Why does a child with special needs need a pediatrician who manages special needs patients only?

Although families may go through financial hardships, adjustments with employment, or lack of family support, research has shown that families that have children with special needs have increased risk for having financial instability, social isolation or family disruption. A physician who manages patients with special needs will address these issues continually throughout the patient’s childhood and even as he/she transitions into adulthood.

The demands placed on primary care doctors to manage both healthy and children with special needs may be difficult for some families. Bon Secours Developmental & Special Needs Pediatrics has committed to providing special attention to these special patients. Longer appointment times for both preventive and acute care are provided. The team consists of a pediatrician, who has had extensive experience in special needs children, and access to child life specialists, nutritionists, social workers and nurse navigators. The team works to ensure that the special needs child receives specialized care focusing on the complete wellness of the child to include medical, developmental/educational, psychological and social needs.

Who are children with special needs?

With the advancement of medical science and technology, children are surviving illnesses, birth defects or complications that they would not have survived years ago. Parents can now take their children home even if they require oxygen supplementation with nasal cannulas, tracheostomy tubes, feeding tubes or cardiac pacemakers.

What is a Special Needs Child?

The Department of Health and Human Services Maternal and Child Health Bureau in 1995 defined children with special health care needs as those who have, or are at increased risk of developing, a chronic physical, developmental, behavioral or emotional condition and who also require health and related services of a type or amount beyond that usually required by children (Pediatrics 1998; 102; 137, A New Definition of Children With Special Health Care Needs).

To schedule an appointment with Dr. Bowman, call 804-287-7463
Bon Secours Developmental & Special Needs Pediatrics
5855 Bremo Road, MOB North, Suite 703 Richmond, VA 23226

 

Valerie L. Bowman, M.D., FAAP, with over 20 years in the Richmond area as a pediatrician, currently leads the Bon Secours Developmental and Special Needs Pediatrics medical team. She lives in Richmond with her husband and three sons.

Read her story here.

Bon Secours is a sponsor of Richmondmom

Unfortunately, he was readmitted at 1 month of age for failure to thrive. By 4 months of age he had a nasogastric tube insertion for improved intake of calories so his body could grow and develop. Shortly after turning 1 year of age, my son needed a gastrostomy tube for delivery of his nutrition since he hadn’t mastered eating to sustain his life.

Early intervention services started at 6 months of age with him receiving occupational, physical and speech therapies weekly. Fortunately, EI services were provided at our home, so I was able to maintain my private practice. As Jon approached his third birthday, it became evident that he would need continued services outside the home (EI ends at 36 months of age). I closed my practice so I could take Jon for outpatient treatment. He also entered preschool for developmental delay and received educational services in the school setting.

Jon continues to have his challenges with gross/fine motor delay, speech and feeding, but he has made tremendous gains with the help of these community resources. Jon’s pediatrician often says, “He is the poster child for early intervention.” I cannot stress enough the importance or necessity of early intervention services and early childhood education. As a pediatrician, I’ve seen what happens to children who don’t receive these needed resources. But my experience as a parent has inspired a deeper commitment and passion for treating special needs children.

Valerie L. Bowman, M.D., FAAP, with over 20 years in the Richmond area as a pediatrician, currently leads the Bon Secours Developmental and Special Needs Pediatrics medical team. She lives in Richmond with her husband and three sons.

To schedule an appointment with Dr. Bowman, call 804-287-7463
Or request an appointment online here.
Bon Secours Developmental & Special Needs Pediatrics
5855 Bremo Road, MOB North, Suite 703 Richmond, VA 23226

Bon Secours is a sponsor of Richmondmom

After a seemingly endless winter, spring is officially here. Observing our community, many are taking advantage of the influx of warm weather to work outdoors. However, if you overdo it or throw your back out, you may end up coming up short, come harvest time.

April is occupational therapy month. Occupational therapists (OT) help people develop or regain skills in all areas of life — whether those are basic self-care skills such as brushing your teeth or combing your hair–or the leisure activities that people find meaningful, such as gardening. Check out these tips to help decrease your chance of injury while cultivating your green thumb.

1. Plan ahead. Before you even dip your gardening shoe in your “bit of earth”, consider the type of garden you envision. Think through the logistics of garden maintenance, such as how much weeding, watering and general care the garden requires. Is the hose nearby for easy water access? Consider planting hardy varieties that require less care. Planting perennials instead of annuals gives greater longevity to your garden. Cultivating a rock garden or planting groundcover ensures you have less weeding in your future.
   

   photo credit: Tim Houghton

2. Lighten your Load. Redistribute large bags of mulch, soil, or manure so that you are not carrying such a heavy load. When lifting bags, use your leg muscles instead of your back. Alternatively, if your garden space permits, consider having loose mulch or topsoil delivered straight to where your garden will flourish. If feasible, hiring temporary help for big jobs may also be beneficial.
3. Give yourself a break and change of pace. Take breaks before you tire, or at least every 15 minutes. Change tasks frequently so that you can easily vary positions and use different muscle groups.
4. Have a seat. Sit down when feasible and avoid stooping, bending and twisting.
5. Use a workbench. Consider using a waist high workbench for preparation tasks such as re-potting seedlings or growing kitchen herbs at an easy-to-reach height.

I hope you find these strategies helpful as you nurture your garden, your green thumb, and yourself.

For additional information on healthy gardening from the American Occupational Therapy Association, click here.

Check out strategies for planning a garden your whole family will enjoy.

Just as every person is unique, the symptoms of brain injury may vary from one person to the next.  Common cognitive challenges, however, include memory and attention issues, difficulty with step-by-step tasks, wayfinding and stress management.

Tony Gentry, PhD, OTR/L has treated clients with brain injuries for over 20 years and now directs VCU’s Assistive Technology for Cognition Laboratory, where he has conducted a series of studies on the use of mobile devices as cognitive aids.

Tony has found that reminder alerts on mobile devices can compensate for memory deficits after brain injury, helping people manage everyday tasks that they might otherwise forget.  Tony says, “Nobody likes to be nagged. So when we begin, I ask a person, ‘What are the top 4 or 5 things that people nag you about the most?’  It might be something as routine as brushing your teeth or remembering to take medicine. Then we program the device to do the nagging, which reduces the need for supervision.”

Tony has learned that individuals who have trouble completing multi-step tasks can benefit from step-by-step lists or picture-sequence supports, both of which are available on mobile devices.  Free apps like Muzio and Snapguide allow you to build talking slide shows or instructional videos directly on your mobile device.  Other uses of mobile video include behavioral coaching and wayfinding. For an example, see this video designed for one of Tony’s classes by a VCU Occupational Therapy student team.

Many people with brain injury face daily anxiety and stress.  Tony explains, “Apps that offer instruction in deep breathing or relaxation can help. Sometimes music, puzzle or game apps offer welcome distractions from worry.  If a person with a brain injury is at risk of wandering, it is important to use a GPS-based person-tracking app, such as Find my iPhone or Family Tracker to help caregivers find her/him, if they get lost.”

For school, finance management and organizational work tasks, a host of apps are available.  The same is true of healthy living apps that address fitness, sleep and diet.  The biggest challenge, Tony feels, is keeping up with all the available tools and selecting the best suite of apps for each particular client.  He cautions against using too many apps.  In his research, most clients rely on only 3 or 4 apps – typically a reminder, a task-sequencing list, a task management video or two, and a relaxation app.  This gets the job done without the risk of overwhelming or confusing a person with too many choices.  He starts with reminders, and as a person becomes competent in their use, adds an additional support one at a time.

Tony says, “There is a growing body of research evidence showing that mobile devices help people with cognitive-behavioral challenges function more independently.  Best of all, these devices are portable, relatively inexpensive, and – because they are so popular with the general public — they are not stigmatizing.”  He cautions that it is important to work with a clinician who understands brain injury and the devices themselves, one who can follow a step-by-step assessment, intervention and follow-along approach to ensure success.  Without that, a device that may have been life-changing can end up gathering dust in a drawer.

Tony Gentry, PhD OTR/L is an associate professor in the occupational therapy department at Virginia Commonwealth University, where he directs the Assistive Technology for Cognition Laboratory, which conducts research in the development and utilization of smart homes, mobile applications, and sensor-based telehealth strategies to support individuals with cognitive-behavioral challenges. 

Photo Credit: Dave Pyle

As a young girl visiting relatives in England, I recall sitting in the back seat of my grandfather’s 1972 Vauxhall, wearing my safety harness, careening down English country roads.  My grandfather was driving.

In his younger years, he successfully drove around wooded country lanes with hairpin turns and through the busy streets of London.  But over the years his skills had changed.  Although Granddad was behind the wheel, this effort actually took two “drivers”.  Since he was totally blind in one eye (as a result of aging), with failing vision in his “good” eye, my grandmother served as co-pilot.  “Turn left! Turn right!  Car coming on the right! Mind the lamppost!” Granny would shout.   Are you cringing yet? It was harrowing, to say the least.

Do you have a loved one who’s driving skills may have changed?   Have you observed difficulties such as trouble changing lanes, minor accidents, or getting lost on familiar routes?

Penny Eissenberg, Occupational Therapist and Director of Therapy Operations at Health South Rehabilitation Hospital in Richmond, manages the operations of their driver rehabilitation program.  Penny shared that if you suspect a problem with a loved one’s abilities, the first step is to go for a drive with the individual.

“Spending time with them (while they are) driving helps you gather information.  The driver is never going to hear a family member’s concerns if they feel they don’t have the perspective of being in the car with them.”  Penny remarked, “It’s a difficult conversation to have and you need to feel out the right time for it”. And if the time isn’t right, don’t broach the topic in the moment; but find the right time to address it.  Penny shared that it is all part of the process.  And she should know, since she has 12 years of experience guiding clients and their families through these steps.

Driver rehabilitation specialists offer a neutral, objective assessment. “I have broad shoulders, and sometimes, someone has to be the bad guy.  I can do that for families when that is necessary.”  However, the goal of driver assessment and rehabilitation is “not to stop people from driving, but rather, to help keep a person driving as safely as possible for as long as possible,” Penny continued.

“After the initial conversation, the next step is a visit to the doctor,” Penny said.  “Sometimes changes in driving can be due to a change in pharmaceuticals, or other issues which can be addressed.”

Depending on the situation, the physician may recommend a driving assessment.  Occupational therapists who specialize in driver rehabilitation are uniquely qualified to perform driver assessments, due to their training in assessment of physical, cognitive, visual and visual-perceptual abilities, as well as analyzing a task to break it down into manageable pieces (often called activity analysis).   As part of increasing safety while maintaining independence, an occupational therapist may recommend strategies such as driving during daylight hours only, or modifications to a vehicle, such as wider mirrors or booster seats.

My Granddad did eventually give up driving.  But I am sure having these tips would have been helpful in the process, both in decision making, as well as maintaining a degree of independence once his car was garaged.  If you have a concern about a friend or family member’s driving abilities, consider these tips from the American Occupational Therapy Association.

To find a list of certified driver rehabilitation specialists, click here.