Metrotelepractice In Metropolitan Detroit

History of TheraSuit

Richard and Izabela Koscielny are physical therapists, who have a daughter diagnosed with cerebral palsy and tried out suit therapy with her. After significant improvements with the suit, they modified and created their own suit specialized for therapeutic benefits, called TheraSuit™.

How Does TheraSuit Work?

• TheraSuit worn over a prolonged time will correct proprioception and accelerate progress with functional strengthening
• Skills practiced become more fluent when TheraSuit is worn
• TheraSuit facilitates the development of new gross and fine motor skills faster than typical therapy approaches

Benefits Seen with TheraSuit

• Retraining the central nervous system
• Restores ontogenetic development
• Provides external stabilization
• Normalizes muscle tone
• Aligns the body to as close to “normal” as possible
• Provides dynamic correction
• Normalizes gait patterns
• Provides tactile stimulation
• Influences the vestibular system
• Improves balance
• Improves coordination
• Supports weak muscles
• Decreases uncontrolled movements in ataxia and athetosis
• Improves body and spatial awareness
• Provides resistance to muscles to further enhance strengthening
• Improves speech production and fluency through head control and trunk support
• Promotes gross and fine motor development
• Helps decrease contractures
• Helps improve hip alignment through vertical loading

Patient Populations

• Most major neurological diseases/diagnoses:
  
  • Autism
  • Down Syndrome
  • Cerebral Palsy
  • Cerebral Vascular Acciden
  • Traumatic Brain Injury
  • Spinal Cord Injury

• Posture/alignment asymmetries

Intensive Physical Therapy Schedule

• Intensive physical therapy is meant to be done 3 hours/day, for 5 days/week for 3-5 weeks
• Recommended to complete 3-4 intensive bouts of therapy throughout the year
• Breaks between the bouts have been shown to be more beneficial for the patient vs continuously pushing for months on end
• Recommended to complete HEP 1-hour/day to compliment exercises done in intensive, allowing the patient to not only maintain, but improve their functional abilities
• The schedule of 4  weeks was created specifically in order to change the neuro-pathways, and allow for increased improvements

In General

• Week 1 works on correct muscle activation and beginning to complete basic concentric exercises
• Week 2 works on solidifying concentric movements and working into eccentric movements
• Week 3 solidifies the eccentric movements and introduces isometric holds
• Week 4 focuses all on isometric holds, working into more complex exercises, as well as creating POC and HEP for time off between bouts of intensive

Work to decrease primitive reflexes and general movements that are present → goal-directed movements → selective effective strategies → refining skills → maintaining through practice

If you've searched online for information about Applied Behavior Analysis (ABA), you've probably seen conflicting opinions.

Some families describe ABA as life-changing. Others have questions after reading recent news stories or social media discussions about the field.

At MetroEHS, we believe parents deserve clear, honest information.

What Is ABA Therapy?

Applied Behavior Analysis (ABA) is an evidence-based therapy that helps children develop skills that improve their daily lives.

Depending on a child's needs, ABA may focus on:

• Communication
• Social interaction
• Play skills
• Safety awareness
• Emotional regulation
• Independence
• Daily living skills

The goal of ABA is not to change who a child is.

The goal is to help children gain skills that allow them to communicate, participate in their communities, and live as independently as possible.

Why Has ABA Received Negative Press?

Recent media coverage has raised concerns about billing practices and quality issues within parts of the industry.

Like any healthcare field, there have been instances where providers failed to meet professional standards.

However, these stories often fail to distinguish between unethical providers and the thousands of clinicians who deliver ethical, evidence-based care every day.

Families should know that poor practice is not the same thing as ABA itself.

What Does High-Quality ABA Look Like?

High-quality ABA is:

💥 Individualized

Every child receives goals based on their unique strengths, needs, interests, and family priorities.

💥 Data-Driven

Clinicians continuously measure progress and adjust treatment plans based on results.

💥 Family-Centered

Parents are active members of the treatment team.

💥 Play-Based

Modern ABA often incorporates games, preferred activities, peer interactions, and natural learning opportunities.

💥 Focused on Meaningful Outcomes and Success!

Success isn't measured by how many hours a child receives.

Success is measured by improvements in communication, safety, independence, social participation, and quality of life.

A discharge plan should always be discussed in any therapeutic service. ABA shouldn’t be a life-sentence for anyone. Make sure that you have a discharge plan in place from the moment you begin therapy.

Is ABA Regulated?

Yes.

ABA is one of the most highly regulated autism services available. Treatment plans require clinical oversight, supervision by Board Certified Behavior Analysts (BCBAs), ongoing documentation, ethical standards, and regular review processes.

Quality providers continuously evaluate progress and reduce or discontinue services when goals have been achieved.

What Should Parents Look For?

When evaluating an ABA provider, ask:

• How are goals selected?
• How is progress measured?
• How often does the BCBA supervise treatment?
• How are parents involved?
• How does the provider collaborate with other therapists?

The best providers welcome these conversations.

Why MetroEHS Believes in Integrated Care

💥 Children do not develop skills in isolation.

💥 Communication affects behavior.

💥 Sensory processing affects communication.

💥 Motor skills affect participation.

That is why MetroEHS brings together ABA, Speech Therapy, Occupational Therapy, and Physical Therapy under one collaborative, clinically integrated, model.

When therapists utilize clinical integration, children benefit from coordinated goals, shared expertise, and a more complete understanding of their needs.

The Bottom Line

Parents should absolutely ask questions about ABA.

They should expect ethical care, measurable outcomes, and meaningful progress.

But families should also know that ABA remains one of the most extensively researched and evidence-based interventions available for many children with autism when delivered appropriately.

The conversation should not be whether ABA is good or bad.

The conversation should be: What does high-quality ABA look like, and how do we ensure every family has access to it?

At MetroEHS, we believe children deserve individualized, compassionate, evidence-based care that celebrates who they are while helping them build the skills they need to thrive.

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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.