“A developmental milestone is a functional skill or a specific task that most children can accomplish by a certain age,” she explains. “They reach milestones in the way they move, play, learn, speak and act. In babies, these skills include sitting up, taking the first step and waving goodbye.”

Parents often receive a chart showing developmental milestones from the hospital after giving birth or from their pediatrician. The Centers for Disease Control and Prevention (CDC), considered the authoritative source, features a developmental milestone tracker on its website, as well as an app that can be downloaded to a smart phone. The CDC occasionally updates typical time frames for development, so Dr. Jones recommends that parents review it to stay current.  

“I always counsel families to not only identify a milestone, but to pay attention to how a child is achieving it,” she says. “For example, if they are crawling in a way that is not typical, this could signal a problem.”

Parent education and empowerment are essential to a child’s development, says Erin Neville, PT, DPT, PCS, a pediatric physical therapist at HSS. She explains that signs of a developmental  variation that might warrant a medical consultation include asymmetrical movement, in which the child favors one side of the body; regression in skills they had previously mastered; a lack of interest in movement and play; fear of engaging in a common age-appropriate activity; or not keeping up with one’s peers. 

Parents and caregivers should discuss all concerns with the child’s pediatrician, the HSS experts say. Dr. Jones advises families to make a video to show the doctor, if possible. “The more information they can gather before the appointment, the more productive the consultation will be,” she explains. “It is also critical to act quickly because early treatment leads to better outcomes. More often than not, a caregiver’s instincts are correct. At times, though, our job is to reassure nervous parents, reminding them that children develop at different rates.”

Dr. Jones’s goal is to get to the bottom of why a child is experiencing a developmental delay so she can develop a successful treatment plan. “Could it be genetic, or did something trigger it? Is it due to a neurological issue or underlying condition? Significant progress is being made in diagnosis, particularly in the field of genetic testing,” she says.

Treatment aims to maximize a child’s given potential so they can catch up with their peers and live the fullest and most well-rounded life possible, Dr. Jones explains. It’s an interdisciplinary effort that may involve a physical therapist, occupational therapist, speech therapist, developmental pediatrician, neurologist, psychologist or orthopedic surgeon. At HSS, the team also includes a prosthetics and orthotics department that makes braces for children who need them and a 3D motion analysis laboratory to address gait issues.

“Being able to identify a delay or an issue early so we can provide high-quality services before the age of three — when the brain has the greatest ability to adapt — can completely change a child’s developmental trajectory,” says Katie Ross, MS, OTR/L, ATP, pediatric occupational therapist at HSS. “It can help prevent potential problems in a child’s behavior, learning and social interactions.”

She notes that parents are a child’s best advocates and should be persistent when seeking answers about their development. “We’ve seen families who were not aware of services that their children were eligible for, or they were not familiar with how pediatric occupational therapy could help them. But it can make a big difference,” says Ross.

Both physical and occupational therapy use play to help children meet developmental goals. Therapists seek to gain their patients’ trust and build their confidence so that they are willing to engage in exercises not only in the rehab setting, but at home as well.

“We may only see a child once or twice a week, so the family plays a vital role. They have the best insights about what will motivate their child so they can integrate therapeutic activities into their daily life,” explains Neville, the pediatric physical therapist. “Every patient is different, but with timely and appropriate treatment in a supportive environment, many children can make significant progress, reach their milestones, and achieve their goals and dreams.”

The findings address a common but counterproductive trade-off in orthopedic surgery: Health insurers typically stop paying for rehabilitation before patients are fully recovered and able to return to full physical activity. As a result, up to 30 percent of such patients may reinjure their surgically repaired knee or damage the other, healthy knee, leading to significantly increased healthcare costs in the long term.

The researchers say the findings, which are available online as part of the AAOS 2020 Virtual Education Experience, should prompt insurance companies to consider paying for more rehabilitation sessions for patients who have undergone reconstructive procedures such as ACL surgery.

“Historically, ACL reconstruction has been performed and patients have been cleared back to sports using simple time-based criteria, which is a one-size-fits-all solution for a problem that’s not one-size-fits-all,” said Peter D. Fabricant, MD, MPH, pediatric orthopedic surgeon at HSS. “The purpose of this study was to ask, ‘Is an enhanced postoperative rehabilitation approach cost-effective for insurers?’ We found that although it might cost them a little more money up front to pay for additional sessions and testing, they save money in the long run. These savings occur because they pay for fewer repeat surgeries due to re-tearing or tearing the ACL of the other knee. Both of these happen at a higher rate following reconstruction when using simple time-based criteria to release the patient back to sports participation. Also, patients are happier because they don’t reinjure their knees as frequently.”

For the study, Dr. Fabricant and his colleagues used nationally available data about the costs of rehabilitation and ACL surgery to develop a cost-benefit model for enhanced rehab. These comprehensive programs — which include improving biomechanics in the affected knee and retraining the muscles in the area — are thought to reduce the risk of re-tearing and needing a revision procedure by at least 25 percent, and also reduce the risk of tearing the ACL of the opposite knee by 50%.

According to the model, if the additional cost of a typical enhanced rehab program is less than about $2,500, insurers actually save money because that extra cost is offset by the savings associated with reducing subsequent injury of both knees. If the program is more successful — reducing the risk of revision surgery by say, 50% — the break-even point is even greater, the study showed. Additionally, these re-injuries tend to occur early on, so the cost of a second surgery comes quickly.

The specific nature of the particular rehabilitation program is less important than simply having access to the additional sessions. “This study doesn’t say you need to do exactly these exercises and exactly these things to get these better outcomes,” said Joseph T. Molony, Jr., PT, MS, SCS, CSCS, manager of the Young Athlete Program at HSS who helped conduct the research. “It simply says that if you spend more time at the end of rehabilitation working on neuromuscular retraining, return-to-play testing, looking at mechanics and having more follow-up visits with the physician, you’re going to lower the reinjury rate substantially.”

“The beauty of this study is that we’re not recommending a specific program or number of sessions,” Dr. Fabricant added. “Given any program, whether it involves testing, therapy sessions ­— whatever it is — if you stay within a certain range, any program that meets those criteria would be cost-effective.”

Dr. Fabricant said the findings empower physicians, surgeons, patients, and physical therapists with a critical piece of evidence in their efforts to convince insurers to cover more intensive rehabilitation for ACL injured patients. “This arms the provider with some ammunition so that they can show the insurance companies, not only is it medically necessary, it’s also cost saving.”

"There are limited studies providing data if weighted blankets help people fall asleep or mitigate stress," says Christine Rocchio Mueller, MS, OTR/L, C/NDT, an occupational therapist at HSS, who notes that while the research does mostly support the use, it's been focused on children with special needs.

The effectiveness may be related to deep touch pressure. "This therapeutic touch is a common modality used in occupational therapy practice. Within the literature, it's believed that deep touch pressure helps release serotonin and dopamine in the brain, this produces a calming effect by reducing excitability," says Mueller. "The change in arousal level can help an individual fall asleep or manage stress symptoms."

Mueller reminds readers to make sure the weight of the blanket doesn't impair the ability to breathe or move.

Read the full article at TotalBeauty.com.