• Therapy

    Children and youth with special healthcare needs often require a multitude of therapies to help them overcome their developmental limitations. Developmental therapies refer to Occupational (OT), Physical (PT) and Speech-Language Pathology (SLP) therapies. While information and resources are provided for the individual therapies, remember that there is often overlap in the treatment of some disabilities such as feeding problems, which may be evaluated and treated by both occupational therapists and speech-language pathologists.

    The Complex Care Center at Cincinnati Children's helps educate patients and families about each therapy type and puts them in touch with the proper resources.

  • Occupational, physical and speech-language therapy professionals can be helpful in diagnosing and treating disabilities. It is important to describe the patient's disabilities in detail and what service you are seeking because therapists differ in their areas of interest and expertise as well as in the type or style of treatment they practice. Programs that do not have a certified therapist may not be adequate for more significant disabilities. It is important to inquire about these issues before choosing a therapist and to consider other approaches if your child is not making good progress.

    Questions to ask a prospective therapist about their practice might include:

    • Patient age range
    • Conditions treated
    • Methods used
    • Experience and use of assistive technology

    Occupational therapy services include comprehensive evaluations, parent education and treatment for children with a variety of diagnoses and problems. The goal of occupational therapy is to improve self-help skills and adaptive behavior for individuals with developmental delays, illnesses or injuries that limit their ability to function independently. New skills are taught as well as assistance in the areas of motor and sensory development. Areas that the occupational therapist may assess or address include:

    • Developmental delay
    • Fine motor and handwriting difficulties
    • Flexibility
    • Oral motor / feeding problems
    • Positioning for functional skills 
    • Self-care skills
    • Sensory integration / sensory processing disorders
    • Visual motor skills
    • Visual perceptual skills
    • Splinting
    • Wheelchair obtainment and adaptation

    Sensory integration may be assessed and therapy provided to determine how the individual takes in information and processes it based on the five senses of touch, taste, smell, sound and sight. This may include how a child perceives his body, the world around him and his ability to adapt. According to the theory of sensory integration, the many parts of the nervous system work together so a child can interact with the environment effectively and experience appropriate satisfaction. Having poor sensory integration may interfere with many activities necessary for daily functioning, such as brushing teeth, playing on playground equipment or even hugging. 

    Physical therapy services include comprehensive evaluation, parent education and treatment to help patients develop and acquire skills or the parts of skills necessary to achieve their highest level of function. Physical therapists work with individuals with developmental disabilities but also work in the areas of sports medicine, orthopedics, pain management, trauma and a variety of medical diagnoses. Physical therapy may assess areas of:

    • Balance
    • Coordination
    • Endurance
    • Flexibility
    • Gross motor function
    • Mobility and motor function 
    • Pain
    • Posture
    • Strength

    Speech-language pathology services often include comprehensive diagnostic evaluations, consultations, parent counseling and treatment for patients with communication disorders. Services may also be provided for patients with feeding or swallowing dysfunctions. Feeding or swallowing evaluations often include a video swallow study (X-ray), or an endoscopy evaluation.

    Because every child's needs are unique, treatment programs may include a wide range of specially designed services. Following evaluation and diagnosis, the speech-language pathologists recommend an individualized plan of care for patients that may include individual or group sessions. Home-based speech-language pathology services are often available for patients who are unable to travel for treatment due to a medical condition. Augmentative communication systems may be developed for patients who are unable to develop an oral communication system or for patients who cannot communicate orally on a temporary basis.

    Feeding Disorders are a more common problem than most people realize. Many situations can lead to feeding disorders, and they are rarely an isolated problem. Often they can be linked to a range of issues, from complex airway difficulties to food selectivity.

    A child with a feeding disorder may experience one or more of the following:

    • Limited or poor intake
    • Food refusal
    • Slow or inadequate weight gain
    • Problems tolerating tube feedings
    • Suspected or known problems with airway protection and swallowing (aspiration)
    • Choking
    • Sensory problems (reacts emotionally or aggressively to touch)
    • Lack of appetite
    • Swallowing and chewing difficulties
    • History of gagging
    • Oral sensitivity
    • Picky eaters
    • Fear / anxiety related to eating

    Patients often receive the same type of therapy in different venues such as school, early intervention and / or community-based programs. It is important to have just one of the therapists oversee the program to insure the best results. A physician may also need to assist in obtaining the ideal services for the patient.

    Insurers may limit the total number of visits / sessions or limit services based on whether the disability is due to a developmental delay (habilitation) or a loss of function from an accident or illness (rehabilitation). Many insurers deny further benefits if they determine that there hasn't been reasonable progress toward existing goals and there aren't new goals to work towards. Continuing therapy in this situation would be considered "maintenance of function" and most therapists will also follow this philosophy even though many patients may then regress in function and comfort. Therapy can be reinstated if the therapist can come up with new goals. One way this can happen is if the patient regresses. This, along with developmental / habilitative therapy, are the two main barriers that patients and families face. It is also important to check your coverage to see if there is a limit on the combined number of sessions for all therapies. You can use several strategies to assist you with insurance issues:

    • Denials are sometimes reversed on appeal if you involve your therapist and / or physician in writing a letter of medical necessity. This can be helpful if insurance is denied due to an issue of habilitation (disability due to a developmental delay) or rehabilitation (disability due to a loss of function from an accident or illness). This is a hotly debated issue as many pediatric professionals feel that the child who doesn't walk or talk at age 2 has "lost a function" through injury or maldevelopment of the brain during the perinatal period and / or delivery. Often, the obstetrical and neonatal medical records or a brain MRI can document an injury that would be comparable to that of a stroke or head trauma injury (TBI) later in life. Political advocacy at the State and Federal levels is still needed to eliminate one of the most significant examples of discrimination of children by our health care system.
    • Policies that limit the number of services often allow reevaluations that may identify a new goal based on the changing developmental expectations as a child ages. This may then allow additional therapy sessions.
    • If your policy limits the total number of sessions for all therapies, it may be helpful to choose a therapist who can assist with multiple issues. For example, occupational therapy alone may address motor delays and feeding problems and replace the need for additional physical therapy and speech pathology sessions.
    • Early Intervention services and schools, through an IEP, can provide therapies for qualified children. The services should be clearly identified and individualized by a certified therapist. Continued involvement of a hospital or community-based therapist is important for continuity and coordination of services.
    • Standards for Appropriateness of Physical Therapy Care, prepared by the American Physical Therapy Association, provides additional information.
    • Aaron W. Perlman Center at Cincinnati Children's provides assessments, consultation, advocacy and support to children and adults on a wide array of assistive technology.
    • Bioworks has multiple locations throughout Cincinnati and provides braces and orthotics.
    • Brace Shop & Prosthetic Services
    • Pocket Full of Therapy provides an online catalog of products to help parents, educators, occupational therapists and other health care providers who support children with special needs. They also have newsletters and an idea exchange.
    • Cincinnati Occupational Therapy Institute, Inc., Cincinnati, Ohio: 513-791-5688
    • Cincinnati Speech Services, Cincinnati, Ohio, 513-451-1551, offers therapy from ages 2 years through adults and is a provider for the Ohio Autism Scholarship Program.
    • Communication Improvement Services, Fairfield, Ohio, 513-720-0350, specializes in communication issues related to ASD, Asperger’s Syndrome, PDD(NOS), non-verbal learning disability or ADHD.
    • Comprehensive Concepts in Speech and Hearing, Inc., Cincinnati, Ohio: 513-777-8599
    • Habilitation Services, Cincinnati, Ohio: 513-682-1156
    • Hand Rehabilitation of Western Hills: 513-574-5400
    • Hearing, Speech, and Deaf Center of Greater Cincinnati: 513-221-0527
    • New Perceptions, for Northern Kentucky residents: 859-344-9322
    • Premier Physical Therapy Services, Cincinnati, Ohio: 513-733-3370
    • Redwood, located in Northern Kentucky, provides educational, therapeutic and vocational programs and life experiences to children and adults with disabilities: 859-331-0880
    • Signing Safari teaches parents and caregivers about the benefits of sign language to enhance communication with their infants and toddlers. Email for information on programs in the Cincinnati area. 
    • Speech Language Services, Cincinnati, Ohio: 513-232-9488
    • Speech Therapy Consultants, Cincinnati, Ohio, provides speech services in the home. They see children of all ages. Medicaid and most insurances are accepted: 513-513-4552 

    • Therapeutic Resources, Cincinnati, Ohio: 513-771-0153
    • Tri-County Speech Associates Inc., Cincinnati, Ohio: 513-671-7446