Memorial Day Weekend Closures at MedCare

Saturday, May 25th both our Stafford and Northshore clinic locations will be open for regular business hours. 

Monday, May 27th the following locations will be CLOSED in observance of Memorial Day:

• Corporate Offices
• Northshore Clinic
• Spring Clinic
• Katy Clinic

If you receive home therapy or home nursing services, please check directly with your nurse and/or therapist to see if they will be working that day. 

Sábado, 25 de Mayo ambas nuestras clinicas Stafford y Northshore estarán abiertas horas regulares.

Lunes, 27 de Mayo las siguientes ubicaciónes estarán cerradas en conmemoración del Día de los Caídos:

• Oficinas Corporativas
• Northshore Clínica
• Spring Clínica
• Katy Clínica

Si recibe terapia en el hogar o enfermería en el hogar, por favor consulta directamente con su enfermera y / o terapeuta para ver si se va a trabajar ese día.



Atlanto-Axial Instability and Children with Down Syndrome

As therapists, we are always encouraging children to run, jump and play. There are times when physical activity could be dangerous to your child’s health, however, especially children with Down syndrome. Children with Down syndrome are at risk for developing a condition called Atlanto-Axial Instability (AAI). AAI is a condition in which the first and second bones of the neck have too much flexibility. These bones, called cervical vertebrae, can cause damage to the spinal cord when there is too much flexibility. 

How common is Atlanto-Axial Instability in children with Down syndrome?

Approximately 15% of children with Down syndrome have AAI and have no symptoms. Only 1-2% of children with AAI have symptoms.

What are the symptoms of Atlanto-Axial Instability?

Although physical symptoms of AAI are very rare, some symptoms that could indicate pressure on the spinal cord include:

▪ Neck pain

▪ Torticollis or tilting of the head and neck

▪ Loss of balance or changes in walking pattern

▪ Changes in sensation in the hands or feet

How do I know if my child has Atlanto-Axial Instability?
AAI is diagnosed through a series of neck X-rays. X-rays of the head and neck are taken from the side (lateral view), with the head bent forward (flexed), and with the head tilted backwards (extended). On X-ray, a space between the 1^st and 2^nd cervical vertebrae larger than 4.5 mm is positive for AAI.



Does my child need to have X-rays if they have no symptoms?

It is recommended that all children with Down syndrome have X-rays taken during their preschool years (ages 3-5). Any child who wants to participate in sports should have X-rays prior to starting the sport as well, even if previous X-rays were negative. This will ensure that it is safe for your child to participate.  Our Physical Therapists recommend that any child with Down syndrome have X-rays prior to starting treatment and will require X-rays prior to working on any jumping activities with a child.

If my child is diagnosed with Atlanto-Axial Instability, are they restricted from physical activity?

Children with AAI can still participate in physical activity; however, they should avoid activities that put excess strain on the head and neck. Activities that should be avoided include:

▪ Gymnastics, tumbling and somersaulting

▪ Vigorous jumping/bouncing, such as trampoline activities

▪ Contact sports such as football, hockey and soccer

▪ Diving

Where can I find more information on Down syndrome or Atlanto-Axial Instability?

Your pediatrician and your child’s therapists are great resources for information. There are also several national and local agencies with excellent information, including:

▪ National Down Syndrome Society:

http://www.ndss.org/

▪ National Association for Down Syndrome:

http://www.nads.org/

▪ Down Syndrome Association of Houston:

http://www.dsah.net/

Sommer L. LaShomb, PT, DPT, PCS

Physical Therapist



Reasons for Discharging Patients from Therapy Services

As pediatric therapists, we treat many children who have disabilities or conditions that will affect them for the rest of their lives.  So why would we discharge a patient who has a life-long condition from therapy services?  This is a question that many parents and caregivers ask our therapists and our clinical directors, so we wanted to take some time to explain what the reasons are behind why we discharge patients from therapy.

1.       The child has met his/her goals:  As therapists, this is our ultimate goal!  We want every child that we work with to progress to the point where they no longer need our help.  When we do an initial evaluation, we establish individualized goals for each child and we focus our treatment on meeting and achieving those goals.  When your child meets his/her goals, it’s time for celebration and also time for graduation from therapy!  This can be bittersweet for both the families and the therapists at times.  Therapists can become like a part of the family, and it’s hard for us to say goodbye to patients that we’ve worked with.  But as the saying goes, all good things must come to an end!

2.       The child is functioning at a level that is appropriate for his/her age or diagnosis:  Therapists can’t “cure” children of any disability or condition.  What we can do is help a child reach what we call his/her “maximum functional potential”.  Maximum functional potential means that your child is functioning at a level that is safe and reasonable for them to complete their everyday activities given their disability or condition.  For example, not every child will have the ability to walk independently.  However, if a child is able to safely and independently walk with a walker at home, at school, and in the community, then they have reached their maximum functional potential for that skill.

3.       The child is not willing or able to actively participate in therapy:  The therapy relationship, like all relationships, requires the participation of both parties involved.  Children have to be capable of being an active participant in therapy in order to gain something from it.  Sometimes, children have behavioral issues or physical limitations that make it difficult or even impossible for them to participate in therapy.  When this is the case, we recommend the families address those issues first, before we attempt to provide therapy. 

4.       The child is not making progress in therapy:  In order for us to justify that what we are providing is helping the child, we have to be able to show progress.  As therapists, we understand that each child is different and will progress at different rates.  We’re not saying a child has to meet every goal every time we evaluate, but we do need to have documented evidence that the child is making progress towards his/her goals.  This is especially important for insurance reimbursement.  Insurance companies will not pay for therapy services for individuals if they do not show progress.

5.       The child no longer needs skilled therapy:  The services that we as therapists provide are considered skilled services.  Therapists have specialized degrees and are licensed by the state to provide therapy services, meaning that not anyone is able to perform the skills that a therapist does.  However, there are skills that do not have to be provided by a licensed therapist and can be taught to caregivers.  Skills like range of motion (ROM), therapeutic exercises, sensory integration techniques, etc. can all be taught to and performed by people who don’t have a license or a degree in therapy.  When a child just needs therapeutic interventions that are unskilled, the caregivers can provide those interventions and skilled therapy is no longer needed.

6.       The parents/caregivers do not follow through with therapy recommendations:  Therapy is just a small part of a child’s world, usually just a few hours a week.  So we need help from you, the parents and caregivers!  Caregivers are expected to work with their children outside of therapy on the same goals that we work on so that the child achieves something called carryover.  Carryover means that a child is able to perform a task not just in therapy, but anywhere they are asked to complete the task.  For example, a child may learn how to tie his/her shoe in Occupational Therapy, but if he/she can’t tie the shoe at home when the caregiver asks, outside of the therapy setting, then how will they be independent with their dressing skills?  When therapists give recommendations to caregivers and those recommendations aren’t followed, it can slow or even stop a child’s progress in therapy and if that is the case, we may need to discharge.

As pediatric therapists, our job is to make therapy fun for the child and we do our best to make sure that they are successful both in therapy and out in the real world.  Prior to discharging any patient, we look at all the factors affecting the child before we make a decision to discharge.  We hope this blog helps you have a better understanding of the reasons for discharge from therapy.

MedCare's Upcoming Marketing Events!

The following is a list of upcoming events where MedCare will be present!  Feel free to stop by, say hello and get valuable information about the services we provide as well as current job openings with our company!

Texas Job Fair

Texas Southern University

Tuesday, April 2^nd

10a-3p

http://www.tsu.edu/academics/colleges__schools/Jesse_H_Jones_School_of_Business/JHJ%20Flyers%20CPP3.pdf

Houston Children’s Festival

Saturday, April 6^th

10:30a-6:30p

Downtown Houston

http://www.houstonchildrensfestival.com/

ECI Project Grow Transition Meeting

Tuesday, April 16^th

4706 Airport, Rosenberg, TX

Physical Therapy Career Fair

University of North Texas Health Science Center

Wednesday, April 17^th

10a-1p

http://web.unthsc.edu/info/200573/physical_therapy/930/2013_career_fair

Student Night TOTA (Event Sponsor)

Wednesday, April 17^th  

5:30p-7:30p

Shriner’s Hospital for Children

http://www.tota.org/gulfcoe.html

1^st Annual Autism Conference

Saturday, April 20^th

8:30a-1:30p

Nolan Ryan Junior High

11500 Shadow Creek Parkway Pearland TX 77584

http://www.arcgulfcoastchapter.org/Events.html

MDA Muscle Walk

Saturday, April 27th

8a-10a

Houston Galleria

http://www2.mda.org/site/TR/Walk/77-716-HoustonMetroDistrict?fr_id=4341&pg=entry

NDTA Annual Conference

May 17^th-19^th

Marriott Houston Westchase

http://www.ndta.org/conferences/seminars.php?conference_id=1765

Long-Term Planning for Children with Special Needs

Long-Term Planning

Planning for the future is fun and exciting when planning for a vacation, wedding, or retirement. Planning for a future where we are absent from our loved ones’ lives is much more difficult but far more essential than planning for events! It all boils down to communication and having all the important documents in one place. A binder is a great way to organize and keep all important documents in one place that is accessible to family members or other designated caregivers as needed. Here are 10 must-have documents to include in your binder:

1.       Important legal papers:

a.       Birth certificate,

b.      Social Security card,

c.       Health insurance cards,

d.      Medicaid award letter

2.       Letter of Intent – this is a not a legal document but is a very important way to pass vital information about an individual with a disability to future caregivers. This important document should be updated once every year. Be sure to sign and date this document every time you update it! Information to include:

a.       People to contact if something happens to you (include names and relationship/role, addresses, mail and e-mail addresses of other children/individuals, extended family, case manager, and close family friends)

b.      Current situation and family life

c.       Daily routine

d.      Sleeping preferences

e.      Eating habits – food likes/dislikes

f.        Education performance/routine

g.       Strengths and preferences

h.      Future living plans

i.        Employment

j.        Medical Care

                                                              i.      Medical diagnoses

                                                            ii.      Medical Doctor(s) (contact information)

                                                          iii.      Eye doctor (contact information)

                                                           iv.      Dentist (contact information)

                                                             v.      Allergies and reactions

                                                           vi.      Drugs and adverse reactions

                                                         vii.      Medications currently taken

                                                       viii.      Therapies – types and schedule (contact information)

k.       Behavior Management (counselor and contact information)

l.        Social activities

m.    Religious/Spiritual Life

n.      Strengths and preferences

o.      Guardians and trustee

3.       Final arrangement written instructions:

a.       Burial/cremation preference

b.      Religious service or other services

4.       Advance health care and financial directives:

a.       Powers of attorney

b.      Living wills

c.       Health care proxies

5.       Trusts and wills (copies of):

a.       Special needs trusts

b.      Living trusts

c.       Insurance trusts

d.      Location of signed copies or originals so they can be accessed if needed to complete property transfers

6.       Major assets list with policy and account numbers, and names of any brokers, insurance agents, or investment advisers:

a.       Insurance policies

b.      Stocks

c.       Mutual funds

d.      Bank accounts

7.       Guardianship papers and advocacy organizations with your personal thoughts about these organizations.

8.       Government agencies you have dealt with and the caseworker or contact at the agency; include contact information.

9.       Government benefits the individual may or does receive, as well as copies of any completed application forms, include contact information.

10.   Miscellaneous papers such as tax returns filed for the individual, housing option information/applications, school applications, documents referenced to in the Letter of Intent, and/or photos.

Add other “must-have” documents to your binder according to your individual with special need’s unique needs and future plans. For more resources related to long-term planning for your child, contact MedCare's Social Worker, Karen McWhorter, LMSW-IPR, CPS.

Information adapted from www.friendshipcircle.org and http://specialchildren.about.com/od/longtermplanning/a/letterofintent.htm.

Planning for your Child with Special Needs’ Future

Planning for your Child with Special Needs’ Future

Trusts? Advance Directives? Insurance? Guardianship? It is typically late at night when you are trying to fall asleep or during the middle of the night that these issues skip through your mind and one of two things happens: you reassure yourself you have “plenty of time” to plan because your child is still young…..OR…..the hard knot develops in the pit of your stomach/chest and you are unable to fall asleep!

A recent webinar, ‘Financial Planning: Kids with Special Needs,’ presented by Greg Zibricky, Founder and President of Provider Group Wealth Advisors broke difficult financial planning concepts and special needs planning into easy to understand components using the work “F.A.M.I.L.Y.”

F – Flexibility is essential. As parents, we must be open to modification or adaptation throughout any planning process.

A – Access to health insurance and government benefits can often be tricky and complex. MedCare encourages all families to explore as many government benefit programs your child may be eligible to receive. Medicaid Waiver programs are essential for individuals who will have lifelong physical and/or intellectual disabilities. More information about these important programs can be obtained from MedCare’s Social Worker, Karen McWhorter.

M – Money not only refers to the need to have financial resources available but also refers to how children with special needs are designated as beneficiaries and how trusts are structured and named so that your child with special needs is still able to keep government benefits and other important resources.

I – Insurance. Public insurance is available through Medicaid and if your child (and household) qualifies for Social Security Income (SSI). Children with Special Needs can also stay on their parents’ health insurance until the age of 26 years old….but talk with your Human Resources designee as early as possible to ensure you have completed the appropriate paperwork for this important exception.

L – Legal planning is essential so that you have a Will in place, Advance Medical Directives, and a Special Needs Trust fund for your child.

Y – Yak, Yap, and Yell!!! Planning and communication is essential to ensuring that your plans for your child will be carried out as you envision them today and tomorrow.

The most important part of planning for your child’s future is TO GET STARTED!! The first step you can take is to create a M.A.P. (Making Action Plans). The best M.A.P. will include your child with special needs. Be sure to include the following components in your M.A.P., which can consist of words, pictures, etc. Visuals are very helpful!

·         Hopes and Dreams

·         Current feelings

·         Nightmares and fears

·         Gifts and strengths

·         Successes

·         Positive future plans

After your child’s M.A.P. is drafted, it can and should be revisited at regular intervals and important life transition points (middle/high school completion, turning 21, etc.). Flexibility is key to this part of the process and adjustments can be made to all components of the M.A.P.

With money and assets, the biggest key is that you want to maintain control of your child’s funds as much as possible, and therefore, assets should not be put in the name of your child. It is best to research insurance options with a professional who can fully explain the difference between the different types of policies: Term Life, Whole Life, and Universal Life, and advise which type is best for your situation. With whatever life insurance policy you choose, you can ask for an “In-Force Illustration” and your insurance provider will tell you what would happen if the policy went into effect from “today” for you to see how the funds would roll out and what would happen. It is best to request an “In-Force Illustration” from time to time so you know what will happen in the event of your death.

Parents of children with special needs should have a Will that designates a guardian if your child is under the age of 18 or if you have chosen to file for guardianship over your child. Many families provide for A Special Needs Trust in their Wills but this type of Trust can be established at any time.

A Special Needs Trust

·         Protects the beneficiary (your child) from creditors/predators

·         Preserves eligibility for SSI and Medicaid

·         Provides distributions for supplemental needs

An example of how a Special Needs Trust can be titled was given as follows: “Gregory and Dawn Z, Trustees of Aaron Paul Z Discretionary Supplemental Needs Trust, Dated 2/27/2013.” One of the important things to remember is that you can change trustees if needed. Parents should contact a financial planner who has worked with families of children with special needs to find out about different types of Special Needs Trusts and what works best for your situation. For more information, go to www.metlife.com/individual/planning/special-needs/index.html#overview.

Finally, COMMUNICATE your desires and wishes for your child to your family and friends. There are several tools you can use to communicate this information – a “Provide Care Journal” or a “Letter of Intent” – you will outline your vision for where you want your child to “Live – Work – Play – Worship.” These items are very important if anything happens to you, so other will know what you were doing and continue with your plan for your child’s life. Go to www.specialneedsanswers.com for a guide, which can be found under the “resources” tab. The Special Needs Answers website can also assist with finding a Special Needs Planning Attorney. Other resources include www.specialneedsalliance.org, a group of Special Needs Attorneys. To find a Special Needs Planning Attorney in your area, Google: “Special Needs Planning Attorney, Houston, Texas.” (Italicized words can be changed to match your location.)

NOTE: This is intended to be a brief overview of the information shared and not intended to be a complete guide to the complex issue of planning for your child’s future needs.

Karen P. McWhorter, LMSW-IPR, CPS

Licensed Master Social Worker

Promoting Language Development Through Play-Based Activities

Promoting Language Development Through Play-Based Activities

It is the beginning of 2013 and we wanted to take the time to discuss how parents can use play-based activities to promote language development in a child’s life.  Did you know the first few years of a child’s life are critical to the development of cognitive, speech, and language skills?  Have you ever wondered why your child’s therapist's use games and toys in the therapy session?  Well, Speech-Language Pathologists are trained to align strategy, procedure, and theory to play-based activities.  Parents frequently ask speech-language pathologist what kind of toys to get their toddler, so we will briefly recommend toys and discuss how a parent/caregiver can use techniques to increase language development.  After all, you do not need specialized training to provide a positive start to your child’s life!  Before we recommend our toys it is important to know that in order to use these toys to help support speech and language development YOU, as the parent/caregiver, must help to facilitate that language.  In order for the child to learn these concepts, he/she must have someone there to teach the concepts. 

Okay let’s get started!!!!  Below are a list of a few toys and how they can be used to promote language development.  These are to give our parents/caregivers ideas on how to select toys and what we are looking for.

Toy #1:  The Baby Doll- The Baby Doll is a great toy.  You can use a baby doll to teach language concepts such as:

·         Body parts

·         Clothing labels

·         Verbs/feelings (i.e. eat, drink, sleep)

·         Basic concepts (i.e. prepositions, colors, size concepts) when used with other baby toys.

·         Answering “wh” questions (i.e.  Is she sleeping?, Where is the baby?)

Toy #2:  Cars/Trucks/Trains- Toddlers love to play with these toys.  These toys promote several language concepts that a child can gain.

·         Basic Concepts

o   Like counting, big/small, some, all, more, fast, and slow.

·         Part/Whole relationship (i.e. wheels, windows, bumpers, doors)

·         Verbs and Adjectives- Cars are a great tool for working on actions and describing words (i.e. go, stop, fast, slow, and etc.)

·         Social/pragmatic skills

o   Turn-taking

o   Saying “May I have the car please?”

Toy #3: A Farm Set- This is a great toy to have in the home.  Let’s look at some of the language concepts that you can find with this toy.

o   Naming animals and animal sounds (you can pair this activity with the Old MacDonald song).

o   Basic Concepts 

§  Prepositional concepts (in, on, out, under, between, next to)

o   Answering “WH” questions (i.e. Where is the cow?, Who is eating? Which animal makes the oink sound?, etc.”

Toy #4: Stacking/Nesting Items- These toys can be used for multiple language concepts.

o   Prepositions (i.e. in/out)

o   Color concepts

o   Shape concepts

o   Size concepts

o   Counting skills

o   Cause and effect relationships

Toy #5:  Toy phones

o   The toy phone is a classic item in a world filled with technology.  The toy leaves room for spontaneous language.  Turn-taking skills, producing more words, some children will even practice speech sounds on his/her pretend phone.

When selecting a toy, look for items that interest the child but have multiple language concepts.  The idea is for the child to work on language skills without knowing they are working.

We are also recommending an awesome website  http://playonwords.com/award/pal2012books/ that gives an award called the PAL  Awards (Play that Advances Language) established by respected speech and language expert Sherry Artemenko.  This website recognizes exceptional toys, games, and books through their design, content, and quality that promote play that advances language.  Here you will find great toys, books, and games to have in the home that will facilitate language development!

Be sure to contact your speech-language pathologist if you would like further information!

Brittney Goodman M.S.,CCC-SLP

MedCare Pediatric Rehab Center