By Maureen Grossi, PT
One of the favorite activities enjoyed by many of the students and therapists at HollyDELL is our Aquatic Therapy Program. Each week on a rotating basis, we take a group of students for one-to-one therapy to the therapeutic pool at Virtua Health and Wellness Center at Washington Township.
Aquatic therapy is often confused with adaptive aquatics (teaching swimming to disabled individuals) and aquatic fitness (group classes supervised by an individual with some training in aquatics). While there are certifications at various levels that provide training for these positions, aquatic therapy is specifically administered by a state-licensed physical, occupational or speech therapist. In addition to licensure, advanced training through sanctioned continuing education courses provides best practice for aquatic therapy.
HollyDELL’s Aquatic Therapy Program has been extremely beneficial for our students in so many ways. The act of being able to freely move–sometimes for many, their very first time–has been a sheer joy to experience. The temperature of the water is in a therapeutic range of 90-94 degrees. The warmth of the pool helps to relax muscles and increase blood flow to affected areas. The properties of the water help us as therapists use the pool as a medium to facilitate therapeutic goals, enhancing our students functional abilities, whether it is working on reaching, grasping and releasing or walking and taking steps.
As pediatric therapists, we use play as a means to gain functional skills. In the water, we use various toys and flotation devices. The pool noodles help with vertical suspension and can act as a “play horse” by straddling the noodle and working on trunk control and sitting balance. When climbing onto the large flotation mat, the students can work on weight shifting, strengthening and movement transitions, as well as balance activities. Using the dive toys helps students overcome the fear of putting their head in the water and working on breath control. The sprinkling cans, buckets and squeezable fish engage the students to work on reaching, range of motion and strengthening.
The dynamic of the group setting is amazing for peer interaction and encouragement. Some of our more timid students are willing to accept the challenge from another student to beat their time, or race to collect more fish or to stay on the mat the longest.
Our students frequently have various orthopedic surgeries and are so delighted when finally given the clearance to return to aquatic therapy.
Buoyancy can be used to progress through exercise by being assistive (move toward the water surface), supportive (move parallel to the water surface) or resistive (move opposite to the water surface). This helps to increase range of motion as well as strengthen the trunk, arm and leg muscles.
Viscosity is another physical property of water that is helpful in therapy. This provides resistance to movement through the water which allows the students to work on strengthening in a fun and supportive environment. By changing the speed of movement through the water, we can increase or decrease the resistance. When we walk in front of the student and create drag, this lessens the amount of resistance they experience.
A third property of water useful in therapy is hydrostatic pressure. This is the pressure water exerts equally at rest in all directions. It is helpful for sensory-motor development as it enhances body awareness and proprioception (the ability to sense the position of our joints). It helps with reducing edema, which many of our post-operative students experience. It also helps strengthen their respiratory and cardiac function by providing some resistance to chest expansion. Depending on which depth of water we work with the students, this can be modified to make it easier or harder.
HollyDELL’s Aquatic Therapy Program is provided by the occupational and physical therapy staff and organized by Kate Marrocco, our community outings teacher and Jen Bennett, our physical therapy aide. It takes a team effort to make this program work. Our school nurses and all the classroom staff are invaluable in helping the students participate and make this program successful!
About the author…
Maureen Grossi, PT graduated from Temple University School of Allied Health in 1979 and received her Bachelors of Science in Physical Therapy. She is a state licensed physical therapist in NJ and PA and is certified by the state of NJ as a School Physical Therapist. She has been a life-long member of the APTA and a Credentialed Clinical Instructor by the APTA. In addition to her licensure, she is an NDT certified practitioner and a member of the NDTA Association. She has be certified as an ATP by RESNA, the Rehabilitation Engineering Society of North America. Maureen has had the pleasure of working at HollyDELL School since 1992. She has spent most of her career working in pediatrics with developmentally disabled children and young adults. Maureen lives in Washington Township, NJ with her husband and two awesome rescued cats. She has three grown children and four grand kittens.
Students in Elementary II “Travel around the World” to Japan to work on their letters and fine motor skills using chop sticks.
By Jodi L. Coates, PT, DPT, C/NDT
Here at HollyDELL School, our expert staff blends warm, nurturing care with state-of-the-art technology for the benefit of special needs students. The Rifton TRAM is one exciting example of adaptive equipment and technology used daily here by our physical therapists.
The Rifton TRAM is a versatile transfer and mobility device that is used at HollyDELL to help transfer students throughout the school and to work on gross motor skills and gait training in Physical Therapy. With the TRAM, students can perform standing transfers to change seats or get into other adaptive equipment such as a stander.
Students who are non-weight-bearing can be transferred in a comfortable, fully supported sitting position. We also perform this type of transfer utilizing the TRAM to assist students in going onto a pool chair-lift so they may enjoy participation in our Aquatic Therapy Program.
In our Physical Therapy program, we are now able to work on standing, weight shifting, taking steps and walking with some of our students who were previously unable to work on these skills due to physical limitations. The TRAM makes it much easier for our students to stand by supporting a portion of their weight. This enables them to work on weight shifting and stepping in all directions as well as higher level skills like walking and kicking. We can even help students work on balance using a balance board while supported in the TRAM.
Because the TRAM provides our students with the extra postural support they often require, we as therapists have our hands free to facilitate their movement, enabling them to participate in a variety of fun and challenging activities.
In the past, it required three physical therapists to position one of our taller students, Saniah who has cerebral palsy, in a gait trainer walker. The TRAM allows us to position her and facilitate steps independently, therefore allowing us to work on gait training on a regular basis. This has been a wonderful experience for Saniah because she loves to be up on her feet and walking. She literally laughs out loud and smiles from ear to ear while she is walking.
As physical therapists, we capitalize on the TRAM’s ability to support our students, giving us the freedom to facilitate movement. Our HollyDELL students are able to participate in–and truly enjoy–a wide variety of activities by utilizing the Rifton TRAM.
About the author, Jodi L. Coates, PT, DPT, C/NDT
Dr. Coates graduated from the University of Delaware in 1992 with a Bachelor’s degree in biology, Hahnemann University in 1994 with her Master’s degree in physical therapy, and earned her Doctor of Physical Therapy degree in 2011 from Neumann University. She has worked as a pediatric physical therapist for the past 22 years at HollyDELL School. She has also worked in early intervention, as well as the public school and outpatient pediatric settings. Her focus has been on working with infants, children and young adults with developmental disabilities to help them achieve their full potential. Dr. Coates has been an Adjunct Assistant Professor in the Doctor of Physical Therapy program at Rutgers University since 2013. She is certified in Neurodevelopmental Treatment and is an APTA Credentialed Clinical Instructor. She lives in South Jersey with her husband and three children.
By Jennifer Latino, M.A., CCC-SLP/L
One of the greatest rewards of being a speech and language specialist at HollyDELL School is teaching students the power of communication. In our lives today, technology constantly changes and improves, and we rely on it more than ever. One of the most exciting technologies that we are using at HollyDELL is something called EyeGaze.
EyeGaze is eye tracking technology that allows our students to access a computer by simply looking at a monitor and moving their eyes to operate the computer or augmentative communication device. This has opened up many more options for students with disabilities, especially those who may have limited use of their hands. EyeGaze technology is also used for recreational activities such as playing computer games, browsing the internet and communicating with friends and family.
It is very exciting that this technology has been combined with augmentative communication devices, making it particularly valuable to the speech and language specialists at HollyDELL School. Students who have struggled to use switch scanning to activate an augmentative communication device now experience a faster and easier way to communicate at school.
With EyeGaze technology, a camera is mounted to an augmentative communication device or computer. The camera indicates where a student’s eyes need to be positioned for making accurate selections. After a student’s eyes are lined up, a gaze point is established through a series of measurements and algorithms, allowing the gaze to operate as a mouse click.
At HollyDELL, we have had many positive outcomes when trialing EyeGaze technology with students. Most importantly, we have learned something new about each student’s capabilities. The camera requires that students remain in an upright position, so it encourages positive postural control. Students have also shown improved attending skills when participating in these activities. The speech and language specialists have also found this to be an essential assessment tool.
As the speech and language specialists, we know that approximately 90% of all learning occurs through our visual systems. We have also learned that nearly 70% of individuals having cerebral palsy also present with a visual impairment. EyeGaze technology is another tool that we have to foster independence and empowerment through communication.
About the author…
Jennifer Latino, M.A., CCC-SLP/L began her career as a Speech & Language Specialist at HollyDELL School in 2000, after receiving her master’s degree from Temple University. She left HollyDELL to begin her own consulting agency to provide support for students who needed augmentative communication and assistive technology services in the southern New Jersey area. In 2007, Jennifer relocated to North Carolina and worked for a private pediatric therapy practice where she provided speech, language and feeding therapy. After her daughter was born in 2009, she returned to New Jersey and HollyDELL, where she could best utilize her knowledge in the areas of technology and feeding to work with a fantastic group of kids. Jennifer is PECS trained and attends conferences to remain up to date with the newest technologies. She holds a Speech & Language Specialist certificate from the New Jersey Department of Education, a Certificate of Clinical Competence from the American Speech-Language-Hearing Association and a New Jersey State License as Speech-Language Pathologist.
By Kathleen Cherico, OTR/L
At HollyDELL School, technology is an exciting way for our students to engage in activities for both fun and learning. The Occupational Therapy Department is thrilled to have the TAPit®, a new and innovative technology to provide our students with more opportunities for success.
The TAPit® (Touch Accessible Platform for Interactive Technology) is a 42″ LCD monitor that is powered by a laptop computer. One feature, “intended touch,” recognizes the difference between purposeful or “intended touch” and accidental or non-intentional screen activations. For example, an arm or hand resting on the screen will not activate the TAPit®. Many of our students at HollyDELL have difficulty with refined or controlled movements of their arms and hands, making the use of a standard or touchscreen computer a challenge. The TAPit®’s “intended touch” technology has given many of these students the opportunity to be successful in accessing a computer with more independence. Because the screen is a shatter-resistant safety glass, has a low-glare screen, and it’s the same type of screen as used by the military, it resists marks and scratches allowing even our more active students to safely participate in computer activities.
TAPit® works with all of our educational and adapted software programs that are currently being used by the classrooms and therapy departments here at HollyDELL. It also supports the use of a mouse, the use of adapted switches for scanning or cause/effect programs and the use of on-screen keyboards or voice recognition for typing. It virtually does everything our computers do but in a bigger, better way. It offers a multi-sensory experience for the students because of its larger size and versatility. They can see it, feel it and hear it better. The larger size screen allows for more than one student at a time to work on the TAPit®, encouraging socialization, communication and turn-taking.
One of the reasons we love the TAPit® is that it is accessible to all of our students. With the press of button the screen can be raised, lowered or tilted at various angles to meet our individual students’ needs. The versatility in the adjustments of the screen allow it to be positioned to encourage reaching as well as pointing, crossing midline, and even weight-bearing on one arm while using the other, thanks to its “intended touch” technology. Visual motor and/or perceptual motor skills are being addressed in all activities as well. The students can kneel, stand, be positioned in a stander or walker, sit in a classroom chair or wheelchair, or be positioned on the floor, a bolster or therapy ball.
A variety of therapy goals and objectives can be incorporated while the students are engaged in activities using the TAPit®. Because it is on wheels, it can be easily moved so that it can be used in a variety of settings in the school environment including all therapy rooms, classrooms and even outside if needed.
Kathleen Cherico, OTR/L, graduated from Temple University’s College of Allied Health Professions in 1984 with a Bachelor of Science Degree in Occupational Therapy. She is a state-licensed occupational therapist in New Jersey and is certified by the state of New Jersey as a School Occupational Therapist. Kathleen began working as an occupational therapist in a pediatric hospital in the Child Development Program, spent a brief period of time working for a private pediatric consulting agency, and then worked for 5 years in a hospital setting in acute care, rehab and burn care. In 1992, she began working at HollyDELL School, known at the time as the Cerebral Palsy Center. For over 25 years Kathleen has worked with developmentally disabled children and young adults. Her passion is working with the students in the area of assistive technology, watching them learn and have fun while independently engaging in activities. She continues to attend various professional conferences and workshops to stay up to date in the latest technology advances and has received a Continuing Education Certification in Assistive Technology. Kathleen lives in Washington Township, NJ with her husband and son, a dog and cat. She has two daughters who are grown and now live on their own. In her spare time, she enjoys spending time with family and friends and traveling.