“I Can Do It!”: Ways to Grow Your Child’s Independence

1. “I Can Do It!”: Ways to Grow YourChild’s Independence NDSS Webinar Series Tuesday, April 29, 2014 Katie Bergeron Peglow, PT, MS COO of Adaptivemall.com

2. “I Can Do It!”: Ways to Grow Your Child’s Independence • Some of my First Memories include Down syndrome (DS). • My younger sister, Carrie Bergeron, was born with DS when I was 4 ½ years old. • She always strived to be independent like myself and our other two siblings. • Thankfully, Carrie has worked hard and has been blessed with abilities that allow her to be semi-independent at the age of 37. • Carrie is a self-advocate and national speaker/performer. • Our family created Adaptivemall.com & Special Tomato Brand Products. • The Story Behind the Brand NDSS Webinar Series

3. “I Can Do It!”: Ways to Grow Your Child’s Independence • Focusing on early developmental milestones in today’s presentation • Right amount of support • Not too much, just enough • Patience NDSS Webinar Series

4. “I Can Do It!”: Ways to Grow Your Child’s Independence • ROLLING • SEATING • CRAWLING & CREEPING • STANDING • WALKING • TRICYCLES & BICYCLES • BATHING • FINE MOTOR SKILLS NDSS Webinar Series

5. “I Can Do It!”: Ways to Grow Your Child’s Independence ROLLING • The Facts of Rolling… • Average Age for Children with Down Syndrome to Roll From Stomach to BackIndependently = 6 months(1) • Average Age for Children with Down Syndrome to Roll From Back to StomachIndependently = 7 months(1) (1) Winders, P.C. (1997). Gross motor skills in children with Down syndrome. Bethesda, MA: Woodbine House. NDSS Webinar Series

6. “I Can Do It!”: Ways to Grow Your Child’s Independence ROLLING • What kind of products will help? • Use toys, stuffed animals, people to motivate the movement • Rolling from Stomach to Back • Happens first • Typically easier • Utilize gravity with the head • Rolling from Back to Stomach • Happens second • More difficult • Engaging the core and leg muscles against gravity NDSS Webinar Series Photos courtesy of Winders, P.C. (1997). Gross motor skills in children with Down syndrome. Bethesda, MA: Woodbine House.

7. “I Can Do It!”: Ways to Grow Your Child’s Independence SEATING • For Children with DS, sitting often looks like… • Wide base of support • C-curve to the spine • Forward head • “Hanging” on their joints NDSS Webinar Series

8. “I Can Do It!”: Ways to Grow Your Child’s Independence SEATING • The Facts of Seating… • Average Age for Children with Down Syndrome to Sit Independently = 11 months(1) • Key Measurements • Hip Width • Thigh Depth • Foot to Knee Height • Bottom to Top of Head Key Measurements (1) Winders, P.C. (1997). Gross motor skills in children with Down syndrome. Bethesda, MA: Woodbine House. NDSS Webinar Series Graphics courtesy of Adaptivemall.com

9. “I Can Do It!”: Ways to Grow Your Child’s Independence SEATING • What kind of products will help? • Pre-sitting • Full support • Tilted seating surface • Gradually bring chair upright as head control improves NDSS Webinar Series Photos courtesy of Adaptivemall.com&Bardum.no

10. “I Can Do It!”: Ways to Grow Your Child’s Independence SEATING • What kind of products will help? • Upright Sitting • Pelvis needs a good foundation • Support for the feet • Footrest • Floor NDSS Webinar Series Photos & Graphic courtesy of Adaptivemall.com

11. “I Can Do It!”: Ways to Grow Your Child’s Independence SEATING • What kind of products will help? • Active Sitting • Input from environment to know where their body is in space (proprioception) • “Fidgets” & “Movers” - Kore Stool • Curved bottom allows movement in all directions • 3 different sizes of fixed seat heights – foot to knee height • Encourages anterior pelvic tilt NDSS Webinar Series Photo courtesy of Adaptivemall.com

12. “I Can Do It!”: Ways to Grow Your Child’s Independence SEATING • What kind of products will help? • Active Sitting • Working the core muscles • Therapy Balls • Swings NDSS Webinar Series Photos courtesy of noahsdad.com&dsamidlands.org

13. “I Can Do It!”: Ways to Grow Your Child’s Independence SEATING • What kind of products will help? • Active Sitting • Using sitting in tasks • Use a bench with slight tilt forward • Grounding feet to floor • Active use of leg muscles • Engaging core muscles • Puzzles • Pieces on floor – reach down to get • Puzzle on table • Sit to stand to place the piece can be added to increase the difficulty level NDSS Webinar Series Photo courtesy of www.assistireland.ie

14. “I Can Do It!”: Ways to Grow Your Child’s Independence CRAWLING & CREEPING • The Facts of Crawling & Creeping… • Average Age for Children with Down Syndrome to CrawlIndependently = 14 months(1) • Average Age for Children with Down Syndrome to CreepIndependently= 17 months(1) (1) Winders, P.C. (1997). Gross motor skills in children with Down syndrome. Bethesda, MA: Woodbine House. NDSS Webinar Series

15. “I Can Do It!”: Ways to Grow Your Child’s Independence CRAWLING & CREEPING • What kind of products will help? • Use toys, stuffed animals, people to motivate the movement • Crawling is with the belly on the floor • Arm pulling and leg pushing • Start with both sides of the body doing the same thing at the same time • Work towards reciprocal movement (right side does the opposite of the left side) • Creeping is with the belly off the floor, also called quadruped • Arms & Legs are used • Strong core muscles are essential • Uses reciprocal movement NDSS Webinar Series Photos courtesy of noahsdad.com

16. “I Can Do It!”: Ways to Grow Your Child’s Independence STANDING • The Facts of Standing… • Average Age for Children with Down Syndrome to Pull-to-StandIndependently = 17 months(1) • Average Age for Children with Down Syndrome to Stand Independently = 21 months(1) (1) Winders, P.C. (1997). Gross motor skills in children with Down syndrome. Bethesda, MA: Woodbine House. NDSS Webinar Series

17. “I Can Do It!”: Ways to Grow Your Child’s Independence STANDING • What kind of products will help? • Start with Supported Kneeling or Tall Kneeling • Increases the strength of the hip, leg and core muscles • Helps increase balance • Right & Left Legs are doing the same thing • Use your couch with cushions removed as a working surface NDSS Webinar Series Photo courtesy of noahsdad.com

18. “I Can Do It!”: Ways to Grow Your Child’s Independence STANDING • What kind of products will help? • Half-Kneeling • Precursor to Pulling To Stand • Legs are doing opposite motions NDSS Webinar Series Photo courtesy of noahsdad.com

19. “I Can Do It!”: Ways to Grow Your Child’s Independence STANDING • What kind of products will help? • Pulling to Stand • Use benches, stable toys or furniture to encourage the movement • Standing Independently • Cruising NDSS Webinar Series Photo courtesy of noahsdad.com

20. “I Can Do It!”: Ways to Grow Your Child’s Independence WALKING • The Facts of Walking… • Average Age for Children with Down Syndrome to Walk Independently (at least 3 steps unsupported) = 26 months(1) • Key Measurements if adaptive equipment is needed • Floor to Elbow Key Measurement (1) Winders, P.C. (1997). Gross motor skills in children with Down syndrome. Bethesda, MA: Woodbine House. NDSS Webinar Series Graphic courtesy of Adaptivemall.com

21. “I Can Do It!”: Ways to Grow Your Child’s Independence WALKING • What kind of products will help? • Hypotonia makes this an extra difficult task • Going through the typical sequence of physical developmental milestones will help strengthen all of the muscles needed for walking • Children will most likely need a push toy to start NDSS Webinar Series Photo courtesy of billandria.blogspot.com Photos courtesy of http://billandria.blogspot.com

22. “I Can Do It!”: Ways to Grow Your Child’s Independence WALKING • What kind of products will help? • Some may need support for longer • Walker – no positioning accessories • Gait trainer – positioning accessories added on as needed and taken away with progress NDSS Webinar Series Photos courtesy of parentmap.com&confessionsofadownsyndromedaddy.com Photos courtesy of http://billandria.blogspot.com

23. “I Can Do It!”: Ways to Grow Your Child’s Independence TRICYCLES & BICYCLES • The Facts of Tricycles & Bicycles… • Average Age for Children with Down Syndrome to Ride a TricyleIndependently (15 Feet) = 61 months(1) • What is the end goal? Independence! • Success • Fun • Next level challenge • Key Measurements if adaptive equipment is needed • Inseam Key Measurement (1) Winders, P.C. (1997). Gross motor skills in children with Down syndrome. Bethesda, MA: Woodbine House. NDSS Webinar Series Graphic courtesy of Adaptivemall.com

24. “I Can Do It!”: Ways to Grow Your Child’s Independence TRICYCLES & BICYCLES • What kind of products will help? • Tricycles • Work on Reciprocal Motion • Muscle Strength • Social Skills • Many sizes available through adult sizes • Accessories available with some models if needed • Look for a wide turning radius to prevent tipping NDSS Webinar Series Photos courtesy of Adaptivemall.com

25. “I Can Do It!”: Ways to Grow Your Child’s Independence TRICYCLES & BICYCLES • What kind of products will help? • Bicycles • Work on Reciprocal Motion • Muscle Strength • Social Skills • Balance • Start with a balance bike to focus on balancing first • Progress to a bike with pedals NDSS Webinar Series Photos courtesy of Adaptivemall.com&striderbikes.com

26. “I Can Do It!”: Ways to Grow Your Child’s Independence BATHING • The Facts of Sitting in the Bath… • Average Age for Children with Down Syndrome to Sit Independently = 11 months(1) • Sitting independently in the water takes on a whole new set of challenges • Key Measurements • Hip Width • Bottom to Top of Shoulders Key Measurements (1) Winders, P.C. (1997). Gross motor skills in children with Down syndrome. Bethesda, MA: Woodbine House. NDSS Webinar Series Graphics courtesy of Adaptivemall.com

27. “I Can Do It!”: Ways to Grow Your Child’s Independence BATHING • What kind of products will help? • Sitting independently is one thing, sitting independently in water is another • Bouyancy • Slipperiness • “Dream Baby Deluxe Safety Infant Bath Seat” • Bar folds forward out of the way for easy transfers in and out • Suctions to floor of tub • Great kiddie pool option NDSS Webinar Series Photo courtesy of myliddybug.blogspot.com

28. “I Can Do It!”: Ways to Grow Your Child’s Independence BATHING • What kind of products will help? • Similar support for older children • Holds trunk secure for safety while allowing sitting • Great kiddie pool options NDSS Webinar Series Photos courtesy of Adaptivemall.com

29. “I Can Do It!”: Ways to Grow Your Child’s Independence FINE MOTOR SKILLS • Many toys help with… • Strengthening of Hand Muscles • Finger Isolation • Muscle Control • Life Skill Development • Problem Solving • Color & Shape Recognition NDSS Webinar Series Photos courtesy of differentlythesame.net, noahsdad.com &lovethatmax.com

30. “I Can Do It!”: Ways to Grow Your Child’s Independence GOAL = INDEPENDENCE • Find Key Motivators • Right Amount of Support • Practice • Patience • Challenge at the Next Level • Be Creative • Celebrate Successes • & Have Fun! NDSS Webinar Series Photos courtesy of facebook.com/ActivateHere

31. “I Can Do It!”: Ways to Grow Your Child’s Independence Q & A THANK YOU! • Katie Bergeron Peglow, PT, MS • Pediatric Physical Therapist • COO of & • Email: katieb@bergeroncompanies.com • Customer Service: 1-800-371-2778 • International #: 1-315-429-7112 • Fax #: 1-315-429-8862 NDSS Webinar Series Please understand that although I am a licensed physical therapist, I cannot act in the capacity of your professional therapist(s). An in-depth knowledge of your child’s medical condition and abilities are required to make any final product recommendations. Your therapist(s) is best qualified for this reason.