Looking Past Limitations
Source: Donna Hurley
Early Intervention is a family orientated program which provides therapeutic intervention for children ages birth to three years who have developmental delays or disabilities, and also provides support for their families. Children who are serviced in these programs are treated by a multi-disciplinary team whose expertise in referrals to community services (sibling support groups, parenting seminars), providing information as to how to access available resources, (financial, medical and educational) helps to provide a supportive environment for the child and parent to come and learn.
This team approach involves a staff of professionals who work together to achieve a common goal. In the case of early intervention clients, the common long-term goal is to strive for the child to reach his/her developmental potential, for the family to gain knowledge of their child's diagnosis and to learn advocacy for their children within the community and school setting. The short-term goals, called the Individualized Family Service Plan, are individualized stepping stones which lead to the long-term goals.
The team at my center, Brandecker Easter Seals in Chicago, Illinois, is comprised of numerous health professionals: physical, occupational and speech therapists, child development educators, a nurse, a social worker, a medical physician and a center manager. As the team physical therapist, I have the unique opportunity to work in the Early Intervention Program as well as in our various supportive programs. These specialized programs include an Equipment Loan Program, a Car Seat Program and a Toy Lending Library. If the child requires special equipment that would benefit him/her at home (wedges, bolsters, feeder seats, bath chairs, positioning units), they are fitted for the child and loaned to the family on a quarterly basis. Individualized exercises and/or proper positioning instructions are explained to the parents and home instructions are provided. Toys used in therapy are also loaned out at the parent's or a team member's request so that the caregiver can stimulate their child's development at home.
On the initial visit, our team evaluates the child, designs and implements an individualized program for the child and family. Goals are made with the parents so that what is worked on in the clinic is meaningful to all involved and will more likely be followed through at home. Many times the parents have very high or unrealistic goals for their child. This may be partly due to their lack of knowledge of a diagnosis and prognosis, or a parent may still be somewhat in denial of their child's condition. At the time of goal setting, the team listens to the family's desires and main priorities for their child and often times will have to modify their original goals to address a parent's goal. If a parent's goal for the child is to sit with minimal support, I as the physical therapist, have to explain to the parent what the normal developmental sequence is and suggest that we first work on tolerating various positions (prone, sidelying, sitting), try to achieve head and trunk control, work on techniques to reduce tone, etc. After explaining why I want to start at a lower developmental level then advance as the child progresses, the parent's concern for walking is acknowledged and addressed and my concern for realistic treatment goals and family education is achieved. Our team feels that a parent's opinion should be valued and taken into consideration during goal setting and we try to see our new client though the eyes of his/her parent. We also stress to the parent that they know their child better than we do and performance in the clinic does not always reflect how the child performs at home. Many times the child will not perform activities for us, but is doing the activity or a similar activity at home. The therapeutic treatment of a child is not only the relationship between the therapist and child, but also consists of the relationships between the therapist, child, caregivers and siblings.
A child need not have a specific diagnosis to enter the Early Intervention program. We have evaluated clients who are four-months old with Down's syndrome and ones that are twenty-four months old with a diagnosis of Developmental Delay. My treatment sessions may be very similar for the two children in the above example because I start my treatment programs with the child at the developmental level at which he/she is found. After taking into consideration some of the individual precautions each child may have, all of my therapy sessions concentrate in the following areas: head and trunk control, balance, transitional movements, developmental sequences, protective reactions/primitive reflexes, tone, positioning, and equipment. Additional higher level skills include ball skills, ambulation/gait pattern, and stair climbing.
Some Early Intervention programs only provide consultive therapy for their clients, but our program provides thirty minutes of direct individual therapy per week with a maximum of a two hour session. Due to the child's poor endurance or time restraints, some sessions are used to co-treat with another therapist or the educator. As a therapist, I find these special sessions very helpful. I use these opportunities to not only expand my knowledge of the other disciplines, but also to provide comprehensive services for the child. For example, I can be working on sitting balance, and the other team member might be working on fine motor skills or speech. Both disciplines get to see how the child is performing and we can provide feedback to each other as well as the rest of the team. This collaboration is crucial for providing optimal service for our children and families.
People often ask me if my job is depressing, seeing so many children with such severe deformities or disabilities. I am human and at times I do feel sorry for some of my clients and their families. However, I have gained great respect for the caregivers, whether they are a biological or foster parent/relative. These people love their children unconditionally. This is not to say that they wouldn't prefer that their child function "normally", but rather, they have accepted this little human being just as he/she is, with all the joys and inconveniences that present themselves. What I have to do is look at my client, remind myself that this child is someone's most precious gift, and try to assist the child in reaching his/her full potential.
I have found working in Early Intervention a very rewarding professional and personal experience. As a therapist, I am allowed to spend time with families during the treatment sessions, teaching them how to assist their child in reaching his/her goals, and the families are usually very eager to learn how they can help their child. With the proper exercises, positioning and equipment, the children can have their function enhanced and deformities prevented. The work can be demanding, both physically and emotionally, but the hugs, kisses, and sincere gratitude from the parents and children make it worth while.
Inspired by my clients, their families, and my co-workers, I wrote the following poem which is meant to express the thoughts of some children I treat (see bottom of page):
Donna S. Hurley received her B.S. in Biology from Chicago State University in 1983, earned her B.S. in Physical Therapy from Northwestern State University in 1984. Donna has worked for the past thirteen years with clients ranging in age from four months old to 94 years old, and has specialized in Pediatrics during the last seven years. Currently she is employed by The Psychological Corporation/Therapy Skill Builders as a Project Manager for therapy related tests and intervention products.
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