Therapeutic Services for Children

Specialized Treatment

Specialized Treatment
Handwriting Without Tears®

Handwriting Without Tears® is a method of teaching handwriting developed by Jan Z. Olsen, OTR.  It follows a development sequence of imitation of letter formation, followed by copying, and finally independent writing.  Olsen’s theory is meant to give the best chance for success in writing letters and to teach correct motor habits.  The Handwriting Without Tears® method uses activities that incorporate tactile and kinesthetic input and exploration in addition to games, songs, and rhymes in order to capture the child’s interest and help them to develop handwriting readiness.  The Handwriting Without Tears®  workbooks begin with basic school readiness skills and continue through manuscript and cursive writing.

Each workbook gradually increases its focus on development of eight key components of legible handwriting including:

  • Memory
  • Orientation
  • Placement
  • Size
  • Starting point
  • Sequence
  • Control
  • Spacing
Sensory Integration Therapy

Sensory integration (SI) is an unconscious process of the brain.  It occurs without us thinking about it- like breathing.  It helps us organize information detected by our senses (taste, sight, hearing, touch, smell, movement, gravity, and position).  It gives meaning to what we experience by sifting through all the information and selecting what to focus on (such as listening to a teacher and ignoring the noise of outside traffic).  It allows us to act or respond to the situation we are experiencing in a purposeful manner (known as an adaptive response).   Sensory integration forms the underlying foundation for academic learning and social behavior.  (Sensory Integration and the Child, A. Jean Ayres, 2005)


TheraTogs™ were designed and developed by Beverly Cusick, PT, MS.  It is an orthotic undergarment and strapping system, which is worn by children with sensorimotor impairments, and specific musculoskeletal, posture, balance, and movement issues.  TheraTogs™ are custom fit to promote bone and joint development, joint stability, and improved body awarenenss, posture, balance, gait movement skills, and motor performance.

Therapeutic Listening™

Therapeutic Listening™ is a term used to describe combined use of a number of electronically altered compact discs in a prescribed manner, but with equipment that can be used in many environments.  Sheila Frick, OTR designed this program.  Therapeutic Listening™ programs are individualized to each client and are suited for application in home and school settings.  Maximum effectiveness in treatment outcomes is promoted by daily use.  The use of modulated and filtered music in conjunction with sensory integrative occupational therapy techniques seems to increase the effectiveness of both treatment modalities.  There is commonly a decrease in the time necessary to meet treatment goals in the areas of: modulation, balance and movement perception, and an increase in exploration of the environment, sense of physical competence, and drive to challenge one’s practic and sequencing abililities; and improved social competence and language abilities.

Neurodevelopmental Treatment

NDT is a therapy approach developed by Karel and Berta Bobath in the 1950’s.  It was originally developed to provide treatment to children with Cerebral Palsy, but over the years has expanded to encompass a broader range of conditions.  NDT is a movement and function oriented technique of inhibiting muscle groups that cause abnormal muscle use and facilitating functional movement patterns.

Floortime Approach

The Greenspan intervention method revolves around a concept he calls “floor time” — time which the caregivers/therapists, spend entering the child’s activities and following the child’s lead. If the child wants to line up cars in a row or twirl a top, the parents will join the child in his or her preferred activity (with the intent of developing this action into an affective interaction) rather than demanding that the child join them in their preferred activity (a process which, at best, will produce no more than rote action and reaction).

Starting with this mutual, shared engagement, the parents are assisted to draw the child into increasingly more complex interactions, a process known as “opening and closing circles of communication.” For example, the parent may begin to take turns with the child who is lining up his cars, until the child begins to expect and wait for his parent’s turn. Then, the parent may “accidentally” place a car in the wrong spot, tempting the child to open and close a circle of communication as he corrects this appalling error.

Greenspan also reminds us that these children need to have caregivers/therapists describe new situations for them, preparing them beforehand and rehearsing to help them anticipate what is expected. They need the adults in their lives to empathize with their reality and to shape their behavior in small, manageable steps. Caregivers/therapists are encouraged to be firm on limits, but to avoid making a confusing number of rules. Finally, they are reminded that when limits must be increased, “floor time” must also be increased so that life doesn’t degenerate into a power struggle. “Floor time” should also be increased whenever regression is observed.

Drawing on his vast clinical experience, Greenspan finds that as much as 50% of the group presenting with severe relationship, communication, motor, sensory and cognitive difficulties — that group typically labeled with autism/PDD — is actually “ready to take off”.  With appropriate relationship-based therapy this group will respond with surprising speed to play, will become joyful, and will learn to cue off their own affect, rather than off artificial prompts or rewards.

Greenspan reminds us that processing delays do not equal a central reasoning deficit. The child’s learning curve over time, rather than a cross-sectional assessment done by formal testing, is our best predictor of outcomes. Assume the best, he encourages, and don’t assume a ceiling

Myofascial Release Technique

Myofascial Release is a highly specialized stretching technique used by therapists to treat patients with a variety of soft tissue problems.

To understand what Myofascial Release is and why it works, you have to understand a little about fascia. Fascia is a thin tissue that covers all the organs of the body. This tissue covers every muscle and every fiber within each muscle. All muscle stretching, then, is actually stretching of the fascia and the muscle, the myofascial unit. When muscle fibers are injured, the fibers and the fascia which surrounds it become short and tight. This uneven stress can be transmitted through the fascia to other parts of the body, causing pain and a variety of other symptoms in areas you often wouldn’t expect. Myofascial Release treats these symptoms by releasing the uneven tightness in injured fascia.

In other words, Myofascial Release is stretching of the fascia. The stretch is guided by feedback the therapist feels from the client’s body. This feedback tells the therapist how much force to use, the direction of the stretch, and how long to stretch. Small areas of muscle are stretched at a time. Sometimes the therapist uses only two fingers to stretch a small part of a muscle. The feedback the therapist feels determines which muscles are stretched and in what order.

Each Myofascial Release technique contains the same components. The therapist finds the area of tightness. A light stretch is applied to the tight area. The therapist waits for the tissue to relax and then increases the stretch. The process is repeated until the area is fully relaxed. Then, the next area is stretched.

The therapist will be able to find sore spots just by feel. Often, patients are unable to pinpoint some sore spots or have grown used to them until the therapist finds them. The size and sensitivity of these sore spots, called Myofascial Trigger Points, will decrease with treatment.

Most patients are surprised by how gentle Myofascial Release is. Some patients fall asleep during treatment. Others later go home and take a nap. Most patients find Myofascial Release to be a very relaxing form of treatment.

Myofascial Release is not massage. Myofascial Release is used to equalize muscle tension throughout the body. Unequal muscle tension can compress nerves and muscles causing pain. Progress is measured by a decrease in the patient’s pain and by an improvement in overall posture.


The Feldenkrais Method is named after its originator, Dr. Moshe Feldenkrais, D.Sc. (1904-1984) [about], a Russian born physicist, judo expert, mechanical engineer and educator.

The Feldenkrais Method is a form of somatic education that uses gentle movement and directed attention to improve movement and enhance human functioning. Through this Method, you can increase your ease and range of motion, improve your flexibility and coordination, and rediscover your innate capacity for graceful, efficient movement. These improvements will often generalize to enhance functioning in other aspects of your life.

The Feldenkrais Method is based on principles of physics, biomechanics and an empirical understanding of learning and human development. By expanding the self-image through movement sequences that bring attention to the parts of the self that are out of awareness, the Method enables you to include more of yourself in your functioning movements. Students become more aware of their habitual neuromuscular patterns and rigidities and expand options for new ways of moving. By increasing sensitivity the Feldenkrais Method assists you to live your life more fully, efficiently and comfortably.

The improvement of physical functioning is not necessarily an end in itself. Such improvement is based on developing a broader functional awareness, which is often a gateway to more generalized enhancement of physical functioning in the context of your environment and life.

Anyone–young or old, physically challenged or physically fit–can benefit from the Method. Feldenkrais is beneficial for those experiencing chronic or acute pain of the back, neck, shoulder, hip, legs or knee, as well as for healthy individuals who wish to enhance their self-image. The Method has been very helpful in dealing with central nervous system conditions such as multiple sclerosis, cerebral palsy, and stroke. Musicians, actors and artists can extend their abilities and enhance creativity.

Through lessons in this method you can enjoy greater ease of movement, an increased sense of vitality, and feelings of peaceful relaxation. After a session you often feel taller and lighter, breathe more freely and find that your discomforts have eased. You experience relaxation, and feel more centered and balanced.

Brain Gym

Brain Gym was developed in the 1970’s by Dr. Paul Dennison, who pulled ideas from yoga, developmental optometry, applied kinesiology, and traditional Chinese medicine. It was based on a precept that every learning situation is comprised of sensory input, integration and assimilation, and action. Brain Gym is made up of simple and enjoyable movements and activities designed to facilitate each step of the learning process by “waking up the mind/body system, and bringing it to learning readiness”. There are 26 different movements associated with Brain Gym. They can be categorized into groups, such as Midline Movements, Deepening Attitudes, Lengthening Exercises, and Repatterning, and mixed/matched as appropriate to the needs of the individual person. Therapists may often incorporate these movements into a child’s session to help them achieve their individual goals.


PROMPT is an acronym for Prompts for Restructuring Oral Muscular Phonetic Targets. The technique is a tactile-kinesthetic approach that uses touch cues to a patient’s articulators (jaw, tongue, lips) to manually guide them through a targeted word, phrase or sentence. The technique develops motor control and the development of proper oral muscular movements, while eliminating unnecessary muscle movements, such as jaw sliding and inadequate lip rounding. At Support by Design, we have expert PROMPT therapists with extensive experience to assist with motor speech development and sound acquisition.


Torticollis is a condition that causes a child’s neck muscle (sternocleidomastoid muscle) to tighten resulting in tilting and rotating of the head. If not treated, this condition can lead to plagiocephaly, flattening or asymmetry of the face and skull, gross developmental delays, lack of bilateral use of extremities, and visual tracking deficits. Early diagnosis is key since treatment is most effective at a younger age. Torticollis is treatable with timely physical therapy treatment.

At Support By Design, our physical therapists are trained to treat torticollis with the use of various techniques. Techniques include stretching, massage, active and passive range of motion, strengthening exercises, environmental adaptations, visual tracking exercises, bilateral coordination exercises, postural training and parent education., HotDoodle™ Custom Web Design and Quality Affordable Website Designers for Small Businesses and Professionals
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