Assistive devices, splinting and AFOs

By Natan Gendelman | http://www.enabledkids.ca | http://www.healthinmotionrehab.com

As we’ve indicated before, cerebral palsy is a neurological condition which results from damage to a certain area of the brain. When this occurs, a child’s ability to control specific parts of his body is affected, leading to impaired function and mobility. Since the brain is not sending the appropriate signals to parts of his body, a child will try to function in any way that he can and fight the condition that he is in. In turn, this will cause hyper tone, as we have written about before in our previous blogs.

In the case of a child, having hyper tone may cause certain patterns to occur during development. High tone in the trunk, for example, will lead to high tone in his hands, arms and legs, as well as to improper sensorial development. Now, what happens is that it becomes difficult for him to learn to walk properly, perform grabbing motions, or even bend his hands in the first place. For kids with cerebral palsy, this can result in the emergence of certain patterns like forming crab hands without bending them, or performing robot-like movements where the whole body is moved at once. When these methods of moving are left unchecked, they can have severe consequences on a child’s condition, and what he will be able to accomplish.

The effects of splinting and other devices

With this in mind, many people try to address these problems through the use of assistive devices, splints and AFOs (ankle-foot orthoses). Splints and other assistive devices are often used to maintain an appropriate range of movement in a child’s joint. However, it’s important to note that their usage may cause a chain reaction to occur in a child’s condition. When a child has a splint applied, his brain is not taught the appropriate function to go with the movement. Therefore, while his limb may be held in the correct position, his muscles will be stretched passively--that is, without the child’s active participation. This sends a message to the brain that the device is a foreign body, causing his body to try and fight it. As a result, that is why a lot of therapists find that a child’s tone will go up the moment a splint is taken off.

Making the decision

So, the question is: should we be using splints? Like I’ve said before, each situation has to be dealt with as a separate case which depends on the child’s condition, his ability to move and function, and--very importantly--his age. One key factor which will affect his need for these devices is his weight bearing and movement. A crucial part of joint development, weight bearing plays a necessary role in several movements which are part of a child’s function including sitting, crawling, standing, and walking. If a child places weight on his feet and hands in the process, he will not need a splint because his function will be corrected by his own weight. As he progresses from his knees to standing and then walking, the child then learns how to shift his weight properly. However, if a child is not moving at all, then--again, depending on the case--the use of a splint or other device may prove to be the most beneficial option.

For these reasons, it is important to understand and consider your child’s needs and condition before choosing and implementing splints, AFOs and other devices. Remember, their use will immediately limit certain movements for your child. As a result, it’s a good idea to think twice, do your research and learn how to use them safely and wisely.

If you have any questions or comments about this article, feel free to leave me a message down below or send an email to natan@enabledkids.ca. Thanks everyone, and I hope to hear from you soon!

As we’ve already discussed, cerebral palsy is a designation which covers many symptoms. In medical terms, it is not attributed as a disease or genetic disorder, but characterized as a condition with several possible causes. Whether congenital or acquired, cerebral palsy occurs when certain parts of a child’s brain has been damaged, affecting his ability to function, communicate and control his movements. Since the brain acts as the control centre for the nervous system, this will also lead to changes in his cognitive and sensory development. For a child, this many first become evident from his clenched fists and hypertonic muscles affecting either the limbs, trunk, or one side of the body. He will throw himself backwards when touched on his back, instead of putting his head forward when raised up from his hands. Also, the child may not trace objects, roll to both sides, or he might use one side more than the other. Parents are often the ones who watch their child the most, and notice when something is wrong.

As parents continue learning about their child’s condition there are several things that they need answers to, and the prospects for their child’s development is one of the main issues that may arise. Having worked in rehabilitation for over 20 years, I’ve had many parents asking us: Is cerebral palsy curable? My answer to that question is that it really depends on each child’s specific development, stage of condition.

Now, I know that I am going to cause a lot of debate here, but it is not my goal to argue about this issue. Instead, I would just like to show everyone my standpoint on this issue based on my years of experience and practice in the field. First, to tackle this issue we need to determine that every case of CP is different and can vary from being really mild to severe. When dealing with extremely severe cases, then I agree: there is no cure. Can we improve their ability to function, and bring them as close to independence as possible? Yes we can, when we give them the right approach and treatment. However when we’re dealing with certain mild cases, then there is the possibility for the condition to be cured—if caught on time and dealt with in the right circumstances.

How is this possible? Well, until a child turns one year old his development is still in its early stages. He starts to learn how to roll, crawl and stand, which are huge first milestones in his progress. By doing this, the child is starting to discover the world and open himself to new experiences. When a child is diagnosed with CP during this time period, he will not have had time to form improper functions (movements, communication) to compensate for his condition. Since he has not begun the subsequent cycle of disability and loss of independence which often occur in children with neurological disorders, you have the opportunity to take the child and guide his learning. When given the appropriate methods and appropriate stimulation, his brain will form new functional pathways. This is something called: brain neuroplasticity, and since the pathways are in their developmental stages, it is very possible to develop your child and help him accomplish independence.

So how can we do this? If we get into the specifics and talk about spastic cerebral palsy, we need to consider how hyper tone develops in a child’s body. When a child’s muscle tone is increasing, this does not allow proper function to take place. Consequently, this leads to compensation in his movements and begins a vicious circle affecting his mobility. Once a child learns to move in the appropriate way, he can then progress on to the normalization of function. In my opinion, if a child can move, then he can learn. As a physiotherapist, I have seen many cases progress to a point where a child doesn’t even appear to have a condition after treatment has finished (watch Sean or Katerina’s treatment). So, if a child has achieved normal tone and normal function, why should he be aware of a condition that is no longer affecting his life? Again, I am highlighting that each child has to be seen as an individual with his own condition, and that not everyone can work out of it to such a degree. But for years, we have seen children brought out of their disorders, and today these certain individuals can run, interact and play without any signs of cerebral palsy.

We need to remember that, first and foremost, therapy is something that happens all the time. A child’s learning doesn’t just occur in the treatment room; parents play a key role in their his improvement. If there is a possibility for your child to become independent, what he can achieve will depend greatly on how you guide his development. Keep this in mind, stay optimistic, and believe in what your child can accomplish.

For more articles, visit www.enabledkids.ca.

Understanding hypertonic cerebral palsy

Cerebral palsy is a catchall term used to describe a wide variety of symptoms originating in the brain. The brain is the information centre of the nervous system, which governs the entire body. Therefore, once it is affected it ultimately impacts a person’s daily life functions.

When a child is diagnosed, please keep in mind that it does not set anything for your child’s future. The diagnosis involves just a general idea of what symptoms may arise. However, there are many factors which have to be taken into account for each individual. For example, even the most minor cerebral palsy can become severe if treated improperly or not at all. As well, a child’s personality has a great impact on his condition. Therefore, one child’s cerebral palsy will differ from another. The prognosis for a child with cerebral palsy will also depend on how early the disorder is detected. The younger the child is, the more likely he will be able to create alternative pathways in his brain. In some cases, with appropriate treatment, the child will be able to walk away from his cerebral palsy completely.

Hypertonic Cerebral Palsy is a condition where all the muscles in the body become tense. A child with this condition will appear “stiff.” Muscle tone is something that is present in every person. However, when a child’s nervous system is affected, it sends abnormal impulses to his muscles. As a result, the muscles contract / become spastic. The condition of a child’s hands and legs (extremities) usually follow the trunk. The trunk is king—or in other words, the center of the body. Once affected, it starts a snowballing effect on the rest of a child’s physique: if a child cannot roll from side to side, the tone in the trunk will increase (i.e. become hyper tone). This leads to increased tone in the hands and legs, which ultimately hinders a child’s daily function.

To reduce or normalize tone, a child has to be taught how to move and function in a proper way. This is learning and not rehabilitating. Rehabilitation involves regaining skills. The child never had these functions in first place—therefore, he is learning. You can compare this with learning how to drive a car. Do you remember the first time you drove? How tense you were, and how much you sweated? A child with cerebral palsy is not excluded from these feelings. The skills which he is learning are acquired skills. They were not given to him during the stages of his development. When a function becomes part of his daily interaction, he will begin to use his body and extremities in the appropriate manner. When learning to crawl for example, a child will start to put weight on his legs and hands. If he is taught to roll, he will begin to develop normal tone in his trunk. As he repeats these actions more and more, this normal, functional weight bearing will allow the tone to normalize. This will enable him to learn and perform a greater range of daily functions and movements.

Whether a child is learning to eat, use the washroom, or dress himself, these functions are necessities for daily living. They are not exercises, but practice for real-life activities. He needs to know how to do these tasks, and that is what we, as therapists, aim to achieve.

By understanding your child’s condition, his learning process and the chain reactions which occur, we will enable him to learn, grow and develop independence in his everyday life.

For more articles, visit www.enabledkids.ca.

Mayo Clinic Releases First Children's Book Based On Therapy Dog

Mayo Clinic released its first children's book featuring "Dr. Jack," a 9-year-old miniature pinscher who is Mayo's first facility-based service dog. Escorted by his owner, Mayo employee Marcia Fritzmeier, Jack is part of the health care team that helps patients with physical activity, rehabilitation, and speech therapy. Mayo physicians place an order in a patient's medical record when requesting a visit by Dr. Jack, who sees approximately eight to 10 patients per day.

"In looking for ways to convey the Mayo Clinic model of care, we found a truly remarkable ambassador for Mayo: a little dog named Jack, who actually is a member of the Mayo team," says the book's author Matt Dacy, of Mayo's Department of Development. "This book is the story of Mayo as told through the experience of Jack in a way that children can understand and adults and readers of all ages can appreciate."

"Why do we offer animal-assisted therapy to Mayo Clinic patients? Because it works!" says Brent Bauer, M.D., Mayo Clinic Department of Complementary and Integrative Medicine. "Of course, almost every patient 'feels' better after a visit by a dog like Jack. But scientific studies have shown this type of therapy can reduce pain in children, improve outcomes in adults hospitalized with heart failure, and reduce medication use in elderly patients."

In the book, Dr. Jack wears an identification tag with the Mayo Clinic three shields -- which stand for clinical practice, education and research. When a young boy at Mayo Clinic meets Dr. Jack, he rubs his tag and the two go on an amazing tour of Mayo Clinic, including a helicopter ride on Mayo One. The book includes a biography of Jack by Jenee Marchant and a medical essay on the "Healing Dimension of Pets" by Edward Creagan, M.D., of Mayo's Department of Oncology. Mayo Trustee and former first lady Barbara Bush wrote the book's foreword and John Noseworthy, M.D., Mayo Clinic president and CEO, provided the welcome. The book is illustrated by Robert Morreale, unit head of Mayo's Section of Medical Illustration and Animation.

Source
Mayo Clinic

3-D 'Occupational Therapy' For Children

It was her love of ballet that led her to work with children who have motor disabilities. The retired dancer, now an occupational therapist, is pioneering a new "virtual" method to analyze movement patterns in children - and more effectively treat those with debilitating motor disorders.



Dr. Dido Green of Tel Aviv University's Department of Occupational Therapy in the School of Health Professionals is using a "virtual tabletop" called the ELEMENTS SYSTEM, developed by her partners at Australia's Royal Melbourne Institute of Technology, to "move" kids with disabilities and provide home-based treatments using virtual reality tools. Combining new three-dimensional exercises with two-dimensional graphical movement games already programmed into the tabletop (which resembles an early video game), she reports not only success but also enthusiasm among her young patients.



"I've been working with children with movement disorders for the last 20 years," says Dr. Green. "By the time I meet these children, they're sick of us. They've been 'over-therapied,' and it's difficult to get them to practice their exercises and prescribed treatment regimes."



Fun for kids from three to fifteen



"The virtual tabletop appealed to children as young as three and as old as 15," Dr. Green reports. "The movement-oriented games allowed them to 'make music' and reach targets in ways that are normally neither comfortable nor fun in the therapeutic setting," she explains.



Dr. Green determined that children with partial paralysis and motor dysfunction resulting from disorders such as cerebral palsy may be helped by giving them a new interface to explore. Building upon earlier research she conducted at the Evelina Children's Hospital in London, Dr. Green found that virtual reality applications enhance the skill sets learned by her patients.



Coupled with new technology involving 3D Movement Analysis, a technique she is now integrating into research at Tel Aviv University, Dr. Green hopes to develop this virtual tabletop - type game into new and effective therapy treatment regimes.



"Traditional approaches are labor-intensive and their results limited," Dr. Green says. "Our research aims to create a complete system for therapist, parent and child. It could bring daily treatments into the home and provides therapists with a complete solution to track and analyze improvements or setbacks in the most accurate way to date."



From the virtual to the real world



In children who attended sessions with her interface for three days a week over a period of about one month, Dr. Green found some impressive results. One child with a paralyzed hand was able to perform more complicated movements, culminating in a "eureka!" moment when she opened a door for the first time in her life. The girl was also able to gain control over some motor movements essential for basic life tasks, such as buttoning sweaters, opening doors, or going to the washroom. These are skills some children never develop with current therapy regimes.



In the near future, Dr. Green hopes to develop the technique for remote rehabilitation, enabling children to practice movements at home with parental supervision. Therapists located elsewhere could "log in" with a webcam and computer to coach the students or monitor their progress.



The researcher also plans to analyze brain function using trans-cranial magnetic brain stimulation. Currently, brain function relating to motor activities is analyzed with magnetic resonance imaging (MRI). But many children are too impatient to sit in an MRI machine, so clinicians need a more accurate means of analyzing movement in children with disabilities to develop individualized therapy regimes.



Source:

George Hunka

American Friends of Tel Aviv University

Promise For Improving Hand Function In Teens With Cerebral Palsy: Modified Home Video Game

Engineers at Rutgers University have modified a popular home video game system to help teenagers with cerebral palsy improve hand functions. In a pilot trial with three participants, the system improved the teens' abilities to perform a range of daily personal and household activities.


The modified system combined a Sony PlayStation 3 console and a commercial gaming glove with custom-developed software and games to provide exercise routines aimed at improving hand speed and range of finger motion.

The Rutgers engineers, who are members of the university's Tele-Rehabilitation Institute, worked with clinicians at the Indiana University School of Medicine to deploy systems in participants' homes for up to 10 months. A description of the modified system and its use in the pilot trial appeared this week in the journal, IEEE Transactions on Information Technology in Biomedicine.

"Based on early experience, the system engages the interest of teens with cerebral palsy and makes it convenient for them to perform the exercises they need to achieve results," said Grigore Burdea, professor of electrical and computer engineering and director of the Rutgers Tele-Rehabilitation Institute.

Each system communicated via the Internet to allow the Indiana and Rutgers researchers to oversee participants' exercise routines and evaluate the effectiveness of the systems. The system is an example of both virtual rehabilitation, where patients interact with computer-generated visual environments to perform exercises, and tele-rehabilitation, where patients perform exercises under remote supervision by physical or occupational therapists.

"All three teens were more than a decade out from their perinatal strokes, yet we showed that improvement was still possible ," said Meredith Golomb, associate professor of neurology at the Indiana University School of Medicine and Riley Hospital for Children pediatric neurologist in this study. "The virtual reality telerehabiltiaiton system kept them exercising by rewarding whatever movements they could make, and all three showed significant progress in hand function."


Golomb oversaw the pilot study where participants were asked to exercise their affected hand 30 minutes a day, five days a week, using games custom developed by the Rutgers engineers. The games were calibrated to the individual teen's hand functionality. An on-screen image of a hand showing normal movements guided the participants in their exercises.


After three months of therapy, two participants progressed from being unable to lift large, heavy objects to being able to do so. Participants showed varying improvement in such activities as brushing teeth, shampooing, dressing, and using a spoon. At 10 months, one participant was able to open a heavy door.

The modified PlayStation 3 is the second system based on commercial video gaming technology that Burdea and his institute have developed to investigate economical and engaging rehabilitation therapy tools. Earlier work involved modifying an older model Microsoft Xbox to help stroke victims recover hand functions.

"Systems like this have the potential for widespread deployment in outpatient clinics or the homes of people needing rehabilitation services for any number of illnesses or injuries," said Burdea, a noted inventor of virtual rehabilitation technology. "Well-designed custom games are likely to hold patients' attention and motivate them to complete their exercises, versus conventional therapy regimens, which patients may find boring or tedious."

Burdea acknowledged the popularity of gaming platforms and many newer games that physically engage their players, but noted that they generally are not suitable off-the-shelf for rehabilitation needs. Games for rehabilitation need to focus on the specific impairment, and they require professional oversight to ensure that patients exercise within therapeutic bounds while not over-exercising and risking stress or injury.

The systems that Burdea and his colleagues built combined a PlayStation 3 console with a Fifth Dimension Technologies 5 Ultra sensing glove, a flat-panel television, mouse, keyboard and digital subscriber line modem for Internet communication. They reprogrammed the game console using the open-source Linux operating system and developed games written in Java3D.

One game promoted range of finger motion by asking participants to clean up bars of "dirty" pixels on the screen to reveal an image. Another promoted finger movement speed by asking participants to flick away an on-screen butterfly. A third promoted hand opening and closing speed by asking participants to manipulate an on-screen unidentified flying object.

The developers also wrote software to manage participant scheduling and performance data and to administer subjective evaluation questionnaires.

In addition to Burdea and Golomb, the article's co-authors are Meghan Huber and Bryan Rabin, both Rutgers undergraduates during the study, and Ciprian Docan and Moustafa AbdelBaky, Rutgers graduate students. The study was funded in part by the National Institutes of Health and the Clarian Foundation.

Source:

Carl Blesch

Rutgers University

Minister Harney Welcomes Consultation Programme On The National Rehabilitation Hospital, Ireland

Harney TD, Minister for Health and Children yesterday, 20th May, 2008, welcomed the major consultation programme being undertaken by the National Rehabilitation Hospital which is taking place today, Tuesday, 20th May, 2008. The Minister said "I believe that it will give the hospital an excellent opportunity to obtain the views of key stakeholders and will help to deliver the best possible facility for patients" The consultation programme is part of the planning process for the redevelopment of the National Rehabilitation Hospital (NRH) which was committed to in the Programme for Government. When completed, the new NRH will provide additional treatment and diagnostic capacity. The consultation day is being held in the Rochestown Lodge Hotel in Dun Laoghaire and participants will include members of the Hospital's staff, local public representatives as well as the general public."This is an important step in the planning of the new National Rehabilitation Hospital and I would encourage all those with views on the redevelopment to participate in the consultation process" concluded Minister Harney. Department of Health and Children
Article URL: http://www.medicalnewstoday.com/articles/108291.php

Kids get health benefit from yoga

By Megha Satyanarayana
Detroit Free Press


DETROIT — When Alayna Kurek panicked one day about forgotten homework, the 9-year-old stunned her school counselor by using a yoga breathing technique to calm down.

That stress-relief method is a reason Sherri Kurek said she takes her two children, Alayna and Olivia, 7, to classes for kids at the Yoga Studio of Shelby.

"It’s the one thing they stick with," said Kurek, an in-home transcriptionist from Shelby Township, Mich.

Alayna gets exercise, going from downward-facing dog position to cobra to frog. And her improved confidence shows when she teaches her classmates how to pretzel up, Kurek said.

Karen Lutz, who teaches child yoga classes at Providence Hospital in Novi, Mich., said, "A 4-year-old — they have a short attention span. They really don’t care where their feet are." But as younger yogis mature, she said, "They want to know, ‘Where do my feet go?"’

University of Michigan pediatrician Dolores Mendelow says yoga, if done properly, is a suitable alternative to tumbling and team sports for getting stressed-out, sedentary children socializing, exercising and building discipline.

"It requires practice, patience and accepting of self-limitations," she said.

Second-grader Mya Sornig, 8, practiced a new sun salutation recently in Jane Schwab’s class at Yoga Studio of Shelby. In a circle with the Kurek sisters and studio owner Lisa Tokarz’s two children, Schwab, a retired schoolteacher and certified yoga instructor, said, "Lift your left toe like you’re warming your toes in the sun."

Mya pushed her left leg into the air, and wobbled, which mom Jennifer Sornig of Sterling Heights, said is a reason to trek to the studio. A physical therapist, she knows a strong abdomen can stave off back and posture problems.

A preliminary study of pediatric health benefits of yoga, published in 2008, finds motor skills and concentration improvements, on top of better posture and breathing.

At Providence Hospital, yoga is integrated into strength-building exercises for children with Down syndrome and cerebral palsy, who often lack muscle tone and breathe weakly. Parents help, said therapist Annmarie Dempsey.

"The younger kids, with most yoga poses, we try to find a name that relates to the pose to make it fun," she said.

Yoga stretching and body alignment can create a better athlete, said Michigan State University strength coach Mike Vorkapich. Players use back and arm movements to improve strokes and pitches, he said.

Listening improves too, said Jennifer Hayes, an MSU yoga teacher. She sometimes teaches without demonstrating postures. She hears this all the time: "Wow, this is harder than I thought."

Breakthrough Parenting for Children With Special Needs

By Judy Winter; 258 pages. Subtitle: Raising the Bar of Expectations




Winter combines her talents for journalism and parenting in a book that is part inspiration, part how-to, and wholly optimistic about your family's survival as you take on the challenge of raising a child with special needs. It's a particularly useful guide to those just starting out on the journey of dealing with special needs, and hearing from everybody that it's too hard and their life is over and their situation is tragic. Breakthrough Parenting offers a much-needed antidote to all that gloom and doom.


Pros
Takes an upbeat approach to the challenging task of special-needs parenting. Gives parents of children newly diagnosed a voice of experience to guide them, Full of specific tips for a variety of situations and relationships. Includes inspirational stories of individuals with disabilities succeeding. Offers listings of resources with every chapter

Cons
More useful to those just starting out than those who've been at it a while. May seem too upbeat if you're really struggling. Book was published in 2006, so some resources may not be up to date

Description
Part One: Welcome to Breakthrough Parenting for Children With Special Needs

Chapter 1: The Perfect-Baby Dream
Chapter 2: First You Cry
Chapter 3: No Labels, Yes Hope
Part Two: Guidelines for the Preschool Through College Years
Chapter 4: The Pre-K and Elementary Years
Chapter 5: Middle School, Junior High, and High School
Chapter 6: Advocating for Techniques and Programs That Work
Part Three: Focusing on the Family
Chapter 7: Embracing a New Definition of Family and Planning for the Future
Chapter 8: Preserving Your Marriage, Caring for Yourself, and Surviving the Death of a Child
Chapter 9: Meeting the Needs of Siblings
Part Four: Honoring Special Needs Excellence
Chapter 10: Honoring Special Needs Excellence
A Conversation With Timothy P. Shriver, Ph.D.
A Conversation With Dana Reeve

Guide Review - Book Review: Breakthrough Parenting for Children With Special Needs
Learning that a child has special needs can be traumatic for parents -- in no small part, because professionals tend to present it as the End of the World. They'd do a much better service by passing on this book, which acknowledges the grief that must be processed but also provides an action plan for getting on with your life and your child's.

Each section of the book starts off with a "Bill of Rights," including one for children and young adults; parents; siblings; and professionals. Among the rights Winter bestows on parents are the right to "Grieve the loss of a child with special needs" and "Ask tough questions, including Why? -- but also to "Celebrate your child's birth," "Move about freely in society with your child," and "Be proud of your child's accomplishments." Since our children are so often looked upon as nothing but tragic, I appreciated the balance.

Illustrating the points on hoping for the best for your child are stories of individuals with special needs and their families breaking expectations and living their lives. Also helpful are lists of resources at the end of each chapter that can send you off in pursuit of information for your particular situation.

If you've been a special-needs parent for a while and found your way to advocacy and empowerment and favorite resources of your own, the tips and pep talks here may be less useful than if you'd found them in the early days. Still, as your child grows and changes and moves on through school, there are always new suggestions that can help. And it may inspire you to think about how you can pass on your experience to parents starting out with trepidation, in a support group, a blog, or even a book of your own.

Helping Children With Complex Needs Bounce Back

The Bottom Line
By Kim Aumann and Angie Hart; 223 pages. Subtitle: Resilient Therapy™ for Parents and Professionals.
What makes a child resilient? How can we help our challenged children find a happy life, and maybe grab a little bit of that for ourselves? Resilient Therapy™ seeks to identify the elements that lead to resiliency in children and adults, and teach parents how to pass those on. For those stuck in despair, it's a cheerful helping hand; but if you've been adjusting to your child's challenges all along, it may serve as nothing more than an encouraging pat on the back.

Pros
A positive look at parenting children with complex special needs. Offers a useful way to think about resilience, and foster it. Also takes into account parents' needs for resilience, and helps them get some. Permission given to skip whatever parts of the book are not useful to you
Exercises throughout help you apply the advice given

Cons
Like the critics mentioned at the end of the book, I wouldn't call this "therapy". Much of this you may already know -- though it's never bad to have a reminder. If your child is very challenging or you feel very challenged, this may be easier read than done

Introduction
Chapter 1: Basics
Chapter 2: Belonging
Chapter 3: Learning
Chapter 4: Coping
Chapter 5: Core Self
Chapter 6: Let's Get Real - It's Tough But So Are You

Guide Review - Book Review: Helping Children With Complex Needs Bounce Back
Here's a nice surprise I got while reading Helping Children With Complex Needs Bounce Back: Though I'd never heard of "Resilient Therapy" before picking up this book, it turns out I've been doing it all along. Whether that means this therapy is really just a collection of common-sense wisdom about pulling yourself up by your bootstraps, or that I'm intuitively brilliant at special-needs parenting, I can't say -- I'd tend toward the latter, don't you know, but I rather suspect the former is more like it.

If you've found a way to be happy, and raise happy kids, despite significant challenges, this book may feel like a confirmation of everything you've ever figured out, and that's got to feel good. You may even pick up a few more tips and ideas along the way. The book is probably more useful, though, for parents who know they have to pull themselves out of basic survival mode but don't know how to do it. The authors are cheerful and friendly, the text is easy to read and structured so that you can easily skip over parts that don't interest, and the advice is solid and helpful. There are exercises to help you think through how the suggestions will work in your family, and encouraging quotes from families who have put them into practice.

Though the title says it's about helping children, the book puts at least as much emphasis on helping parents learn how to bounce back. That seems right, in a "put your oxygen mask on first so you can put your child's on" in a sort of way. But also, I suspect that many parents of children with special needs marvel at how much more resilient their kids are than they themselves feel. Since your child's unlikely to explain it all for you, this book steps in.

Visitors Guide 'Let’s Go with the Children’

Take a break from the usual overseas holiday this summer and inspire your family with all that England has to offer!

Planning the family holidays this year could present us all with some exciting challenges. The economic downturn not only makes the working week a little more worrisome but when you do have the chance to take a break, you feel like you still need to save money.

A recent survey suggested that more than half of us will stay in the UK this year and whilst this may not initially seem like the most appealing prospect, for families with children there is a world of adventure and hidden gems to be found on English soil – and a great deal of them are free of charge!

You don’t have to opt for the traditional seaside holiday either. Stay in your local areas of Yorkshire, Durham or Cumbria for example and discover a wealth of beautiful countryside and little known attractions.

There are literally hundreds of ways to be thrifty without compromising on fun! Whether you stay for a week or just for a day you can find exciting activities, whatever the weather and whatever the budget.

The brand new ‘Let’s Go with the Children’ Guide books cover 14 regional areas of England and offer endless ideas on places to go and things to do with the family this summer. Your biggest problem will be deciding where to go first!

Here are a few suggestions on how to nurture your child’s hidden passions or talents, whilst ensuring the whole family has hours of fun for less this summer, whatever the weather and whatever the budget!

Yorkshire, North East & North West - Free Places to Visit...

Hexham Park 01434 652121.

Small but perfectly formed Green Flag award winning park beside stunning Hexham Abbey with play and picnic areas, boarding and BMX facilities.

Newcastle Discovery Museum 0191 232 6789 www.twmuseums.org.uk.

Discover all about life in Newcastle and Tyneside, from maritime history and world changing science and technology through to fashion through the eras and military history. The museum is bursting with interactive displats; the perfect place to learn and have fun.

National Glass Centre, Sunderland 0191 515 5555 www.nationalglasscentre.com.

Take a fascinating tour, see glass artists at work and walk across the glass roof. Children’s workshops during school holidays. The National Glass Centre promotes the art, history and science of glass in a context that is relevant to place, through a programme of exhibitions, new commissions and education that is international in its scope and vision, and fosters meaningful debate and participation between artists, audiences and educators.

Hamsterley Forest 01388 488312 www.forestry.gov.uk/hamsterleyforest.

2000 hectares of mixed woodland lying between the Wear and Tees valleys on the edge of the North Pennines Area of Outstanding Natural Beauty.Hamsterley is a delightful oasis of broadleaved and coniferous woodland, sprawling along the sides of a sheltered valley. With way marked walks, cycle routes and horse riding trails, all levels of fitness and ability are catered for.

Consett to Sunderland Railway Path 0845 113 0065 www.sustrans.org.uk.

Part of the award winning C2C route, this popular traffic free cycle route is 21 miles long using former railway lines with lots of fascinating flora, fauna and public works of art along the way. There is plenty to visit along the route. Between Stanley and Beamish you pass the intriguingly named Hell Hole Wood, managed by the Woodland Trust and part of the Great North Community Forest.

Captain Cook Birthplace Museum, Middlesborough 01642 311211 www.captcook-ne.co.uk.

Experience life below the decks and find out about the world famous navigator through interactive displays. It is housed in a purpose-built building close to the granite urn marking the site of Cook’s birthplace cottage in Stewart Park, Marton, and Middlesbrough. The museum tells the story of one of the world’s greatest navigators and mariners through themed display galleries, temporary exhibitions, associated activities and events and a lively education programme.

Wynyard Woodland Park 01740 630011 www.wynyardwoodlandpark.org.uk.

Enjoying a beautiful woodland setting, this 180 acre park has many historical features. Facilities include a visitor centre, Planetarium, observatory, cycle ways, picnic spots, sculpture trail and play area. There is a railway carriage which acts as a classroom, a Virtual Visitor Centre Project and a new sculpture trail.

Robin Hood’s Bay, Whitby www.robin-hoods-bay.co.uk Take a net and a bucket to hunt for fossils on the rocky shores between Robin Hood’s Bay and Boggle Hole. Children must be supervised. Whether you are on a day trip or a weekly holiday to Robin Hood’s Bay, in a family group, finishing the coast to coast or simply getting away from it all, there is much to indulge in and certainly something for everyone. In addition to simply soaking up the scenery and relaxing in the surroundings, let your taste buds be tickled and your creative side tempted!

Lotherton Hall Estate, Leeds 01132 813259 www.leeds.gov.uk.

Explore the stone circle within the Boundary Trail, wander through one of Europe’s largest walk-through aviaries, admire the red deer or simply run off steam in the delightful grounds. Enjoy a great day out at Lotherton Hall and Estate and explore the fine country home within extensive grounds, including a red deer park, bird garden, nature trails, café and extensive family play area.

Manor Heath Park Jungle Experience and Walled Garden 01422 365631.

The Jungle Experience at Manor Heath Park, Halifax is a tropical oasis packed with fish, quail, terrapin and butterflies as well as a collection of plants from all over the world, where visitors can enjoy the all year round tropical atmosphere. The walled garden has many traditional and modern designs of planting, and the well kept park has a children's play area, picnic tables, mature trees and well kept gardens. A must for all the family!

Cusworth Hall Museum and Park, Doncaster 01302 782342 www.doncaster.gov.uk.

Discover lots of traditional toys in the childhood room and enjoy a picnic in the grounds. Cusworth Hall, Museum and Park re-opened to the public in May 2007, after several years of extensive restoration work.The Hall and its surrounding parkland have been transformed, stunning ceiling paintings in the Italianate Chapel have been revealed and restored, after being hidden under layers of paint for 50 years.The Great Kitchen, Bake House, Still Room and Laundry are also sometimes open to the public, giving a glimpse of what life was like 'below stairs'.

Graves Park Animal Farm, Sheffield 01142 582452 www.gravesparksheffield.info.

Get close to cuddly baby animals, domestic and rare breeds. In the park take the bird and sculpture trail and check out the play area. The farm has three distinct sections, just off the Hemsworth Road Car Park is a farmyard which houses the collections small animals such as Specialist Chickens, Guinea Pigs and Rabbits, the area is tarmac and accessible for disabled people. The farmyard is also home to the main barn where there are often baby animals, including piglets and lambs which is particularly popular with families.

Old Penny Memories Museum, Bridlington 01262 608400.

Old Penny Memories is one of the biggest collection of antique slot machines in England. Visitors to the museum can actually play the slot machines with the exchange of their money into old pennies. Admission is free, so you only pay if you play. Those visitors who are just wanting to look around are welcome to. The collection of machines and memorabilia dates from Edwardian 1920s up to the swinging 60s. You can feel the atmosphere of the era with the seaside organ music playing.

Spurn Lightship, Hull www.hullcc.gov.uk.

See how the crew lived aboard the ship which guided others into Hull’s port. Built in 1927, the 'Spurn' served for almost 50 years as a navigational aid in the treacherous River Humber. Now enjoying a leisurely mooring in Hull's attractive marina, she and her knowledgeable 'crew' are prepared to receive and welcome boarders who wish to explore.

Low Barns Nature Reserve, Durham 01388 488728.

Discover acres of beautiful woods, lakes and meadows including a visitor centre and observatory. Low Barns Nature Reserve is a 50 hectare wetland site with areas of mixed woodland and grassland. The Reserve is situated on an ex-gravel extraction site, which has been managed by Durham Wildlife Trust since operations ended in 1964.Wetland features include three lakes, interconnecting streams, a number of mature ponds, and a wet pasture. The River Wear also flows through the reserve.

Bowlees Picnic Area, Teesdale 0191 383 3594 www.durham.gov.uk.

Charming spot on the River Tees from where you can explore Gibson’s Cave, Summerhill Force and Low Force. There is a Visitor Centre run by Durham Wildlife Trust over the Bowlees Beck. One of the most attractive sections of the Pennine Way is only a 15-minute walk away. This section follows the River Tees midway between Middleton and Cauldron Snout. It can be reached by crossing the Tees on the Wynch Bridge, near Low Force.

Bowes Castle, Durham 0191 269 1200 www.bowes.org.uk/castle.

Explore the vast ruins of this open-access, three-storey, 12th century keep overlooking the River Greta. The present ruins of the castle are fifty-three feet in height, the remains being of the keep, surrounded on two sides by the remains of an original inner moat. There are few remains of the original bailey wall but it is possible to climb up part of the inside of the keep itself.

Locomotion: The National Railway Museum at Shildon 01388 777999 www.locomotion.uk.com.

Open-air museum with vehicles and interactive displays to explain the life of Timothy Hackworth and the development of railways. There’s a fun packed programme of special events throughout the year. For a fabulous day out, try their exclusive package culminating in driving a steam engine. There is an Easter Fair for all the family and events through school holidays.

Brimham Rocks, Harrogate 01423 780688 www.brimhamrocks.co.uk.

Take sturdy shoes to explore these spectacular rock formations including the Dancing Bear and Druid’s Writing Desk. Tracker packs available for over 5s. The curious rock formations at Brimham in Nidderdale are scattered over some 50 acres on Brimham Moor and provide a great variety of weird and wonderful shapes. Many of the gritty monstrosities suggest all manner of things, including elephants, hippos, bears, mushrooms and some are said to have associations with druids, Mother Shipton and even the Devil himself.

Whinlatter Forest Park 017687 78469 www.forestry.gov.uk.

Explore the mountain forest on foot or two wheels, orienteering, playground and picnic area. From April to August annually watch the Bassenthwaite Ospreys through the live nest camera or visit the Lake District Osprey Project and see the ospreys from the outdoor viewpoint or visit the exhibition and live video camera at Whinlatter.

Talkin Tarn Country Park, Cumbria 01697 73129 www.visitcumbria.com.

Stroll around this delightful glacial tarn, hire a boat in summer or enjoy the Boathouse Tearoom all year round. The tarn is glacial in origin, being formed about 10000 years ago, and is fed by underground streams. You can sail, windsurf, canoe or hire one of the wooden rowing boats. Fishing is available at the Tarn. There is a small camping and caravan site, and a permanent orienteering course is laid out around the park. The shop hires mountain bikes and there are suggested routes taking you through beautiful countryside. There is a 1.3 mile path round the tarn which is suitable for wheelchairs. The Boathouse Tea Room has superb views of the tarn, and a blazing log fire.

Aira Force Waterfall, Cumbria 01768 482067 www.visitcumbria.com.

A magnificent beauty spot, Aira Force and the Ullswater Valley are home to a large variety of wildlife, including Wordsworth's famous daffodils. Probably the most famous of the Lake District waterfalls, the main force falls 70 feet from below a stone footbridge. Aira Force provides a glimpse of a landscaped Victorian park with dramatic waterfalls, arboretum and rocks scenery.

Low Sizergh Barn, Lake District 015395 60426 www.lowsizerghbarn.co.uk.

There is a farm shop, tea room, craft gallery and farm trail on this organic dairy farm near the Lake District national park. The farm shop is filled with one of the best selections of local and speciality foods in Cumbria, with farm products -- our own organic Kendal cheese, organic eggs and ice cream made from our milk -- taking pride of place. Watch the milking from the gallery between 1.15-3.15pm.

Lancaster Canal Trust 01524 735504 www.lctrust.co.uk.

Run by enthusiasts, experience their narrow boat "Waterwitch" for a trip along the pretty northern reaches of the Lancaster Canal.

Abbott Lodge Jersey Ice Cream, Penrith 01931 712720 www.abbottlodgejerseyicecream.co.uk.

Meet the Jersey cows at this working farm, try the ice cream and work up an appetite in the indoor and outdoor playgrounds. The farm offers a tea room, function room for educational visits and you can watch the calves at their computerised feeding station. Sampling the ice cream is a must!

Alderley Edge, Cheshire 01625 584412 www.nationaltrust.org.uk.

Dramatic wooded hill rising out of the Cheshire plain. Legend says that kind Arthur lies sleeping underground. Explore mysterious trails and seek the wizards well. Alderley Edge is designated an SSSI for its geological interest. It has a long history of copper mining, going back to Bronze Age and Roman times. The mines are open twice a year, organised by the Derbyshire Caving Club. There are views across Cheshire and the Peak District and numerous paths through the oak and beech woodlands, including a link to Hare Hill.

Cheshire Workshops, Buwardsley 01829 770401 www.visitchester.com.

Discover candle making and watch working craftsmen. Lots of activities for children at weekends and school holidays including candle dipping, badge making, card making and pottery painting. Open 10-5pm Delamere Forest Park, Cheshire 01606 882167 Take a picnic and explore this extensive forest. Visitor centre and ranger-led activities throughout the year, with extra events during school holidays. Good network of cycle paths.

Delamere Forest Park is Cheshire's largest area of woodland and is a place for families to let off steam, escape the crowds and find peace in the heart of the forest.

Ainsdale on Sea Beach & Discovery Centre, Southport 0151 9342967.

Explore this extensive, clean beach and the maze-like sand dunes. Hire a free bicycle from the centre or take part in extreme kite activities.. Ainsdale-on-Sea is an ideal starting point for exploring Sefton's Natural Coast. A mile from the village of Ainsdale, it is Southport's main bathing beach with Lifeguards on duty during the summer season.The beach is one of the most popular on the coast and achieves the Seaside Award annually.

Wirral Country Park, Cheshire 0151 327 5145.

From the restored Hadlow Station, walk or cycle along 12 miles of footpaths, with shorter pathways into other areas. Fantastic bird watching, with great views over the Dee Estuary to North Wales. Visitor centre and guided walks. Wirral Country Park is a place of contrasts. Badgers and Foxes hunt the quieter parts, birds nest in the dense hedges or feed on the berries in winter, and you may see up to 10 kinds of butterfly in summer. Head for the 60 feet high, boulder-clay cliffs and look out over the Dee Estuary and you'll smell the tang of mud and salt, feel the sea breeze and get a sense of space quite unlike the enclosed, inland Wirral Way.

Greater Manchester Police Museum 0161 856 3287 www.gmp.police.uk.

Step back into unruly Victorian Manchester, see the wooden pillows in the Victorian cells, plus uniforms and equipment. Learn about forgery and forensic science.

Three Owls Bird Sanctuary & Reserve 01706 642162 www.threeowls.co.uk.

Relying heavily on donations, this sanctuary takes wild distressed birds, rehabilitates them and returns them to the wild. Between 300 and 1600 birds can be seen depending on the season.

Stockport Hat Works 0845 833 0975 www.hatworks.org.uk If you have ever wondered how hats were made, then this is the place for you. View the history of hat making from its origins through to mechanisation in the mills with working machines in action.

National Football Museum, Preston 01772 908442.

Investigate all aspects of the beautiful game including displays and Hall of Fame, Match of the Day Interactive and the Goalstriker Experience. Discover the best football museum in the world. Exciting moments, unforgettable memories, world famous objects, legendary players, 'hands-on' fun for all the family ... best of all it's FREE Hadrian’s Wall World Heritage Site 01434 332002 www.hadrians-wall.org.

This famous frontier was built by the order of the Roman Emperor Hadrian. Along its length are many museums, forts and temples. Follow the national trail, an 84 mile trail from coast to coast with links to 40 short walks. Steeped in history there are 14 major Roman sites, forts and museums and countless milecastles and turrets to explore, as well as many great non-Roman places on offer. Explore the stunning landscape of the World Heritage Site on foot, or cycle, at your own ease ‘Let’s Go with the Children’ Guide Books are published by Boomerang Family Ltd.

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