Types of Therapy

Our children greatly benefit from several types of therapy services. They will continue to learn and improve throughout their lives, and therapy services are essential to their development. The earliest possible start to therapy is very important. Physical, occupational, and speech and language therapy are all three vital types of services. In addition, hippotherapy, water/aquatic therapy, and music therapy are also very helpful and enjoyable for our children.

Physical Therapy

Pediatric physical therapists work with children and their families to assist each child in reaching her or his maximum potential to function independently and to promote active participation in home, school, and community environments. Physical therapists use their expertise in movement and apply clinical reasoning through the process of examination, evaluation, diagnosis, and intervention. As primary health care providers, PTs also promote health and wellness as they implement a wide variety of supports for children from infancy through adolescence in collaboration with their families and other medical, educational, developmental, and rehabilitation specialists. Pediatric physical therapy promotes independence, increases participation, facilitates motor development and function, improves strength and endurance, enhances learning opportunities, and eases challenges with daily care giving.
( http://www.moveforwardpt.com/find-your-condition/children-with-disabilities/ )

Speech and Language Therapy

A speech-language pathologist is a health professional trained to evaluate and treat people who have speech, language, voice or swallowing disorders (including hearing impairment) that affect their ability to communicate. A speech-language pathologist will talk to you about your child’s communication and general development. He or she will also evaluate your child with special speech and language tests. A hearing test is often included in the evaluation because a hearing problem can affect speech and language development.

Speech and language are tools that humans use to communicate or share thoughts, ideas, and emotions. Language is the set of rules, shared by the individuals who are communicating, that allows them to exchange those thoughts, ideas, or emotions. Speech is talking, one way that a language can be expressed. Language may also be expressed through writing, signing, gestures, pointing, or using communication devices. Augmentative and alternative communication (AAC) includes all forms of communication (other than oral speech) that are used to express thoughts, needs, wants, and ideas. We all use AAC when we make facial expressions or gestures, use symbols or pictures, or write.

People with severe speech or language problems rely on AAC to supplement existing speech or replace speech that is not functional. Special augmentative aids, such as picture and symbol communication boards and electronic devices (such as ipads), are available to help people express themselves. This may increase social interaction, school performance, and feelings of self-worth.
( http://www.nidcd.nih.gov/health/voice/speechandlanguage.html )
( http://www.asha.org/public/speech/disorders/AAC.htm )

Occupational Therapy

Occupational therapists and occupational therapy assistants help people across the lifespan participate in the things they want and need to do through the therapeutic use of everyday activities (occupations). Common occupational therapy interventions include helping children with disabilities to participate fully in school and social situations, and helping people recovering from injury to regain skills. Occupational therapy services typically include an individualized evaluation, during which the client/family and occupational therapist determine the person’s goals,
customized intervention to improve the person’s ability to perform daily activities and reach the goals, and an outcomes evaluation to ensure that the goals are being met and/or make changes to the intervention plan.

Occupational therapy services may include comprehensive evaluations of the client’s home and other environments (e.g., workplace, school), recommendations for adaptive equipment and training in its use, and guidance and education for family members and caregivers. Occupational therapy practitioners have a holistic perspective, in which the focus is on adapting the environment to fit the person, and the person is an integral part of the therapy team.
( http://www.aota.org/Consumers.aspx )


Hippotherapy is a treatment that uses the multidimensional movement of the horse; from the Greek word “hippos” which means horse. Specially trained physical, occupational and speech therapists use this medical treatment for clients who have movement dysfunction. Historically, the therapeutic benefits of the horse were recognized as early as 460 BC. The use of the horse as therapy evolved throughout Europe, the United States and Canada.

Hippotherapy uses activities on the horse that are meaningful to the client. Treatment takes place in a controlled environment where graded sensory input can elicit appropriate adaptive responses from the client. Specific riding skills are not taught (as in therapeutic riding), but rather a foundation is established to improve neurological function and sensory processing. This foundation can then be generalized to a wide range of daily activities.

The horse’s walk provides sensory input through movement which is variable, rhythmic and repetitive. The resultant movement responses in the client are similar to human movement patterns of the pelvis while walking. The variability of the horse’s gait enables the therapist to grade the degree of sensory input to the client, then use this movement in combination with other clinical treatments to achieve desired results. Clients respond enthusiastically to this enjoyable learning experience in a natural setting.

Physically, hippotherapy can improve balance, posture, mobility and function. Hippotherapy may also affect psychological, cognitive, behavioral and communication functions for clients of all ages.
( http://www.americanequestrian.com/hippotherapy.htm )
( http://www.americanhippotherapyassociation.org/ )

Water/Aquatic Therapy

Therapeutic activities performed in an aquatic environment provide excellent opportunities for children to develop their motor skills. Therapists are able to use the unique properties of water to enhance therapeutic activities.

The gravity-lessened environment of water can help children explore and practice movements and skills they are not yet able to perform on land. Water provides resistance to active movement through all planes of motion facilitating gains in strength for all major muscle groups. Movement through water provides increased tactile and proprioceptive input that enhances body awareness and motor learning.

Aquatic therapy can be an effective intervention for children with abnormal muscle tone, muscle weakness, poor postural control, decreased endurance, and limited mobility. Children working to develop higher-level motor skills such as breath control, balance, coordination, and gait are likely to benefit from aquatic therapy.
( http://www.childrenstherapycorner.com/whataqua.html )

Music Therapy

Music Therapy is the planned and creative use of music to attain and maintain health and well being. People of any age or ability may benefit from a music therapy programme regardless of musical skill or background. It focuses on meeting therapeutic aims, which distinguishes it from musical entertainment or music education. It allows an individual’s abilities to be strengthened and new skills to be transferred to other areas of a person’s life. Reasons for referral include physical, psychological, emotional, cognitive and social needs that may be addressed within a therapeutic relationship.

Music Therapy programs address a variety of objectives, including socialisation, communication (verbal/non verbal), relaxation, stimulation, pain or stress management, emotional expression or coping, self-expression, self-esteem, motivation, independence, and physical, motor and cognitive skills.

Therapy research demonstrates the effectiveness of music therapy programs in many areas including:
Effect on mood and affect
Emotional support for clients and their families
Psychosocial growth
Physiological responses (eg heart rate,respiration)
Neurophysiological functioning
Pain perception
Physical rehabilitation
Speech, language and communication
( http://www.austmta.org.au/about/frequently-asked-questions/ )


Learning Strategies

Here is a list of some learning strategies from our PTHS families that have been very successful with their child. These strategies are from discussions within our International Pitt Hopkins Syndrome Support Group (given with permission from the families).

Learning how to point

About isolating the index finger, here is more detail about what we did with Victor on a daily basis. When he was sitting in his chair, I would hold one of his hands in one of mine, holding all but his index finger in a little fist. I would then:

- use my other hand to push his index finger up and down for a minute or so, all the while making funny noises and games to make him laugh.
- After that I would put my free index finger near his and ask him to try to touch it. I would make it very close so that a little movement in his part would make our fingers touch (big yeahs when that happened of course). The better he got, the further away I would put my finger. When he didn’t move his finger, I would tap it with mine to make him “feel” that that was the finger he was supposed to move.
- We would then go back to moving the finger up and down in what we called “finger war.” Since his natural inclination is to put the finger down, I would make it so that the tip of finger would be over mine and I would push his finger up lightly (I was winning) or pretend he was too strong when he push mine down (he would win then).

Two great things happened then. When I would say “Let’s play finger war” both his index fingers would immediately assume a slight pointing position which got better over time. The second is that movement of his right index finger came along too (he is mostly left handed) even though we practiced a lot more with his left hand than with his right hand.

I’ve tried the same technique with his thumb and it worked. I’m working on his middle finger now to help make a number 2 with his fingers but this is a lot harder.I have noticed though that he is starting to move his middle finger independently.

Walking technique on treadmill in physical therapy: Gait Training

When Victor was about 18 months old, his physical therapist used a technique called “Body weight-supported treadmill training” (Gait Training) to help him learn how to walk. It had a harness that hung Victor over a treadmill, and we actually moved his legs with our hands to “train” him to walk. The PT said this would send information to his nervous system to learn how to move his legs for walking. It was very successful with Victor, and within some months he began to move his feet on his own. At his 2nd birthday he took his first independent steps, and at 2 1/2 he began to walk independently. He was very wobbly for a few years (an ataxic gait), and then began to be more steadily between 4 and 5 years old. At 5 1/2 he walks well, but is unsteady with uneven ground and with curbs. He needs assistance with stairs.

“Hand over hand” learning

We have found that Christopher learns things best by teaching him hand over hand. He doesn’t seem to be able to watch something and copy us but needs to be put through the motions himself. He doesn’t find motor planning very easy but learns if we keep repeating the actions. We then gradually remove our hands for different sections of the activity. We also give him verbal prompts.

Christopher now feeds himself with a special spoon and plate but for a very long time we held his hand around his spoon and scooped up the food and brought it up to his mouth. He allowed us to do this, as he loves his food so much. When he was happy with this movement we would bring his spoon up near to his mouth and stop. He soon learnt that he had to lean forward a bit and pull the spoon to his mouth. Gradually we not only stopped short of his mouth but we let go so he had to hold his spoon too or he didn’t get his mouthful. This all took months, as we did not want to frustrate him as food means so much to him. Gradually we were able to stop prompting him with our hand much further from his mouth until eventually we were just scooping up the food with him.

I did not think Christopher would be able to learn to scoop his food but with continued hand over hand and gentle reduction of prompts he managed it. We were so thrilled the first time he did this all on his own. He was very pleased with himself too.

We then had to work on him putting his spoon down resting it on the side of his plate rather than just dropping it between each spoonful. Again we did this by hand over hand and lots of verbal prompts.

We have always had Christopher’s bowl on a non-slip mat so that it stayed in one place for him. We usually take his special spoon and plate with him but he can manage if we forget with a shallow bowl and a normal spoon. His spoon handle is shaped for a left-hander but it’s also possible to find spoons that are built up for either hand so that they are easier to grip.