Cerebral Palsy: the most common motor disability. A group of disorders that affect a person's ability to move, maintain posture, and balance themselves.

Cerebral Palsy is often caused by damage that has occurred in the brain that affects its overall development. This disruption of development affects the ability to:

Nearly 70% of Cerebral Palsy cases are the result of an injury at birth?

Over 1 million people in the U.S. are living with CP?

Approximately 10,000 babies are diagnosed with CP each year?

When Cerebral Palsy might appear noticeable: 

CP might be recognizable as early as infancy or during the years of preschool and is categorized as a “non-progressive” disorder. Non-progressive essentially means that it will not continue to develop or get worse.

*CP increases the likelihood of seizure activity or one becoming blind or deaf

 stiffness and difficulty moving (most common type)

causes problems with balance and depth perception

How do we treat CP at Marshall Pediatric Therapy?

Marshall's multidisciplinary approach to treatment ensures that there's a comprehensive level of commitment to care. Marshall Pediatric Therapy offers Pediatric Occupational Therapy, Speech-Language Therapy, Physical Therapy, Mental Health Therapy, and a behavior program (Building Blocks Program), for children diagnosed with autism. Together, these disciplines can work together to address all possible concerns. Below you can see how Occupational Therapy, Physical Therapy, and Speech-Language therapy services contribute to what is being addressed. Marshall Pediatric Therapy has successfully treated a wide array of Cerebral Palsy diagnoses, ranging from milder to much more complex conditions. Marshall works with each individual patient and their family to instill confidence along the way.

*Note that some symptoms are more obvious than others

Cerebral palsy in relation to incontinence

Cincinnati Children’s Hospital CP Clinic:

https://www.childneurologyfoundation.org/disorder/cerebral-palsy/

A Cerebral Palsy Diagnosis 

Dynamic Movement Intervention (DMI) - SO, what is it? 

First and foremost, we would like to congratulate our very own Physical Therapist, Chloe Isaacs, PT, DPT, CIMI-2 on the recent completion of her certification in 

 and for being the FIRST in the state of Kentucky to become certified and bringing this method of treatment to Marshall Pediatric Therapy. Chloe is a graduate of the

In this post, we will not only introduce you to all things associated with DMI, but we will show you a few examples of DMI techniques first-hand from one of Marshall’s current patients, our sweet friend, Lillie. We are confident that the discovery and implementation of this technique have been a “missing link” for the overall effectiveness of some therapeutic treatments. We are excited to see how this form of intervention will help shape the world of pediatric therapy and future patients.

DMI Therapy. What is it and how exactly could it help benefit MY child?

is defined as “a therapeutic technique that is used in both

to help treat children with motor delays by improving automatic postural responses and promoting progress towards developmental milestones." The goal of DMI is to provoke a specified active motor response from the child in response to defined dynamic exercises prescribed by the therapist. This comprehensive intervention incorporates current research on neurorehabilitation, technologies, and methodologies. DMI stimulates neuroplasticity to facilitate new neuronal connections and the development of motor milestones. 

Regardless of the level of cognition and extent of neurological deficit or damage, affected children benefit from DMI motor intervention as it pertains to stimulating 

 Children diagnosed with any type of motor delay including conditions such as:

Children at risk, such as those who are born prematurely can also benefit from this therapy due to the strong neuroplastic changes that this treatment stimulates within the developing brain.

After a brief assessment, the therapist will identify areas of deficit, which will guide the treatment. The therapist chooses exercises that will challenge the child’s neurological system to the highest level of skill as well as exercises that develop the core and foundational milestones. Exercises involve movement against gravity, progressively more challenging support, provocation of desired movements, as well as postural and strength challenges. 

During a treatment session the child will complete many different exercises which provide novel and varied sensory and motor challenges and each exercise is repeated around 5 times. Exercises may be repeated from session to session until the movements become automatic, which results in improved balance and function. Exercises are conducted on a tabletop or the floor based on the child’s abilities.

DMI Therapy works well in conjunction with other therapeutic techniques and therapy equipment. These are often combined in a treatment session to provide better alignment and enhance optimal outcomes.

1. Gross Motor Skills – Improving the gross motor skills of children from birth by developing automatic motor movement. (Promotes Neurological Maturity)

 – Continuously increasing the challenge to encourage the child to respond with greater independence.

- All exercises focus on optimal anatomical alignment and stimulate postural control and verticality.

 - Muscle and joint range of motion is achieved by movement (Dynamical and functional stretching).  

 – Improved balance is a common thread through most DMI exercises.

 – Improving actions and skills that lead to attaining milestones such as rolling, sitting, standing, and walking.

 The strong sensory information provided by the exercises sends afferent messages to the brain to create specialized synapses that fine-tune balance, muscle control, and movement.

8. Modifying Tone, Primitive Reflexes, and Abnormal Patterns of Movement

 - DMI strives to provide normalized movement patterns to children with neurological dysfunction to assist with the integration of disruptive primitive reflexes.

 DMI focuses on gross motor skills, however, many other skills develop as a byproduct of this intensive intervention

One really great component of DMI is the encouragement of the parent’s involvement and participation in order for the treatment to be the most successful. At Marshall, we are advocates for this approach as well. The success of one’s individual therapy journey far surpasses what is introduced and accomplished in the clinic setting itself. When a parent is willing to learn and takes therapy techniques home that are assigned by our professional clinicians, they are continuing to challenge the child to reach milestones at a much quicker pace. 

"You always want to help challenge the child at their highest cognitive level. If you aren’t challenging the brain enough, especially during its prime developmental years, the brain is not able to successfully create neuro-pathways. It’s always important to remember that If you aren’t going out of your comfort zone, you aren’t going to see the change.” - 

Neuro pathways help to send signals from one side of the brain to the other. There are three types of neurons. 

= stimulated by our senses (sight, smell, taste, touch, hearing), and

 = help connect the neurons together. When there’s a disruption in the connection, this is when the child might experience difficulty with certain skills that require the intervention of therapy. 

We want to introduce you to one of our current patients and friends, Lillie, and her awesome mother, Brittany, who have opened up to share their pediatric journey and testimony so far. To advocate for Marshall, and for DMI. Brittany shares that traveling the distance from Mt. Sterling to receive services at Marshall Pediatric Therapy is "

Lillie is a little over two years old and has been coming to Marshall since November 2022. A brief glimpse at her diagnosis: Lillie was born 35 weeks premature and has the genetic disorders of both 

. Due to these conditions, Lillie has some onset setbacks developmentally that we are working through.

, in which instead of two chromosomes, they are born with three. Though this condition is identified as genetic, it’s usually not something that is inherited, it is rather due to genetic error at random

, also a chromosomal condition that is associated with many abnormalities in multiple parts of the body including:

An alarming statistic is that children with 

often times present so many life-threatening medical complications, that they oftentimes die before birth, or within one month after birth. 5-10% of children diagnosed with Trisomy 18 live past their one year and those that do, experience a high level of severe intellectual disabilities.

We are so grateful to be part of sweet Lillie's journey as a culmination of innovation and reliable resources that provide hope and peace of mind. When you are a patient at Marshall, you are treated like FAMILY!

Interested in booking an initial evaluation with one of our clinical experts!? We've got you covered 

Are you a clinician and Interested in becoming certified in DMI Therapy? Learn more 

An Introduction to Dynamic Movement Intervention (DMI) 

Long before I ever thought of physical therapy, before I knew what a pelvic floor was, I had a favorite picture book as a child titled “Everyone Poops.” Perhaps, even you read it yourself. Picture after picture of different animals and their piles of poop made me giggle, and I marveled at how even the tiniest ant pooped as I did.

But, what I didn’t know until I became a pediatric therapist, is that everyone 

poop with ease. And, even more importantly, the number of children affected by constipation and/or related urinary incontinence. According to van den Berg et al, up to 30 percent of children suffer from constipation and accounts for approximately 3% to 5% of all visits to pediatricians. Chronic constipation can result in a variety of long-term and short-term impairments including progressive bowel issues, enlarged rectum, colon dysfunction, and urinary incontinence at either daytime or nighttime.

According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), by 5 years of age, over 90% of children have daytime bladder control. However, that leaves 10% of children over the age of 5 with daytime or nighttime leaks or complete incontinence.

With all that said, you might be asking yourself “how can a physical therapist help my child with their bowel and bladder problems?” I would have to agree it sounds a little out of the box. When I first became a pediatric therapist, I never saw myself impacting the way kids can void and manage their bathroom time. But, with lots of research, additional training, and a whole lot of love, I’ve been able to work with families and kids to achieve their goals and resolve daily leaks, decreased awareness of when they need to void, nighttime leaks, and constipation. How? By specifically targeting a group of muscles called the 

I like to tell parents to think of their child’s pelvic floor as a bowl. It sits at the base of the pelvis, and like a bowl, holds in liquids such as urine or solids such as feces. Now, imagine that the bowel is made out of really thin paper, or in other words is 

Do you think it would still hold in liquids well? I’d say not. A weak pelvic floor can result in leaks, daytime or nighttime, or urgency, i.e. when your child does the “potty dance” and can hardly make it to the bathroom in time. Together with other core muscles, the pelvic floor plays a role in posture, breathing, and relaxation for when we actually do need to use the restroom.

Which brings us to constipation. When the pelvic floor muscles are overactive or have trouble relaxing, your child may experience painful bowel movements or straining. This can result in withholding patterns, and over time causes chronic constipation. Chronic constipation can also lead to incontinence or leakage, as an impacted bowel press on our bladder and urethra.

But, how might a Physical Therapist address these issues, and what does a pelvic floor PT session look like?

First, an evaluation would occur. This would include:

●  Current voiding patterns such as when and how often

●  Current concerns you have for your child

●  A postural assessment in sitting, standing, and lying

, visual inspection of your child’s perineum

●  Discussion with you and your child about voiding awareness

Once you and your therapist determine what needs your child has, you meet with your therapist on a weekly or twice weekly basis.

This is where it gets tricky; pelvic floor therapy is a commitment. It requires additional homework for you as a parent, with various strategies, charts, and logs completed in order to best monitor your child’s progress. BUT, the end result is wholly worth it.

So what does the therapist do exactly? Your therapist will implement a variety of techniques, including core strengthening, biofeedback, SEMG biofeedback, games, pictures, and relaxation techniques to get your child engaged and their muscles working correctly. Each week, activities will progress or change to further challenge your child and achieve their goals.

Thinking your child might need pelvic floor therapy? Great candidates for this type of therapy include

●  Children leaks or “accidents” after being toilet trained for at least 1 year

●  Children that are having difficulty toileting training past age 5

●  Children experiencing leaks at night

●  Children with diagnosed constipation

●  Children who need >5-10 minutes to complete their bathroom routine

●  Children who report pain or discomfort when urinating or having a bowel movement

●  Children or adolescents who leak with activity, such as sports, jumping, running, or giggling

●  Children who have difficulty “holding” when they have the sensation to urinate

●  Children who experience “streaking” of feces in their underwear consistently

If you take nothing else away from this article, I hope that you know the following 3 things:

Have questions about incontinence, constipation, or your child’s toilet routine? Consider 

 us at Marshall Pediatric Therapy and scheduling a Pelvic Floor Evaluation today!

It Hurts When I Poop, I Dance When I Pee, Why Your Child's Pelvic Floor is as Important as Their ABC's 

W-sitting is when a child sits on their bottom with their knees bent and feet positioned outside of their hips. If you’re standing above your child, you will see their legs and body make the shape of a W. 

Why Do Physical Therapists Not Like W Sitting? 

Prolonged W sitting can lead to the following issues: 

A child could be W sitting for many reasons such as core/trunk weakness, excessive hip flexibility and/or joint hypermobility, or low muscle tone. They may also W sit because it is easier for them! With a wider base of support, it requires less muscle work. 

With prolonged W sitting, some children can develop tight hip and leg muscles. Here are some ideas to try at home with your child! 

For a calf stretch, you can have your child sit or lie on their back. Holding your child’s foot in your hand, apply light pressure at the base of the toes and flex the foot up towards their head. Hold for 30 seconds once you feel resistance. There are two muscles in the calf, so keep their knee straight for a gastrocnemius muscle stretch, and you can bend their knee to stretch their soleus muscle. 

○ To prevent toeing-in, start by holding your child’s heel with one hand. With the other hand hold the front of foot at the base of their toes, and gently pull toes in outward direction, toward the pinkie toe side. 

If your child W sits, they most likely have weak core and hip muscles. Here are some activities to try at home! 

Encourage the child to “fix their legs” by demonstrating different floor positions such as sitting with legs crossed, legs in front, or side sitting. Other positions may include offering a child a low bench or stool to sit on. 

W Sitting

The ability to hold an object in one hand and move it without assistance from the other hand.

Children start to develop these skills between 2-4 years old with a single object. The order of development of these skills are first finger to palm translation, palm to finger translation, rotation, and lastly shift. By the ages of 6-7, children are able to manipulate and stabilize more than one small object within their hand. This allows children to use these in-hand manipulation skills more purposefully and functionally to complete everyday tasks. 

A child with poor in-hand manipulation can be observed manipulating objects with both hands and/or stabilizing the object with a table or body. Children who have difficulty with in-hand manipulation may be unable to complete certain tasks, require additional time, or may appear clumsy when handling objects. Many daily tasks required these higher level hand skills. Examples include: using a fork and knife, adjusting grip on paper when cutting with scissors, positioning a grip when writing/drawing, manipulating clothing fasteners, and operating tools. 

Poor or delayed in-hand manipulation skills can result in difficulties with the following: 

The components of in-hand manipulation: 

 The ability to turn an object end over end. An example of this is flipping a pencil over in one hand to use the eraser instead of writing with the tip of the pencil.

Simple rotation is the ability to roll a small object between the thumb and finger tips. An example of simple rotation is using the fingertips and thumb to open a small jar. 

 Complex rotation is the ability to turn an object end over end. An example of this is flipping a pencil over in one hand to use the eraser instead of writing with the tip of the pencil.

simple or complex rotation is being performed while holding an object with the hypothenar aspect of the hand (ring and pinky finger). 

 The ability to move objects between the fingers. A couple examples of this are when you try to separate two pieces of paper that are stuck together, or when you move your fingers closer to the end of your pen/pencil to begin writing. 

the ability to move an objects in a linear manner with finger tips while holding an object with the hypothenar aspect of the hand (ring and pinky finger). 

 Translation can be broken into two separate skills: finger to palm translation and palm to finger translation. Kids use finger to palm translation when they pick up small objects like pebbles, marbles, or cheerios one at a time, moving them with the fingers of only one hand into their palm. They use palm to finger translation when they move those small objects from their palm back to their fingertips one at a time to place them on the floor or table.

 the ability to move an object from fingertips to the palm of the hand. Ex: picking up marbles with fingers and thumb and moving them into the palm. 

 the ability to move an object from the palm of the hand to the finger tips. Ex: moving coins from the palm of the hand to the finger tips to insert them into a piggy bank.  

 holding an object with the hypothenar aspect of the palm (ring and pinky finger) while moving objects from palm to fingertips or fingertips to palm.

Activities that promote in-hand manipulation skills