treated as unique individuals, so these approaches, along with others, are often combined to best help your child experience success with eating.

Sources

2019. Tooomey, Kay. SOS Approach To Feeding.
2020. Tarbox, J and Tarbax, C. Training Manual for Behavior Technician Working with Individuals with Autism Spectrum Disorder. Retrieved from Sciencedirect.com.
2021. Fraker, Fishbein, Cox, Walbert. Food Chaining: The Proven 6 Step Plan To Stop Picky Eating, Solve Feeding Problems, and Expand Your Child’s Diet. Da Capo Lifelong Books.