A pediatric PT assessment includes evaluating to see if the nervous system is functioning at an age appropriate level and the effects of an immature system on a child’s school day.

The gross motor ability: A lack of proficiency in this area will create tension and frustration while taking part in various sports activities, ball games, jumping, running, skipping, climbing up or down stairs, riding a bicycle and more.

Core strength: Decreased core strength affects sound production, respiratory health, postural tone during sustained sitting, effectiveness of throwing ,fine and gross motor skills.

Shoulder and hand strength :Decreased shoulder and arm and finger strength will make it difficult to write, draw, cut, dress/undress oneself, and perform many other actions that require refined use of these muscles.

Neglect of one side: Tendency to use only one side for functional activities will eventually lead to the brain forgetting about the neglected side. It becomes more obvious when the child draws a picture of a person. Eg If the child is neglecting her left arm, she will draw a person with only one arm.

Midline crossing/bilateral coordination system: Bilateral coordination enables both feet or both hands to work together simultaneously, allowing the body to move fluidly through space. When the midline crossing ability is not yet developed, it can affect gross and fine motor skills, spatial awareness, as well as the ability of the eye muscles to track a moving object. Usually these are the children who do not like sports, cannot keep up with peers in physical education classes and are usually the last to be chosen into a team.

Awareness and willful control of the movement of the eyes: A lack of proficiency in moving the eye muscles will cause difficulties in areas such as reading, sports, throwing and catching, bike riding, and other visual-motor activities. Weak eye muscles can cause dizziness, nausea, lack of balance, and more. Vision testing from a developmental optometrist is sometimes recommended.

In normal condition, the brain crosses the midline automatically, combining information between its two hemispheres and allowing the person to use both sides of the body at the same time. But when the brain has difficulties doing so, the lack of integration between its hemispheres can cause the person to be unable to manage his/her emotional impulses. Similarly, in a person who struggles with bilateral coordination, one might also witness disproportionate or uncalled for emotional responses to a simple event.

Posture: Improper posture will make it very difficult for a person to sit comfortably for extended periods of time. It also physically affects the angle of the vertebrae and joints and causes pressure on the nervous system, which can cause an accumulation of tension in the muscles, or constant cramps in certain muscle systems.

The ability to breathe efficiently: In order to maintain the proper level of oxygen in the body and brain, a person must be able to breathe efficiently. A good posture along with good flexibility of the ribcage contributes to efficient breathing patterns.

Hyper tactile sensitivity (touch): Hypersensitivity to touch can make the child avoid gentle stroking, move away from other children, flinch/shy away from or avoid various substances that cause sensitivities (e.g., sand, grass, cotton, tags in clothing, certain materials, certain textures and so on). Furthermore, it can make the child rub against things, seek out a strong massage-like touch or a hug that is too strong, play with aggressiveness toward others, and more.

Hypersensitivity to pain: Hypersensitivity to pain can cause any touch to be painful. It can make the child resist hugs or massages, or constantly move while sitting. The child may avoid physical closeness to people.

Hyposensitivity to deep touch: Hyposensitivity to deep touch can make the child act aggressively to such an extent that he might throw himself against a wall, seek out fights with other children and wrestle at any opportunity. What is a "normal" touch for a child who is hyposensitive is often too aggressive for others, and may cause others to avoid him.

Hypersensitivity in taste: Hypersensitivity in taste can make the child avoid many types of food, eat only certain foods for a long period of time, or react harshly to food with a texture that doesn't feel good in his mouth.

Hypersensitivity to smell: Hypersensitivity to smell can cause autonomic (involuntary) responses such as dizziness, nausea, headaches, rapid/increased heartbeat, excessive sweating, strong emotional responses to different smells and possibly avoidance of different kinds of foods.

Hypersensitivity to sound: Hypersensitivity to sound can cause concentration and thinking difficulties in any place with soft or changing sounds (like a classroom, for example). It may also cause the child to withdraw, move away from places crowded with people, or be afraid of loud noises. The child may even listen to very loud music in order to block out other sources of sound, allowing him to focus on a task—like homework, for example.

Hypersensitivity to light and vision: Hypersensitivity to light and vision is usually expressed in sensitivity to different types of light (bright, dim, fluorescent light, different colored lights, etc). This can create concentration problems in class, or the need to expend too much effort on learning tasks. It can also cause difficulty in the child's wanting to communicate with different types of people.

Spatial orientation ability: This ability is connected to the child's entire perception of himself and his body in regard to the environment. When the child cannot identify “top”, “down, “side”, “back” on him/herself, (s)he will have difficulty later on in elementary school with writing and transferring these concepts during play activities and PE.

Play skills: Children’s work is play. Play abilities reveal a lot about the status of the neurological system, especially the vestibular system.

The vestibular system malfunction: A condition that can cause, lack of balance, fear, tension, general numbness of the body, poor body awareness, poor safety awareness, poor play repertoire, inability to keep up with peers in PE( dexterity, timing, jump roping etc), visual tracking, auditory issues and more.

PT treatment address all and while each therapist has her own unique treatment strategies to address the above systems, my emphasis is on providing activities to facilitate the maturation of the vestibular system(structured movement program that places your child’s head and body in various planes and speeds), bilateral coordination/crossing the midline and eye tracking(using techniques like Brain Gym and Balance-Audio-Visual Exercises), increasing play repertoire, posture and flexibility amongst other goals.

The sensory diet allows children ample opportunities to receive beneficial sensory input at frequent intervals, thereby enabling children to participate more fully in the activities that comprise their daily schedule. Implementation of the sensory diet spans all aspects of the child’s day, particularly those involving the school and home environments.

What is Sensory Diet?
In a sensory diet the therapist incorporates meaningful activities that provide specific sensory stimuli to elicit an adaptive response, thereby assisting the child in his or her overall motor and conceptual learning.

The sensory diet allows the child ample opportunities to receive beneficial sensory input at frequent intervals, thereby enabling him or her to participate more fully in the activities that comprise his or her daily schedule. Implementation of the sensory diet should span all aspects of the child’s day, particularly those involving the school and home environments. The change in environment that a parent can influence can also result in beneficial changes well beyond the reach of a therapy session. To have an optimum effect, the sensory diet should be designed for the child’s unique sensory processing needs. In this manner, the child benefits from specific sensory input that is synchronized with the recommended treatment approaches.

Useful Links

• www.sierf.org
• www.sinetwork.org
• www.devdelay.org
• www.SensoryResources.com
• www.out-of-sync-child.com