Wednesday, May 19, 2010

Physical and Occupational Therapy

The question of whether or not to seek professional physical and occupational therapy for a child with a disability is one that his parents often ask themselves, and one that gets asked repeatedly by doctors, neighbors, friends, strangers. Erik and I were all for professional therapy in theory, before Alex came home from the hospital, but began to question its place in his developmental program once we actually experienced it. The type of therapy, duration (how many minutes can a child do therapy at one session? how many months or years should the child continue in the therapy?) and whether it should be conducted by a professional or at home, or some combination of both, depends on the child and the disability, and on the ability of the parents to provide therapy at home.

After several months of Birth to Three, we found the sessions to be somewhat instructive to us as parents, providing us with ideas of new ways to challenge Alex to use his disabled hand and foot, but the 45 minutes sessions once a week were not, in and of themselves, that helpful to Alex. The therapists who met with Alex were very nice, and knew their stuff, but they just didn't do much that we weren't already doing. The sessions often cut into nap time, or meant staying home from the beach, or not going to Grandma's. And when Connecticut presented us with a $50/session fee, we opted out.

A year and a half later, we began to ask ourselves if we should find professional therapists, ones covered by insurance, to be sure we were giving Alex every opportunity to exercise his hand and foot. We asked ourselves this question because we were barraged with the question by pretty much everyone who met Alex, and we got that same disapproving look by many when we said, "Uh, well, we do our therapy at home." To many, I realize it sounds like, "Uh, well, we can't be bothered with his therapy," which is about as far from the truth as a comment could be.

So, we rationalized that you never get another chance at the age of 2-3, an age when the brain is going crazy to develop, and we should be positive we were not missing something in Alex's therapy. So, we found good therapists and enrolled. But the other day, as Alex worked on Mr. Potato Head with his therapist, I wondered why for the $30/session we were paying for these services, the hour we drove, the $25 we paid for the babysitter for Izzy or the time we spent entertaining her at the therapists' office, I couldn't just pull our own Mr. Potato Head out of the toy box and work with Alex at home. True, I had not looked at Mr. Potato Head as a therapy tool, but as we experienced with Birth to Three, the greatest benefit from our professional sessions was what we took away as parents--new ideas for home play.

There are three good things about professional therapy. First, they provide parents with new ideas for therapeutic play. This is a big benefit, but I wonder why we can't just find descriptions of therapeutic play in a book or on the internet (maybe I haven't searched hard enough). Second, children often respond more positively when challenged by a stranger (therapists) than by their parents. Alex is a very agreeable kid, so we don't usually face this problem. Finally, professionals have all kinds of toys and tools appropriate for the child, depending on the disability. In our case, we have most of those same toys at home, in some form or another. We do not have a ball pit, but we do have swings, balls of all shapes and sizes, pegs and pegboard, blocks and shapes, tunnels for crawling through, and we do own Mr. Potato Head.

And so, with some new ideas in hand, we will again stop professional therapy this summer. I don't advocate at-home-only therapy for everyone. It takes dedicated parents with access to the ideas, patience and a few tools to be effective. It also depends on the disability of the child. There are therapies that simply can not be done at home. But therapy at home works best for us, and it has become a part of our lives. We don't eat, drink, bathe, play, read, walk, run, swim or do pretty much anything, without working Alex's left hand, foot and balance, encouraging his independence and self-esteem. Our lives are one long therapy session, much more effective than 20-30 minutes with a professional. But on the other hand, in another year, maybe we will need to refresh our ideas with the pros.

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