Christa Cooper: Welcome back to Easterseals: Real People, Real Impact. It’s Christa Cooper here. Today, we’re talking about pediatric physical therapy and how it can help children build strength, coordination, balance, mobility, and independence. Joining me today is Kim Tobat from Easterseals. She’s a pediatric physical therapist.
When you hear physical therapy, you might think someone is recovering from an injury or surgery, right? But pediatric physical therapy looks a lot different.
Kim Tobat: It really does. We primarily start working with children when they’re little, as early as a couple of months old, all the way up to 21 years old. It’s more like playtime when you’re working with kids. You observe them in that type of setting to see if there are any deficits that might be contributing to their difficulties.
Christa: Right. Pediatric physical therapy plays an important role in reaching developmental milestones and being able to participate in everyday activities, which is so crucial for a child.
Kim: Yes, it really is, especially for parents who might be first-time parents and don’t know exactly what those milestones are. During pediatrician visits, if they have concerns, we educate them about things like tummy time, playing on their backs, moving to a sitting position, getting onto their hands and knees, and crawling. Then children begin moving into upright mobility skills, which include cruising along furniture, or sidestepping, then walking, running, jumping, and playing with balls.
Q: How did you become a pediatric physical therapist?
Christa: I want to go back to the basics for just a minute. Tell us a little bit about yourself, how you got into becoming a pediatric physical therapist, and how long you’ve been with Easterseals.
Kim: I always knew I wanted to work with children and do something medical-related. I started volunteering at physical therapy offices and then got to observe some pediatric physical therapy in a school setting. I really found a passion for it, so I pursued it as my career.
I’ve been working with Easterseals for 23 years and have loved every moment of it. I’m happy where I am and happy that I get to help families in our community.
Christa: That’s amazing, and that is a long time. You must absolutely love what you do and working for Easterseals. When you’re evaluating a child, what are you looking for?
Q: What do physical therapists look for when evaluating a child?
Kim: Basically, you’re watching and observing the child through play when you first meet the family. You’re getting an idea of their age in months. In some cases, children are born prematurely, so you have to accommodate for that.
You watch them on their back, on their belly, playing on their sides, and sitting up if they’re able to. You’re looking for any difficulties they might be having. Some children might not have very good head control. Some might not have the strength in their upper arms to support themselves when getting into a hands-and-knees position. Some might not have very good balance, so when they’re sitting, they fall side to side without protecting themselves.
Others might not have the strength or flexibility to stand yet, or they might be up on their tiptoes. Parents might be concerned and wonder, “Why is my child up on their tiptoes?” Those are the things that lead us to do an evaluation to see if there may be a concern.
Christa: Right. We’re looking at signs or things parents might wonder about, such as whether their child is hitting those milestones and developing on track. How can the family play a bigger role in that process? I’m sure they do, whether it’s a parent, grandparent, or caregiver.
Kim: It’s really important to realize that every child develops at their own pace. Even though there are milestones we want children to reach at certain times, falling behind on a milestone doesn’t necessarily mean the child needs services.
It’s about the physical therapist talking with the family to see what they’re most concerned about and what the child isn’t doing. Then we focus on that, do the assessment, and see where they are.
Sometimes, families come to us just to have an evaluation and see if their child is on track. That gives them reassurance that their child is doing fine. We also give them activities to help their child progress in the right direction and educate them about upcoming milestones.
Families know their children better than we do. They’re the experts, so it’s really important that we listen to them and address their concerns and needs.
Q: How can families support physical therapy at home?
Christa: I’m sure a lot of this involves things they need to work on at home, too. Having the family or caregiver involved plays a huge role.
Kim: Absolutely. If we recommend services for a child, our main role is to act as a coach for the family.
We spend a large portion of a session setting up the environment for the little one to play in. We want it to feel like play for these kids. We take toys they like and set up the environment for them to be successful so they want to continue playing with us. That way, we can keep doing repetitions of an activity to build strength.
With kids, we can’t give them weights like an adult and say, “Here, do this many reps.” Instead, we do repetitions of a functional position. That might mean being on their tummy, supporting themselves on their arms, and reaching for a toy. We keep doing that activity multiple times. Then we might move the toy out to the side and see if the child can start to pivot on their tummy.
It’s a progression, and we’re teaching parents how to handle their children, where to put their hands, and which toys might be good to use to stimulate them and keep them engaged. Our role is to teach parents, help them feel comfortable handling and working with their child, and show them how to set up their environment for success.
Christa: You went through a lot of details about what a typical therapy session looks like, which answers my next question. Is that pretty much on point, or do you have anything else to add about what someone can expect?
Kim: Sessions will last depending on what the child can tolerate, but we usually allow up to 60 minutes to work with a child. We also consider the family’s availability and what works with their schedule so we can provide services when needed.
We usually see children once a week in the community, which means in their own environment, their own natural habitat. That makes them more successful because they have everything that makes them feel comfortable at home. We also offer clinic-based services, of course.
My primary focus is early intervention, which serves children from birth to three years old, so most of my work is done in the home.
When we come in, we greet the family and try to make the parents and children feel comfortable and at home. Then we talk with the parents about an activity we worked on during the last session and ask if they’ve had any struggles with it.
If they are having difficulties, we start back with that activity to help them feel confident. Then we see how the child does and progress to something else or change the position they’re playing in.
When children get restless or upset, that’s not our goal, but it can happen when they’re challenged. We try to change their position and give them new activities to play with.
As I said, sessions last about an hour, and we try to move children through normal positions. Being on their back or side tends to be more restful, while tummy time, sitting, and practicing upright skills require a lot more energy. We keep that in mind when moving between the different positions.
Q: What is durable medical equipment (DME)?
Christa: Let’s talk about something parents may have heard of but might not completely understand: DME, or durable medical equipment. Can you explain what that is?
Kim: Sure. Durable medical equipment includes pieces of equipment that help children move, play, or participate safely in functional activities.
Depending on the child’s needs, that might include a walker, an adaptive stroller, a wheelchair, standers, or bath chairs for children who might have more difficulty with hygiene.
Supportive seating can help children who don’t have a lot of trunk or head control and need additional support to maintain good posture for breathing, feeding, and using their arms to play.
Equipment can also include braces, such as orthotics for the feet, and hand splints. It’s about helping children get the right equipment so they can function at their highest level.
We also help families understand that there are a variety of products available, so they don’t have to feel they have only one option. We work with them through the insurance process and try to make sure the equipment is covered by writing a letter of medical necessity that explains why the equipment is needed for their child.
Q: How do you help families navigate the emotional side of adaptive equipment?
Christa: When a parent is told their child needs a piece of equipment, such as a wheelchair, the emotional aspect of that can be huge. How do you approach that conversation?
Kim: It can be difficult. When a child needs adaptive or medical equipment, it can make them more noticeable out in the community, and that can sometimes be hard to accept.
But many families realize that the equipment offers so much ability for their child to function better, explore their environment, and become more involved in the community. It really is a wonderful thing.
You approach it by presenting the equipment, letting the family digest the information, and waiting for their response. You want to know if they want that help rather than making them feel it’s required, because it’s not. We’re all trying to help the child function as well as they can. Independence is the big thing.
Q: How does pediatric physical therapy make a difference in a child’s life?
Christa: Absolutely. Let’s talk about how therapy really makes a difference.
Kim: Every child is unique, and therapy and progress look different for every child we work with. Sometimes, it means learning to sit comfortably on the floor. It might mean learning how to climb on playground equipment to keep up with their peers.
It’s about making everyday activities a little easier for the child and the entire family working with them.
Christa: It truly is all about independence. You seem so passionate about what you do, and I’m sure you have many stories to share. Is there an “aha” moment when you really saw success with a child you were working with in physical therapy? Do you have a short story to share?
Kim: Sure. In 23 years, I’ve had a lot of wonderful experiences.
When I first began working with Easterseals, I worked with a high school senior who had a form of cerebral palsy that affects the legs. In his case, he used a wheelchair.
When I met him, I asked, “What’s your goal for this year, your senior year?” He said, “I’d like to walk across the stage and get my diploma.”
I said, “If you’re determined, let’s do it.”
We met once a week, and we were fortunate enough to use the gym at his high school. We worked on strength, flexibility to improve his range of motion, and endurance so he could walk. Since he used an electric wheelchair, he didn’t have to use his arms much to get where he needed to go. We also worked on gait training, which is helping someone walk better and more functionally.
The staff at the high school were really good. They gave me the distance he would need to walk to receive his diploma, so we had a long-term goal to work toward.
The day before graduation, we practiced a couple of times to make sure he felt confident. And he nailed it. He walked across that stage, and his whole graduating class stood up for him. It was a really heartwarming moment.
Christa: That’s just one example of the many success stories you have. It shows how getting involved in physical therapy can help someone with everyday independence and truly change lives.
Kim: It really is. It’s a priceless gift to give someone the opportunity to get stronger and healthier. It really is wonderful.
Christa: I can tell how passionate you are, and I love that. Hearing this story and hearing how passionate you are about working with these children is giving me chills.
Q: What do you want every parent to know about pediatric physical therapy?
Christa: If you could share one thing you wish every parent knew about what you do and how you help children, what would it be?
Kim: As a parent, just know you are not alone. There are many people out there who have children who need additional help to reach their milestones, get stronger, and become as functional as possible.
Accept that every child is going to develop differently, and that’s okay. That’s what makes them unique and special.
Seek an evaluation. It’s the right move, and it will give you information to help you and your child reach their greatest potential. We’re here to help. We want to give you the tools and confidence to help your child along the way.
Christa: I think you said something really important: You’re not alone. That’s true. Parents should know that one phone call or one visit to the website to get more information could be a moment of change for their child and their family, helping them get the support they need.
Thank you for joining us for Easterseals: Real People, Real Impact.
