Latest / Root Cause Conversations / Why "Wait & See" Isn't Always the Right Answer (with Jill Moscicki from Leap Pediatric Therapy)

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Why "Wait & See" Isn't Always the Right Answer (with Jill Moscicki from Leap Pediatric Therapy) · Root Cause Conversations

• 0:03
  Speaker 1: Hey guys, I'm Amanda Mavrakos, and I am your host here on Root Cause Conversations, where we're talking about speech therapy, tongue ties, oral health, plus diving into faith, family, and wellness for people of all ages.
• 0:21
  Speaker 1: I am a speech language pathologist and a small business owner behind Salt and Light Speech and Language Resources here in Alabama.
• 0:29
  Speaker 1: A heads up, this podcast is for educational purposes only.
• 0:33
  Speaker 1: It is not individualized medical advice, and it is not meant to diagnose or treat anything.
• 0:40
  Speaker 1: So always loop in your own provider for anything specific to you or your child.
• 0:46
  Speaker 1: Thank you so much for pulling up a seat at the table and joining us today.
• 0:50
  Speaker 1: So let's just get into it.
• 0:52
  Speaker 1: And okay, mamas, if you have ever felt like something was off with your baby or even your toddler's movement patterns, and you weren't really sure whether it was worth mentioning to your pediatrician, this episode is for you.
• 1:07
  Speaker 1: Today we're talking with Jill, a pediatric physical therapist and the owner of LEAP Pediatric Therapy in Pelham, Alabama.
• 1:15
  Speaker 1: She works with kiddos birth all the way to age 22, and she looks at the underlying issues of why your kiddos might be struggling with things like tortocolis or even hitting those early physical milestones.
• 1:28
  Speaker 1: And why trusting your gut and catching things earlier really makes all the difference.
• 1:35
  Speaker 1: Hey, good morning, Jill.
• 1:37
  Speaker 1: Thank you so much for being here with us today.
• 1:39
  Speaker 1: Good morning.
• 1:39
  Speaker: Thank you so much for having me, Amanda.
• 1:41
  Speaker: I'm really looking forward to getting a chat today.
• 1:43
  Speaker 1: Yeah, of course.
• 1:44
  Speaker 1: Thank you so much for being willing to come on the podcast and share your expertise.
• 1:49
  Speaker 1: I know that you and I met through a local Birmingham group of ladies who own their own business in the healthcare and wellness sphere.
• 1:57
  Speaker 1: So it's been really great connecting with you in that capacity, but also just working with kiddos in our community as well.
• 2:04
  Speaker 1: So thank you for all you do at Leap Pediatric Therapy.
• 2:08
  Speaker: Thank you.
• 2:08
  Speaker: Yeah, I know.
• 2:09
  Speaker: I'm really excited.
• 2:09
  Speaker: I know you and I share a lot of friends.
• 2:11
  Speaker: And so I think the one part that I really like the most about Birmingham is that we're so community driven for sure.
• 2:18
  Speaker 1: Yes.
• 2:18
  Speaker 1: I mean, and when you look at it, it it's a huge population.
• 2:22
  Speaker 1: But when you look at the connections you make with people, like in your community or in a professional setting, you're really only like a stone's throw away from three other people that you probably already know.
• 2:33
  Speaker 1: So I think we're really lucky in that way.
• 2:36
  Speaker: For sure.
• 2:36
  Speaker: And I think like especially since I'm not from here, I notice it a lot more.
• 2:39
  Speaker: I'm like, oh, you all know each other.
• 2:41
  Speaker: This is so fun.
• 2:42
  Speaker: I know you, you know me.
• 2:43
  Speaker: This is great.
• 2:45
  Speaker 1: Yeah, I've been, I think it's been a real blessing for us for sure.
• 2:48
  Speaker 1: Well, can you just tell us a little bit about yourself, your background, and your practice?
• 2:54
  Speaker: Yeah, of course.
• 2:55
  Speaker: So I'm originally from Buffalo, New York, born and raised.
• 2:58
  Speaker: I went to college there as well.
• 3:00
  Speaker: So I did my undergraduate and then I received my doctorate of physical therapy from Damon College.
• 3:06
  Speaker: I have exclusively worked in pediatrics since graduation.
• 3:10
  Speaker: I've been very blessed to work in a lot of different settings.
• 3:12
  Speaker: So I've done early intervention school setting as well.
• 3:16
  Speaker: So both public school and then the charter schools.
• 3:19
  Speaker: And then I've also worked in outpatient.
• 3:21
  Speaker: A little over a year and a half ago, I had the idea to do something new.
• 3:28
  Speaker: And I was very fortunate to be able to start my own practice.
• 3:32
  Speaker: So Leap Pediatric Therapy was born.
• 3:34
  Speaker: Like you said, we service zero to 22, and we are located in Pelham.
• 3:39
  Speaker: And the one really cool thing about our practice is that there is not a lot of other outpatient-specific PS places in that area.
• 3:48
  Speaker: So we really are getting those kiddos that we're trying to get them services a lot closer to home versus having to drive really far in order to get those services.
• 3:56
  Speaker 1: I know your, I know your community has totally got to appreciate that because, you know, even in speech therapy, the wait list can be a lot.
• 4:05
  Speaker 1: And so I know they're glad to have you there.
• 4:08
  Speaker 1: So zero to 22, that's a really big range right there, Jill.
• 4:12
  Speaker 1: So what has kind of drawn you to working with kiddos throughout a span like that?
• 4:18
  Speaker 1: Like what are you, what are you seeing that connects it all together?
• 4:21
  Speaker: For sure.
• 4:21
  Speaker: With that wide age range, wow, it just keeps me on my toes.
• 4:24
  Speaker: And you know, every day is a little bit different.
• 4:26
  Speaker: Um, but I think the biggest thing is that, you know, our development doesn't stop once we hit a certain milestone.
• 4:33
  Speaker: Your body is always growing and it's always changing and it's always learning in different ways.
• 4:37
  Speaker: I mean, even past 22 as well.
• 4:39
  Speaker: So when I get a little, I'm really thinking about, okay, what are we looking at right now?
• 4:44
  Speaker: What things do we need to address or improve on?
• 4:47
  Speaker: But I'm also looking at the future.
• 4:49
  Speaker: Um, how are we going to look at everything across the lifespan?
• 4:53
  Speaker: And I'm really fortunate.
• 4:55
  Speaker: These kids learn a lot from me, but I'm also learning so much from them and taking that and then being able to apply it to help other families as well.
• 5:03
  Speaker 1: Okay.
• 5:03
  Speaker 1: All right.
• 5:04
  Speaker 1: That sounds amazing.
• 5:06
  Speaker 1: So you shared with us that you primarily worked in pediatrics throughout your physical therapy career.
• 5:13
  Speaker 1: What do you think made this your calling, Jill?
• 5:16
  Speaker 1: Like, what kind of spoke to your heart that this was the population and the age group that you really wanted to work with?
• 5:22
  Speaker 1: Can you tell us a little bit about that?
• 5:24
  Speaker: Yeah, of course.
• 5:25
  Speaker: So I think I was very stereotypical in the fact of going into PT school.
• 5:29
  Speaker: And I was like, okay, I was an athlete growing up.
• 5:31
  Speaker: I really want to work with athletes.
• 5:34
  Speaker: Got to that part of the school, and I said, well, this is really fun.
• 5:38
  Speaker: But then next was my pediatric semester.
• 5:41
  Speaker: And I really feel like PEADS chose me.
• 5:43
  Speaker: I was very fortunate.
• 5:44
  Speaker: Like I said, I got to do a rotation for clinicals.
• 5:49
  Speaker: And it was there that that really, really fell in my heart that PEADs is something that I wanted to do.
• 5:55
  Speaker: Got to see, again, wide range of kiddos.
• 5:58
  Speaker: And it's just so fun to see kiddos doing something for the first time or helping a family caregiver comes in and they're really stressed and being able to just help ease their mind and get to hang out and do some really fun things throughout the day.
• 6:13
  Speaker 1: Okay.
• 6:14
  Speaker 1: Thank you for sharing that with us.
• 6:16
  Speaker 1: So I want to ask you just a little bit about what you specifically treat at Lee.
• 6:21
  Speaker 1: I know physical therapy has a broad scope of practice.
• 6:23
  Speaker 1: There's a lot of different things that you can do.
• 6:26
  Speaker 1: What are some of the primary things that you see?
• 6:28
  Speaker 1: Let's just talk about babies first.
• 6:30
  Speaker 1: What are what are you seeing first in babies?
• 6:32
  Speaker 1: And then we'll just kind of move through the lifespan if that's okay with you.
• 6:36
  Speaker: Yeah, of course.
• 6:36
  Speaker: So I think one of the biggest things for babies that I see is going to be plagiocephaly and tortocolis.
• 6:42
  Speaker: I see a lot of kiddos that were premature at birth, so trying to get them caught up with their gross motor milestones.
• 6:48
  Speaker: And then really just overall, are we hitting our milestones?
• 6:51
  Speaker: It's kind of that developmental delay.
• 6:54
  Speaker 1: Okay.
• 6:54
  Speaker 1: Can you tell us a little bit more about tortocolis and what that treatment would actually look like for a kiddo?
• 7:02
  Speaker: Yeah, of course.
• 7:03
  Speaker: So tortocolis refers to the muscles in your neck.
• 7:06
  Speaker: And usually what happens is your SCM, so your sternocleidomastoid muscle, it's going to be really tight on one side.
• 7:14
  Speaker: So that muscle has two drops.
• 7:16
  Speaker: It's going to tip your head to one side and it's going to turn your head to the opposite side.
• 7:19
  Speaker: So kiddos that have tortocolus usually have a preference to look to one side more than the other.
• 7:25
  Speaker: Sometimes that's also paired with plagiosophily as well.
• 7:29
  Speaker: So that refers to the head shape, and that can be flattening on one side of the head.
• 7:34
  Speaker: With regards to treatment, it kind of looks a little bit different.
• 7:38
  Speaker: I think the favorite thing in PT is it depends.
• 7:41
  Speaker: And that's really true here as well.
• 7:44
  Speaker: So at the end of the day, there's more than one thing that can cause sordicallus.
• 7:49
  Speaker: And sometimes it's multiple things that are causing tortocolis.
• 7:52
  Speaker: Whenever I get a kiddo, I'm doing a full screen on them.
• 7:56
  Speaker: So I'm looking at, you know, their resting pattern, their movement pattern.
• 8:01
  Speaker: Do they have symmetrical movements?
• 8:03
  Speaker: What does our head shape look like?
• 8:05
  Speaker: Is there a restriction in movement?
• 8:07
  Speaker: Going just through everything like that.
• 8:09
  Speaker: And then the treatment is obviously going to depend on what the cause is.
• 8:14
  Speaker: So could be positioning in utero.
• 8:17
  Speaker: Was there a complication at birth?
• 8:19
  Speaker: Did this muscle get stretched while we were leaving the birth cavity?
• 8:23
  Speaker: What's our positioning look like during the day?
• 8:25
  Speaker: Are we getting a lot of tummy time?
• 8:27
  Speaker: Or are we spending a lot of the time in the bouncer or in the swing?
• 8:31
  Speaker: Are we able to track a toy?
• 8:33
  Speaker: Do we have any vision concerns going on?
• 8:35
  Speaker: What does our vestibular system look like?
• 8:37
  Speaker: Can we tolerate certain movements?
• 8:39
  Speaker: And then the other one, big one, do we have any history of reflux?
• 8:44
  Speaker: Are we spinning up a lot?
• 8:45
  Speaker: Are we happy spitter upper?
• 8:47
  Speaker: Or are we a kiddo that is just not having a good time like eating?
• 8:51
  Speaker: Sometimes it's one of these things.
• 8:53
  Speaker: Sometimes it's a multitude of these things, and it's kind of all intertwined and webbed together.
• 8:59
  Speaker: And so just kind of going in, picking apart, okay, what am I seeing and what changes can we make in our day-to-day?
• 9:05
  Speaker: So kiddos are gonna come in and we're gonna sit and talk with the family and say, all right, tell me a little bit about what you've been seeing, go through, do some range of motion, see if there's any of those restrictions.
• 9:18
  Speaker: And then a lot of what treatment looks like is parent coaching.
• 9:22
  Speaker: It's gonna be what you do outside of physical therapy that makes the most difference.
• 9:27
  Speaker: You know, if you only work out one time a week, you're not really gonna see much of a change.
• 9:31
  Speaker: And so I really try hard, you know, with whatever we're giving these families, whether it be stretching, whether it be repositioning, whether it be tummy time, that I'm having family on the floor with me, I'm having them do the activity themselves and that they feel comfortable doing it so that they're able to recreate it at home with kiddo.
• 9:50
  Speaker 1: Okay, that sounds like a lot.
• 9:52
  Speaker 1: Do you like with all of that information?
• 9:54
  Speaker 1: And I know this is this is like anything in healthcare, when we're talking about root cause issues and we're trying to figure out like how did this happen in the first place?
• 10:03
  Speaker 1: Sometimes there's more than one thing happening there.
• 10:06
  Speaker 1: And it's our job to put those pieces together.
• 10:09
  Speaker 1: So when you're talking with families about this, and we're looking at like root cause issues for tor tortoolis or having a flat spot on their head, how do you convey that to parents?
• 10:22
  Speaker 1: Like it depends, is hard sometimes for parents to hear and understand.
• 10:28
  Speaker 1: And also, I get a lot of questions.
• 10:30
  Speaker 1: How long is treatment going to be?
• 10:32
  Speaker 1: And I'm sure you get a lot of those questions too.
• 10:36
  Speaker 1: So, how do you explain this to parents in a way that's easy for them to digest and also understand that it depends is really just patient specific.
• 10:46
  Speaker: That's a really good question.
• 10:48
  Speaker: I think for me, what I really try to focus on is after I've done the whole screen, I have a pretty good idea of what could potentially be causing what I'm seeing.
• 11:01
  Speaker: And so I'll talk about it with the family and just say, okay, this is what's going on.
• 11:06
  Speaker: And then here is a reason or two what might have caused it.
• 11:09
  Speaker: But no biggie, because good news is you're sitting here in PT and there's ways that we can address it.
• 11:15
  Speaker: And so it's not always necessarily focusing on what caused it.
• 11:19
  Speaker: Knowing what caused it is great because it helps to drive my treatment session, but really focusing on okay, yes, we know what what's going on now.
• 11:28
  Speaker: How do we address it?
• 11:31
  Speaker 1: That's great.
• 11:31
  Speaker 1: Yes.
• 11:32
  Speaker 1: And I know they appreciate that.
• 11:34
  Speaker 1: And so that's babies.
• 11:37
  Speaker 1: What are you primarily seeing in your toddler population?
• 11:41
  Speaker 1: Like, what does that look like at your practice?
• 11:43
  Speaker: Oh, toddlers are fun.
• 11:44
  Speaker: They keep me on my toes.
• 11:46
  Speaker: Um, I have a lot of kiddos with different diagnoses.
• 11:49
  Speaker: Cerebral palsy is going to be a big one, Down syndrome.
• 11:52
  Speaker: Have a couple of kiddos with just different genetic conditions.
• 11:57
  Speaker: Some kiddos just have standard typical delays, and we're not really sure where the delays are coming from.
• 12:05
  Speaker 1: So if you're looking at like functional motor delays with your toddlers, do you guys assess retained primitive reflexes?
• 12:14
  Speaker 1: That's a really hot topic and a hot word right now.
• 12:16
  Speaker 1: I know a lot of kiddos that come into my clinic just for speech therapy.
• 12:20
  Speaker 1: Some of the assessments I do, you know, cause me to look at things through a different lens and then refer out to PT or OT because there is a suspected retained primitive reflex.
• 12:31
  Speaker 1: Could you talk a little bit about that and how it affects like motor development in these kiddos?
• 12:36
  Speaker 1: Yeah, for sure.
• 12:38
  Speaker: So retain primitive reflexes.
• 12:40
  Speaker: Yeah, I agree.
• 12:40
  Speaker: They're a pretty hot topic.
• 12:42
  Speaker: The main thing with a primitive reflex is everyone is born with these.
• 12:46
  Speaker: And the emphasis is on the word primitive.
• 12:49
  Speaker: Okay.
• 12:50
  Speaker: So these are your first things that are going to help save you in life.
• 12:54
  Speaker: They help you breathe, they help you hold on to mom, et cetera, et cetera.
• 12:59
  Speaker: The idea is as we grow and develop, we want to replace the primitive with a more mature movement pattern.
• 13:06
  Speaker: Sometimes what I see is these kids come in, they're a little bit older, they're at the point where this reflex should have been integrated and I should have a more mature movement pattern, but I'm not.
• 13:16
  Speaker: And my body is getting stuck because I don't have that more mature movement pattern.
• 13:21
  Speaker: So the idea of integrating this reflex is it's going to allow the body to move on from this immature movement pattern into a more mature movement pattern to be able to achieve what we're wanting to see functionally.
• 13:36
  Speaker 1: Okay.
• 13:37
  Speaker 1: All right.
• 13:37
  Speaker 1: That that's really good.
• 13:39
  Speaker 1: And if I remember correctly, just on the patients that I've seen at my practice and referred out, like 12 and 13 year olds can still have retained primitive reflexes, right?
• 13:50
  Speaker 1: Oh, for sure.
• 13:51
  Speaker 1: I mean, I have some myself.
• 13:53
  Speaker 1: We've all got our own issues, don't we, Jill?
• 13:57
  Speaker 1: It's okay.
• 13:59
  Speaker 1: It's okay.
• 14:00
  Speaker 1: Yeah, it's totally okay.
• 14:02
  Speaker 1: So if we all right, so I'm gonna switch topics here because this is kind of helping me connect some dots in my head about some things that I want to ask you that I think may be beneficial for some of the parents to hear.
• 14:14
  Speaker 1: So when we're talking about motor milestones, I know that crawling is essential.
• 14:19
  Speaker 1: And sometimes I see kiddos for speech therapy that they have skipped that crawling stage.
• 14:26
  Speaker 1: Can you tell us what that would look like?
• 14:30
  Speaker 1: How does that impact future motor development?
• 14:33
  Speaker 1: And what could have caused that kiddo to skip the crawling stage?
• 14:37
  Speaker: For sure.
• 14:37
  Speaker: So there's a lot of different reasons as to why a kiddo could skip crawling.
• 14:42
  Speaker: I think the biggest one I see is a kiddo comes in and I go, Hey, how did they feel about tummy time when they were little?
• 14:49
  Speaker: Well, it was usually a fight, and for one reason or another, we didn't get enough tummy time, whether it be we had some medical complexities going on, we weren't able to get on the floor, or we had a lot of reflux, and so it was very painful for us to be on our belly.
• 15:07
  Speaker: Some kids don't like it because of their vestibular system and they just don't like the positioning, and so they've skipped it.
• 15:14
  Speaker: Crawling is super important though, because it's going to connect the right and the left side of your body and getting them to do opposite things at the same time.
• 15:23
  Speaker: So, for my older kiddos, how I see it in functional movement is we have a really hard time with switching our feet going up and down the stairs.
• 15:33
  Speaker: A lot of difficulty with riding a bike.
• 15:36
  Speaker: I know there's also some fine motor carryover as well in the occupational therapy land.
• 15:41
  Speaker: And so weakness of the upper extremities is another one that we see just because they didn't get a lot of weight bearing through their arms.
• 15:47
  Speaker: So crawling is very important, in my opinion.
• 15:50
  Speaker: Um, I would prefer if kiddos didn't skip that milestone, but sometimes they do, and that's okay because there's also other things that we can do, even if you are a little bit older, just to kind of help build that strength and reintegrate those reflexes in.
• 16:05
  Speaker 1: Yeah, that was great.
• 16:07
  Speaker 1: I didn't know all of that.
• 16:08
  Speaker 1: I knew it was really important for kids to crawl, but I just really didn't understand why or what could be causing that.
• 16:15
  Speaker 1: I even heard, I don't know if this is true or not, Jill.
• 16:18
  Speaker 1: I'm just tossing this out there.
• 16:20
  Speaker 1: I even heard, I think it might have been on a podcast or an article, that sometimes the kids that are born via C-section, they may have some challenges with overall milestone and motor development.
• 16:33
  Speaker 1: Is that true?
• 16:35
  Speaker: I definitely think there is a correlation with that for sure.
• 16:38
  Speaker: That is actually one of the questions that I'll ask parents is, you know, was your baby born diagonally or were they born via C-section?
• 16:44
  Speaker: It just gives us a little bit more insight into what birth looked like and all that stuff.
• 16:50
  Speaker 1: That's so interesting.
• 16:51
  Speaker 1: Oh, wow, that's really cool.
• 16:52
  Speaker 1: Thanks for sharing that.
• 16:54
  Speaker 1: I hear things all the time and I'm like, is that true?
• 16:57
  Speaker 1: So I I try to ask other people so I can get all the information because families ask us all sorts of questions.
• 17:03
  Speaker 1: And so I feel like we at least need to have a thimble's worth of knowledge to share and at least direct them somewhere else, which is why I refer parents to people like you, Jill, because these are things that I don't know.
• 17:16
  Speaker: You're right back at you.
• 17:18
  Speaker: You know, I get so many speech and feeding questions, and I'm like, I don't really know about that one, but let me call my friend Amanda and see what she's asking.
• 17:27
  Speaker 1: So you had mentioned earlier some of your population is cerebral palsy, Down syndrome, genetic disorder.
• 17:36
  Speaker 1: Do a lot of these kiddos need special equipment, Jill?
• 17:41
  Speaker 1: Like, can you tell me what that would look like or why they would need orthotics or a standard or the little, the little reverse walkers that I see?
• 17:51
  Speaker 1: I know they have a name, but I can't remember the name of them.
• 17:53
  Speaker: Mysterio Walker, you're you're close.
• 17:55
  Speaker: Reverse walker's pretty darn close there.
• 17:57
  Speaker: Yeah, that's a that's a really good question.
• 17:59
  Speaker: So whenever I'm looking at a kiddo, I'm thinking about structure and I'm also thinking about okay, is there anything else that I can give them as a tool in their toolkit that then can help them to improve their posture, help them move a little bit easier, or help them to hit a milestone that they might not be hitting right now?
• 18:21
  Speaker: So that's a really fun one.
• 18:23
  Speaker: I love the world of equipment.
• 18:24
  Speaker: There's so much going on.
• 18:26
  Speaker: And like you said, it can range anywhere from just like inserts in your shoes to gate trainer, standing device, any of that kind of stuff.
• 18:35
  Speaker: Um, orthotics, I'm looking at our posture.
• 18:40
  Speaker: Do I need to address your feet?
• 18:44
  Speaker: Do I need to look at your knees?
• 18:45
  Speaker: Do I need to look at your hips?
• 18:47
  Speaker: My main thing that I feel like I tell families over and over and over again is that building up your strength in your body is like building up a house.
• 18:56
  Speaker: You want to have really good foundation.
• 18:59
  Speaker: If you have a really good foundation, then you're gonna build a really good house.
• 19:02
  Speaker: So, do I have really good posture?
• 19:05
  Speaker: Do I have really good strength?
• 19:07
  Speaker: Do I have really good movement?
• 19:09
  Speaker: All of that leads into one another.
• 19:11
  Speaker: So whenever I get a kiddo and I'm thinking equipment, kind of introduce it slowly to the family.
• 19:17
  Speaker: Try to find something that the kiddo can try in clinics so the family can see the difference with the device or the orthotic and without the device, and just see okay, can we walk a little bit faster?
• 19:30
  Speaker: Can we move a little bit quicker with whatever we are trialing that day?
• 19:34
  Speaker: Really trying to make sure that it's gonna fit the kiddo's needs the best and the family's needs the best.
• 19:40
  Speaker: So it's not too bulky, it'll fit in their house.
• 19:43
  Speaker: It's something that the kid can take on and off themselves, that they can wear to daycare, all of that kind of stuff.
• 19:48
  Speaker: I'm really thinking about.
• 19:50
  Speaker: And then the other biggest thing going back to the community, right?
• 19:53
  Speaker: I think a lot of it is collaboration.
• 19:55
  Speaker: So talking with orthopedists, talking with the people that do all of our ordering.
• 20:00
  Speaker: So um the reps like at national seating, mobility, and new motion, just making sure we're all on the same page and thinking about what's best for the kiddo and thinking about all of those factors into one.
• 20:14
  Speaker 1: So you had mentioned posture.
• 20:16
  Speaker 1: So I want to go back to that really quick because I see this a lot in my clinic.
• 20:21
  Speaker 1: So when somebody comes in and they have myofunctional concerns, usually it's mouth breathing, low resting, tongue posture, even maybe a potential tongue tie.
• 20:31
  Speaker 1: I always look at their posture.
• 20:34
  Speaker 1: And I have a background in physical therapy, so I have enough knowledge to be able to assess a few things.
• 20:40
  Speaker 1: And so what I'm seeing is a lot of rounded shoulders, forward head posture, even like some anterior pelvic tilt and that significant lumbar curvature.
• 20:52
  Speaker 1: And so then I'm like, okay, well, we need to do PT because there's some issues here.
• 20:58
  Speaker 1: And as it relates to what I'm doing, I'm looking at their ability to be able to breathe properly and to keep their tongue where it needs to be from a speech therapy standpoint.
• 21:08
  Speaker 1: What are you guys looking at from a physical therapy standpoint?
• 21:11
  Speaker 1: Like, how do we tie all of these things together?
• 21:14
  Speaker 1: Because we're one person and it's all connected.
• 21:17
  Speaker 1: So can you tell us about from your perspective?
• 21:19
  Speaker 1: Like, if I refer a kiddo to you for these things, like what is that treatment intervention going to look like?
• 21:26
  Speaker: Of course.
• 21:26
  Speaker: So your body is really smart automatically.
• 21:29
  Speaker: It's always going to find the easiest way to do something and the way that it can save the most amount of energy.
• 21:37
  Speaker: And so if that means having a posture that is those rounded shoulders, is that forward head posture, is that lumbar spine, it's easier for the body because it's not having to make those muscles that it should have working, work is hard.
• 21:51
  Speaker: And so that is trying to be just a little lazy, isn't it?
• 21:55
  Speaker: I mean, work smarter, not harder, right?
• 21:57
  Speaker: So, like false kiddos when this happens.
• 21:59
  Speaker: Or even myself, because I'm not perfect with my posture either, right?
• 22:04
  Speaker: But what a lot of it is looking at okay, where are we hanging out and where are we making these compensations?
• 22:14
  Speaker: And what muscles are we not using?
• 22:17
  Speaker: The muscles that we're not using are obviously going to be the ones that are weak because they're not being used.
• 22:22
  Speaker: And so a lot of the focus is how do I strengthen those muscles to then help improve my posture?
• 22:28
  Speaker: And sometimes when I have a kiddo where they might need just a little bit more help to improve their posture, that's where things like orthotics come into play.
• 22:38
  Speaker: Okay.
• 22:40
  Speaker 1: And so if you have a kiddo that comes in with these types of issues, let's just say I sent someone to you, what kind of exercises do you give them?
• 22:48
  Speaker 1: Can you give us like an example of some core exercises that you would give some someone to do?
• 22:54
  Speaker 1: That's a great question.
• 22:56
  Speaker: So obviously it's gonna depend on how old the child is for sure.
• 23:00
  Speaker: Um, if it's an older kiddo, I can tell you to do glute bridges, or I can tell you to do sit-ups, or I can tell you to hold a certain yoga position.
• 23:08
  Speaker: Was a kiddo who's a little bit younger, we got to make it look like play.
• 23:13
  Speaker: Right.
• 23:14
  Speaker: Um, different developmental positions holding those.
• 23:18
  Speaker: Can we do animal walks?
• 23:20
  Speaker: That's movement, that's strengthening.
• 23:22
  Speaker: Can we lift our bottom up and put the car underneath to drive?
• 23:27
  Speaker: All of that kind of fun stuff.
• 23:29
  Speaker 1: Okay, yeah, it sounds like you make it fun for the little kiddos, and you kind of have to, or there's not going to be a lot of carryover of participation there.
• 23:37
  Speaker 1: For sure.
• 23:38
  Speaker 1: I don't know a lot of four-year-olds that just want to exercise for the sake of exercising.
• 23:44
  Speaker: So I haven't that many either.
• 23:46
  Speaker: I've had one or two, surprisingly.
• 23:47
  Speaker: Well, that's usually because they have an older sibling, they want to be just like older sibling.
• 23:53
  Speaker 1: Yes, yes, for sure.
• 23:54
  Speaker 1: All right, so let's.
• 23:57
  Speaker 1: I'm kind of moving us around here.
• 23:58
  Speaker 1: So let's go back to like the equipment.
• 24:02
  Speaker 1: As a parent who's faced with some functional motor challenges for their kiddo, and it's time for us to look at some equipment or some devices to help us move better and function better.
• 24:18
  Speaker 1: As you're working with families on this, do you feel like that's kind of hard for them to move forward with using equipment?
• 24:26
  Speaker 1: Can you tell me a little bit about the insight into that and what you're hearing them tell you?
• 24:32
  Speaker: For sure.
• 24:33
  Speaker: I definitely see that.
• 24:35
  Speaker: I think it's really hard because there is still, unfortunately, that stigma around okay, I have something that's going to set me apart from somebody else and I look quote unquote different.
• 24:45
  Speaker: And so a family a lot of times is really thinking about how is my child gonna look and how's my child gonna look to others.
• 24:52
  Speaker: So that is definitely one of the challenges.
• 24:54
  Speaker: And I feel that for sure.
• 24:56
  Speaker: Um, it's hard to live in the world that we live in.
• 24:59
  Speaker: And so definitely trying to keep that in mind.
• 25:02
  Speaker: I think the biggest thing that I really try to do is get a hold of a device or have one in my clinic for the kiddo to trial and just letting the parents see the difference that it makes, letting them take it home and try it for a little bit before they make that decision of okay, do we want to go ahead and actually move forward with this?
• 25:24
  Speaker: Trying to really move at their pace and letting the device really do the work of speaking on the importance and the need for it.
• 25:32
  Speaker: A lot of times parents will take it home, they'll be kind of skeptical about it, or you know, I didn't really want to use this at first, but and then it's always the butt.
• 25:41
  Speaker: They see how much it's helping their kid.
• 25:44
  Speaker: And so usually like being able to see it really makes everything click and connect.
• 25:51
  Speaker 1: I'm sure that talking about it's one thing, but actually seeing your child use the device and seeing how much it improves their mobility, their quality of life.
• 26:00
  Speaker 1: I mean, that's gotta be really eye-opening to these families.
• 26:04
  Speaker 1: But and it also helps convince them that this is the best path for your kiddo in this season to help them get to, you know, from point A to point B and then just keep moving on down through the different points as they grow in development.
• 26:18
  Speaker 1: So let's talk about that wait and see approach.
• 26:24
  Speaker 1: Don't you love that, Jill?
• 26:26
  Speaker 1: It's it's just so outdated and we shouldn't wait and see on anything.
• 26:33
  Speaker 1: You have providers on every corner that can help you understand why wait and see is not the best approach.
• 26:40
  Speaker 1: So if a parent comes in and they have suspected tortois or the flat spot on their little head, what would you want that parent to know?
• 26:52
  Speaker 1: If we're talking to somebody right now and somebody has told them to wait and see about these things, what's your advice to those parents?
• 27:01
  Speaker: Yeah, you are never going to hurt your child by getting an opinion early on.
• 27:05
  Speaker: Okay.
• 27:06
  Speaker: Waiting and seeing if it improves on its own, it can sometimes mean that you're gonna miss that window when it's the easiest to help.
• 27:13
  Speaker: And so I would say just ask.
• 27:16
  Speaker: You don't know what you don't know, just go seek another opinion.
• 27:19
  Speaker: And if you go and there's really nothing going on, great, you feel good about it and you don't have to worry.
• 27:25
  Speaker: And if you go and there is something, well, good news, we can address it and it's early on versus waiting down the line and kind of having more of that snowball effect where now it's more than just one thing I'm trying to address.
• 27:39
  Speaker 1: Yes, I totally agree with you on that.
• 27:41
  Speaker 1: And it just when I have a parent call me, these are the best ones.
• 27:45
  Speaker 1: They're like, hey, I've got a two-year-old and she only has like 15 words, and I'm really concerned.
• 27:51
  Speaker 1: But the pediatrician told me to wait six months, but I'm not waiting six months.
• 27:55
  Speaker 1: I want to come see you now.
• 27:56
  Speaker 1: I'm on your side, I'm on team, mom and dad.
• 27:59
  Speaker 1: Let's get those kids in the door as soon as possible.
• 28:02
  Speaker 1: Because, like you said, you're not going to do any harm by seeking that advice early on.
• 28:07
  Speaker 1: It's when we wait and it kind of snowballs, and then we end up in therapy maybe two or three times longer than what it would have taken had you came in a year earlier.
• 28:18
  Speaker: Yeah.
• 28:18
  Speaker 1: I think that's great advice.
• 28:19
  Speaker 1: And I tell that to my kiddos and parents as well, um, because that's important.
• 28:24
  Speaker 1: Let's get them in the door and get them seen.
• 28:26
  unknown: Yeah.
• 28:26
  Speaker: And I mean, it may not even result in you needing sessions.
• 28:29
  Speaker: It might really just be the evaluation or, hey, let me just keep monitoring you and checking you, taking in on you.
• 28:37
  Speaker 1: Exactly.
• 28:38
  Speaker 1: I have that too.
• 28:39
  Speaker 1: I mean, sometimes it's just, I don't know what you call them, but I call them tweeners.
• 28:44
  Speaker 1: They may need therapy, they may not need therapy, they're kind of between.
• 28:48
  Speaker 1: And so I say, hey, I don't think we need therapy now.
• 28:51
  Speaker 1: I'm gonna give you a home program and I'm gonna check in on you in three months and then we'll see.
• 28:56
  Speaker 1: And these parents are usually calling, like, hey, all of this has worked.
• 29:00
  Speaker 1: Like they they just didn't know what they didn't know.
• 29:03
  Speaker 1: And so sometimes just coming in and doing the evaluation and getting the education and support that they need so that they can move forward with implementing things at home as well.
• 29:12
  Speaker 1: Yeah, for sure.
• 29:13
  Speaker: I'm gonna take that term from you.
• 29:15
  Speaker: I like that one.
• 29:17
  Speaker 1: Start using that.
• 29:18
  Speaker 1: Well, I learned it from a physical therapist that was my supervisor years ago.
• 29:22
  Speaker 1: And he was like, We got us another tweener.
• 29:27
  Speaker: I don't have, I don't really have a name for their kiddos that have that.
• 29:30
  Speaker: So I'm gonna start using that.
• 29:32
  Speaker 1: Okay, yeah.
• 29:33
  Speaker 1: So we talked about a lot of things today.
• 29:38
  Speaker 1: We've talked about babies, we've talked a little bit about toddlers.
• 29:42
  Speaker 1: What about that older age group, like the teenagers?
• 29:45
  Speaker 1: Tell me what you're seeing in that area as far as physical therapy intervention goes.
• 29:51
  Speaker: So I think there's like two distinct things that I really see.
• 29:55
  Speaker: The first is participation.
• 29:57
  Speaker: So these kiddos are wanting to participate in a sport with their peers.
• 30:01
  Speaker: For example, I had a girl, she really wants to do cheerleading.
• 30:05
  Speaker: And so, okay, how can we address everything that we need?
• 30:09
  Speaker: So she's able to participate with her friends.
• 30:12
  Speaker: The other that I have is for my kiddos that are a little bit more complex and have a little bit higher needs.
• 30:19
  Speaker: Okay, what does life look like as we continue to age?
• 30:22
  Speaker: You know, we're taller, we're bigger, mom and dad are getting older.
• 30:27
  Speaker: How is that gonna look?
• 30:28
  Speaker: Because it's not always safer if we live in a two-story house, it's not always safe for mom and dad to keep carrying us up the stairs.
• 30:35
  Speaker: So talk a lot about okay, what are we looking at?
• 30:38
  Speaker: What are our plans for the future?
• 30:40
  Speaker: How can we continue to keep building strength?
• 30:43
  Speaker: But how are we gonna protect the kiddo's body?
• 30:45
  Speaker: How are we gonna protect the caregiver's body as well?
• 30:48
  Speaker: So it's just a lot more of a conversation.
• 30:51
  Speaker 1: Yeah, for sure.
• 30:52
  Speaker 1: That's and it's probably things that we don't really think about until we're in the middle of it.
• 30:58
  Speaker 1: Like if you have a 12-year-old in a two-story house, you can't continue to carry them up and down the stairs.
• 31:05
  Speaker 1: So, do you kind of walk them through like any home modifications they would need or any equipment or anything like that?
• 31:12
  Speaker 1: Like, what does that look like for that family?
• 31:14
  Speaker: Yeah, for sure.
• 31:15
  Speaker: Definitely take a look at what does the home look like?
• 31:18
  Speaker: And like you said, are there any modifications that we can make to the home?
• 31:23
  Speaker: You know, whether it be picking up rugs so that we're not tripping over them or adding a grab bar into the bathroom or next to the bed to make transfers a little bit easier.
• 31:34
  Speaker: The other thing is really looking at caregivers' abilities and, you know, do they have anything going on as well?
• 31:41
  Speaker: How are how are they feeling?
• 31:43
  Speaker: Um, and really just trying to help them to understand it's okay, and you really want to help at the same capacity that you have been, but that's not gonna be helpful to you in the long term because that's gonna hurt your body a lot earlier on, and just really trying to get them to understand, okay, yeah, that worked for right now.
• 32:03
  Speaker: We got to switch it up and let's learn how to switch it up a little bit.
• 32:08
  Speaker 1: Yeah, yeah.
• 32:08
  Speaker 1: Well, good.
• 32:09
  Speaker 1: I'm glad you can do that for them because sometimes we're just stuck in the moment and all we can think about is what we have in front of us.
• 32:16
  Speaker 1: It's hard to think what three years might look like for ourselves or our child or just our family as a whole.
• 32:23
  Speaker 1: And sometimes it may be we might need to sell this house and move into a one-story home, you know, and that's a bigger commitment and a definitely a bigger change for families to look at.
• 32:32
  Speaker 1: So I'm glad that you're able to kind of talk through that and walk through it with them and let them know like what does the future hold for us for sure?
• 32:39
  Speaker 1: All right, let's go back to babies for just a minute.
• 32:42
  Speaker 1: What is one thing a parent might do today if they notice that their baby is maybe favoring one side or the other, they're not kicking their arms and legs and moving as much as they could, or their body just seems kind of stiff and tight.
• 33:00
  Speaker 1: Can you talk a little bit about that?
• 33:03
  Speaker: Of course.
• 33:04
  Speaker: So I think the biggest thing is continuing to give your baby opportunities to actively look, move towards something that they're trying to avoid.
• 33:13
  Speaker: Not forcing it, but you know, if we have that preference to look to one side, okay, let me put all the toys on the other side.
• 33:21
  Speaker: Or okay, it's kind of hard for me to move my legs, I'll gently move them for you and see.
• 33:26
  Speaker: Okay, I put a toy close here.
• 33:28
  Speaker: Can you try and kick it type situation?
• 33:30
  Speaker: At the end of the day, trust your gut.
• 33:32
  Speaker: If you've been trying these things for a little bit and you're not feeling like there's much of an improvement, it's okay.
• 33:39
  Speaker: It's okay to seek help.
• 33:40
  Speaker: And going back to that, you're never gonna hurt anyone by going to seek an opinion early.
• 33:46
  Speaker 1: That's right.
• 33:47
  Speaker 1: Yeah.
• 33:48
  Speaker 1: And thank you for continuing just encouraging parents to do that.
• 33:51
  Speaker 1: I think, I don't think we can say that enough, Jill.
• 33:53
  Speaker 1: I really don't.
• 33:54
  Speaker 1: I honestly think that we've kind of gotten into a culture of somebody else needs to tell us that there's a problem before we need to do something.
• 34:04
  Speaker 1: And that's just not the case.
• 34:06
  Speaker 1: You are a parent, you see your kid every day, you know them best, and you absolutely know when they need more support.
• 34:12
  Speaker 1: So we're just going to continue preaching that, guys.
• 34:14
  Speaker 1: Get your services as soon as you can.
• 34:16
  Speaker 1: It doesn't hurt to go in and see a specialist and get an opinion, even if you don't need treatment.
• 34:22
  Speaker 1: That way you at least have a baseline about what that looks like or what those next steps might be for your family for sure.
• 34:28
  Speaker: Yeah, I know.
• 34:29
  Speaker: And I think the most important thing too is you don't have to know everything about development.
• 34:35
  Speaker: I don't know everything about speech.
• 34:37
  Speaker: So that's where I tag you in.
• 34:39
  Speaker: I don't know everything about OT.
• 34:41
  Speaker: That's where I tag somebody else in.
• 34:43
  Speaker: And so it's okay to get advice and opinions from other people.
• 34:47
  Speaker: You don't have to know everything all the time.
• 34:51
  Speaker 1: That's so right.
• 34:52
  Speaker 1: And again, that's why it's important to have a good care team that's looking at the child from all the angles and helping you figure out what those next steps could be and what you need to do.
• 35:02
  Speaker 1: So thanks for working with me, Jill.
• 35:04
  Speaker 1: I appreciate you and everything you do for our mutual clients as well.
• 35:08
  Speaker 1: Is there anything else that you think our family should know today?
• 35:12
  Speaker 1: Like, is there something that people are coming into the clinic and you know, you're like, if I could say this thing to everybody who walks in the door, this is what I would say.
• 35:22
  Speaker 1: Or if you have any other advice or helpful tidbits you'd like to share with us?
• 35:27
  Speaker: So another really good question.
• 35:29
  Speaker: I think that my biggest thing, like I said earlier, that I tell everyone is you're gonna build a good house, you gotta have a good foundation.
• 35:37
  Speaker: It really does matter what you're doing outside of the clinic that's gonna really make a change and you're gonna see the most difference.
• 35:46
  Speaker: So, how can I put into practice what I'm doing into everyday life?
• 35:51
  Speaker: I mean, as a PTA, really just trying to build those lifelong goals and lifelong love for movement, that's really gonna keep you healthy.
• 36:00
  Speaker: A body that is in motion stays in motion.
• 36:04
  Speaker 1: Ah, yeah, so true.
• 36:06
  Speaker 1: I think that was on a commercial.
• 36:07
  Speaker 1: I just don't remember.
• 36:08
  Speaker 1: But you know, all of that is great information and it's good for everybody to hear this.
• 36:16
  Speaker 1: It's not just for kiddos, it's for us adults too.
• 36:18
  Speaker 1: We need to keep staying in motion and exercising and taking care of our body and our mind and our soul and our spirit.
• 36:25
  Speaker 1: It's all connected.
• 36:26
  Speaker 1: We're all one person.
• 36:27
  Speaker 1: Sure.
• 36:28
  Speaker 1: So, Jill, before we close today, can you tell people where they can find you?
• 36:34
  Speaker: Yeah, of course.
• 36:35
  Speaker: So you want to search Leap Pediatric Therapy.
• 36:38
  Speaker: Our website is www.leapbeham.com and our Instagram handle is leapbam.
• 36:45
  Speaker: So L-E-A-P-B-H-A-M.com.
• 36:49
  Speaker: On the website, there is a form for interest.
• 36:52
  Speaker: If you want to fill that out, if you have any questions, we can connect.
• 36:55
  Speaker: Um, you're more than welcome to DM me on Instagram as well.
• 36:58
  Speaker 1: Yes.
• 36:59
  Speaker 1: Well, I will link your website and your Instagram handle and all that information down in the show notes so people can grab that information and connect with you.
• 37:07
  Speaker 1: I really encourage our listeners to follow Jill on Instagram.
• 37:11
  Speaker 1: And if you're in that in the Birmingham area and you need a pediatric physical therapist, Jill is amazing.
• 37:18
  Speaker 1: She would love to provide services for your family.
• 37:20
  Speaker 1: And Jill, I just want to thank you so much for coming on and sharing your expertise and answering all my questions.
• 37:27
  Speaker 1: I know it probably is falling on a lot of ears that needed to hear this information.
• 37:33
  Speaker 1: And, you know, when you know better, you do better.
• 37:36
  Speaker 1: And when you have more education, you can make better choices.
• 37:39
  Speaker 1: I always say an informed parent helps make better decisions for their kids.
• 37:43
  Speaker 1: So you provided a lot of great information for me today, things that I didn't know.
• 37:48
  Speaker 1: So thank you so much for being willing to come on the podcast.
• 37:51
  Speaker: Of course, thank you so much for having me.
• 37:53
  Speaker: You know, that's one of my favorite things about being in PEEDS is just being able to share my education and information with everybody.
• 37:59
  Speaker: You know, no questions, a silly question.
• 38:01
  Speaker: So ask away.
• 38:02
  Speaker: I'd love to help.
• 38:03
  Speaker: Yes.
• 38:04
  Speaker: Well, great.
• 38:05
  Speaker 1: We'll see you guys next time.
• 38:06
  Speaker 1: Thanks for tuning in.
• 38:08
  Speaker: Thank you.
• 38:11
  Speaker 1: Thank you for joining us on our Root Cause Conversations podcast today.
• 38:15
  Speaker 1: If this episode gave you something to think about, please do me a favor and hit subscribe so you don't miss what's coming next.
• 38:23
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• 38:29
  Speaker 1: You never know who's sitting with these exact questions that we talked about in our episode.
• 38:33
  Speaker 1: I've got everything we mentioned, plus more, on today's guest and all the ways that you can connect with me sitting right below in the show notes.
• 38:43
  Speaker 1: So make sure you check those out.
• 38:45
  Speaker 1: And if you're still short on answers after today, I am praying you get the wisdom you need whenever and however you need it.
• 38:53
  Speaker 1: Come find me over on Instagram, and I will catch you guys next time.