Body Awareness Drawing Activity

Did you know that your child’s body awareness can be increased by encouraging better drawing skills? Often times a young child will draw a picture of themselves and it will have minimal body parts and some of them in the wrong places. Arms coming out of the head, legs coming out of the head, mouth bigger than the face- are just some of the common characteristics. Try to teach your child through drawing with them and example how to draw their body parts in the correct places. You can also encourage your child to draw more body parts on their self-portrait; adding body parts like hair, nose, eyebrows, ears, hands, fingers, feet, etc. You will find that not only do your child’s drawing skills increase, but also their body awareness will increase.

Great article on “When School Based PT Goes Too Far”

Please see below this great article from ADVANCE magazine:

School-Based Therapy

According to federal IDEA guidelines, physical therapy in school is considered a related service. As such, related services are provided to children in special education, primarily to ensure the child is able to participate in learning tasks.

For example, if a child requires assistance due to safety issues related to walking and getting to class, the focus of therapy would be addressing adaptation and performance in the educational setting, and is based on education-related difficulties that impair the ability to function in the school environment.1

These services are to provide a child with equal opportunity that would not exist without therapy service and not merely maximization of a child’s potential. Legal mandates require the school-based therapist to deliver only those services necessary to assist students in benefitting from their educational programs.

Eligibility for therapy must be based on the student’s educational goals and whether the expertise of PT is needed to help the student achieve these goals. To require related services for every child with a disability would be inconsistent with the concept of individualization that has been part of the act since its inception in 1975.

Related services are only required to the extent that such services are necessary to enable the child to benefit from special education. Related services, as with any other service in an IEP, are determined on an individual basis by the child’s IEP team.2

Changing Times

This paragraph is now included with every evaluation I complete in my job as a school-based physical therapist in a large, urban school district in one of the poorest cities on the East Coast. I am currently in my 16th year in this position, and my 28th year as a practicing therapist.

Every year, for the past several years, this paragraph has grown. It used to be a mere two sentences, simply stating that school-based services were not intended to replace clinical services, and that we make every effort to coordinate services, and encourage parents to seek both, when necessary.

Sadly, in my opinion, times have changed. I tend to add more information to that paragraph when I am once again faced with defending my reasoning for not providing direct services to a student.

The primary role of my job in the school is to keep students in the classroom. In terms of mobility and accessibility, I will do my professional best to determine the most efficient and safe way for the student to get from point A to point B. It is not simply my opinion, it is what the law intends.

A large part of IDEA involves the least-restrictive environment (LRE). A student attending their neighborhood school, with no accommodations, no adaptations, and no special education services, is the baseline. It is the starting point. This means that my thinking and recommendations to the team must start at the minimal amount of service I believe a child can have in order to benefit from his physical therapy

Interpreting IDEA’s Guidelines

The problems we’ve been facing in my district in recent years stem from parents who’ve been led to believe that more services means better education. More and more we are sitting in meetings that last several hours, and continue over several days, with “advocates” who are not advocating for the best education for the child, but advocating against the school district.

It’s a certainty that I spend more time during the course of the school year defending my professional opinion regarding the lack of need for direct school-based PT intervention than I do servicing students who actually benefit from my skillset.

A large part of the problem is a lack of understanding, even within our profession. Despite physical therapy education advancing to an entry-level doctorate, very little, if anything, has been added to the curriculum regarding school-based services. Basically, little has been added from a baseline of zero information.

Given that school-based services are federally mandated, and therefore present in some form in every public school, it would seem appropriate to give physical therapy students information on the guidelines.

I’ve had both advocates and colleagues tell me that the law can be interpreted in different ways.

Yet after researching, reading, and studying the laws, guidelines, and practice act for 16 years, I no longer see a large scope for interpretation: “Related services are only required to the extent that such services are necessary to enable the child to benefit from special education.”

We like to joke about the ridiculous levels of service and the goals that cross our desks from students transferring into our district. The top two on my list are one student who received direct school-based PT with a goal of improving his golf swing, closely followed by the eight-year-old autistic child who received direct PT services in school working on successfully climbing an 8-foot ladder while wearing his backpack.

We’ve had varsity basketball players with advocates insisting they needed services to improve visual motor skills, and homebound students with nothing on their IEPs except range-of-motion of their extremities.

Best as a Team Approach

Simply, the role of physical therapy in the school setting comes down to function. If a student cannot access or participate in school activities, he cannot benefit from their education.

It’s not the role of the school-based therapist to meet all therapeutic needs of the child, or to rehabilitate the student. This can be difficult for parents, teachers, advocates, and administrators to understand. This is further hampered by the lack of cohesive understanding among our profession. Over and over again we hear statements such as “the student needs therapy in school because he has cerebral palsy.” Or “the student needs therapy because her motor skills are not normal.”

SEE ALSO: An Early Head Start on Child Development

In much the same way that special education could never be expected to bring an intellectually disabled student’s IQ to “normal,” special education-related services cannot be expected to normalize skills in cases of abnormal neurologic or musculoskeletal systems.

School-based physical therapy service is a valuable part of special education. Much like a therapist is an important team member in the care of a patient in a hospital, therapy works best in schools when it’s incorporated as part of a team approach to provide the most effective educational outcomes.

Lisa J. Bogacki is a self-employed subcontractor for Pediatric Therapeutic Services Inc. and the sole physical therapist in the Reading (Pa.) School District.

This article was found from ADVANCE magazine at:


Astronaut Training Program

What is the Astronaut Training program and why do we do it here at Littlefield? We will let the Astronaut Training protocol book do the talking:

“Although not always acknowledged, the vestibular system is central to our survival as well as to our ability to function in daily life. Vestibular deficits are often found in children with delayed motor development, perceptual or attention deficits, learning disabilities, emotional problems, language disorders, and autism. For example, gravitational insecurity may underlie a child’s fear of being moved, swinging and climbing at the playground, or riding on an escalator. The vestibular system teams up with the auditory and visual systems to perform many important tasks by helping us understand the 3-dimensional space, or spatial envelope, that surrounds us wherever we go. Through the proper functioning of our Vestibular-Auditory-Visual Triad the sights and sounds of our world become meaningful and entice us to move, explore, and engage with objects, people, and events…The dynamic interaction between the members of the Vestibular-Auditory-Visual Triad provides the backdrop for virtually everything we do and thus determines much about the quality of our lives. Listening to the carefully selected music and space-sounds on the enclosed CD while engaging in the specific head, body, and eye activities described in this book can improve vestibular function. These activities are our version of Astronaut Training: a sound activated vestibular-visual protocol designed to enhance the dynamic interplay of moving, looking and listening.”

Teaching Children to Jump with advice from Littlefield

Jumping is a motor milestone that requires strength, balance, coordination, body awareness and motor planning. Jumping typically occurs in a step-wise manner, with children first experimenting with weight shifting, jumping down, jumping over, jumping up, hopping on one foot, and finally alternating hopping on single leg and double leg as in hopscotch. Listed below are some fun ways to work on teaching your kids how to jump:

  • Colored targets- provide additional visual input to the child in order to cue them to jump towards their desired target.
  • Creating obstacles- obstacles that vary in size, height and width challenge your child in order for them to learn to gauge how much they need to bend their hips/knees as well as learning how to use momentum to propel themselves up higher to clear the obstacle in their way.
  • Animal jumps- role play allows children to be creative while they are working towards getting stronger. Fun jumps to try include: frog jumps, kangaroo hops and flamingo stance.
  • Trampolines- make jumping fun and easy for kids when they are first learning how to jump and can still be a fun/creative way to work on the progression of jumping as they get older. Trampolines provide additional assistance with the rebound given from the springy surface, but the pliability of the surface also provides challenges to their strength and balance in order for the child to not fall over.



Melissa Littlefield and Emily Nelson’s Story

The story of our owner Melissa Littlefield and our Speech Language Pathology Assistant Emily Nelson begins in 2006.

Emily was first diagnosed with Spondylo Arthritis at 13 years old. Her mother, brother, many aunts, uncles, and cousins have a large number of Autoimmune Disorders ranging from Arthritis to Crohn’s Disease to Lupus. This diagnosis was hard for Emily’s mother to hear, but she knew the process from her vast knowledge of Autoimmune Disorders and the history of her brother’s diagnosis at 7 years old.

At 15 years old, she had a new diagnosis of Fibromyalgia. Emily’s doctor recommended an “amazing physical therapist” Melissa at Littlefield Physical Therapy. Melissa worked with Emily to manage the strength and flexibility of her hips and ankles. This helped her pain and comfort as she tried to be a normal high school kid.

Emily knew from a young age that she was interested in Speech Language Pathology due to many family members needing speech services from brain traumas. Melissa encouraged this path while talking during their therapy sessions and even introduced her to a Speech Language Pathologist. Melissa’s upbeat personality and caring nature was something Emily knew she wanted to be as a therapist. As many Littlefield patients know, Melissa can find ways to work on goals without the patient knowing.

In the years to follow, Melissa and Emily would see each other around Temecula. Melissa, with her contagious smile, would update Emily on how Littlefield was growing. From adding new Physical Therapists to beginning Occupational Therapy, Littlefield was becoming a large part of the community. While away at college, Emily heard, from her mom, that Littlefield started to offer Speech Therapy services. There was a spark of excitement in her but she did not know where her life was going to take her.

After graduating with a Bachelors in Speech/Language Pathology, Emily was looking for a clinic to complete internship hours to become a Speech/Language Pathology Assistant. She remembered that Littlefield had a Speech Therapy department and gave Melissa a call. Melissa remembered Emily and agreed to having her as a student. Tamara, Littlefield’s Lead Speech Therapist, took Emily under her wing. She taught Emily many ways to access children and help their speech and language skills. Tamara has the same upbeat and kind nature that Emily saw in Melissa many years before. She could not believe that Melissa found therapists with similar personalities. It was an honor to become a part of the Littlefield team in August 2015 as a Speech Language Pathology Assistant.

Emily was diagnosed with Rheumatoid Arthritis at 22 years old. After she began her internship hours at Littlefield, she began to see Heather at the On Track office. Heather has strengthened her muscles and eased the pain from arthritis. With the many diagnoses, Emily has been on continuous medications since she was 15 years old. Her pain is now managed as she continues to adapt to life with Autoimmune Disorders.
Melissa and Emily are excited to see where the next 10 years will take them. Littlefield and our therapists love to be a continuous part of our patients’ lives. We know that “graduating” from services does not mean you are gone forever.

Equipment Clinic at Littlefield

A little bit about Littlefield’s Equipment Clinic…

Littlefield is running a monthly equipment clinic where several of our physical therapists work with local vendors and families to determine the best durable medical equipment available for their needs.  Patients can schedule for the clinic if they want to trial the best durable medical equipment on the market. Our physical therapists work with the equipment vendors to fit our patients’ for standers, wheelchairs, adaptive strollers, gait trainers, bath chairs, etc. These vendors work with durable medical equipment only, so patients seeking orthotics can discuss them with their therapist during their session.

Once you have attended equipment clinic your therapist and our administrative staff will inform you of any changes or updates along the way. To give you a better understanding of when to expect that you will get the equipment you requested here is some information regarding time frames.

Durable Medical Equipment Time Frames:

Welcome to the world of Durable Medical Equipment.  Obtaining equipment can be a challenging process for families as there are so many steps to complete by so many different people.  The average length of time to obtain equipment is 3-6 months.  Therapists rely heavily on parents to stay on top of it all and expedite the process.  Therapists complete a letter of medical necessity and send it to our amazing medical records staff member Janice who is excellent with getting things to the right person.  The letter will go to your doctor’s office and once a prescription for the changed items has been signed then it will go to your equipment vendor.  If you would like to assist with expediting the process then feel free to contact your doctor for a prescription.  Your therapist will tell you what the prescription needs to say.  Once you obtain the prescription, send to your vendor.  Once the vendor has the prescription, letter from your therapist and quote from your equipment expert than they is able to submit to your insurance for ordering.  At that time, follow up with your insurance every 1-2 weeks until they have approved the item. Once approved follow up with the vendor regarding ordering and then the process should go fairly smoothly.

Time frames for equipment are typically as follows:

Parent/therapist discuss needs 1-2 weeks

Demo is set up with vendor 2-3 weeks

Equipment is selected.  Vendor writes quote/PT writes letter of justification 1-2 weeks

Prescription is obtained from MD 1-2 weeks

Full packet sent to insurance (letter, quote, prescription) 1-2 weeks

Insurance approves equipment 2-4 weeks

Equipment is ordered 1-2 weeks

Equipment is shipped to vendor 2-4 weeks

Equipment is delivered to patient at PT office and adjusted by vendor for patient 1-3 weeks.

Any of these steps may be shorter or longer depending on parent follow up as well as availability of staff involved to complete their portion in a timely manner.  Insurance denials will lengthen the process typically by 2-3 months.  Please let your therapist know if you have any questions along the way.

There are certain circumstances where you may find that you aren’t a good candidate for a certain type of equipment or that your insurance company may not approve the specific piece of equipment that you need. In this case we would like to provide some additional resources on companies/associations that offer assistance and the possibility of obtaining used equipment for your child.

Website Resources:

  • Cecily’s Closet: A non-profit organization in San Diego, CA that works to recycle the use of durable medical equipment for children with special needs.
  • Physical Therapy for All: A non-profit public charity dedicated to provide equipment and therapy services to children in need.
  • Ability Tools: Provides Californians with disabilities the resources to obtain/donate all different forms of assistive technology and equipment.
  • Pass It On Center: Provides resources based on location regarding companies and associations that offer reuse programs for assistive technology for children and adults with special needs.
  • Goodwill Industries- Assistive Technology Exchange Center: Offers equipment loans, reuse and support to families and children who are learning how to use assistive technology.

Visual Motor Strengthening at Littlefield

Did you know that Occupational Therapists can do Vision Therapy with your child? Here at Littlefield we have several therapists that have undergone additional training to understand and administer quality vision strengthening with your child. Some of the tests that our Occupational Therapists can do are: Bruininks-Oseretsky Test of Motor Proficiency, Second Edition (BOT-2), Developmental Test of Visual Perception, Third Edition (DTVP-3), and The Beery-Buktenica Developmental Test for Visual Motor Integration (VMI). We have a wonderful program in place to tailor meet the needs of your child. Our Occupational Therapists create a program that goes well with a Developmental Optometrist. We are also well versed in doing the Astronaut Training Program which works on connecting and integrating the Auditory-Visual-Vestibular Triad to help improve the quality of any participant’s life. Schedule your appointment today!

Swimming Safely During Your Summer

Since June is National Safety Month, here at Littlefield we wanted to share some extra helpful information regarding your child’s safety around water. Summertime is officially here, which means that it is even more important to be aware of your child’s safety around pool and/or beaches. Parents also need to supervise their children near bathtubs, nearly 30 percent of home drowning incidents occur when a child falls into a pool or is left alone in the bathtub.


Here are some resources from the National Safety Council to share with your family, friends and little ones in order to ensure a safe and fun summer by the water.

Movement Matters with Carriers

We know that you parents are busy out there! We have some great strategies for you parents to get your baby moving without changing your daily routines. A great idea is to put your baby in a carrier strapped to your chest for at least a couple of hours per day and do everything that you normally do throughout the day-clean the house, do homework with your kids, take the dog for a walk, go shopping. Putting your baby in the carrier will allow your child to get much more stimulation and movement in their day. As you move into different positions, your baby is moving into different positions.

Stroke Awareness

A stroke occurs when a clot blocks blood flow to an area of the brain, resulting in death of brain cells and damage to the brain. This can result in a variety of symptoms. These can range from weakness and altered sensation to paralysis and complete loss of sensation. Physical therapists can help a stroke patient to learn or restore movement patterns essential for day-to-day activities. In addition to motion, a therapist can help improve muscle control, regain balance and stability and boost confidence. A therapist will also help a stroke patient avoid exercises and activities that can be potentially harmful, while creating a safe home environment conducive to rapid recovery.

May is National Stroke Awareness Month and many people think strokes only occur in the elderly population, however the number that occurs in the younger population is starting to rise. It is important to be able to recognize the symptoms and signs of a stroke in order to get the necessary treatment. The American Stroke Association teaches the acronym FAST to help:

  • Face drooping. Does one side of the face droop or is it numb? Ask the person to smile. Is the person’s smile uneven?
  • Arm weakness. Is one arm weak or numb? Ask the person to raise both arms. Does one arm drift downward?
  • Speech difficulty. Is speech slurred? Is the person unable to speak or hard to understand? Ask the person to repeat a simple sentence, like “The sky is blue.” Is the sentence repeated correctly?
  • Time to call 911. If someone shows any of these symptoms, even if the symptoms go away, call 911 and get the person to the hospital immediately. Check the time so you’ll know when the first symptoms appeared.


  1. American Stroke Association. Warning Signs.