What Is Intensive Feeding Therapy at MetroEHS and How Does It Work?

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

Greetings, fellow guardians of childhood! Today, we embark on an epic quest to uncover why early intervention in pediatric therapy is the ultimate secret weapon in the battle for our little heroes’ futures. Grab your capes, as we delve into the extraordinary world of neuroplasticity!

What is Neuroplasticity?

Imagine your brain as a high-tech superhero headquarters, constantly adapting and evolving with every new challenge and adventure. Neuroplasticity is the brain’s superpower that allows it to reorganize itself by forming new neural connections throughout life. This means that even if our tiny champions face developmental hurdles, with the right support and early intervention, their brains can reroute and expand like an elastic superhero — ready to tackle any villain that stands in their way!

The Sidekick Advantage: Why Early Intervention is Key

Just like every superhero has a trusty sidekick, children thrive when they receive early intervention in therapy. Research shows that the earlier kids receive therapeutic services, the more they can harness the powers of neuroplasticity to strengthen their skills, build resilience, and achieve their personal goals. Waiting too long can mean allowing obstacles to grow larger than life, much like letting a villain strengthen their force field!

Fighting Supervillains: Common Developmental Challenges

From speech delays, motor skill challenges to difficulties in feeding, utilizing early intervention means therapists swoop in like The Flash, delivering focused support to help children navigate these hurdles. With specialized tactics, our tiny heroes can battle their challenges and emerge triumphant, all whilst building confidence and unlocking their hidden potential!

The Dynamic Duo: Parents and Therapists Unite!

In this superhero tale, parents are the ultimate allies, teaming up with skilled therapists to devise personalized action plans tailored to each child’s unique needs. The synergy created by early intervention turns this duo into an unstoppable force—ready to level up skills in communication, socialization, and physical abilities. Together, they create a supportive environment where our little champions can flourish!

MetroEHS prioritizes early intervention in pediatric therapy because it isn’t just best practice; it’s a superhero saga ready to unfold with amazing successes! Using the incredible force of neuroplasticity, our little ones can script a future filled with hope, happiness, and triumph.

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.