The great outdoors provide many opportunities for all children to be active. Using lightweight plastic bowling pins helps children with special needs improve their mobility.

Did you know that lots of movement is essential in developing a child’s motor skills? It’s why playtime is such an important part of a child’s overall development.

The next time you’re at a playground, just take a few minutes to watch the different activities. You are likely to see kids running, darting, climbing, scooting and jumping. But whatever movements you see, they all have one thing in common: they help to develop a child’s large muscle groups.

Fortunately for parents, it’s fairly easy to find simple, fun and creative activities for children to do each day. The following ideas may be a good starting point, or you can always ask your little one what activities he or she would like to do. Just make sure the activities are age- and skill-appropriate, and discuss any concerns with your child’s health care provider.

1. Visit your local playground: Playgrounds are all different and require different skills, so be sure to visit several in your area. While you are there, you can practice different skills such as climbing, going up and down stairs, and moving to and from a seated position; play games such as Simon Says and Follow the Leader; or teach your child how to swing.
2. Use the sidewalk: This should be done with caution, but you can use the sidewalk as your own personal play area by jumping over the cracks, running or creating artwork with sidewalk chalk.
3. Embrace the great outdoors: There is a lot to do outside, including climbing a hill or taking a hike. Or you can play in your own backyard by pretending to be different animals (hop like a bunny, jump like a frog, walk like a bear), dancing (Hokey Pokey or Chicken Dance, anyone?) or jumping rope!
4. Play ball: Using both small and large balls, you and your child can focus on developing and improving throwing, catching and kicking skills. Just be sure to use equipment that is soft and won’t hurt the hands or feet.
5. Focus on the core and shoulders: Many kids have decreased core stability or weak shoulder muscles. Activities that help to strengthen both areas include wheelbarrow walks, crab walks, bear walks and push-ups.
6. Create your own obstacle course: Whether indoors or out, you can set up different stations that focus on jumping, climbing and crawling…just to name a few.
7. Ride a tricycle: Riding a tricycle develops movement, coordination and sitting balance. Adaptive trykes are available should your child benefit from using one.
8. Try a new sport: If your resources allow, you can enroll your child in gymnastics, soccer or taekwondo. Spending time around typically developing kids can also help to model gross motor skills. Plus, there are organizations that offer programs for children with special needs.

~ Gayle Talley, PT, ATP
Physical Therapy Supervisor
Addison Office

The kids, parents and nurses all enjoyed a special flight in a beautiful plane.

Not many kids get the chance to fly a plane, but that’s exactly what two kiddos from Epic’s Addison office recently accomplished at the Collin County Regional Airport in McKinney, Texas.

Gillian and Virgil – aka Lil’ Johnny – participated in Challenge Air, a wonderful program that improves the quality of life for children with special needs through the experience of flight.

And what an experience it was!

Lil’ Johnny, Gillian and their moms showed their excitement after completing their respective flights.

Gillian and Lil’ Johnny not only received a red-carpet welcome, but also sat in the co-pilot’s seat during their respective flights.  Plus, their parents and nurses got to go along on the flights to enjoy the adventure.

“Gillian has been going for three years now, and when she gets up in the air… and the pilot literally hands over the steering to her, it is just so exhilarating knowing my daughter who cannot walk, crawl or even speak is actually flying a plane,” said Kimberly, Gillian’s mom

Paula, Lil’ Johnny’s mom, also raves about the program. “Over the years, I have seen the pain in my son’s eyes as he watches other children doing things he cannot do. At Challenge Air, he can do the cool stuff too!”

Challenge Air was started in 1993 by Rick Amber, a former fighter pilot for the US Navy and teacher. The organization sponsors events throughout the US. For more information, visit Challenge Air’s website.

While dehydration is a common body fluid disturbance, it can lead to more serious medical problems – including shock and tissue damage – if not treated quickly.

With the hot summer months quickly approaching, it’s important to keep your kids well-hydrated throughout the day and to know the warning signs of dehydration.

The following four tips will help get you started, but it’s always best to check with your child’s health care provider before making any changes to his or her fluid intake.

1. Maintain adequate fluid balance: Make sure your child gets plenty of fluids each day, especially when she is sick or physically active on hot days. If you have a special needs child that receives fluid intake through artificial means, such as a gastrostomy tube, you should contact your physician to obtain guidelines on how much extra fluid to give during the summer months to prevent dehydration.
2. Know the early warning signs: Early recognition of dehydration is the best way to manage it. Parents should always be cautious when their child is having diarrhea or a fever, is vomiting, or has increased sweating during the summer months.  Report any changes immediately to your home care nurse and your child’s doctor.
3. Know when to contact your physician:  Signs of dehydration in children can present in many ways.  A sunken appearance of the “soft spot” on your infant’s fontanel (top of head), dry oral mucosal membranes, and absence of tear production when crying are just a few signs to look for in infants.  Lethargic behaviors and increased sleepiness are also signs that your child is possibly dehydrated. Decreased urine output is also another sign that it’s time to contact your child’s health care provider.
4. Choose the right fluid to rehydrate:  Knowing which fluids to choose to rehydrate your child is very important. Pedialyte is an electrolyte supplement /oral rehydration solution used most often in children, and can also be given to special needs kids via gastrostomy tubes. However, you should avoid using fluids such as sports drinks, soda, water, tea, and juices to rehydrate.  These fluids lack the electrolyte replacement that is required to rehydrate.

~ Marvelous Kirven, Clinical Director
Temple, Texas

Reading repetitive books aloud to your children is a great way to strengthen their speech development.

Nothing compares to the sweet sound of a child’s voice. The cooing, babbling and talking all reveal what the child is thinking as well as how he or she is developing.

But when it comes to speech development, what should children be able to say and when?

Though each child is different – and boys generally develop speech patterns more slowly than girls – most children should be able to say at least eight or 10 words by the time they reach 18 months. While delayed speech can be a sign of other developmental delays or learning disorders, it usually isn’t a major concern.  However, it’s always best to address all concerns with the child’s health care provider.

The good news is that many children with delayed speech can learn to catch up with their more talkative peers through a little parental encouragement. To get started, check out the following five tips to help your child improve his or her speech habits.

1. Have her hearing checked – A late talker should have her hearing checked to rule out auditory problems – even if she got a clean bill of health on her newborn hearing test.
2. Talk to him – For a child in the early stages of speech development, hearing his parents talk to one another is not the same as hearing a parent talk directly to him. Simple activities include naming your actions and his actions, as well as naming colors, shapes, activities and items. Singing repetitive songs and reading repetitive books will also help.
3. Watch her gestures, eye contact and play style – Does your child interact nonverbally at an age-appropriate level? Does she seem to understand verbal cues even if she doesn’t speak? If so, she is more likely to catch up when she begins to speak and less likely to experience long-term effects of delayed speech.
4. Consider baby sign language – Many parents fear that a child who signs will become dependent on sign language instead of learning how to talk. But the Mayo Clinic reports that both typically developing children and those with developmental delays can benefit from using baby sign language.
5. Consider an early intervention program – If you want some help and encouragement, or if you are concerned that your child may be lagging significantly behind in normal speech development, your local early intervention program can help level the playing field between your child and his peers.

If your child is showing signs of delayed speech, therapy may help. To learn more about Epic’s speech-language therapy for children, contact the office nearest you.

Before the big event!

Childhood cancer is no laughing matter. But that doesn’t mean that raising money to find a cure can’t be fun! Just ask Julie Boughter, LPN field nurse at Epic’s Downingtown branch.

“In April, I was one of over 200 people who had gathered for one reason: to raise money to find a cure for kids battling cancer,” said Julie.

And the way Julie and her fellow fundraisers decided to do this was by shaving their heads!

“People would often ask if I was scared to shave my head,” said Julie. “But it’s just hair. It will grow back.”

Jack, Julie’s client, isn’t sure what to make of the new hairdo.

While Julie has not been personally affected by cancer, she has a close friend who has. In celebration of Julie’s friend’s five-year cancer-free anniversary, both women decided to shave their heads at one of St. Baldrick’s head-shaving events. So far, the event has raised over $85,000.

The event also raised another valuable resource: human hair. Julie was able to donate her 10-inch braid to Pantene Beautiful Lengths, which helps women fighting cancer get real-hair wigs.

“I am lucky to be cancer-free, and if shaving my head helps raise money and bring awareness to this great cause, then that is the least I can do,” said Julie.

So far, Julie has raised over $1,500 for St. Baldrick’s, and her fundraising page will continue to accept donations throughout the year.

And one of the best ways to do this is to play!

Playtime is integral in a child’s development of language skills. As therapists, part of our job is to guide a child’s development through play activities and to teach parents to do the same.

As an ode to summer – and to Better Speech and Hearing Month – here is a list of five summer activities that will help parents focus on language development while playing with their little ones!

1. Plastic bugs: Found at your local big-box retailer for about $3, these little creatures are a great, inexpensive toy that can strengthen language development! Here’s how:

• Talk about each bug individually and its different body parts (legs, wing, body).
• Discuss how the bugs are similar and different. What colors are they? How many legs or spots do they each have?
• Hide the bugs in the yard or house, and work on following directions and using prepositions – “the bug is on the chair” or “under the table”

2. Nature walk: Whether at your local park or in your own backyard, now’s the perfect time to get outside. While you are there, take the time to talk about what you are seeing:

• The colors of the flowers, bugs and plants
• Relationships and actions (what grows, flies, makes sounds)
• The size of items (big flowers, little flowers, tall trees, short trees)
• Other kids on the playground (who is running, sliding, throwing, swinging). This is a great activity to practice verbs!

3. Water play: Enjoy a hot day with water play! Fill up a small pool or even a bucket with water. You can use cups, big spoons and strainers while discussing the different steps throughout the activity:

• Talk about actions (splash, pour, fill, dump, scoop)
• Label items (boats, spoons, cups)
• Talk about body parts (splash with your hands, splash with your feet, do little splashes with your fingers)

4. Follow the Leader/Simon Says: Both activities are great for toddlers and school-age children. Use Follow the Leader to work on identifying body parts and actions, as well as following directions. Younger children can participate by following visual instructions.

• Make sure you talk about what you’re doing and label, label, label! (“Shake your hands, shake, shake, shake” and “Stomp your feet, stomp, stomp, stomp”)
• Work on opposites (up/down, stop/go, loud/soft, high/low)
• Make instructions harder if the children are older (have them follow two or three directions at a time)
• Take turns being the leader and being “Simon.” But most of all, have fun!

5. Sidewalk chalk: This is a great activity for children of all ages. Older children can use sidewalk chalk to draw pictures and discuss what they are doing:

• Have them tell you about the picture they drew.
• Can they make up a story about their artwork or draw a picture to match a favorite story?
• Ask them to draw items in specific places (draw a butterfly above a tree, draw a blue fish under a bridge). They can use this activity to learn about following multi-step directions as well as prepositions.
• Ask your toddler to find items in an older sibling’s pictures.
• Use chalk to make a road for cars, and talk about driving the car on the road, parking the car, and going over a bridge.

The above list includes just a few of the speech development activities you and your child can do together while also having fun! Plus, helping your child learn language skills through play does not have to be expensive or time consuming.

What are you waiting for? It’s time to play!

~ Mollie Elliott, MS, CCC-SLP
Speech Therapy Supervisor – Addison, TX

Research has shown that the increase is not only due to improved diagnosis and awareness, but also genetic and environmental factors.

As occupational therapists, we often work with children with autism and help others see the unique ways that these special children see the world. We are also committed to helping children with autism adapt to their environments while helping to educate others on how to best interact with a child with autism.

While occupational therapists often focus on activities of daily living (dressing, grooming, toileting, and other self-care tasks), we also help children with autism overcome their sensory issues.

The ability to sensory regulate is one of the most common challenges facing children with autism. Sensory issues can include sensitivities to touch, sound and sight, as well as movement and balance issues that affect attention, language and posture, among other things.

During therapy, the occupational therapist works with the child to improve fine motor skills, bilateral coordination (using both sides of the body at the same time), grasp patterns (holding different objects), and other skills required for functional activities.

By using a variety of activities that involve the different senses and modifying the therapy techniques, occupational therapists can help improve a child’s attention and focus. And the real joy comes from helping children with autism come out of their shells and engage with others.

~ Anna Shveima, OTR
Occupational Therapy Supervisor – Dallas

But it can take some time to get used to having a nurse in your home caring for your loved one.

How will this new person fit into your home life? Will you even like this person? But more importantly, how do you know if this person is really capable of caring for your loved one?

If you have never experienced this situation before, it can be a unique and rewarding aspect of your home life. But it can also be a bit unnerving if you don’t know everything the home care agency has gone through to select your caregiver.

At Epic, we take great pride in hiring the top nurses and matching them with our clients. But before our nurses enter a home, we first go through several steps to ensure they possess the knowledge, skills and abilities to provide the necessary care

So how do we do this?

• Licensure – We check the state’s board of nursing examiners to ensure each nurse is licensed and in good standing – no disciplinary action. Each Epic office also re-checks licensure twice a month for all nurses.
• Professional references – We obtain two professional references from previous employers.
• Background checks – We conduct criminal background checks to see if there are any offenses. We also check with the Office of the Inspector General for any issues with Medicaid/Medicare.
• Drug testing – Our nurses must pass a drug test before entering a client’s home.
• Skills testing – Nursing candidates must pass several in-office tests (medications, OSHA, general nursing, documentation, etc.) to ensure they can provide the necessary care. Also, all candidates must demonstrate to their local nursing supervisor that they are proficient with gastric and tracheostomy tubes, ventilators and PICC lines, when appropriate.
• In-home orientation – Prior to working in the home alone, our nurses will participate in an in-home orientation with a preceptor and demonstrate that they have the knowledge to care for the clients.

As you can see from the above requirements, ensuring the highest level of care is priority one at Epic Health Services. It’s why we hire the best and provide them with on-going opportunities for advanced training – and why our clients are confident in the level of care they receive.

But some children have difficulty developing the skills needed to become more independent.

That’s when an occupational therapist or occupational therapy assistant can help!

Occupational therapists and occupational therapy assistants help children achieve independence. The therapists work with children on self-care – dressing, grooming, toileting, bathing and self-feeding – as well as everyday tasks at home or school.

As a result of occupational therapy, children improve, develop and restore their fine motor functions.

So what can parents expect from occupational therapy?

First, an occupational therapist will provide an individualized evaluation and discuss goals with the parents. Second, the therapist will develop customized interventions to improve the child’s ability to perform daily activities and reach his/her goals. Third, an outcomes evaluation is conducted to ensure that the goals are being met or to make changes to the intervention plan.

Wondering if occupational therapy is right for your child? Children with the following diagnoses typically benefit from occupational therapy:

• Developmental delay
• Perceptual motor delay
• Visual perceptual delay
• Feeding difficulties/disorders
• Sensory integrative dysfunction
• Dysgraphia (moderate handwriting difficulty)
• Gross motor planning problems (uncoordinated)
• Fine motor planning problems
• Difficulty maintaining attention
• Autism spectrum disorders (PDD, Asperger’s Syndrome, etc.)
• Neurological impairments resulting in delay of skill development
• Genetic disorders resulting in delay of skill development
• Prematurity

Our therapists our committed to helping your child succeed. If you have questions or want more information about our occupational therapy services, contact the Epic branch nearest you.

On March 2, Epic’s Addison office participated in Ducky Palooza, the ultimate rubber ducky race at the Frisco Aquatic Center in Frisco, TX. The event benefited Hope Park, a new 13,000 sq. ft. park designed for all children, regardless of ability and with a focused consideration for children with special needs.

Dana Buckner, client relations director, and Travis Nash, operations manager, not only represented the Addison office and provided information about Epic, but also cheered on the team’s sponsored duck – Ducktor Seuss – in the rubber ducky beauty pageant.

While Ducktor Seuss got a lot of votes, which meant more money raised for Hope Park, he sadly did not win the grand prize.

“Ducky Palooza was a fantastic success,” said Travis. “The event raised awareness and money for a great cause.”

The Addison team is now looking forward to helping build the park, which will take place April 5 – 14. Volunteers are still needed and encouraged to visit Hope Park’s website.

Be a part of the fun!  Be a part of history!  Be a part of building an amazing gift to families all over the North Texas area!