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Key Takeaways: Physical Therapy and Early Intervention Q&A with Ashley Fielding, PT

May 22nd, 2023  | News


Ashley Fielding – pediatric physical therapist and fellow HIE mom – joined Hope for HIE to discuss the benefits of physical therapy and the power of early interventions to promote growth, development, and progress! 

If you missed her Live Q&A, don’t worry! Like any good partner, we took notes and are willing to share! Read our key takeaways below.

Key Takeaway 1: Early Intervention services create new roadways in the brain

Really, it all comes down to neuroplasticity, which is the brain’s remarkable capacity to adapt and change by forming new neural connections. When a pathway in the brain is impacted or injured, it can be trained to build a new one! The ability to do this is highest from birth to five years of age, which is why early interventions, which occur within the first three years of life, can profoundly impact a child’s development. 
Ashley quotes one of her favorite physical therapists, Karen Pryor – author of 10 Fingers, 10 Toes – to help understand the power of early intervention services on neuroplasticity. In her book, she likens neuroplasticity to building roadways: neural pathways initially resemble rough trails, but with increased traffic and use, they become more defined and form roads or highways. In other words, the development of these new pathways depends on the frequency with which we use or reinforce these new connections, and that’s why high-quality and consistent early intervention services are so powerful!

Key Takeaway 2: HIE can impact fine and gross motor development

HIE affects every child differently, and the degree of their fine and gross motor development depends on the impacted area of the brain and the extent of its injury. That said, HIE is associated with higher risks of developing motor conditions that will constitute future physical therapy services. These include the following:

  • Muscle tone abnormalities. These can manifest as an increased stiffness of the joints or muscles [hypertonia] or as increased floppiness [hypotonia.]
  • Decreased range of motion in muscles and joints. This can result in a contracture, which is the permanent shortening of the muscle, joint, or surrounding tissue, and may warrant surgery.

  • Heightened risk of developing cerebral palsy. Approximately 40% of those with HIE develop CP, whose symptoms often include difficulty with coordination, muscle weakness, stiffness or spasticity, and balance and posture. 

Key Takeaway 3: There are early signs and symptoms of needing physical therapy services

While every child is different and may reach gross and fine-motor milestones at different times, certain signs and symptoms can indicate the need for physical therapy services. As parents or guardians, it is always helpful to know what these look like so you can elevate them to your child’s medical team! These include:

  • Increased stiffness of muscles or joints. You may notice that your baby has difficulty stretching or bending their arms and legs, and their movements may seem jerky or awkward. For example, when trying to bend their elbow, the limb may stay straight or require extra effort to bend. Additionally, spasticity can cause babies to have difficulty relaxing their muscles, making it difficult for them to sit up, crawl, or walk.
  • The increased floppiness of muscles or joints. It’s important to keep in mind that babies are still developing their trunk muscles, so some head bobbing is normal. However, if a baby is not trying to hold up their head or trunk, this could be a cause for concern.
  • A strong rotation of the head to just one side. This may indicate torticollis, wherein the baby’s head is tilted to one side due to the tightening muscles of the neck.
  • The presence of Moro reflex after 2-4 months. Also known as the startle reflex, this occurs in newborns as they react to sudden movements or loud noises. When triggered, the baby throws their arms and legs out, brings them back in, and may cry. It typically disappears by 2-4 months of age. If it persists, this may indicate developmental concerns and is worth elevating to your child’s medical team.
  • The presence of the ATNR reflex, or asymmetric tonic neck reflex, after 6 months. This is a reflex that occurs in infants when their head is turned to one side. When the head is turned, the arm and leg on the same side as the direction of the head turn will extend, while the opposite arm and leg will flex. This creates a fencing-like position. The ATNR reflex typically appears at around 2 to 3 months of age and should disappear by around 6 months. If it persists beyond 6 months, it may be a sign of a developmental delay and is worthy of elevating to your child’s medical team.

Key Takeaway 4: The process of initiating PT or other early intervention services may differ by state or region

There is no single or correct pathway to beginning PT or other early interventions, and this is because every state and region works differently. However, Ashley does recommend taking the following steps to initiate care:

  • Begin by asking your child’s pediatrician or medical team for referrals if the standardized measures or progress of developmental milestones call for one.
  • Research your state’s Early Intervention contact information. The CDC has a great resource that outlines early intervention programs by state, which can be found at the link at the bottom of this blog!
  • Ashley, who is based out of California, called her early intervention regional center to see if she was eligible to “self-refer.” While this may not be possible in every state, it might be a process worth considering!

Key Takeaway 5: Physical Therapists abide by three universal goals

While every patient is different and calls for their own individualized care plan, Ashley says that physical therapists all have three goals and approaches when it comes to providing services:

  • Goal One: Strengthen muscles, improve balance and body alignment, manage pain, and increase independence.
  • Goal Two: Work closely with other early interventionists and medical providers to increase the consistency and quality of care for your child
  • Goal Three: Explore different modalities [like water or heat] to customize patient plans, promote progress, and improve function.

Key Takeaway 6: Data should be a scrapbook of information, not just a screenshot! 

Doctors use standardized measures and screeners to measure gross and fine motor skills; however, Ashley cautions against using these small screenshots of data as the totality of your child’s progress and abilities. This data, while valuable, is just one picture in what should be considered a scrapbook of information to assess and celebrate progress! This is because these assessments do not always take into consideration the following:

  • Environmental factors. For example, a child may only perform well on a standardized assessment related to stairs if they are environmentally exposed to them consistently.
  • The quality of movement or how movement patterns have changed. Physical therapists may observe fine details and are privy to how their patients’ movements have improved or changed, but it is important to note that standardized measures do not always capture these small victories. This is why it is so important for medical professionals and parents alike to look at the whole scrapbook of growth! 

Key Takeaway 7: The benefits of physical therapy are clear!

Ashley explains how the benefits of physical therapy for children with motor function difficulties or delays are numerous, and this isn’t just because she is a physical therapist herself! Long-term outcomes have shown that these interventions have the power to impact their quality of life significantly! Some benefits include:

  • Improved muscle tone [impacts posture and balance]
  • Increased strength [impacts everyday autonomy and independence]
  • The ability to address and potentially correct abnormal movement [reduces the likelihood of further complications or surgeries]
  • Increased access to orthotics and other equipment needs [such as wheelchairs or gate-trainers, which can improve a child’s mobility and independence]
  • Increased access to educational resources, exercises, and activities [fosters growth and progress at home]

Key Takeaway 8: Fostering growth at home is most effective when exercises are embedded into your daily routines

Intervention burnout is real, and HIE family members are no strangers to feelings of guilt when they believe they should be doing more to help their child at home. Ashley knows these emotions firsthand, which is why she believes that embedding PT exercises into your already-existing routines and habits is a game-changer.

Physical therapists can help you incorporate exercises into times when you are already interacting with your child, like during diaper changes and bath times! This way, you are not burdened with additional items on your to-do list; instead, you can feel as if you are accomplishing these tasks in small, manageable increments throughout the day!

Many parents may worry about the cost of expensive workout or exercise equipment needed for physical therapy exercises. However, Ashley reassures families that most of the activities can be accomplished using household items like scarves, cardboard boxes, or even blankets. This makes it easier for families to incorporate exercises into their daily routines without having to invest in expensive equipment.

No matter what, growth is fostered the most at home when it is an enjoyable experience for everyone involved. Physical therapists can work with you to create exercises that are fun for your child and can be viewed as a bonding experience as opposed to one that feels burdensome.

Key Takeaway 9: Ashley recommends the following tools and resources:

  • Regional State/Early Intervention Centers: Regional State/Early Intervention Centers can be found by contacting your state’s Department of Health or Department of Education. You can also search online using keywords such as “Early Intervention Centers” or “State Intervention Programs,” along with your state’s name.

    Another resource is to contact your child’s pediatrician or local hospital for more information and referrals. They may have a list of Early Intervention Centers in your area or be able to point you in the right direction.

    Additionally, there are online directories and databases that can help you locate Early Intervention Centers near you, such as the Early Childhood Technical Assistance Center (ECTA) and the National Early Childhood Technical Assistance Center (NECTAC). The Center for Disease Control (CDC) also has a helpful database of state intervention programs.

  • Center for Parent Information and Resources: The center provides a wide range of information, resources, training materials, and technical assistance on topics such as special education, early intervention, and transition to adulthood.
  • Zero to Three Organization: This organization provides parents, professionals, and policymakers with resources, information, and training related to the physical, social, and emotional development of young children. Zero to Three’s mission is to ensure that all babies and toddlers have a strong start in life with the support and resources they need to reach their full potential.
  • Instagram Hashtags and Handles: Instagram hashtags, such as #pediatricphysicaltherapy, can be a helpful resource for parents seeking information about physical therapy services and ways to help their child at home. By following these hashtags, parents can access a wide range of content from physical therapy professionals and organizations, such as exercises and activities to improve their child’s motor development, information about assistive equipment, and tips for promoting overall health and wellness. Additionally, parents can find a supportive community of other families who have experienced similar challenges and can offer insights and advice.

If you found this blog helpful, watch the full recording on our YouTube channel to listen to Ashley respond to poignant questions from our community!



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