Early Intervention From a Physical Therapist’s Perspective

Updated: Dec 23

Andrea, a Physical Therapist, talks about Early Intervention and the importance of Pediatric PT in children 0-3 with developmental delays.

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Host:  0:19 

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Jamie:  1:26 

Hello everyone and welcome to another episode of I am able I am your host Jamie Lord Tovar. And today with me I have Andrea Jarvis.

Andrea:  1:39 

Yes. I’m great. Thank you.

Jamie:  1:42 

Thank you so much for agreeing to talk to me. My pleasure. So can you give me a little bit of your background? Can you tell me first, what is your occupation? What is it that you do?

Andrea:  1:57 

I am a physical therapist.

Jamie:  1:59 

Okay. And so what is your education background?

Andrea:  2:04 

I graduated from physical therapy school as a doctor of physical therapy in 2017. So I’ve been practicing as a pediatric physical therapist for four and a half years. My whole career thus far has been entirely in pediatrics.

Jamie:  2:17 

Oh, okay. Great. All right. So today, we’re talking about early intervention. Can you tell me what your connection is with early intervention?

Andrea:  2:26 

I am super passionate about early intervention. It’s my favorite area of Pediatrics. I was introduced to it as an area at my last, the last place that I lived, I came to California via Connecticut. So in Connecticut, I worked as a physical therapist and early interventionists there for two years before moving here to LA and working as a physical therapist and early intervention here. Oh, cool.

Jamie:  2:55 

Okay. Yeah. For the folks out there who don’t really know what early intervention is, can you kind of tell us a little bit about it? What is an early intervention?

Andrea:  3:07 

Absolutely. So there’s a lot of things that go into the definition of early intervention. The kind of short answer is that it’s a system of supports and services for infants and toddlers who are ages birth to age three, who have some kind of developmental delay, that developmental delay could be because of a medical diagnosis or some kind of diagnosed condition. But there are other children, plenty of children who have a developmental delay for an unknown reason, who just need a little bit of extra support to meet their milestones. Early Intervention can include a wide variety of professionals. I’m a physical therapist, right? There’s a lot of other therapists you know, occupational therapists, speech therapists, audiologists nursing nutrition, of social workers, psychologists, a lot of different professionals participate in early intervention.

Jamie:  3:58 

So there’s a huge, huge population of people who, who were out helping with with our little ones that are under three Okay, so last I spoke with, Yuna, who’s an occupational therapist, so we get to hear a little bit about that side of early intervention. So today, we’re gonna get to learn more about physical therapy, which is really awesome. It’s something that I I’m, I’m an occupational therapy assistant. So this will be some this will be a place that I will actually be learning some new things to, which Is always amazing. Alright, so we’ve talked about developmental milestones. So for physical therapy, what are some of the milestones that you’re looking at?

Andrea:  4:47 

As a physical therapist? A lot of motor development happens in those first three years of life, particularly that first like year and a half are really, really huge for for gross motor milestones that In his early months, I’m looking at rolling over sitting, crawling, pulling to stand walking kind of that progression. And then in those older kids, I’m looking more at like, stair climbing, running, jumping, throwing balls more that kind of active the things you think of preschoolers doing.

Jamie:  5:20 

Okay. All right, cool. Nice. So, um, you said that with, with the little ones you’re helping with, like rolling over and things like that. When you talked about gross motor? Can you explain what gross motor is?

Andrea:  5:38 

Yeah, so gross motor milestones, are those really big movements. So your movements that require your whole body if not your most of your body to achieve?

Jamie:  5:51 

Okay, all right. So unlike with occupational therapy, we focus more on like the fine motor. So we’re working with mainly like, like the hands and you and you’re working more with the entire body?

Andrea:  6:04 

Basically! Yes, yes, absolutely.

Jamie:  6:09 

So how, how do children become? How do you get them evaluated? When they when you feel like there are some physical delays, some developmental delays?

Andrea:  6:25 

The process for getting an evaluation kind of depends on your location, it depends on a few factors. But the one constant way to find get connected to an evaluation is to speak with your pediatrician. And have your pediatrician refer you for an early intervention evaluation. States are required to provide those services. That’s a requirement under law by law. So those services are available, regardless of where you are.

Jamie:  6:53 

Okay, all right. So is it. So you’ve been in California a couple years you were practicing in Connecticut? Is there? Is it different as far as like getting an evaluation, the process as it is a different there than here? Or

Andrea:  7:12 

the referral for an evaluation is a little bit different? How those evaluations get from being referred to maybe the therapist who’s going to do the actual evaluation, but the evaluation itself once a therapist is there in your home? It looks very similar regardless.

Jamie:  7:29 

Okay. Okay. All right. So you were just saying so you can have treatments at at your home or in a pediatric clinic is, is that correct?

Andrea:  7:40 

Yep. So you can have early intervention services, anywhere the child is so that could be in a clinic, that could be in a home, I work primarily in homes that could also be in the community to be at daycare could be at the park, the grocery store, the beach, you could go anywhere and find ways to foster a child’s development.

Jamie:  7:58 

Okay. All right. So what are some? So you’re primarily you do your service at home? And which I would think would be like, the best place though, because you’re actually going to see the child in like, the context, their environment? And so it might be a little bit easier. Is that true, or than to go like to a clinic? Or is it kind of the same with physical therapy?

Andrea:  8:28 

I think there’s sort of pros and cons to each I think the big draw to the clinic is for some families is that you have access to these really great therapy tools and you know, big trampolines and climbing structures and, you know, other therapy, things that you don’t have in your home. But a lot of families are drawn to services in the home because the therapist can really join the family and what they’re doing in there, in their daily routines can go to the playground that they play with their child with and see exactly how their kid always falls down those stairs every single time or why they can’t climb in their bathtub. And you know, you can see it hands on right there and right.

Jamie:  9:05 

Yeah, okay. All right, cool.

Andrea:  9:10 

I found it to be really, really valuable as a therapist, but also for families to be able to join them in what they do every single day and to really, really see what families mean when they tell you my kid can’t do this, or I get frustrated every time I don’t know how to help my child walk up the stairs or whatever. It’s, it’s really, really meaningful to join them where they are.

Jamie:  9:34 

Yeah, okay. Oh, yeah, that’s good. Yeah, I’m with occupational therapy. I’ve kind of feel like it’s the same, because it’s just easier than because it’s sometimes it’s difficult with the parents to get, you know, the and the total picture because, you know, they’re not therapists. They don’t know exactly. You know, what we’re truly asking or maybe, you know, they’re not quite getting the whole idea. So, so when you have therapy in a gym, you said you use like trampolines and other things like that. Well, yeah, entered equipment that you typically use for like, four little ones for under three. In the, in the gym.

Andrea:  10:21 

Yeah. So I actually don’t primarily work in the gym. So I my, you know, range of creativity with the gym tools is not as not as broad as, but definitely, you know, most gyms have like a set of stairs have some balanced themes and stepping stones and scooter boards. Yeah, trampoline and those sorts of things.

Jamie:  10:51 

Yeah. Okay. Which kids love, right? Absolutely. So you have to be really creative than when you’re when even though you’re using like things that they use all the time. But I would assume that you might use some things a little bit differently just to increase like, their motivation, or do you like okay, do you help them with like, say, like, riding the scooter, or we’re balanced and things like that? Or

Andrea:  11:19 

are you referring to in the home or in the clinic

Jamie:  11:20 

in the home? I’m sorry? Oh, yes, yes.

Andrea:  11:23 

Yes, in the home, you have to be really, really creative. But what’s fun about that is that we can use the things that are motivating to the child are often already there. And so you know, if they like their scooter, we can work on balance with the scooter. I love a diaper box, I can use a diaper box for anything across any stage of development. I love a diaper box and families have them every family’s got a diaper box laying around. Because we all know we go through way too many diapers in those first years. Um, so yes, you definitely have to get creative. But it poses this really fun opportunity for the parents or the caregiver, whoever that is, and myself to kind of figure out what they’ve gotten the home I might have, you know, you say you want to work on something balanced that your child’s balances is you’d have some concerns about that. Here’s kind of an idea I have, how could we make that happen? What kind of steps will do you have? Or what kind of what do you and parents come up with the best thing better than anything I could ever come up with using the things that they have laying around, which is really fun.

Jamie:  12:32 

Oh, that’s awesome. That’s really good. So it sounds like parents or caregivers are totally involved in the treatment, then they’re with the collaborating with, with like goals, the different things that they’re looking forward to have help with. And then also coming up with ideas. And then so then you give them like, an occupational therapy, we do a lot of parent education, I would assume with physical therapy. It’s, it’s very similar.

Andrea:  13:07 

Yes, yeah. So parents are definitely involved in sessions and caregivers, whoever it is teachers, if we’re at a daycare or preschool, I’m definitely involved. And they Yes, we always come up with something together to do between visits. So with my families, I usually say my, I usually ask the question, what stood out to you today that you want to work on between Now in our next visit? That’s my go to question. Sometimes parents are like, Yes, I know exactly what I want to work on. I want to do this, this and this, or just this one thing, I oftentimes just one thing, just to focus on. Sometimes parents don’t know what they want to do. They don’t know what they want to work on. So they sort of I don’t know, what do you think and that provides a really, a really nice opportunity for me to really collaborate with them and kind of remind them well, we worked on, we worked on walking up the stairs today, we worked on you know, this and this, one of those things seems valuable to you and important to you. And usually they’re able to narrow down and pick something that I always asked at the start of the next session. I always asked how did it go, you were going to work on fill in the blank. How do they go? And usually they’ll say, Oh, wait great, or Oh, my goodness, it went terrible. And I don’t know what happened. You weren’t there. And it provides a really fun opportunity to problem solve with the family to figure out how to make that better.

Jamie:  14:32 

Okay, good. And it sounds like and then if you you’re giving them homework to do when you’re not there, that and then you kind of you’re holding them accountable for like okay, you know, I expect you to do this and so that’s really good. That’s absolutely I’m getting some when I decide I want to do home health care and OT now I have some good, some good ideas of, of ideas of things to do with the parents and things that are out So see, I’m learning more stuff to love it. So for physical therapy, how long are the treatments usually are they like an hour or?

Andrea:  15:15 

It so depends on the child. So anybody, babies often don’t make it a whole hour, they just don’t. Um, the rest of that hour could be used to, you know, could really collaborate with the parent and do some problem solving maybe if the child’s not like actively practicing rolling or something. Um, but sometimes those sessions are a little bit shorter and older kids can do a little bit longer, it seems like an hour is kind of the average typical Across Ages, I think most therapists kind of recommend an hour total. And that provides plenty of opportunity to review what you know, the quote, homework, the things that you were supposed to work on that you said you were hoping to work on with your child and then join them in their routine and continue on the growth and learning.

Jamie:  16:06 

So and then. So like for occupational therapy, we usually have our sessions are like, either like once a week or twice a week. Is that the same for you? Typically?

Andrea: 16:19 

Yeah, and again, it so depends on what the family’s priority is, and how much support they feel they’re needed. I mean, early intervention is ultimately the goal of it is to support the family in order to support the child. So, you know, if I kind of do an evaluation, and I think, okay, my recommendation based on everything I’ve heard, my professional recommendation would be one time a week for an hour, maybe that’s what I would say. And then the family, you can see it on the caregiver space, if they agree or disagree. The parent might say, Okay, I’m feeling really overwhelmed right now I don’t, I don’t feel like I have the tools I need to be able to, to support my child. So maybe we’ll we’ll talk about okay, we’ll do twice a week. And then we can bump that down. As you feel more comfortable and gaining the tools you need to support your child. So it’s definitely for me and every therapist is a little bit different how they get to that point. For me, it’s very much a collaboration and and based on what the family kind of support the family feels like they need.

Jamie:  17:17 

Okay, cool. And so you had said before now I’m but I’m thinking back to the diaper box. You have all kinds of activities that you can do with that. So can you give me some examples of like what you would do with like a maybe like a really little kid. And then maybe even though we’re talking about early intervention, maybe like some someone a little bit older, just so we kind of get an idea of what,

Andrea:  17:46 

yeah, so for like an itty itty bitty kiddo, under the age of one, a diaper box is the perfect height for kneeling is like sitting on your knees and makes like a nice little table to play with a toy. And pulling to stand standing supported add a little surface to play with a toy. They’re often especially if they’re full, or you can weigh them down, they’re there, they feel a little bit more stable than maybe some of the other toys that a child might be playing with at that stage. So that’s like a little kid under the age of one that would be something that I would do. I’m like maybe older, like 2123 years old, kind of a little bit older once they’re walking and climbing, climbing in and out of a diaper box is a motor planning activity. How do I get out of this box without it slipping over on me and falling? How can I put my things in and take them out? I’m even older kids than that. If you’re talking about you know, 567 older, you can do toe taps on a box, you can use it like a step up. If they’re really really, if they’re really really big, you can jump over you can use it as part of an obstacle course and run around it. You can use it for anything. Oh, wow. It’s a fun tool.

Jamie:  19:02 

Sounds like so you do a lot of obstacle courses to then for during your treatments or are just saying

Andrea:  19:14 

I don’t typically do a lot of obstacle courses mostly for the reason that I’m, well there’s two reasons my my caseload tends to skew a little bit younger. So a one year old isn’t really going to participate in an obstacle course the same way a five or six year old would right um, but also I I’m really really focused on what a child’s doing in their daily routine and really joining that child and what they’re doing so it’s very, I’m whatever the child is, if I’m doing it for playtime, which is typically what motor skills that’s the routine motor skills fallen. I’m really joining that child in what their activity they’re directing and sort of modifying the environment to achieve what it is that the parent is hoping to do. So it’s I’m doing less structured, we’re gonna step up and down 10 times and more. The child is we’re learning to walk, and they’re really engaged in this ball, how can we use this ball to promote they’re walking in what they’re already doing?

Jamie:  20:15 

Okay, all right. So like use the ball is like a motivator to move in a certain way or direction?

Andrea:  20:22 

Yeah, absolutely.

Jamie:  20:25 

So what are what are some of the other activities that you do more often? Like? What are some I know that you have like a wide range of, of clients, and everybody’s different. But are there a few things that you in your, in your practice that you typically see? Or are there any activities that that you work on more often?

Andrea:  20:56 

So my, my caseload skews, sort of learning to walk and under on the developmental continuum. So most of the activities that I’m doing with families and their their kiddos is just driven around, playing with toys and interacting with toys for movement. So for a kiddo who’s learning to sit that would be figuring out how to arrange the toys, so that it promotes their posture to be more upright. If it’s a little kiddo who’s rolling, it’s using those toys to motivate them to turn over and, and beginning to use those hands to reach towards toys. And older kid that might be spreading toys out all over the couches and things to try to motivate them and promote their movements in a standing position between different surfaces or towards different toys.

Jamie:  21:51 

Okay, so how do you when a child is having difficulty with like crawling, crawling, how, what do you? What are some of the things that you do to help encourage crawling or?

Andrea:  22:06 

Well, the big question is, why are they not crawling? So the first step would be to figure out, is it because they have low tone and, and a weak core? And they physically can’t support themselves that way? Is it because they figured out that it’s faster for them to army crawl on their belly while they’re holding their toys than it is to be on their hands and knees? Um, is it because they have pain or tightness somewhere? It’s so step one would be to kind of figure out why. And then step two, to figure out the motivating factor for that kid, kids don’t want to move unless they want to, we can’t make them great. So figuring out that motivation for that child is that huge, huge step.

Jamie:  22:51 

So it sounds like you spend a lot of time like trying to solve puzzles or mysteries, your Creator, and in a way,

Andrea:  23:00 

it’s so true. It’s so true. And I say to some kiddos, and I’ve said to parents before to you are just a little puzzle, to figure out I use that phrase, you know, talking with I do because it’s it truly is a little puzzle. And you have to kind of take what you’re seeing and figure out how to get from what you’re seeing to what the parent is hoping to see. Yeah, it’s fun, though. It makes it definitely keeps life interesting. And you never know what you’re gonna get before you walk into a session. So it definitely keeps you on your toes.

Jamie:  23:32 

Everybody’s different. And just depending on food, yeah, you just Yeah. You don’t know what it’s absolutely, what your day is going to be like. So you had mentioned low tone, can you tell the audience what low tone is in case they’re not aware?

Andrea:  23:47 

Sure. So the muscle tone of a child is how responsive the muscle is to movement, and willing to engage in movement. So a low tone child would be that would be a child where you pick them up, and they just like flop into you, they have no resistance to you picking them up. They’re just like a floppy baby. They are a blob on the floor, they don’t move a lot. They’re just kind of just kind of their content to be there. Whereas a high tone child would be like the kind of tone that you would see in a child maybe with cerebral palsy where their muscles are really, really, really tight and they’re, they’re very tense stuff that would be a high muscle tone, a high muscle tone in a child.

Jamie:  24:34 

And so what do you do if a child has like high muscle tone? Do you do stretches or is there a way to try to loosen them up?

Andrea:  24:48 

So tone muscle tone, high muscle tone typically does not change with well muscle tone in general doesn’t change without some kind of medical entity. Attention. So high muscle could kiddos who have high muscle tone might get like a botox injection, they, you know, could have some kind of medical intervention, there are positions that you can put children in to sort of break we call kind of breaking their tone or sort of get them into a position where their tone is not as active. And that kind of depends on the child, it depends on what what positions their tone is, in not every child has just global high tone or global low tone, where every muscle in their body is the same, there’s typically a variety of tone.

Jamie:  25:40 

So that sounds like then positioning is like one of the things that you can do to help with the tone either high or low.

Andrea:  25:49 

Yeah, absolutely. So you know, working with working with parents to figure out, you know, how can I support my child in a highchair if it’s a high tone child, they might kick out and like straighten their body and not want to relax into sitting. So figuring out what kind of support that child needs to be able to relax their body into sitting for a low tone child, that may be the kid that just like melts over as they’re eating and like kind of flops to one side. And so you know, figuring out what we can use to support their trunk a little bit more on the sides or putting, you know, just figuring out the straps, maybe some shoulder straps or something to promote upright posture.

Jamie:  26:29 

Okay. Alright, let’s see. So, um, let’s, you’ve answered most of my questions are ready? Do you have any advice for parents out there who think their child might not be developing the way that they, they feel like they should be or as quickly as they should be?

Andrea:  26:55 

Absolutely. So the two things that I would say are the first, that you as the parent are the expert on your child, and you’re the your child’s biggest advocate. So if you have any concerns, regardless of how silly or small or whatever that you think they might be, it’s worth mentioning, because if it’s true, if it’s alerting something in you, then it’s worth mentioning, you can always bring that up to your pediatrician, it’s better to get an evaluation and for the evaluator to say, oh, everything is going great. These things are on track, here’s what you can look forward to in the future, then to kind of wish you had done that sooner. Um, I also like to remind parents that just because their child does have a delay in an area is not at all a statement. On the, you know, your ability to be a parent, and your ability as a parent and I and recognizing that you need a little bit of support and your child needs a little bit of support to meet those developmental milestones is a huge sign of love and care for your child.

Jamie:  28:00 

Like that, that’s, that’s good. Is there anything else you’d like to share with our listeners?

Andrea:  28:08 

Nothing in particular, I love early intervention. I’m I love it. You know, from a provider perspective, I think it’s the most fulfilling area of physical therapy practice and I want to be involved in early intervention in some degree for the rest of my career. There’s so much so much to learn and, and do and, and so many areas to grow in just within those first three years of development. It seems like such a tiny part of a child’s life, but there’s so much that happens there. And it’s so full of, of opportunities to learn.

Jamie:  28:43 

Right? Yeah. I mean, it’s, it’s amazing how much children learn from the time they’re born up until three years old. It’s just, yes, little sponges. It’s just amazing.

Andrea:  28:54 

It is very rewarding. It’s so rewarding to see that like that change and and the excitement that families and parents have when their child reaches a goal that they’d set for themselves or for their child. It’s, it’s so rewarding. I mean, I love what I do. And yeah, it’s amazing.

Jamie:  29:14 

Oh, yes, it’s pretty apparent that you love what you do. And I really appreciate you talking with me about early intervention and physical therapy today. Of course.

Andrea:  29:28 

Happy to do it.

Jamie:  29:30 

All right. Well, if there’s nothing else that you’d like to share with our listeners. All right. I think that that’s it. Well, thank you again, so much for talking with me today. And thank you everyone out there for listening to I am able. I hope that you have a really good evening. Thank you so much.