The Right Step: Choosing Shoes for Early Walkers and Kids in Summer and Winter

Walking is one of the most significant milestones in a child’s life. The shoes they don early on can have lasting impacts on their posture, gait, and musculoskeletal health. As seasons evolve, so should the considerations parents make for their child’s footwear. From a physical therapy perspective, here’s a guide on choosing the right shoes for young children across seasons. For the Early Walkers: 1. Flexibility: Shoes should bend and twist in your hands. This malleability promotes the natural movement of a child’s foot. 2. Flat Soles: Heels or wedges can interfere with a child’s balance. A flat sole aids in stable weight distribution. 3. Breathability: In summer, shoes made of breathable material help prevent overheating and moisture buildup. 4. Snug but Not Tight: A shoe should fit well without constricting the foot. Room to wiggle toes is vital! 5. Wide Toe Box: This feature is crucial. A wider toe box allows toes to spread naturally, aiding balance and reducing the risk of developmental issues or deformities.  6. Ankle Support: Especially crucial for early walkers, shoes with proper ankle support provide stability, helping to prevent wobbles and potential injuries. Summer Selections: 1. Open vs. Closed: Sandals with a back strap are a secure choice. Closed shoes, if preferred, should be made of light, breathable material. 2. Grip is Essential: Non-slip soles are crucial, particularly near pools or damp areas. 3. Avoid Flip Flops: They offer minimal support or protection for young, active feet. Winter Wonders: 1. Insulation: Shoes should be breathable but also offer insulation against the cold. 2. High-Ankled Boots: These boots offer enhanced stability on slippery surfaces and protect against cold. The high ankle also provides added support. 3. Non-Skid Soles: With ice and snow in winter, a shoe with good grip is a must. 4. Room for Socks: Winter shoes should have some extra space for thicker socks without compressing the foot. In conclusion, the aesthetics of a shoe, while appealing, should always come secondary to its functional attributes. The right shoe not only shields the feet but also supports the holistic physical development of your child. When unsure, your pediatric physical therapist is a valuable resource to tap into.

Gross Motor Milestones: A Guide for Parents from a Pediatric Physical Therapist

As a pediatric physical therapist, one of the most common queries I encounter is, “Is my child on track with their physical development?” Understanding gross motor milestones and knowing when it might be time to seek professional guidance is vital for every parent. Here’s a concise guide to help you navigate this essential aspect of your child’s growth. What are Gross Motor Milestones? Gross motor milestones are the significant stages of physical development in a child’s life, starting from infancy to their early school years. They encompass skills involving large muscle movements of the body—think crawling, walking, jumping, and running. Key Gross Motor Milestones: 1. Birth to 3 months:     – Baby begins to lift the head during tummy time.    – Gradual improvement in head control. 2. 4 to 6 months:     – Rolling over (from tummy to back and vice versa).    – Sitting with support and starting to sit independently. 3. 7 to 9 months:     – Starts to crawl.    – Pulls to stand with support. 4. 10 to 12 months:     – Begins to stand without support.    – May take first independent steps. 5. 1 to 2 years:     – Walks independently and starts to run.    – Begins to climb stairs with support. 6. 2 to 3 years:     – Runs confidently and starts to jump.    – Climbs stairs one at a time without holding on. 7. 3 to 5 years:     – Begins hopping, swinging, and maybe even skipping.    – Rides a tricycle and stands on one foot for a short time. When to Seek a Referral: While every child develops at their own unique pace, there are general timeframes in which most children acquire these skills. It’s essential to remember that occasional delays are typical. However, if you observe the following, it may be time to seek a referral: 1. Consistent Delays: If your child is regularly missing milestones or is significantly behind their peers. 2. Loss of Skills: Any regression, like a child who once walked but now doesn’t, warrants a check. 3. Lack of Coordination: If your child appears unusually clumsy for their age or struggles more than their peers with similar activities. 4. Uneven Muscle Use: For instance, if your child uses one side of their body more than the other. 5. Difficulty in Keeping Up: If they struggle to engage in age-appropriate activities or play due to physical constraints. Your child’s health and well-being are paramount. Being proactive and seeking guidance when unsure can make all the difference. Trust your instincts as a parent, but also remember to seek expert advice when needed. Pediatric physical therapists are here to assist, guide, and provide the necessary interventions to ensure your child’s optimal physical development.

Active Family Fun: Boosting Gross Motor Skills the Enjoyable Way!

Engaging in family activities isn’t just about spending quality time together; it’s also a fantastic way to boost your child’s gross motor skills. These skills, involving large muscle movements, play a pivotal role in a child’s physical development. Here are some entertaining and simple ideas to get your family moving while having a blast! 1. Chalk Obstacle Course: Transform your driveway or sidewalk into an adventure-filled obstacle course using just chalk! – Draw zigzag lines, spirals, and circles for children to walk, run, or hop through. – Sketch out numbered lily pads or islands that they can leap between. – Outline large shapes for kids to fill with different movements, like spinning or star jumps. 2. “The Floor is Lava”: A classic game that never gets old and perfect for a rainy day indoors. – Scatter couch cushions, pillows, and blankets across the floor. These are your “safe” zones. – The objective is to move from one side of the room to the other without touching the floor. – It’s a great way for kids to utilize different muscles as they balance, jump, and plan their path. 3. Nature Walks with a Twist: A family walk is always refreshing, but adding a few fun challenges can make it even more exciting. – Organize a scavenger hunt where children need to find specific items, like pinecones or colorful leaves. – Challenge kids to mirror animals they see or talk about, like hopping like a frog or waddling like a duck. 4. Dance Party: Crank up the music and let loose! Dancing is not only fun but also an excellent way for kids (and adults) to develop coordination and rhythm. – Choose different music genres and move to the beat. – Freeze dance: When the music stops, everyone freezes until it starts again. 5. DIY Bowling: Use empty water bottles and a soft ball to create a bowling alley in your hallway. – Set up the bottles in a traditional triangle or in any fun pattern. – Take turns rolling the ball and trying to knock them down. 6. Build-a-Fort: While building a fort may seem like a quiet activity, the physical process involves lifting, pulling, and arranging, all of which are great for gross motor development. – Use chairs, tables, and blankets. – Once it’s built, kids can crawl in and out or incorporate it into their imaginative play. Active play is essential for a child’s physical and cognitive development. Plus, it’s a great way for families to bond. The key is to keep activities engaging and enjoyable, ensuring that children are eager to participate. Remember, it’s not about structured exercise but about moving, laughing, and learning together. So, gather your family, pick an activity, and let the fun begin!

The Benefits of Early Intervention in Pediatric Therapy

Early intervention in pediatric occupational, physical and speech therapy services is a proactive and essential approach to supporting children’s development and addressing potential challenges at an early age. There are numerous benefits of early intervention in pediatric therapy, which can have a very positive impact on a child’s overall growth and future success. Timely Identification of Developmental Delays and Challenges: Early intervention allows for the timely identification of developmental delays and challenges in children. By identifying these challenges early on, therapists and parents can work together to create targeted intervention plans tailored to the child’s specific needs. Optimal Brain Plasticity and Learning: During early childhood, the brain is incredibly malleable, exhibiting a high degree of neuroplasticity. This simply means the brain is pliable, and has the ability to change.  Intervening during this crucial period maximizes the brain’s ability to adapt and learn, leading to more positive outcomes in various developmental areas. Improved Long-Term Outcomes: Research consistently shows that children who receive early intervention in pediatric therapy achieve better long-term outcomes compared to those who do not. Early support in OT, PT and Speech Therapy can lead to improved academic performance, social skills, and overall independence in daily living. Family Involvement and Empowerment: Early intervention is not just about the child; it involves the entire family. Therapists work closely with parents and caregivers, empowering them with knowledge, strategies, and resources to support their child’s development effectively. It is important that we are always collaborating with each individual and their family to best serve the client’s needs and provide the right support to their families. By providing support and resources, therapy helps reduce stress and anxiety for parents and caregivers, promoting a more supportive and nurturing environment for the child. Enhancing Social and Communication Skills: Early intervention can significantly impact a child’s social and communication skills. Therapists use various evidence-based approaches to foster language development, social interactions, and emotional regulation in young children. Some of these examples include AAC devices, PEC systems, and play opportunities with others including imitative, parallel and reciprocal play activities.  Addressing Sensory Processing Issues: Sensory processing challenges can significantly impact a child’s daily life. Early intervention helps identify and address these issues, enabling the child to better process sensory information and be able to attend, focus and engage in various activities with confidence across all of their environments.  Building Self-Confidence and Resilience: Children who receive early intervention support often develop higher levels of self-confidence and resilience. As they see their progress, they gain a sense of accomplishment and belief in their abilities, which positively impacts their overall self-esteem. Early intervention in pediatric therapy is a powerful tool that can positively influence a child’s development and future. By identifying challenges early, involving families, and providing targeted support, we can help set children on a path to success and help them reach their full potential. Our occupational, physical and speech therapists play a crucial role in shaping the lives of young children, enabling them to reach and achieve their individual goals, and supporting the families on their journey to continued growth and success.

YES! You can play with your food!

As a child, my parents used to tell me “Don’t play with your food!”…but times have changed!  Playing with food is a good thing and allows your child to explore and learn about foods without any pressure to eat the foods presented. Food play allows your child to touch, see, hear, feel and possibly even taste a variety of foods. Playing with food allows them to enter into a sensory experience that can help with sensory sensitivities, picky eating, language development, problem solving, social skills, and regulation skills.  Is the food gooey, chunky, slimy, sticky, rough, or smooth? What does the food smell like? What shapes, sizes and colors do you see? Does it make noise when you squish it, play with it, break it, crumble it? Children learn through play! Not to mention, picking up and manipulating food can help promote fine motor skills too. How cool is it that there are so many benefits to playing with food? Moreover, playing with food can make feeding a more fun and positive experience for children who get anxious and stressed when trying new foods. Exploring foods can be incorporated into meal times, but can also be a fun activity during free time or as a creative outlet.  Below is a list of food play ideas that kids can enjoy. Over time and with continued exposure through play, they will get to learn all about different foods, become more comfortable with foods, and move towards eating the foods. Food play ideas: Finger paint with yogurt, salsa, hummus, applesauce or other sauces  Use paint brushes to paint with pudding or purees  Touch and squish wet foods through Ziploc bags Feed their teddy bear or doll during a picnic with real foods Feed any toys with a mouth Make fruit salad/fruit kabobs  Create a Mr. Potato Head with real foods Work on counting: Count Cheerios, pieces of fruit, crackers… Create funny faces with foods  Stack crackers, cookies, cubes of cheese, and see who can make the tallest tower Match different shaped crackers/foods into categories (e.g., shape, color, size) Build a house, car or other ideas out of crackers, sticks, cheese cubes, etc and peanut butter as the glue  Drive cars and diggers through cooked pasta/rice, canned fruit, or yogurt, salsa, or other sauces  Ask your child to help prepare the foods when cooking or baking Serve food to others String cheerios or fruit loops and make food jewelry Stir/pour/shake/mix foods and sing songs Make a noise with a food to draw attention to it (e.g., crunch, splat, pop, splash) Make mustaches with foods (e.g., peppers) or glasses (e.g., cucumbers) Flick and Roll foods across the table to play table finger-hockey or soccer with foods Write names/letters in purees or sauces Make letters/numbers from sticks of foods/cooked noodles Remember it’s all about having fun and exploring foods; try not to stress if your child is not eating the food. Add in some music, sunshine or fresh air and enjoy this time playing together with your child!

Physical Therapy vs Occupational Therapy for Children: Understanding the Differences

As a parent or caregiver, you may have heard of both physical therapy and occupational therapy, especially if your child is dealing with a health issue or developmental concern. While both forms of therapy are geared towards improving a child’s quality of life, their approach and focus areas can be quite different. Understanding these differences can help ensure your child gets the most appropriate care for their needs. Physical Therapy (PT) for Children Pediatric physical therapy primarily aims at improving a child’s physical abilities. It focuses on enhancing a child’s gross motor skills, strength, balance, and coordination, especially those necessary for mobility. For instance, a physical therapist might help a child with cerebral palsy learn to walk with assistive devices, or aid a child recovering from a sports injury to regain strength and flexibility. Pediatric physical therapists also play a significant role in early intervention, helping to mitigate developmental delays in infants and toddlers. Occupational Therapy (OT) for Children On the other hand, pediatric occupational therapy focuses on helping children achieve independence in all areas of their lives. It’s centered around improving fine motor skills, cognitive abilities, visual-perceptual skills, and sensory processing abilities that children need for daily activities or “occupations.”  In this context, “occupations” refer to the everyday activities that occupy a child’s time, such as dressing, eating, playing, and school-related tasks. For example, an occupational therapist might help a child to improve their handwriting skills or guide a child with sensory processing disorder in managing overstimulation. There is often an overlap between PT and OT, and in many instances, a child may benefit from both services. For instance, a child with a physical disability may work with a physical therapist to improve overall body strength and mobility, while also seeing an occupational therapist to work on specific skills such as dressing or using utensils.  Physical therapy and occupational therapy, though different in their focus, are both crucial to promoting healthy development and quality of life in children who need them. A comprehensive understanding of both therapies can help parents advocate for their children and ensure they receive the most appropriate and effective care. Remember, every child is unique, and what works best will depend on their individual needs and circumstances. A discussion with your child’s healthcare provider can provide further guidance on which therapy, or combination of therapies, would be most beneficial for your child.

Speech Dismissals: Was my child dismissed too soon?!

As a parent, coming to terms with the need for therapy can be hard on the heart.  However, once your child starts speech therapy, your therapy team becomes a part of your family.  Obviously, the ultimate goal is to reach dismissal.  Your child has met their current goals and the therapist proudly hands over a certificate of graduation!  What a glorious day, or is it? Sometimes, parents may feel that continued therapy would be beneficial.  Understanding how your child has reached the point of dismissal is often confusing.  Perhaps Johnny still doesn’t say his R sounds or misuses verbs.  As a parent, these types of performance errors can cause concern.   Here are a few things to consider: Therapists follow specific developmental guidelines, use nationally normed standardized assessments, paired with professional experience to determine when your child is ready to be dismissed.   Your child may have many articulation errors when speaking.  If the national guidelines show that the errors are acceptable for your child’s age; continued therapy would not be recommended.   The majority of children will gain these skills without intervention. Your child may have a mild delay that does not warrant direct therapy but would be better served through home programming. Many parents are able to target skills during daily activities! Your child may need the opportunity to be around peers to gain the skills.  For example, many young children show pragmatically unexpected behaviors.  As they start school and interact in peer groups, they will learn many skills naturally.   Should your child be re-evaluated after dismissal? Here are examples of scenarios where a child that may have received services in the past would benefit from a closer look at skills via a re-evaluation. A child has had ample opportunity to gain social skills via peer groups, family groups, community exposure, and parent modeling; yet continues to be inappropriate and show lack of social awareness: Pragmatic Skills Reassessment Needed A child is age 8, not showing awareness of continued articulation deficit, misarticulates all R sounds, has obvious lisping of S/Z, or misarticulated multiple sounds when speaking. Articulation Skills Reassessment Needed A school-aged child cannot tell you what he/she has read, cannot answer comprehension questions, cannot problem-solve with peers, and/or compromise. Language Skills Reassessment Needed A school-aged child commonly uses the wrong vocabulary, does not know grade-level vocabulary when reading, has trouble asking or answering questions expected of their peers, or struggles with grammar when writing. Language Skills Reassessment Needed This is not a comprehensive list of reevaluation skills need; however, if you feel that specific skills are behind peers, have not improved, or commonly get discussed in parent/teacher conferences; a reevaluation can help determine need and assist with planning for future skill acquisition.   Bottom line:  Outpatient Pediatric Speech Therapy covers articulation, oral motor, feeding, receptive language, expressive language, pragmatic language, reading, and all of the pathways that fall between these broad categories.  If you have a concern, reach out!  We would be more than happy to help you determine your child’s current skills and if necessary, help you navigate and plan for growth.

Grasping Development…What Should My Child’s Grasp Look Like?

Your child was recently evaluated for occupational therapy.  When reading over the report you noticed delays in overall grasping skills.  You may be wondering, what does this mean?  And what grasp are we looking for? We will first discuss the progress of grasp on objects such as blocks and small items like a Cheerio or a bead.  And then move towards the progress of a child’s grasp on a writing utensil.  The most primitive grasp you will see is the palmar grasp reflex. Palmar Grasp Reflex – A palmar grasp reflex is when a baby immediately wraps all fingers around your finger, or an object placed in his/her palm. This reflex will integrate (go away) around 4 months of age. At this time, your child should begin to demonstrate a voluntary grasp to pick up different sized objects. (Usually Emerges in Early Infancy) The following progression is noted by Jane Case-Smith an occupational therapist and a leading educator in pediatric occupational therapy as well as The Erhardt Developmental Prehension Assessment.   Ulnar-Palmar Grasp (Crude Palmar Grasp) – The index finger and Thumb are not used in this pattern. (Usually Emerges Around 4-6 Months of Age.) Palmar Grasp – Using the central portion of the palm to pick up objects from a flat surface. This grasp does not involve use of the thumb. (Usually Emerges Around 4-6 Months of Age.) Radial Palmar Grasp – your child should begin to use his/her thumb while picking up objects from a surface. When first adding the help of the thumb to grasp objects, there will be no open space between the object your child is grasping and his/her palm or “web space”. (Usually Emerges between 6-7 months of age.) Raking grasp – This is when your baby will attempt to pick up objects on her own using a “raking” method. You’ll see her reach out and move her arm in a raking motion to try to pull it closer and grab. She’ll usually spread out her fingers and contract them to close around the object, strengthening her muscles with each movement. (Usually Emerges Around 7 Months of Age.) Radial Digital Grasp/Three Jaw Chuck – This is the first grasp where more precise finger movements are required and utilized. Your child will begin to pick up objects with fingertips, rather than the whole hand, which leads into the very important, pincer grasp (see below). (Usually Emerges Around 8-9 Months of Age.) Inferior pincer grasp – Child will begin to pick up small objects with thumb and index finger only. Initially, your child will only be able to use this grasp with his/her arm supported on the table/surface and will use the side of their index finger and a straight thumb to pick up objects. (Usually Emerges Around 9 Months of Age) Mature/Dynamic Pincer Grasp – When the mature pincer grasp is developed, you will notice your child picking up small objects with the tips of thumb and index finger, while holding the forearm off of the surface. (Usually Emerges Around 12 Months of Age) Writing Utensil Grasping Patterns (Info Based off of Jane Case-Smith) Palmar Supinated/Gross Fisted Grasp —  The toddler will use their whole hand as one unit, wrapping all of their fingers around the writing utensil with their thumb positioned at the top of the crayon and their pinkie towards the paper.  They are still working on “proximal stability” and so they move the writing utensil with large arm movement originating from the shoulder. (Usually Emerges Around 1-2 Years of Age) Radial/Digital Pronated Grasp – As they begin to have more finger isolation, they will begin using the thumb functionally for prehension grasping.  In this grasp pattern, the arm is turned slightly inward (pronated) and the crayon is positioned under the palm.  The tip of the writing utensil is held by a straight index finger and adducted thumb.  Again, most movement is from the arm. (Usually Emerges Around 2-3 Years of Age) Static Tripod Grasp – With this grasp you will begin to see the child is beginning to have more control of the writing utensil.  They appear to have better separation of the two parts of the hand, and they use the thumb side for movement and the pinkie side for strength.  It is this time, you will begin to see an opening of the thumb webspace, and the use of the thumb, index and middle finger to control the writing utensil.  The child should be able to stabilize at the shoulder, rest the forearm on the table, and movement should be coming from the wrist, or fingers. (Usually Emerges Around 3 ½ Years of Age.)  Dynamic Tripod Grasp – A mature prehension grasp pattern which will allow your child to make smooth, colored strokes for coloring, tracing, drawing and printing.  You will notice a nice, round open webspace.  The index finger PIP and DIP joints and the thumb’s IP joint will be slightly bent.  The writing utensil rests on the side of the DIP joint on the middle finger and most of the movement comes from the fingers. (Usually Emerges Around 5 Years of Age) Insufficient Grasping Patterns (Info from AnOTMom) The Thumb Wrap – The thumb wrap is one of the most common inefficient grasp patterns. One of the main reasons it’s problematic is because the fingers are in a position where they actually block part of the visual field. It is very difficult to see where and what you are writing with this grasp. Also, the index and middle fingers are stabilizing the writing utensil instead of moving it. As a result, movement comes from the wrist or arm, which leads to large strokes that lack control and precision.  The Thumb Tuck – The thumb tuck is a variation of the thumb wrap, where instead of wrapping the thumb around the fingers/writing utensil, it is tucked in the fingers.  Once again, the fingers and the thumb are stabilizing the writing utensil rather than moving it.  Movement is distal, decreased control and precision. The Interdigital

Posture

Growing up, I vividly remember my mother frequently correcting my posture. The biggest challenge was sitting at the dinner table. My mom would sandwich her arms around me and shift my rounded shoulders and slumping posture back to sitting upright. It was quite alarming when I realized that I was slumping so far over in my chair that my chest about touched the table.  Do you ever find yourself doing this to your kiddos or find yourself correcting your own posture? With virtual schooling and working from home continuing to take place, it is important to evaluate you and your child’s posture. There are many ways to change up our positions that can incorporate different muscle groups and continue to help develop strong core muscles that make sitting up in a chair easier. Here are some tips and tricks on different positions that can help with your child’s posture: Seated Posture: It is recommended that your child sit all the way back in their chair. Place a small, rolled-up towel or lumbar cushion behind their mid-back to protect the spine’s natural curve. Keep the knees bent at a right angle, keeping them the same height, or a bit higher, than the hips, and feet should be flat on the floor.  Have a table that is too tall where your child’s feet cannot touch the floor? Grab a box or stool that can go under their feet to help maintain a right angle throughout the hips and knees, keeping the feet flat on the surface provided. Is your child looking down at their laptop to complete their Google meets and school work? Grab a box, stool or plastic bin to place the computer on that would raise the screen to eye level when they are seated in their chair. Tall Kneel: Tall kneel is a great alternative to sitting in the chair. Whether completing school assignments online, playing games with family and friends, drawing or coloring on vertical surfaces, or watching tv, tall kneel and/or half-kneel are two ways to incorporate core strengthening and balance, and continuing to work on your child’s posture.  Prone: Prone positioning is great for upper-body and core strengthening. Incorporating prone positioning into your child’s daily activities such as when they are coloring, drawing, reading a book, watching a movie, playing with legos or playdoh, or other board games, this is an awesome way to work on their upper-body, core strength and posture. When your child is in the prone position, there are a few things to watch out for including: Holding their breath Moving in and out of the position Laying their head on their arms and/or the floor Pulling their knees up beside their hips   Side Sitting: Side sitting is another way to change up your child’s posture. Side sitting is great for core strengthening and is easy to incorporate into the child’s daily activities when seated on the floor whether inside or outside. Enjoy playing games or going outside for a picnic? Side sitting is an awesome way to work on your child’s core strength, balance and posture. Dynamic Sitting: Have a physioball laying around the house? Adding a ball as an option for a chair is a great alternative. Sitting on a physioball addresses core strengthening and balance, and continues to work on your child’s posture. Similarly to sitting in a chair, we also want the child’s feet to be flat on the floor with 90 degree angles through the ankles, knees and hips during dynamic sitting.  Posture to AVOID: W-Sitting W-sitting is common for kids to move into, however, this is a posture we want to avoid. W-sitting can lead to increased stress on the hip and knee joints, and can lead to the hip and leg muscles tightening which can lead to difficulties with overall strength, endurance, coordination and balance. When sitting in this position, it makes it more difficult for the child to rotate their bodies and shift their weight as well as decreases the need to engage their core muscles because they are getting a wider base of support with the “w.” It is recommended to encourage your child to move out of this position into other postures mentioned above or “criss-cross applesauce.”  If you have any concerns regarding your child’s sitting posture contact your child’s therapist, and they will be glad to help give any tips and pointers to help increase your child’s postural control.

Activity Level vs. Arousal Level? What does it All Mean?

If you have been around No Limits Pediatric Therapies long, you have probably heard the terms AROUSAL level and ACTIVITY level; but what do these terms really mean?  Let’s go to one of No Limit’s OT teams favorite sensory gurus named Dr. Julia Harper for some more information. Dr. Julie Harper, PhD, MS, OTR/L is a wife, mother, occupational therapist, business owner, psychologist, life coach & mentor, speaker and writer. She holds a BS in Occupational Therapy from SUNY Health Science Center (Downstate), Brooklyn, NY, a MS in Occupational Therapy from Boston University, Boston, MA and a PhD in Psychology from Capella University, Minneapolis, MN. She brings all of these roles together to serve her mission of helping people-all people to live their lives beyond limitations. For over 20 years, Julia has worked as a pediatric occupational therapist focusing on creating brain-based therapeutic programs that tap into neural-plasticity, the brain’s ability to adapt and change. Her world-renowned therapy center offers a W.A.Y. to H.O.P.E.™ which merges her two models: HOPE (Harper’s Optimal Protocols for Enrichment), which focuses on re-wiring the brain of those with physiological, learning and limitations in attention and W.A.Y.™ (What About You), which retrains the brain to move beyond emotional and thought limitations. Creating change is at the center of her work, as she knows that to best serve the world, she needs to be an agent of change. This begins with the work she has done to change her own life, from becoming a Certified Master Life Coach, a Master Clinician, a Certified Daring Way Facilitator and Master Practitioner of MER. She hopes that through her change, she can change her clients and have the ripple effect of changing the world. She is a firm believer that all change begins with her. Daily, she lives this change to be the change. (http://therapeeds.com/en/about-us/julia-s-story) Now you know a little background on one of our favorite resources when it comes to sensory processing, arousal level, and activity level, but what does it all mean? Activity level can be broken down into two categories: high activity and low activity.  When speaking about activity level, we are referring to physical activity.  The World Health Organization defines physical activity as any bodily movement produced by skeletal muscles that requires energy expenditure. Physical activity refers to all movement including during leisure time, for transport to get to and from places, or as part of a person’s work. Both moderate- and vigorous-intensity physical activity improve health (https://www.who.int/news-room/fact-sheets/detail/physical-activity).  This is leading to the idea that a child or adult who demonstrates a high activity level demonstrates significant physical activity and seeking of movement.  It then leads us to an idea of a child or adult who demonstrates a low activity level demonstrates minimal physical activity at any given time.   Activity level is visible, fluid and changing.  You can move from high to low activity level or low to high activity level at any point in the day and it usually changes multiple times during a day.  It can even change hour to hour or in shorter time spans.  Remember, activity level is seen and is changing; although you may have a child who typically demonstrates either a high or low activity level.  Now, let’s move on to arousal level.  This can easily be confused with activity level, but it is different and cannot be used interchangeably.  Your arousal level tends to remain unchanging and can be considered more as your state of being.  With that said, according to Julia Harper, a child or an adult can be considered high arousal or low arousal.  She describes the different neuro-chemicals and brain wave patterns within the body that determine arousal level, but that will be left for another day.  What we will discuss today is that depending on your child’s arousal level, the occupational therapy team can better serve your child’s sensory needs by meeting their specific sensory input needs.  This is based on neuro-chemical needs and we can then help create a protocol to meet those needs based off of Julia Harper’s research.  Moving forward, let’s discuss how we determine if your child is high arousal or low arousal.  We can typically describe a high arousal child as a child who thrives on routine, structure, and predictability.  A high arousal child is unable to start off their day with intense sensory input such as spinning and participating in inverted activities, because intense vestibular input is only going to dysregulate your child even more.  This would be working against the whole goal of working with your child to build a toolbox to help improve attention, participation and overall regulation based on their individual arousal level.  They tend to benefit from deep pressure touch and passive proprioceptive input which is calming and regulating.  Now on the other hand, you have a low arousal child.  A low arousal child is a child who tends to be unpredictable, constantly changing, and unrhythmical.  You can usually see this in everything they do.  A low arousal child may always be on the go because they are seeking input to help regulate, but they do not need to start the day off with calming activities.  Instead, they need to start off with intense vestibular input that is constantly changing, unrhythmical and unpredictable.  Starting with intense input followed by deep pressure and tactile input will help set your low arousal child up for success. Now, here is where it gets tricky!  Is my child high or low arousal?  Or are we just looking at if they have a high or low activity level?  This is where your OT comes in.  We at No Limits want to work with you as a family and complete a variety of clinical observations to help determine if your child is high or low arousal.   We can then work with you to see how their activity level usually runs at different points in the day. After determining your child’s arousal level and gaining a better idea of how their activity