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Holiday Gift Guide!!

12/6/2021

 
Therapeutic Beginning’s Gift Guide 2021 

Our therapists and staff at Therapeutic Beginnings have compiled a list of their favorite toys used within the clinic and their home. These gifts promote a variety of skills children need to aid in their development, while also being exciting and fun. It is our hope that it makes your holiday shopping a little easier this year. Happy Holidays everyone!  

Mr. Christopher’s Top 4 Choices: 
  • Top Bright Toddler Toys Race Car Track: This toy offers a chance for cooperative interaction and turn-taking. It is a simple cause and effect that toy that is great for children age 18+ months. 
  • Buildable Toys (ex: duplos, lego or kinex) provides a medium to practice prepositions, direction following and cooperative interactions. 
  • Pretend Play Experiences (ex: dolls, kitchen, farm, etc.) provides situational learning and practice opportunities for language that is heard in everyday life. 
  • Learning Tower: This tool allows children to reach adult-level height and the opportunity to be involved with language experiences. Built for children 18 months and older, this stool encourages exploration and interaction needed for development of communication skills. 
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Ms. Emily’s Choice: The Nugget 
Ms. Emily says “the Nugget is a 4-cushion set. It on the pricier side, but it has seriously been one of the best investments we've made for my daughter (especially during the pandemic and in our rainy climate). It can be used for both excitatory and calming activities.” She uses this tool at home with her daughter to build forts, obstacle courses, and slides down the stairs to promote gross motor skills and sensory regulation. Her favorite feature is that all the cushions are machine washable. 
Another budget-friendly alternative is to utilize objects around the house, such as couch cushions, bean bags, and pillows to create a similar experience to the nugget. 


Ms. Jill’s Choice: Roll and Play
Roll & Play is a plush cube and game card activity for children 18 months and older. In this activity, kids roll the dice to select a color and follow the simple directions on the colored card. It is a fun and interactive game to play as a family that encourages creativity, imitation, play skills, and gross motor skills. Children will also develop their color and number recognition, as well as language skills. 


Ms. Leora’s Choice: Y-O-U
The best resource for your child’s play development: Y-O-U! 
Ms. Leora states, “During this time of year, it is really easy to think about what we should get for our children that will both entertain them and be a great resource for their development. Toys that require motor planning, cause-and-effect understanding, creativity, and pretend play are all excellent. However, these toys will never hold a candle to their most important play resource: you. You reading to your child/having them read to you, pretend playing with them, having them teach you something, making up stories with them, planning and creating “obstacle courses” at home, doing creative crafts together, cooking together, playing side by side with them, acting out stories together, building something together and, yes, playing with a variety of toys with them are all crucial tools that will immeasurably help them as they develop and grow.  So, as you navigate the holiday season shopping, keep in mind that you are the most amazing and beneficial play resource your child could ever ask for! “ 

For more information of stages of play and activities to do: https://va.gapitc.org/lets-play-stages-of-play-and-appropriate-activities-for-each/

Ms. Lexie’s Choice: Snap-Circuits
Ms. Lexie loves the Snap Circuits because it is a great STEM tool for promoting and practicing various executive function skills, such as organizing, planning, sequencing, sustaining attention, and problem solving. There are endless circuit patterns to make and explore that will keep your child engaged and learning. There are a 
wide range of kits varying in size and complexity for children ages 8+, with a beginner set designed for kids ages 5+.

Ms. Renae’s Choice: Lite Brite
Ms. Renae’s favorite toy to promote fine motor skills is the Lite-Brite! This fun and retro toy is great for children age 4+ and up, as it includes small parts. Children place small pegs into a board to illuminate the color and design. This activity promotes fine motor skills of eye-hand coordination, manipulation, pincer grasp, and dexterity, as well as visual-perception and visual motor integration.


Ms. Robin’s Choices: Fine Motor and Gross Motor Kits
Ms. Robin loves this Fine Motor Kit, as it can help children develop skills needed for utensil use, shoe-tying, cutting, handwriting, etc. An idea Ms. Robin has for home use is to place colored balls into the board while holding a few balls in your hand at a time to help with in-hand manipulation. She also suggests using tongs to manipulate and sort balls, placing items precisely with chopsticks, using the spoon to build up wrist stability, having children copy patterns to promote imitation skills, and....SO much more! This kit is suggested for children aged 3-6 years old. 
This Gross Motor kit can be used indoors and outdoors. These activities promote motor planning, bilateral coordination, vestibular/proprioceptive input, balance, planning and sequencing, social skills, and interaction with reciprocal play with peers and siblings. This kit is recommended for children who are 5 years and up. For more budget friendly options, parents can purchase individual items for a smaller kit if desired. 



Ms. Sarah’s Choice: Puppets
Ms. Sarah’s favorite toy in the clinic are Puppets. She has found great success in all age ranges, especially with the frog puppet. She uses puppets to target:
  • Feeding: as a precursor for kids who are having a hard time with new foods, they can feed a puppet.
  • Sharing: KIDS WILL SHARE WITH PUPPETS BEFORE THEY WILL SHARE WITH MS.SARAH! Puppets are smaller and less intimidating. 
  • Perspective taking: particularly if the puppet is an animal, they can work on "thinking like a ____" and talk about what things the animal would like.
  • Drills: having the puppet engage in drills (articulation, language) and see if the kid can catch the puppet being "wrong" and then help the puppet "fix it". Using the puppet is way less pressure for the kiddo.


Ms. Tiffany’s Choice: Craft and Science Kits
Ms. Tiffany says “I absolutely love craft/science kits for gifting! They provide an opportunity to get away from screen time, encourage some quality family time (parents and children can do it together), and often provide unique sensory experiences. They also allow children to work on direction following and sequencing in a fun way.” 

Example below is a slime kit:
Amazon.com : Elmer's Color Slime Kit : Arts, Crafts & Sewing

Ms. Tina’s Choice: Board Games
Ms. Tina’s favorite toys are board games. These activities promote play skills (turn-taking, sharing, impulse control), fine motor skills (manipulation, hand strength, and coordination), and executive functioning skills (problem-solving, impulse control, following direction, etc.). Ms. Tina states “my favorite board games in the clinic for my younger friends (4-6 years old) are Don't Break the Ice and Sneaky Snacky Squirrel. Even setting up the pieces can be therapeutic, as kids must use their problem solving and fine motor skills to place the ice pieces in Don’t Break the ice. For my older friends, I love Blockus and Mastermind to work on visual-spatial skills, working memory, and problem solving.”

Here's to a wonderful holiday season!  May your days be merry and bright!!

Back to School Tips!

8/31/2021

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We are headed back to school next week here in the Olympia area and getting ready to send the kids back (or get them started) can be a little tricky.  Back to bedtime routines, early mornings, longer days with more structure, and homework....so much to adjust to!
There are lots of kids and families who will struggle with anxious feelings regarding returning to this season of life.  The best thing we can do as parents is try to prepare ahead of time to the change in routine.

Here are a few tips that we have found successful:

Visit the School
Whether it is just a random visit or an open house, taking a walk around the grounds and showing them where they will play, eat and learn is a great way to make them more comfortable in their environment.  Open houses are a great time to meet their teacher, see their desk, show them the restrooms, nurses's office and playground.  Knowing what to expect can really set your child's mind at ease.

Read Books About Going to School
Reading books is a great way to give examples of all sorts of scenarios regarding school.  There are so many to choose from for all ages! They can help showcase that your child's feelings are valid and that there are others who might feel the same way they do (shy, anxious, excited, etc) about starting school. 
A few titles we like are First Day Jitters, Penelope's New School, Pigeon HAS to go to school and The Kissing Hand.

Role Play 
This is such a fun way to get conversations going and help your child navigate different situations.  Let them be the teacher and show how they would do things. Or present certain questions and scenarios they may struggle with like sharing, taking turns, conflict resolution, clean up and following instructions. The possibilities are endless really!  Playing school can be a stress free activity with tons of benefits!

Back to Routine
Setting up a routine always seems to be the hardest, yet most productive thing you can do for kids.  They thrive in structure, yet seem to fight it a lot.  The easiest and simplest forms of routine are consistent bedtimes and wake up times.  Sleep (or lack there of) is a major factor in a child's ability to learn, focus, sustain their energy and their overall attitude and happiness.  A rough estimate for sleep guidelines per age group looks like this:
Ages 3-5 years old........................10-13 hours per 24 hour day
Ages 6-12 years old......................9-12 hours per 24 hour day
Ages 13-18 years old....................8-10 hours per 245 hour day

Every child is different and some may need more or less hours than these suggestions, but it's a good place to start. 

Make a Morning Checklist
If mornings are an issue, sometimes a visual schedule or reminder is a great way to keep kids on track and help them take responsibility for the start of their day.  
The example below is easy to print out and place in a frame. They can use dry erase markers to check as they go and then wipe clean for the next day! Make your own or search for great printable online! Print this one here.

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The start of a new year is always filled with all kinds of emotions.  Make sure you take the time to check in with your child (and yourself) on how things are going.  Remember to have fun and don't hesitate to reach out for help if you need it; our therapists are always willing to problem solve and find a solution.

Have a great school year!!   
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Summer Fun Ideas in the PNW

7/5/2021

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​Sun is here, school is out, and it is officially time for summer! Here is a list of family-fun activities in Washington: 

Children’s Museums
Hands-On Children’s Museum in Olympia, WA. 
This museum offers sensory-friendly hour from 9-10 am, sensory-friendly kits, and sensory-inclusive playtimes (Mondays – Thursdays from 2:30 – 4:30 pm). Online reservations are required. https://www.hocm.org/sensory-friendly-events/
  • The museum has fun events planned all summer, including a rock-climbing wall, tinker fairy activity, and bubble mania. Here is a link to the special guest and activities list for the summer: https://www.hocm.org/summersplashfestival/
  • Children’s Museum in Tacoma and JBLM
    • Children’s Museum of Tacoma and Children’s Museum at JBLM are currently reservation only. Children’s Museum also offers virtual playful experiences through their Virtual Play to Learn program. 
    • https://playtacoma.org/playjblm 
    • https://playtacoma.org/childrens-museum-of-tacoma 
Camps
  • Bricks 4 Kidz is a Lego-based engineering summer camp for kids ages 4 to 14. They offer camps in Olympia, Lacey, Tumwater, Pierce County, and Kitsap Peninsula. Upcoming camps include Junior Builder for Pre-K and Kindergarten kids, Minecraft® theme, and Star Wars® theme camps. Please see the link below for additional information, including schedule, cost, and scholarships.   
    • https://www.bricks4kidz.com/washington-olympia-lacey/programs/summer-camps/
Timberland Regional Library Events
Story Trail 
  • Timberland Regional Library has created StoryTrails throughout Washington that will be available during the summer. The StoryTrails are a “fun and engaging way to combine a love of nature and a love of reading.” Families can walk nature trails in local parks while reading a picture book for free. Thurston County locations include Wonderwood Park in Lacey, Percival Landing Park in Olympia, and Cochrane Memorial Park in Yelm.
  • Visit TRL.org/Storytrail for additional information.
  • Zoom Story Time
    • TLR is also hosting weekly Zoom storytimes with other local families and expert storytellers.  
    • Their programs include Baby and Toddler Storytime, Family Storytime, and La Hora Bilingue.
    • Families can sign up for access for zoom storytime at the link below.  https://events.trl.org/events/upcoming?keywords=storytime&branches%5B175%5D=175

We Rock the Spectrum Kid’s Gym

We Rock is a sensory gym for kids of all abilities located in Federal Way and Bellevue. They offer classes, as well as open play with the use of the full gym. Open play must be supervised by a caregiver and be pre-booked. Please refer to the websites for additional information on cost and hours.
  • https://www.werockthespectrumfederalway.com/#
    • https://www.werockthespectrumbellevue.com/


Get outside!
This area is great for trails and parks with playgrounds. There is always a place to explore, find some shade and have a picnic.  Check the links below for some links to the city pages.  All the parks are listed there!

LACEY: http://www.ci.lacey.wa.us/city-government/city-departments/parks-and-recreation/parks-and-facilities
OLYMPIA: olympiawa.gov/city-services/parks/parks-and-trails.aspx
TUMWATER: https://www.ci.tumwater.wa.us/departments/parks-recreation/parks-trails


JUMP JUMP JUMP
Defy Extreme Air Sports is an awesome indoor trampoline park here in Olympia.  They have great packages and are open 7 days a week.  While they don't have a special time for smaller children, they state they are the quietest in the mornings right when they open.  For tickets and hours, visit their website at defy.com


Climbing Fun
Cirque Climbing Gym is fun for the whole family!  They have walls that are great for beginners to more advanced climbers. They also offer classes like Intro to Climbing and Intro to Technique.  It has drop-in/daily rates as well as membership options.  Find out more details here. 

And don't forget about keeping cool! There are pools, splash pads, and lakes to play in.  And the ocean is just over an hour away! 
Summer is a great time to explore new places, learn new things, and also find time to relax and enjoy the great weather. The PNW really shines in the summer months.  

What are your plans this summer?? Tell us in the comments below!





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Summer Time Ideas!! by Ms. Emily

6/4/2021

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Summer is almost here! While we all look forward to the warm weather, the lack of routine and structure can be overwhelming for children. As an occupational therapist, I know that play is the primary occupation of a child.  Play is therapy and therapy is play! That being said, we encourage play activities and outings that are designed to challenge our children, while helping them emotionally, physically, and mentally.  Here are some tips and activities to help keep your summer fun while keeping your child stimulated:  
  • Make a schedule! Look at the calendar together and make a routine for your family. Let your child help in choosing activities. This can include fun activities and daily needs such as chores and errands. Having things written down helps with predictably for our children. Did someone say Water Play Wednesday? Scavenger Hunt Saturday? 
  • Explore playgrounds around your city – or even new cities if you’re family enjoys traveling. Playgrounds provide our children with the ability to explore new environments while providing their bodies with vestibular and proprioceptive input; both which help our bodies remain regulated.  
  • Cook! With what feels like more time in our day, we may be able to incorporate our children in daily meal prep and recipe planning. This gets our minds moving while also incorporating sensory play – a two for one special!  
  • Check locally for sensory friendly times and opportunities in the community; This allows our children to participate in activities that may typically be overwhelming. See below for a few in our local community:  
Hands on Children’s Museum: Sensory Friendly Hour: Sunday’s 9am-10am 
Point Defiance Zoo: https://www.pdza.org/plan-your-day/sensory-inclusive/ 
  • Lastly, my personal favorite and most recommended summer activity: SWIMMING!  Swimming is a great activity for many reasons. It promotes sensory integration, motor planning, bilateral coordination, social participation, play skills, and overall strength! 
 
Most importantly, HAVE FUN! Summer is a great time to make memories with our children – some they will remember forever!  
 
For more summer ideas (the list is endless, truly), ask your therapist and we will be more than happy to provide ideas. We have lots of tricks up our sleeves. Happy Summer!! 

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Could my Child benefit from speech therapy? by Sarah

5/5/2021

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Difficulties with speech-language development is nonbiased and may touch the lives of any family regardless of socio-economic status or cultural background.  Because of the diversity of issues that may be present, there is the potential for confusion in understanding how to remediate issues and when to begin intervention. 
 
How  could speech therapy  help  my  kid?   
Is my child too old or too young to benefit from speech  therapy?  
Why did my doctor refer my child for speech therapy?  
I have specific concerns about my child’s communication, is this something speech therapy can address?  
  
You are not alone: these are some questions that a speech therapist can answer during almost every evaluation. The goal of this post is not only to answer some questions, but to give parents and guardians an idea of what speech therapy is and how it may benefit your child. Specifically, what a pediatric speech therapist may treat, an example of an evaluation, and how to get started if you feel your child may benefit from speech therapy.  
 
Who do pediatric speech therapists treat?  
Pediatric clinics serve kids off all ages, from 0-18 years old.   
Isn’t 0-3 years old too young for therapy?  
Nope! Many children from the ages of 3 and under do very well in therapy. Younger children are  often more flexible in their communication and  learn new skills more quickly.   Therapy for our youngest clients is often play based intervention accompanied by a home-based program. 
Are speech therapists available during COVID19?   
Yes,  we are- In fact, speech therapy is considered an essential service and has remained available through-out the pandemic.  Our clinic follows CDC and state-based guidelines for PPE use and implement a cleaning protocol.  We ask anyone not feeling well to stay at home.  Most parents wait in their car during appointments; however, some exceptions can be made to accompany a child into a therapy room when depending on a child’s needs. In addition, we offer telehealth! This allows for treatment  at  home, and many kids love showing their therapist  their favorite  toys and activities. Telehealth can be offered on an ongoing basis, or on a weekly basis depending on what would serve our families best.  
What do pediatric speech therapists treat?  
Ah yes, the big question. The answer is... a lot.  Speech therapists assess, diagnose, and treat disorders related to  communication. Communication  encapsulates  a vast array of skills, which may include:  
  • Articulation and Speech Sound Disorders- An area intervention that targets errors with specific speech sounds. As a child develops, we expect them to gradually master the sounds in their language and be intelligible to unfamiliar people.  Children with articulation errors may present as:  
  • A young child who strangers can’t understand  
  • An older child struggling with one or more sounds, such as /r/ and /l/  
  • A child who can form sounds correctly, but uses them in the wrong place  
To help you decide if articulation therapy  would be beneficial, take a look at the  speech  sound  development chart  found  here.  It  shows  the ages that sounds are first acquired  and when most children typically master the sound.  
  • Receptive Language- a person's ability to understand the language  being spoken to them. This is not a hearing disorder, and may persist despite having typical hearing.  Challenges in this area may manifest in a variety of different ways depending on your child’s age.  Examples may include:  
  • An infant who does not respond to their name  
  • A toddler  who may need the assistance of gestures to follow simple directions  
  • Answering questions may be difficult, and include  off-topic information  
  • Some children may struggle to follow conversations and not remember important details  
  • Expressive Language- while receptive language is what a person understands, expressive language is what a person can produce in daily conversation.  Delays in this area may present as:   
  • An infant who is a late talker  
  • Reduced vocabulary size   
  • Challenges constructing and organizing a narrative or story  
  • Frequent grammar errors that are not consistent with those that peers make  
For more detailed information regarding both receptive and expressive language development,  here are some helpful resources:  
  • For a simple chart that breaks down skills based on age, click  here  
  • For more detailed information on language development for infants between the ages of 0-6 months-old, click  here  
  • For a more in depth look at language and comparing skills acquired at the same age, try  this  page  
  • Social Pragmatic Language- how a child uses their language to interact with their conversation partners. Even a child with a robust vocabulary and excellent receptive language may struggle to communicate in socially appropriate ways. Difficulties with pragmatic language may present as:  
  • A child who does not  turn to look at  people talking  
  • Some children struggle to maintain an appropriate  personal space  and eye contact.  Different cultures have different social rules  regarding these skills, but a child struggling with this skill will usually struggle in their home culture as well.  
  • Children who interpret  everything literally, including figures of speech and sarcasm  
  • Conversation may focus only on topics they are highly interested in or jump between topics without warning  
Social pragmatic challenges can manifest in a variety of ways. This is one of the most diverse groups of deficits in speech therapy, so feel free to reach out if you have any questions about this area of communication.  Below are some references to help determine  if this may be a challenge for your kid:  
  • For more information about conversation and non-verbal communication, try  this  post  
  • For children that can maintain conversation, take a look at  this  breakdown of conversational skills  
  • This  chart is for children 0-3 years old, and also includes language milestones  
  • Stuttering- this is a fluency disorder that typically manifests when your child is a toddler. Young children may attend speech therapy to eliminate a stutter, while older kids can learn techniques for reducing the impact of a stutter on daily communication.   
  
  • Voice- if your child’s vocal quality recently changed (e.g., suddenly raspy, quiet, pitch breaking not associated with puberty), then a speech therapist  can help. After an ENT examines the structures for abnormalities or differences in vocal function, a speech therapist is needed to help with the following:  
  • Education of vocal health  
  • Teaching and practicing safe vocal techniques  
  • Providing resources for tools to reduce vocal trauma  
  
What would an evaluation look like?  
  A  speech pathologist will determine if your child is demonstrating skills consistent with their peers.  Research has demonstrated trends of development that are considered “typical” for all age ranges. If your child falls in the average range  for their age, then speech therapy won’t be needed. However, if they are placed outside of the average, then therapy will be recommended. Testing may include but not limited to:  
  
  • A parent interview and medical history  
  • Standardized testing  to compare their skills to their peers  
  • Observation while your child engages in structured play activities  or age-appropriate tasks to obtain a speech sample 
  • Having your child tell a story  
  
Speech pathologists have a variety of tools at their disposal to assist with the evaluation process.  Through years of ongoing education and experience, speech therapists acquire many strategies to aid in the testing process and learn to gather information during naturally occurring interactions.  This data can be used and compared to developmental norms to establish clear baseline levels of skills. 
  
If I am interested in speech therapy for my child, what do I need to do?  
  
Talk to your child’s primary physician about your concerns and to get a referral for a speech evaluation. Many pediatricians check speech and language milestones for their patients and will inform you if they are not developing at age expectations. If you have specific concerns about your child’s communication, your doctor may recommend a screening. This is a shorter session with a speech therapist to determine if further testing is needed.  
  
What do I need to do to get ready for an evaluation?  
  
Most clinic settings have an intake packet that is used to help choose the best evaluation tools for your child. Questions that are included pertain to their birth, medical and family histories,  present level skills, and your child’s interests.  Most testing situations are best served when a family arrives 10 minutes prior to the scheduled appointment, to give the evaluating therapist a chance to review this information and adjust their session accordingly.  
  
 If you have any questions or are  interested in learning more, please reach out! We would be happy to speak with you to answer questions or help decide if speech therapy can benefit your family.  
  Stay safe, stay happy, and stay healthy everyone!  
  
Sarah Swanberg  
CCC-SLP  
 ​
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Celebrating Occupational Therapy Month by Renae

4/1/2021

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What is occupational therapy and what will it address? 
A pediatric occupational therapist is ready to help your child with a wide range of skills! We are trained to evaluate and address a variety of skills including: 
  • Bilateral coordination skills – The ability to use both sides of the body in a coordinated fashion.  
  • Executive functioning – The ability to complete higher level cognitive tasks involved in thinking, making a plan, problem solving, and completing activities.   
  • Fine motor skills – Precise and coordinated hand and finger movements. The ability to draw, cut, color, use tongs, snap our fingers are just a few fine motor skills!  
  • Handwriting skills – Handwriting is a complex activity involving language being recorded by hand using a writing surface and a writing instrument.  
  • Range of Motion – Movement of our arms, fingers, legs, head, and other body parts to their full extent 
  • Self-care skills – Dressing, toothbrushing, grooming tasks including bathing and hair care, cooking, and mealtime are all examples of self-care activities! 
  • Sensory Processing – The ability to receive sensory information received from our world and respond to this input. Senses include vision, hearing, touch, taste, smell, body position, movement, and interoception (information about the internal condition of our body—how our body is feeling on the inside). 
  • Strength – Strength involves the ability to move against gravity, manipulate materials that provide resistance to our body such as squeezing putty or dough, , and the ability to sustain body positions – even including standing in one place! 
  • Transitions – Successfully shifting from one activity to another throughout the day.  
  • Visual motor skills – The coordination of the hands, legs, and eyes. These skills are involved in cutting, reading, kicking, or catching a ball. 
  • Visual perceptual skills – The ability to organize and interpret what is seen and give it meaning. 
We also provide home program suggestions to assist your family in continuing to work towards their goals in their home and community settings. Stay tuned in the coming days for specific ideas related to each area listed above. 
It is our great hope that the therapy process will be exciting AND challenging for the children that we serve – we love to see children develop to their full potential and are excited to celebrate their victories with you – big and small! ​

We will continue to post more about OT throughout the month.  
​Check our Facebook page for more information and tips.  

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Understanding Your Insurance

3/2/2021

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​Insurance can be confusing and hard to understand.  All kinds of terms and rules. Of course, you probably grasp the concept of copays and deductibles, but then they throw in other terms like coinsurance and out-of-pocket expenses. What do these terms mean, and how do they affect how much you pay for your child’s therapy?
Here is a brief explanation, so you can understand how they all work.
What are copays and deductibles?
Let’s review copays and deductibles to make sure you understand how they work.
Your copay is the amount you pay for pediatric medical and therapy services. For example, you might pay $25 for a pediatrician visit, and $50 for a specialist visit. 
Your deductible is the amount you must pay before your health insurance covers all or a portion of the bill. If your deductible is $5,000 a year, you must pay that amount on your own before your insurance will cover some of the remaining expenses.
What is coinsurance?
Coinsurance is a fixed percentage that you must pay for each service or visit. The rate might be 20%. This means you are responsible for paying 20% of the allowed amount set in the contract with your provider and insurance company.  Meanwhile, your insurance plan pays the remaining 80%.
Here’s the tricky part, and what often leads to confusion. Coinsurance applies after you have hit your deductible. In other words, even after you have reached your deductible, you will still likely have to pay a percentage of the bill.
What is an out-of-pocket maximum?
The out-of-pocket maximum refers to expenses you are required to pay out of your own pocket during a calendar year. The amount is the most you will pay for covered health care expenses. It effectively puts a cap on how much you have to spend every year. Once you have reached the out-of-pocket maximum, your insurance pays 100% of the remaining costs.
Note: Your monthly premium does not count toward your out-of-pocket maximum, but all copays, deductibles, and coinsurance do.

Here’s an example of how it works:

Out-of-pocket maximum = $6,000
Deductible = $4,500
Coinsurance = 20%
In this situation, you would pay the first $4,500 as a deductible, then 20% of the allowed amount at each visit. However, if your out-of-pocket maximum is $6,000, you are only responsible until you reach that total amount. There is usually an individual out-of-pocket and a family out-of-pocket, which combines all the enrolled members. As with everything regarding insurance, the out-of-pocket maximum varies widely from plan to plan.
How does a visit limit apply?
There are certain plans that also incorporate a yearly visit limit. Once those visits have been exhausted, you have the option to request more visits from your insurance company.  If they decline, you will be responsible for visit charges.  Some offices have certain rates for cash paying patients.  

While these are the most basic of terms and concepts regarding insurance, it’s a good start to understanding how your insurance works.  We always suggest reviewing your benefits package on your own or contacting your Human Resources department for specific questions about your plan. Our administrative staff is available to answer any further questions or walk through special situations that can come up.  Please don’t hesitate to ask, we’ll happily guide you in the right direction. 
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Heavy Work Advice By: Stephanie

2/2/2021

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Let’s face it, children are getting more screen time now than ever before. School is being held via online platforms and the rainy PNW weather is limiting opportunities for outdoor play. iPads, laptops, and other technological devices are not only the forefront of entertainment, but also for education. As parents or guardians, you may be noticing changes in mood, increased meltdowns, restlessness and/or new undesirable behaviors in your children and it is no coincidence.  

The good news is that there are ways to help combat these difficulties. You may have already heard your occupational therapist use the term “heavy work”, or they may have given you activities that incorporate heavy work to complete at home. Heavy work is the term used to describe one of our foundational senses called ‘proprioception’. Proprioception is our ability to recognize where our body is in space and also helps us regulate the direction and amount of force to use when moving. It is detected through sensory receptors in the joints and muscles.  

When a child engages in play that requires pushing, pulling, lifting, or hanging, they are stimulating the proprioceptive sense.  Children with sensory processing concerns will either seek out this sort of activity, or they may completely avoid it.  Kids with proprioceptive dysfunction are often “sensory-seekers” or “sensory-avoiders”. The following are signs that your child may experience proprioceptive dysfunction: 

Sensory-Seeking Behaviors: 
  • Seeks out pushing, pulling, jumping, and lifting activities 
  • Exerts too much pressure for the task (writing too hard, slamming doors, stomping feet when walking, etc.) 
  • Tends to play rough 
  • Enjoys deep pressure (tight hugs, being rolled up tightly in a blanket, sleeping while surrounded by pillows or stuffed animals in bed) 
  • Regularly bumps into objects or people 
  • Demonstrates poor postural control (slumps when seated, leans on objects or people when standing, difficulty with balance activities) 
  • Tends to bite or chew non-food items 
  • Difficulty with coordination activities (riding a bike, jumping jacks, hop scotch, catching/throwing, etc.) 
  • Often drops objects when carrying or holding them 
  • Has a high pain tolerance  
Sensory Avoiding Behaviors:  
  • Cautiously plays with others or avoids contact when playing with peers 
  • Prefers quiet, calm environments or shows distress with noisy environments 
  • Sensitive to touch 
  • Sensitive to various types of clothing 
  • Avoids common playground activities such as swinging or climbing 
  • Strongly dislikes crowded places  
  • Can hear background noises that most other people do not notice 
  • Has poor balance and/or coordination  

Whether your child falls into either category, there are ways to incorporate proprioceptive activities into your day. One way to ensure they are getting this input is to schedule “recess” time during the day, just as they would if they were attending school in-person. However, the purpose of recess is not for kids to do whatever they want, but to choose heavy work activities to complete. For example, when children are offered breaks by their teachers, have them choose their preferred heavy work activity from the list below and engage in that activity for 20-30 minutes. This is a structured way for kids to get the input that they need while also giving them control to choose what they want to do. 

Here are ideas for heavy work activities that can be done indoors when the weather is not in your favor:

 
Chores: 
  • Pull laundry out of washer and/or dryer 
  • Carry large bottles, cans, or boxes 
  • Sort recycling  
  • Carry groceries and/or shopping bags 
  • Load or unload the dishwasher 
  • Rip paper or cardboard  
  • Vaccuum  
  • Sweep or mop floor 
  • Push, drag, or move furniture  
  • Pop bubble wrap with hands or feet 
  • Push a shopping cart 
  • Wipe down surfaces with a towel 
  • Carry or push the laundry basket 
  • Help mix ingredients when cooking or baking 
  • Make the bed 
Playtime: 
  • Animal walks (crab, bear, snake, bunny) 
  • Build a fort 
  • Pillow fight 
  • Build an obstacle course (with couch cushions, chairs, blankets, boxes, etc.) 
  • Squish, knead, and play with play dough or silly putty 
  • Have a relay race with various exercises (wheelbarrow walks, army crawls, duck walks, bear crawls, inchworms) 
  • Freeze tag 
  • Simon Says 
  • Ride a bike or scooter 
  • Give sled rides to siblings in laundry basket, or push heavy objects in laundry basket 
  • Hop scotch 
  • Yoga poses 
  • Jump rope 
  • Wall push-ups, floor push-ups, or chair push-ups 
Engaging in heavy work activities promotes increased attention, a more regulated arousal level, and is beneficial for learning, playing, socializing, and completing daily tasks. It is also important to note that each child will react to heavy work activities differently. Let your child explore and note how each activity makes them feel or act to find the best methods that work for them specifically.  
 
Let your therapist know if you have any specific questions regarding proprioception and ways to incorporate it at home. Together, we can identify the best ways to help your child engage in heavy work to give their body the input it is craving, especially during these uncertain times.

 










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Having a child with special needs: One Therapist's Perspective                           By: Christopher

1/6/2021

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Having worked with pediatrics for most of my life, working as a speech therapist for 23+ years and raising two of my own children; I have been afforded a unique perspective in understanding the trials and tribulations, the obstacles and rewards, and the questions and answers that are prevalent in raising a child with special needs.  With that stated, a prevailing impression that I have found prevalent in my own reflection of my experiences are the comments and considerations raised by families ring a loud bell of familiarity.  Let me elaborate...

For me, I have recognized beneficial characteristics needed in raising a child regardless of their developmental beginnings.  Albeit, family dynamics do present differently and have varying levels of impact and play an integral role when comparing situations.   If we consider that these characteristics reveal themselves as occurring on a spectrum of developmental influence, we can determine that the emphasis of importance is squarely predicated on the needs of a child. The idea is that their value will ebb and flow as needs evolve.  In my opinion, raising a child [any child] comes down to a few fundamental aspects: Love, Stability, Structure, Predictability, Support (freedom to explore/grow).  With these ideals in mind, we can explore the relative similarities regardless of a child’s “needs”.


  • Love: This is simple to say but sometimes rather difficult to conceptualize and can almost feel cliche.  However, it is extremely important in emphasizing the desires we humans have to belong.  The family unit, as well as, care-provider's, bestow a subconscious net that envelops one with trust and comfort unconditionally.  This allows for prosperity in development.
  • Stability: In a continuation of Love, stability provides a foundation and a safe place from which a child can grow confidently through experiences. Stability frees a child from environmental stresses that can detour or hamper development.  Finding stability means a child can spend energy learning new skills and not have to worry about survival.
  • Structure: With structure we are provided with boundaries and consequences.  Both of which are important in establishing expectations and the “rules” for which we learn- in case of a child, play.  Boundaries help to establish beginnings and endings to experience.  They allow for the compartmentalization of like information or experiences for ease of recall and association.  Whereas, consequences help us to test and bring order to our experiences.
  • Predictability: Through predictability we are afforded the opportunity to look beyond the ‘here and now’ while expanding our associated knowledge.  In a given situation, knowing what may happen next, opens the doors to the imagination.  This establishes a new level of processing and allows for the building of associations that link ideas or scripts (i.e., associated ideas that follow an anticipated order) and aids in comprehension.
  • Support (freedom to explore/grow):  When considering development, we have to allow for the opportunity to practice.  All skills require some level of practice to acquire and to assimilate into behavior.  Developmental skills are no different, although they often appear covertly during play. 

Interestingly, it is the last described characteristic where therapists are most often inserting their expertise. Yet, it is through each of the characteristics contributing in concert that a child’s progress is realized.  The highest degree of success is typically appreciated through a coordinated partnership on the part of the family and the therapist. If nothing else is understood from this writing, understand that Love, Stability, Structure, Predictability and Support (freedom to explore/grow) are key considerations for positive development for which all children would benefit.
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Holiday Gift Guide 2020

11/30/2020

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Welcome to our first blog post!

With the holidays right around the corner, our amazing therapists have gotten out their thinking caps to come up with some of the best products and gifts that will stimulate your child's mind and grow their skills.  The list covers all ages, interests and abilities.  We've included links below, but they can be found all over!
(*we are also not affiliated with any of the links provided.)
And, as always, if you have any specific questions, don't hesitate to ask your therapist.  

Let's get started!!

1. The most popular suggestion this year, a weighted blanket!  They are helpful with calming anxious feelings and busy bodies.  They come in all different weights, the ideal amount is about 10% of body weight.  
You can find one here: 

2. Next up are Squigz!  These fun, colorful little suction cups have endless possibilities!!  Great for fine motor skills and creative thinking!  
They look like this!

​
3. Magnatiles are always a hit!  Think legos when it comes to building and science of structures, not to mention the laws of physics!  All while having fun!  

4. Board games are such amazing tools!  They teach great social skills like turn taking, sportsmanship and patience...along with critical thinking!  Here are some of our favorites for littles (here) and a bit older (here). These brands also have other great options, so make sure you peek around!

5. These next ideas focus more on gross motor skills at an early age.  They promote spacial awareness, body positioning and balance.  They also can be enjoyed both indoors or outdoors! 

6. Do you have a preschooler??  This one is for you!  Nothing is better than going back to the basics: blocks, Mr or Mrs. Potato Head, and a sweet little piggy bank.  

7. A few more random fun items that promote cause and effect with
Don't Break the Ice, fine motor skills with bingo dobbers and independent play with this race track.  

8. Books are the gateway to learning!  Your child can learn about rhyming with this classic or about social emotional learning and inclusion in the following books:
I am Enough, Grumpy Monkey, The World Needs More Purple People, The Boy with Big Big Feelings,  I am Human, Strictly No Elephants and the Big Umbrella. For older kids, Wonder is a great read and also was made into a movie. 

9. Memberships are a wonderful way to cut back on "stuff" if that is more your goal.  Think of children's museums near you, zoos, science centers or even trampoline gyms! Subscriptions are also the gift that keeps on giving...... magazines come in all topics and grade levels.  And don't forget about crate boxes!  They also come in all types of themes and age levels.  All very customizable!  We like Panda Crate and Kiwi Boxes, which mail out monthly.  Check out all the fun options here.

10. Who could forget good ole fashion pretend play?!  Some of the best growth comes from using our imaginations!  Dressing up, playing house, and feeding baby dolls teaches empathy and life skills, for boys and girls alike! These are a few of our faves: Baby Alive or this little guy,  wooden food, and dress up clothes. Endless amounts of fun!!

11.  Wanna know what really gets that brain pumping??  PUZZLES!!  The beauty of puzzles is the challenge of them grows with the child.  From sturdy wood puzzles like these to complex landscapes and interesting patterns, there is something for everyone!  You can find them with almost any character or special interest so you can keep their attention until the very end!  Nothing teaches patience like a good puzzle!  

12. And last, but not least, the big dogs.  The equipment that can turn your home into a sensory friendly area and make it feel like being with your OT.  Things like swings, mats, and bars keep the body moving and the brain calm.  Now, there's no inexpensive way to do this, but some of these are worth it and can be used indoor or outdoor. 

Well folks, that's all we've got for you! But remember, these are just jumping off points and suggestions.  Shop around for the best fit for your child and price point.  
Happy Gift Hunting!!
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    Tidbits of information directly from our on-staff therapists. 

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