Joe DiMaggio Children's Hospital

Developmental Programs

The developmental therapy programs offered at Joe DiMaggio Children's Hospital include physical, occupational and speech therapy. These disciplines look specifically at how a child is progressing through the developmental sequence during the critical years from birth through age 6. Developmental therapies provide focused and individualized assessments and treatment programs to promote motor, sensory, cognitive, language, feeding and self-help skills.

With a prescription from your physician, our team of specialists can evaluate your child and identify their specific needs. This allows us – with your help – to develop an intervention plan to help your child overcome challenges and improve the quality of his or her interactions.

Developmental Skills

0-2 Months

• Turns head to both sides when lying on stomach
• Kicks feet alternately when lying on back
• Coordinates sucking, swallowing and breathing
• Follows moving object through most of a circular path with eyes
• Moves limbs, head and eyes in response to voice or noise

3-5 Months

• Raises head and chest to 90 degrees when lying on stomach
• Aligns head with the body when pulled to sitting
• Rolls stomach to back
• Sucks and swallows pureed foods from spoon
• Reaches for dangling objects
• Plays with hands together
• Transfers toys from hand to hand
• Vocalizes when talked to or sung to
• Turns eyes and head in direction of voices and sounds

6-8 Months

• Reaches for toys while playing on stomach
• Sits unsupported for 30 seconds
• Rolls from back to stomach
• Crawls on stomach
• Gums and swallows crackers
• Drinks from a cup with help
• Chews food
• Rakes or scoops up raisins and holds them
• Vocalizes consonant sounds
• Imitates sounds already in repetition

9-11 Months

• Crawls on hands and knees
• Pulls to stand using furniture and walks holding furniture
• Stands alone
• Finger-feeds small pieces of food
• Chews crackers
• Eats mashed table foods
• Pokes with isolated index finger
• Uses thumb and first finger to grasp raisin
• Imitates sounds combinations (mama, dada, baba)
• Imitates non-speech sounds (click, cough)
• Inhibits activity in response to "NO"

12-15 Months

• Walks alone including stops, starts and turns
• Squats in play and resumes standing
• Feeds self with spoon (many spills)
• Chews well
• Builds a two-cube tower
• Scribbles spontaneously (no demonstration)
• Imitates words
• Uses two words meaningfully
• Shows a body part, clothing item, or toy when asked

16-19 Months

• Runs stiffly
• Walks up stairs when held by one hand
• Climbs onto adult-sized chair
• Drinks from a cup without help
• Eats entire meal with spoon without help
• Sorts round shapes in shape sorter
• Follows two familiar directions
• Uses more than two single words to express wants
• Points to three body parts on self or doll

20-23 Months

• Jumps in place
• Walks down stairs held by one hand
• Sucks through a straw
• Makes vertical and circular scribble after demonstration
• Completes three-piece puzzles
• Attempts to fold paper imitatively
• Uses two-word sentences
• Names at least three familiar objects or pictures
• Follows a new instruction exactly

24-27 Months

• Goes up and down stairs alone
• Kicks a ball
• Draws lines up and down after demonstration
• Unscrews jar lid
• Scribbles with circular motion
• Uses own name when referring to self
• Uses three-word sentences

28-31 Months

• Walks on tiptoes
• Builds eight-cube tower
• Responds properly to two requests regarding location
• Uses three different sentence types

32-35 Months

• Rides tricycle using pedals
• Copies a circle already drawn
• Cuts with scissors
• Uses fork
• Spoon-feeds (no spilling)
• Uses four different grammatical constructions appropriately

Amputee Rehabilitation

The amputee rehabilitation program provides each of our patients with individualized treatment, based on a comprehensive assessment. Our goal is to maximize each child's independence and help him or her regain a productive, rewarding lifestyle.

Phase I

• Promotes healing of the involved limb
• Provides education regarding skin care and prosthesis usage
• Helps reduce swelling and prepare limb for prosthetic fit
• Improves strength and range of motion
• Facilitates independence in functional activities prior to arrival of prosthesis
• Assists in prosthesis prescription and fit
• Facilitates desensitization of involved limb

Phase II

• Provides instruction and education in proper skin and prosthesis care
• Instructs patients in donning and doffing the prosthesis
• Provides instruction in proper prosthesis use for ambulation, transfers and activities of daily living
• Facilitates community re-entry

The program specialists involved are:

• Physiatrist or primary physician
• Physical therapists
• Occupational therapists
• Prosthetists

Audiology

Audiology services at Joe DiMaggio Children's Hospital are available for all age groups (newborn, infant, pediatric and adolescent). These following services, which are performed by a licensed, certified audiologist, are available.

A standard audiological evaluation may include:

• Standard audiological evaluation
• Auditory brainstem response (ABR)
• Auditory steady state response (ASSR)
• Visual reinforcement audiometry
• Behavioral observation audiometry
• Play audiometry
• Otoacoustic emissions (OAE)

Immittance testing includes:

• Tympanometry
• Acoustic reflex assessment
• Eustachian tube function

Cancer Treatment Program

Current treatment interventions for cancer include surgery, chemotherapy and radiation therapy. Despite the success rate of these procedures, children may experience physical changes following them. These physical complications may include scar tissue formation, pain, decrease in motion and lymphedema. These complications often interfere with normal daily play/functional activities.

The overall goal of rehabilitation is to allow children to reach their highest level of function for a more productive and enriched life. Accomplishing this involves individualized assessments and treatment plans, the establishment of home programs through patient/family teaching, collaboration with community resources, and coordination with the therapists, patient, family and physician to achieve continuity of care.

Types of therapy intervention include:

• Strengthening
• Improving function of daily activities
• Lymphedema therapy
• Vestibular therapy
• Feeding/Dysphagia
• Voice therapy
• Assistive and/or adaptive equipment
• Range of motion/gentle progressive stretching
• Pain management

Hand Therapy

The Pediatric Rehabilitation Centers offer a wide variety of pediatric hand and upper-extremity rehabilitative services. Our distinguished team, with an average of 20 years experience, includes certified hand therapists. With our highly specialized training, compassion and understanding, we provide a comprehensive therapy program for children to help them reach their maximal functional goal.

Through a results-oriented rehabilitation process we can provide both preoperative and postoperative therapy, following current protocols for any of the following diagnoses:

• Amputations
• Arthritis
• Burns
• Congenital anomalies
• Crush injuries
• Fractures
• Peripheral nerve injuries
• Upper-extremity neuropathies
• Tendon lacerations
• Tendonitis
• Traumatic injury

Specialty services include:

• Newborn, infant, pediatric and adolescent custom splinting
• Wound/burn/scar management
• Adaptive equipment
• Pain management
• Joint protection programs

Dysphagia/Feeding Program

We evaluate and treat various disorders of feeding and swallowing. During the initial visit, the speech-language pathologist performs a comprehensive assessment. At that time, the strength and movement of the muscles involved in swallowing are assessed. In addition, posture, behavior and oral movement are observed during eating and drinking (bottle and cup). Additional tests may be recommended to further evaluate swallowing function, such as a modified barium swallow.

Treatment varies greatly depending on the cause of the symptoms of the swallowing problems. Treatment may include:

• Exercises to increase strength, sensation and coordination
• Diet modification
• Ongoing education of equipment and/or technique recommendations
• Sensory processing to decrease feeding aversions

Early Intervention and Developmental Program

Success in a child's development often depends upon early identification of problems at the earliest possible age. Recognizing early warning signs for childhood problems can improve your child's chances for a happy and independent future. All children are unique, with their own individual strengths and talents, so early identification of a child's development is critical. Our services focus on that very critical period in your child's life from birth to three years of age. In the Early Intervention and Developmental Program, a child will be assessed for risk factors that would result in a developmental delay. Those risk factors may include prematurity and/or other medical conditions.

Your child will be assessed on an individualized scheduled time frame between the ages of 3 months and 3 years by a team of professionals, which includes a pediatric physiatrist, pediatric nurse, physical therapist, occupational therapist, speech-language pathologist and a social worker. Services include assessment, consultation, education and referral recommendations to parents/guardians.

Because early detection is so important, we have included a checklist to help you determine if your child is at risk for developmental delay. If you feel that your child is at risk, please contact your child's primary physician.

Interactive Metronome Therapy Program

The Interactive Metronome allows children who are experiencing difficulty in any of the following areas, the opportunity to improve through this computer-based program:

• Attention and concentration
• Motor planning and sequencing thoughts and actions
• Language processing
• The ability to perform complex problem-solving activities
• Social behavior (aggression and impulsivity)
• Balance and gait
• Academic activities
• Endurance
• Strength
• Motor skills
• Coordination

Interactive Metronome therapy trains the brain to plan, sequence and process information more effectively. It typically involves multiple sessions in which the computer produces a metronome beat heard through headphones. The system challenges the child to improve their accuracy as they actively try to match the auditory or visible beat from the computer program. During training, IM's auditory guidance system progressively challenges the child to improve skills as they progress through a series of engaging, interactive exercises. The difference between the child's response and the actual beat is measured in milliseconds and a score is provided.

The ultimate goal is to achieve a low score, which indicates improved performance. Research has clearly shown that the brain learns through repetition of precise activities. By keeping the beat, the brain is trained to plan, sequence and process information more effectively.

Modified Barium Swallow Testing

Modified barium swallow studies are conducted by speech and language pathologists, radiologists and other professionals in order to evaluate and provide solutions for children experiencing difficulty swallowing or eating. The procedure evaluates the anatomical and physiological function of the swallowing mechanisms. This procedure helps the specialist to determine if there are any treatment techniques that can be applied to obtain a functional swallow, maintain adequate nutrition and hydration and increase safety and awareness.

Neurological Rehabilitation

Neurological disorders are illnesses that affect the brain and nervous system.

We provide a multidisciplinary approach and an individualized program for each patient. This treatment may include physical, occupational and/or speech therapies. Our outstanding pediatric specialists have education and skills specific to treating this younger population. Some have advanced pediatric certifications in neurodevelopment techniques and sensory integration.

Physical Therapy

• Gait analysis and training
• Balance
• Movement, strengthening and endurance exercise
• Aquatic/pool therapy
• Wheelchair and equipment needs
• Patient and family education

Occupational Therapy

• Activities of daily living and home management
• Splinting
• Home modifications
• Upper-extremity strengthening and fine motor coordination
• Cognitive issues
• Patient and family education

Speech Therapy

• Articulation and voice improvement
• Aphasia/ language therapy
• Cognitive retraining for memory and attention
• Swallowing therapy
• Patient and family education

Sensory Integration Program

Sensory integration is a treatment technique that is used with children who have difficulty accepting and integrating information that comes from various sensory systems, including visual, touch, sound, movement and body. The technique is used to help children learn to understand and interact with their inner and outer world. This will allow the child to be successful at school, at home and in play activities. Sensory integration treatment is provided within the safe environment of a therapy session and is guided by a trained therapist.

This is appropriate for people with:

• Attention deficit disorder (ADD)
• Attention deficit hyperactivity disorder (ADHD)
• Pervasive developmental disorder (PDD)
• Autism
• Asperger syndrome

The Roles of Therapists in Sensory Integration Training

Occupational therapy facilitates the development of everyday living skills in a functional and age-appropriate manner. Areas addressed include handwriting, cutting, self-care and play activities. The child is guided to learn how to integrate and perform these tasks successfully and independently.

Physical therapy addresses the area of organization and coordination of movement. The main focus is to assist the child to integrate body awareness to enhance movement skills and balance in all activities, including play skills. As the child gains control of movement tasks, his or her confidence and social skills improve.

Speech-language therapy provides strategies to decrease oral and facial sensitivities, enabling the child with hyperactive oral responses to tolerate and benefit from a varied and nutritional diet. In addition, the speech therapist will provide techniques and activities to enhance communication at home.

How Sensory Integration Can Help Your Child

Successful sensory integration treatment will allow the child to improve and demonstrate accomplishments in all areas, including overall coordination, balance, language, feeding skills, attention span, self-concept, self confidence, school performance and social skills.

Scar Management

You or someone you know may be experiencing a situation where a scar may not look or feel the way you thought it would. If the scar looks or feels raised, bumpy, thick, tight, or if you experience discomfort when someone or something touches the scar, Scar Management at Joe DiMaggio Children's Hospital may be for you.

Services offered include:

• Scar massage
• Techniques to decrease painful sensations
• Scar molds
• Patient education

Occupational Therapy

Occupational therapy is a skilled profession that helps a child lead independent and productive lives through the use of therapeutic activities/exercises, assistive devices, splinting and cognitive/perceptual retraining. Occupational therapy services typically include an individualized assessment, a personalized treatment plan and ongoing reassessment.

Some of the health conditions that benefit from adult or pediatric occupational therapy include:

• Work-related injuries
• Limitations following a stroke or other neurological condition
• Arthritis, multiple sclerosis or other serious chronic conditions
• Birth injuries, learning problems or developmental disabilities
• Burns, spinal cord injuries or amputations
• Specific hand injuries
• Vision or cognitive problems

Physical Therapy

Physical therapy is a profession that works with infants, pediatrics and adolescents who have a physical problem of a temporary or permanent nature. Professionals working in the field of physical therapy have been trained at the university level and are licensed by the state in which they practice. Physical therapists work with children who have limitations in their ability to move or function. They also work to educate the community on preventative measures to preserve health and well-being.

The physical therapy program is designed to help children regain their physical mobility, coordination, sitting and standing balance, postural alignment and strength. The foundation of physical therapy treatment at Joe DiMaggio Children's Hospital begins with a hands-on approach to reach a patient and/or family's desired outcomes. The physical therapist will assess each child's individual needs and concerns to develop an appropriate plan of care. Patient/parent education and participation is emphasized in order to achieve anticipated goals and expected outcomes. Patients and parents are educated on how to take care of themselves or for their child by performing a home exercise program that will complement their physical therapy visits. Our physical therapists will also act as a resource to assist you in making any lifestyle changes necessary to accomplish your goals. If maintained, this education will help improve the child's physical condition over a lifetime

Speech and Language Therapy

The speech and language therapy program consists of master level, ASHA-certified (American Speech Language Hearing Association) and state-licensed speech and language pathologists. We are here to individually evaluate and treat infants, pediatric and adolescents with communication and feeding disorders, including:

• Articulation and speech disorders
• Language impairment
• Oral motor/dysarthria/apraxia
• Fluency and/or stuttering
• Voice disorders
• Dysphagia
• Feeding aversions

Patients, parents and caregivers are educated on strategies to help each child reach his/her maximum potential.

Voice Therapy

Voice therapy is designed to help children enhance voice production and quality. Speech and language pathologists use cutting-edge equipment to provide immediate feedback that is needed to enhance progress. Exercises are geared toward correcting harmful vocal behaviors and to teach a healthy voice production pattern. Therapy may also be used to treat a vocal fold injury. A speech and language pathologist works with children to help them reach their optimal goals and voices