Private AND Public Therapy Services?

Private AND Public Therapy Services?

This is a big topic amongst a lot of my families and within the therapy community in general.  It’s a conversation I would say I have at least twice a month with a family, another physiotherapist or another therapist from a different discipline:

Can I use private therapy services even if I’m getting treatment through the public system?  Why would I see a private therapist if I’m being seen in the public setting?  Should I see one vs the other?

My answer is: do BOTH!

I encourage all of my families to call their local children’s treatment centre (in our area, you can get in touch with either KidsAbility or Thames Valley Children’s Treatment Centre) and put in a referral for services.  Parents can self-refer or a medical doctor/specialist can refer on behalf of a family.  This is a vital resource that can help get access to a variety of services, including therapy and, in the long term, planning transition to school.

The most important thing is to get the referral in early!  Some treatment centres only provide services until school age, at which time care is transferred into the school system.  As well, given the number of children requiring services, wait times for assessment and treatment can be lengthy.  The sooner you put in your referral, the better!

So, what is the role of the private therapist?

Treatment in the public system looks different for different families.  For some families it’s more consultation based – once every month, or six weeks to provide suggestions for exercises at home, providing equipment to increase a child’s function or ease of caregiving.  For other families, it may be blocks of treatment 2-3 times a year to work on specific goals.

This is where a private therapist comes in!  I have a number of families I have seen while they are waiting for public services and, in some instances, we are able to achieve their goals before they get their assessment.  For other families, a private therapist can provide more frequent, hands on treatment to supplement public services they may be receiving.

However, there are some guidelines we need to follow – the College of Physiotherapists of Ontario has a standard of care that lays out the expectations for a physiotherapist who is treating a client who is receiving care from another health care provider (including a physiotherapist).  The key is communication between the client/family and the other treating therapist.  We need to make sure the treatments are compatible, discuss how the therapists are dividing treatment and that there is nothing that interferes with the delivery of safe, quality care.

At the end of the day, I feel like the more help a child can get to accomplish their maximum potential, the better!  If a family can afford private physiotherapy (through benefits, bursaries or private pay) I think it can be a wonderful addition to public services.

The Truth About Toe Walking

The Truth About Toe Walking

Let’s talk about toe walking!  I recently went to a course solely focused on toe walking and was super excited to go.

Why?

Because I had been finding that these kiddos were hard to treat, I often wasn’t getting the gains I had been hoping to, and, when I did, they didn’t always last.

Let me tell you, this course changed EVERYTHING!

I will honestly admit I had been doing it wrong all along!  I had been taught in school (like most physios) that toe walking was the result of tight calf muscles.  So, we did things like stretches, night splints and surgery.  What we now know is that tight calves is the consequence, rather than the cause.

Idiopathic Toe Walking

It isn’t uncommon for children who toe walk to be diagnosed with idiopathic toe walking.  Idiopathic means that there was no known cause, but what has happened over the years is that is has morphed to people thinking there isn’t a cause.

NOT TRUE!

There is always a cause.

Toe walking is super inefficient, and the only reason your body will do it is to meet a greater need.

Toe walkers of today are different then the toe walkers of previous generations.  We are using more equipment with our kids than we used to and more supportive toys when learning to walk.  We have more kids with sensory needs and/or autism.  All of these things make for fundamentally different toe walkers.

Which means that the assessment and treatment of these kids needs to go beyond looking at the calves!

Wait and See

I have come across some families that tell me they were informed that toe walking is normal and not to worry, as they will grow out of it.  Toe walking is NOT a normal part of development – if your child has just learned to walk in the last week or two and you see them up on their toes and then they go back down to the soles of their feet, and this happens less and less, then you likely don’t need to be concerned.  But studies show almost all 18 month olds step with their heel first.

Did you know our balance strategies during walking are developed by 3 years old and the bones in our foot are solidified by 4 years old?

AND it is possible for walking on the toes to actually deform the foot bones!

It’s a challenge to make changes to both of these things after that point.

Lastly, our adult walking pattern is solidified by 7 years old, so how a kiddo walks at 7, is how they will walk as an adult.

That’s why earlier is better to try to address these issues BEFORE our foot, balance and walk are all solidified!

Toe Walking as a Marker

Earlier in this post I talked about how toe walking is inefficient and that the only reason someone will do it is to meet a greater need.  A new study has shown that there’s a correlation between speech difficulties, learning disabilities and toe walking.  This likely explains the underlying reason the child is toe walking in the first place.  Because children typically start walking before they have much speech, toe walking can be a marker for other concerns that haven’t yet emerged, but should be monitored.

Long Term Consequences 

You may be thinking, what is the big deal?  Is it THAT important that my kiddo is up on their toes – they are walking, right?!

Wrong!

There are long term consequences!

Some long term consequences of toe walking include increased frequency of injuries, knee instability, difficulty finding shoes and early arthritis and joint pain.

But what about those kids that can, when asked, put their heels down?  A recent study found their calf strength and overall endurance was significantly less then their peers, which means they have a harder time keeping up!

There is an interesting video/interview here talking about the long term repercussions of toe walking.

So, the long and short of it is that toe walking is a complex issue, much more than most physiotherapist and doctors ever thought.  Treating it is possible without drastic measure such as night splints, botox or surgery.  However, as with most things, the earlier the issue is addressed, the better the likelihood of results.  So, if you have concerns regarding your child’s toe walking, book an appointment with a physiotherapist who has training in toe walking and will take a wider approach than  simply looking at their calves!  If you are in my area feel free to reach out to me at erin@newhorizonsrehab.com or (519) 291-5402.

Sitting Still in School

Sitting Still in School

I came across this article recently and, although it’s a bit older, it got me thinking.  I too, like Angela Hanscom, an occupational therapist, have parents who have been getting feedback from their children’s teachers that they are concerned with ADHD and fidgeting in school.  I often get questions from parents on how long their child should be able to sit for during class.  And, vice versa, teachers who feel that children aren’t able to sit, pay attention, and participate appropriately.

In the article, Angela discusses observing a typical classroom (not special needs) at the end of the day and seeing that kids were tilting back in their chairs, fidgeting, chewing on pencils, etc.  From what I hear from my friends who are teachers, (a variety of elementary grade levels) this is pretty typical.  When I hear this, I can’t help but think that I don’t really remember that from when I was a kid in school.  Sure, there was the occasional kiddo who would play with a pencil, or lean back in their chair on the occasional day, but not the majority of the class on a daily basis.  So what happened?!?  Why is this happening?!

Angela touches on two things in her article, the first being our expectations for kids to sit for longer periods.  I know this will fluctuate from school to school and teacher to teacher, depending on how their classroom is structured.   However, the constraints of getting everything in that needs to be taught, as well as school policies, often means that kids are sitting for looonnng periods of time.

I was speaking to my family on the weekend and got asking my niece a bit about this.  In her school, the children don’t move class to class for different subjects (which we did as kids – at least specialty ones), they stay at their desks and the teachers come to them.

The second is that our kids are just not moving enough! From an occupational therapy perspective, she talks about how not having kids move is effecting their attention.  And I whole heartedly agree!!  But what really got me thinking, is how this all relates to the kids I see here in physio.

I have been seeing more and more kids in the last little while whose parents tell me that their teachers are concerned that they fidget constantly.  When I assess them, the trend tha I’m seeing more often than not is that they don’t have much core strength (*Check out my past blog posts to learn more about our core).  So, I have been paying close attention in sessions, as well as when I get them to come in from the waiting room, and I’m starting to think these kiddos fidget as a strategy to compensate for their lack of core strength. (Hence why this article seemed perfectly timed in a connect the dots kind of way!)  I would have typically described kids with poor core strength as those kids who melt into chairs and lay on their desks (and I do still hear about quite a few of those kids as well), however I like to think of these kids as a new breed of poor core strength kids.  These are the kiddos who parents might think are strong (“They have a six pack, how can they have a weak core?”), however, when you test them they have okay initial strength, but their endurance is not where it should be.  Again this goes back to kids not getting enough time being active – a sport two days a week for 45 mins is just not enough time!  So, instead of melting, they move constantly to recruit different muscles and to give those tired muscles a break.

I also keep thinking that the types of moving kids are doing now is also different to what we used to do as children, and that the issue is starting long before these kids get to school.  But this post is lengthy enough (these next two thoughts I could chat for hours about lol) and I don’t want us all sitting reading and not MOVING, so look forward to future blog posts on container babies (WHAT?! …just wait!) and why risky (and rough and tumble) play is important!

Core Strength in Kids

Core Strength in Kids

We have all heard the buzzword ‘core strength’ being thrown around with respect to health and fitness in adults, and know we should all be working on it. But, what most of us don’t think about is how important core strength is for children and their development. Let’s start at the beginning…

What is the ‘core’?

There is actually an inner core and an outer core set of muscles and they need to work together.  Our inner core is made up of the transversus abdominus, the pelvic floor, the respiratory diaphragm and the multifidus. These four muscles work together deep in the body to stabilize our spine and pelvis.  Our outer core includes the rectus abdominus, the erector spinae, the external obliques and the muscles that stabilize the shoulder blades and hips.  These are the larger muscles that do more of the moving.  The key is for both the inner and outer cores to work in harmony with each other.

Why is core important?

The core muscles primary role is to provide balance and stability – this is no different in children and is, in fact, more important than in adults, as it is the foundation of all skills.

Children should be developing strength from the inside, aka core, outwards to the arms and legs.  This starts with posture/alignment.  Children with weak cores often look like they are melting when sitting on the floor or in a chair, or will use compensation strategies such as W-sitting to keep more stable.  Without this foundation, children can have difficulty with balance, and the more complex gross motor functions such as running, jumping or even playing soccer.  Less often thought of consequences can include difficulty with fine motor tasks such as writing and speech concerns.

How do those relate, you ask?  With fine motor tasks it is important to have a solid trunk and shoulder control, ie. core strength, which then allows easier hand manipulation and more control.  Speech can be affected by a weak core, as one of the four inner core muscles is the respiratory diaphragm which controls our breathing.  Without a properly functioning inner core, controlling and timing our breathing becomes difficult, which then affects how we speak.  Amazing how important our core control is in so many different ways.

How do we work on core strength?

Of course, most of us know the traditional ab exercises, however, these are not the best way to work on both the inner and outer core muscles.  On top of that, for us to engage these muscles properly, we need be in good alignment.  In children it can be an even bigger challenge as, of course, they don’t want to do exercises and so it needs to be fun!

It’s important if you suspect your child has a weak core to see your paediatric physiotherapist to ensure your kiddo has ideal alignment and to work on increasing their core strength.

Accessing Private Physiotherapy Services and Benefits

Accessing Private Physiotherapy Services and Benefits

Accessing Private Physiotherapy Services

One of the first questions I typically receive from a parent who I meet in the community is “How do I get referred to a private physiotherapist?” It’s super easy, but for a lot of families who have never needed physiotherapy, it can seem almost too easy.

The biggest myth out there is that you need a doctor’s referral, which in Ontario is absolutely untrue. Physiotherapists are able to assess and treat without a doctors’ referral. You simply need to call or email and book an assessment. It really is as simple as that! Some of my families comment that, had they known it was that easy, they would have called a long time ago.

For some families, however, there is one exception to what I just said above – if you are planning on using extended health benefits to cover the cost of physiotherapy, (YES! You can do that!!) some health plans require a doctor’s note to be eligible. I always encourage my families to check their benefit coverage first before we start.

Using those benefits!

Lots of families have some sort of extended health benefit plans, typically through one or both of the parents’ places of employment. Most cover physiotherapy up to a certain amount each calendar year. Some people just think of those benefits for physiotherapy to recover from an injury such as a broken bone or sprained ankle; however they can absolutely be used to cover physiotherapy for conditions such as developmental delay, torticollis or plagiocephaly (flat head syndrome in infants).

Every clinic will operate slightly differently -here at New Horizons Rehabilitation Services, clients have to cover the cost of treatment up front and will immediately be given a receipt which they can submit to their extended health provider to be reimbursed. This is typical of private physiotherapy clinics in Ontario.

I always recommend that families let their therapist know if there is a constraint on funding, or if benefits are limited, so together you can plan the most appropriate way to use your funding. As well, ask your therapist if there are any other possible avenues for funding for physiotherapy – there are occasionally bursaries or charity funding that you might qualify for.
If you have any specific questions or concerns about how to access services or using your benefits, feel free to send me an email and I will help as best I can.