Summary
In this episode of “Little Brains Big Steps,” host Megan Williams interviews Franchesca Cox, an expert in pediatric motor development, to explore various therapeutic approaches for children. Franchesca shares her journey into pediatric therapy, highlighting her passion for movement-based interventions that promote independence and mobility.
The discussion delves into several key therapies:
- Dynamic Movement Intervention (DMI): An evolution of Cuevas Medek Exercises, DMI focuses on supporting and provoking motor responses in children to enhance their motor skills.
- TheraSuit Program: Designed for children who may have outgrown DMI due to size, the TheraSuit offers an intensive model to continue motor development.
- Therapeutic Electrical Stimulation (TASES): A modality that complements other therapies by stimulating muscle activation and strengthening.
Franchesca emphasizes the importance of individualized therapy plans and the positive outcomes these approaches can yield.
Resources
Episode Transcript
Megan Williams (00:01)
Welcome back to Little Brains Big Steps. Today’s episode is extra special because I’m interviewing my incredible host, Francesca Cox. Francesca’s experience in motor development is phenomenal and today we’re getting a behind the scenes look at how she helps kids reach their milestones.
Franchesca Cox (00:22)
Thanks, Megan. Hi, everyone. I am super excited to discuss the things that I use in the clinic and why I’m so passionate about helping these kids through movement-based interventions.
Megan Williams (00:33)
So Francesca, to start off, can you remind us about how you got into the world of pediatric therapy and more specifically the kind of motor-based approaches that you’ve kind of gravitated towards?
Franchesca Cox (00:49)
Yes, yes, of course. So I did get into pediatric therapy pretty quickly after I graduated from grad school. I knew I wanted to work with kids. I actually was more inclined. thought I wanted to work in the NICU, but then I realized the focus of OT in the NICU is not what I was super passionate about, which is independence and mobility. And you get a little bit of that in the NICU, but just not as much. And so I…
was in home health a little bit and I took a DMI course that I was introduced to through another podcast. And I think we talked about that in a previous episode, but I loved the DMI course because it allowed me to give parents very real, tangible things that they could do to help their child sit up correctly, more independently with hands-on approach. And so I quickly decided that was the path I wanted to go and
The rest is kind of history. built a practice around intensive therapy starting in 2022.
Megan Williams (01:54)
So was there a of like a defining aha moment that you could specifically remember where you were like, okay, these specific motor based approaches are like the ones that I want to go for and really spend more time and money and energy focusing on?
Franchesca Cox (02:14)
Yes, yes, I was in the beginning of my practice, I did regular OT and then a little bit of DMI. But I just remember thinking I was I had so much not just fun, but it just felt like I was getting better results when I was able to work with a DMI patient. And it’s just maybe my strength versus that it wasn’t the right fit or whatnot. But I saw very tangible changes and it was very exciting to be able to offer that hope.
to these families that they had been telling me we’ve tried everything, we’ve tried traditional therapy, and then they were excited about some of those changes. So it was the beginning of 2023 when I decided, okay, I’m just gonna go all in, I’m gonna take more courses in DMI and start to taper off regular OT, which I have maybe one or two regular OT patients still, which is fun to keep it some variety in the mix and it keeps me.
constantly looking for regular OT based things like vision and fine motor things. But yeah, so it was the beginning of 2023. I decided I was going to sign up for the TheraSuit program because I, we might talk about this later, but the TheraSuit is a nice transition for children who may be quote unquote age out of the DMI based on their size. And so it can, it allows children that are a little bit bigger to continue that intensive model.
And so I, it was the beginning of 2023, I had a patient and I realized he would benefit so much more from these intensive approaches versus traditional therapy. And so, yeah, that was kind of when I knew that’s what I need to be doing.
Megan Williams (03:58)
So as a speech therapist, I am very new to all of these different approaches. I’ve really just learned about them from talking to you and social media and things like that. let’s kind of break down all these different acronyms and the different kind of modalities. So let’s start with DMI. What does DMI stand for? Like what is it?
Franchesca Cox (04:26)
Sure. Yeah. DMI therapy is a modality that was adapted from Cuevas medic exercises. Cuevas medic exercises go, goes 50 years back. It was developed by Ramon Cuevas in Chile. And he must’ve just been a genius of our, of our modern time because he, he, he figured out a way to support a child, but also facilitate and provoke motor response from the child. And we’ll get more into like the, the
the details about DMI, but DMI was adapted by Jake Kraneler and also Joanne Weltman. And they took the CME courses with Ramon Cuevas years ago and their passion was to teach as many therapists as possible. I’m not really sure about all the details as far as the transition CME and DMI, but I do know that DMI allowed Jake and Joanne to
fulfill their passion to teach as many therapists as possible in order to help more kids. And so they created the DMI courses which are now available worldwide to therapists, pediatric therapists, speech OT and PT’s. And I think there might be a few other practitioners in the healthcare field that they are willing to train. But yeah, so that’s what DMI stands for. And essentially it is…
a series of hundreds of exercises that focus on head control, trunk control, postural control, of course standing, crawling, the transitional movements, but also the mobility as well. And so the foundation is one of the foundations of DMI is neuroplasticity and
A key part of DMI is helping children develop better balance and body control so that they can stay upright and move safely. The ability or this ability is called verticality and it helps them understand where their body is in space and how to steady themselves against gravity. So when I’m holding a child or I’m let’s say I’m working on head control, my goal for them or my goal with that child is to give them the least amount of support to in a safe way and in the safest way possible.
but in order to provoke a motor response with the most amount of gravity against working against that child so that they are able to.
Let me rephrase that. So when I’m working with a child, my goal is to give them the least amount of support as safely as possible in order to provoke a motor response so that I am exposing them to the most amount of gravity, if that makes sense. So a lot of times, even like therapists in traditional therapy, they are giving them a lot of times more support than they should be or than they need to because naturally we want to protect the child with poor head control or poor trunk control. We want to
give them an adaptive seating and those are all good things. But in DMI our focus is the least amount of support and that usually means that we’re lowering our support whether it’s at the rib cage, the trunk, the hips or even lower at the thighs if we’re working on like tall kneeling. And so it’s very cool when I’m able to work with a child over a period of time, like they come in for several intensives throughout a year and I’m able to, you know, grade up.
the level of challenge for this child by lowering my support. And so, so that’s kind of a breakdown of DMI. And one thing that DMI works with is two important systems that are built into our body. It’s the vestibular system, which helps the body sense movement and balance. And it also works with the proprioceptive system, which tells the body where the, or I’m sorry, which tells the brain where the body is in space. And so,
which with each exercise, that child is not just learning how to move through space, but they are also learning how to process their sensory systems. And so we’re integrating those sensory systems so that they can, learn that independent movement and not be so afraid of it. Because as we’ve talked about a little bit with the MNRI podcast, these primitive reflexes and these neurological pathways are so strong.
that they have learned since birth a lot of times or since an accident, whatever the case may be. And so we’re trying to create new pathways so that they’re working in a more symmetrical fashion. And so I talk a lot about co-contraction with the parents and that just means that we’re not just pulling from the extensors of the body, but we’re also working with the flexors in the body and we’re working together so that we’re not like a lot of our kids like to arch back.
we’re going to be co-contracting our lower abdominals, our trunk muscles, so that we have good posture and good head control.
Megan Williams (09:20)
And they’re constantly having to gauge and figure out how to work these muscles together and not just in one position. Like it’s got to be, I guess that’s where dynamic comes in because it’s constantly changing in their movements versus if you were just working on a skill isolated to being like in adaptive seating or you know like in a static environment. So that makes sense.
Franchesca Cox (09:46)
Yes. yes.
Absolutely. And another piece to that is we do repetition. So then that’s that neuroplastic quality of DMI is we’re repeating the same exercise at least five times when possible, so that the child is able to learn and it’s really cool to watch. Usually the first time they do the very, very first time they do an exercise, they’re pretty scared or they’re just wondering, what are you doing to me?
Megan Williams (10:11)
Yes.
Franchesca Cox (10:11)
Because most people that handle me are really, really careful and we are being careful. But we’re also, we also know where to put our hands so that the child is safe, but they’re also, you know, they’re exposed to more gravity. And so they’re scared usually. But then by exercise number five in that series, they’re like, they’re responding. And it’s really cool that that neuroplasticity, it happens so fast. And that’s why parents will tell you like, day two of our intensive, we saw, we saw changes. And it’s
Megan Williams (10:15)
yeah.
Franchesca Cox (10:40)
It’s just really cool to watch.
Megan Williams (10:43)
And it’s so neat that you can get that response in just a limited number of repetitions versus all the fatigue that can come from constant repetitions.
Franchesca Cox (10:48)
Yes.
Absolutely, absolutely.
Megan Williams (10:59)
So is there a specific exercise that you could kind of not really go into too much detail? I know because it’s a very complex, but like what is your favorite kind of exercise to do? From the kiddo From DMI?
Franchesca Cox (11:18)
Yes, I would say the majority of children that come to me for DMI, they benefit from trunk extension by low abdomen. And so that’s essentially where the child starts in on their belly on the table, the therapy table. And then we are lifting them right at the rib cage right below with support at the thighs initially. And then we drop our trunk support for that child. I’m sorry, we don’t drop it, but we move it. So we move it in order. We kind of roll our wrist up.
and we’re bringing that child into that functional extension. So we know lots of our children when they’re in neurological, neuromuscular conditions, they have extension, but it’s not functional. They’re throwing themselves past that sagittal point of verticality, past that midline. And so, they’re looking.
Megan Williams (11:59)
Mm-hmm.
Franchesca Cox (12:08)
really close to the ceiling. And so they can see that’s where their gaze is. And so they don’t know where their midline is. But this trunk extension, because of where our hands are as a therapist, that child know they can sense that, OK, I can’t go that far. And they can feel that gravity when they’re when they’re flexed at the hips. And so they’re trying to find that midline and you can see them working. And usually that even my children that are learning to stand, they still benefit from this because
Megan Williams (12:10)
Maybe.
Franchesca Cox (12:36)
a lot of times our kids that are learning to walk, still have that strong extensor tone. And so that’s one of my favorites. And there’s ways to, I modify it in the clinic just depending on, the child’s head control, their extensor tone and all that. And also, of course, the size of the child. It definitely depends on the size of the child, but it’s one that’s across the board is my favorite, one of my favorites.
Megan Williams (12:56)
Yeah,
and that’s so important even from a feeding perspective because you have to have a certain amount of trunk extension when you’re seated. It’s not full trunk extension where all your legs are in hips, knees, and ankles are in extension like truly standing, but when you’re sitting you have to have some kind of…
know, extension of the spine to sit upright and be able to see food coming to your mouth. so yeah, that sounds really like functional and really, really interesting. I like that.
Franchesca Cox (13:30)
Yes,
yes. And the course and the first course that you take, I don’t know if they still do this, but they stressed how functional and important this exercise was. And so I pass it on to almost all my families that I know their children will benefit. And another piece to it is it’s usually pretty easy for the families to do at home. So that’s definitely a winning point for this exercise. They’re not all very simple, but that one is.
Megan Williams (13:51)
my gosh.
Yes, yes,
it’s so important if it’s something that the family can repeat at home to be able to carry over into that home practice.
Franchesca Cox (14:04)
yes, for sure.
Megan Williams (14:06)
So tell me now about TheraSuit. That’s another modality that I’ve seen, but I’m very interested in from a motor standpoint.
Franchesca Cox (14:18)
Yes, TheraSuit is a really cool modality. It’s the TheraSuit method. was developed maybe 30 or 40 years ago by two Polish physical therapists. They had a child with cerebral palsy and I don’t know how they found out about it, but they took what used to be the astronaut training in the 1960s and adapted it for children with CP. And they essentially developed this program that’s a three
three part program and they’re not usually used in combination. the first part is the actual suit, which you see are the bright yellow or the bright red and there’s other colors too, depending on the size and they have the bungees. And so the suit, it’s, if you just wear the garments, it’s a compression garment. But the bungees is what really is the, is where the magic happens. So you put the bungees where you want to facilitate muscle activation. And so my favorite part of the TheraSuit is
especially with my kiddos that have maybe strong extensors like we were talking about earlier, I can put more facilitation through those lower abdominals, through the trunk. And so I can teach them how to use their muscles. It’s almost like I liken it to kinesiotape, but it’s like on steroids. It’s very strong. had us, when I took the course, they had us put a TheraSuit on that was our size. And so you are walking around and if you have bad posture,
Megan Williams (15:33)
Please.
Franchesca Cox (15:43)
you can’t have bad posture in this if it’s put on correctly. Because there is not one way to put it on. There’s so many different ways you can vary it just depending on how the child’s presenting without the suit. And so I’ve had children on both spectrums that have a lot of flexion and then have a lot of extension. And so depending on what my goals are with that child, I can move those bungees around. I can give them a lot of support. A lot of our children don’t actually have weak core. They have weak lower abdominals. And so
And of course, we have a lot of kids that have constipation and so that plays a part in it. And so I’m able to fire, help them fire and activate those muscles. And so it helps with, it helps with posture. And you can even, there’s pieces for the arms and the legs and the feet that hook onto the MIMO, some adaptive Memo shoes. And so you can work on all kinds of things with the suit on. And also there’s a cap that can be attached to,
I think the shoulders of the suit, don’t use the cap very often, but it’s for head control. And so that’s one part of it. The second piece to the TheraSuit program is the spider cage that you’ll see. And they’re usually these white cages that have holes in them and you can attach bungees. that is probably one of my other favorite parts. I probably use the cage more than the actual suit. And usually it’s because I don’t have the child long enough to make the suit.
work the way I want it to. So I can get results a little bit faster with other things if that makes sense. But I have had families that just come in for the suit but the spider cage is really cool. It’s like having the assistance of eight therapists because I have eight bungees I can attach to a harness that the child is in and we can work on anything from sitting transitioning to sitting to standing and walking and so stepping up. I mean there’s so many things I can do. Today I actually put a mini trampoline
in under the cage. So now we have a trampoline in the clinic just so you know. It was super, super fun, but I attached it. I attached the child to the spider cage and we were working on proprioception. We were working on standing and it was so much fun. It’s just so much fun to see. Usually the child is very scared of the cage because we’re moving, we’re giving them that vestibular input, but they almost always end up loving it because
that children love movement. They were designed, they were created to move. And this allows them to enjoy the movement that typical developing children enjoy, like jumping and running and things like that. And this is giving them that balance and it’s really neat. I’m usually behind the child, so I can’t always see what’s going on with their face, but I’ll ask the parent or whoever’s in front of me, like, okay, tell me, if they’re not crying or whatnot, how are they? they’re almost like, they almost always tell me, they’re…
they’re smiling, they love it. And so it’s really cool. A lot of times I have the children with that strong extensor tone that are throwing themselves back and they’re also, that extension goes all the way down to their toes and they’re not planting that heel down. And so this is a really cool way to playfully work on proprioception through those heels and teach them how to weight bear correctly through their feet. And so, so yeah, that’s the second piece. The third piece is the
Megan Williams (18:49)
me.
Franchesca Cox (19:05)
Universal Exercise Unit, the UEU. I don’t use this a whole lot because it requires a level of cognition for children to follow commands and also under, essentially you’re attaching weights to strengthen certain muscle groups. And so if the child doesn’t understand what you’re doing, it’s gonna feel very, the child’s not gonna be comfortable at all and they’ll be upset very quickly. So I usually use it.
Megan Williams (19:27)
Yeah, I would too.
Franchesca Cox (19:31)
Yeah, yeah, for sure, for sure. And there’s other ways to use the UEU but that’s the main purpose is we’re isolating muscle groups for, you know, hip abduction and arm extension and whatever. But I use it with my usually my older kiddos like closer to eight, nine, 10 and up to teenagers. And so it’s easier. My young men that use it like the 12 to 14, 15 year olds, they love it because it’s it’s like a workout, you know, they enjoy the the strengthening piece of it. But that’s essentially
all of the TheraSuit program. It’s an intensive approach to therapy. It was developed. It has tons of research behind it. Like I said, it was created almost 40 years ago. And so it’s definitely been around for a long time. Unfortunately, the United States and probably some of the other Western part of the world, other than us and a few other countries, it is the gold standard for treating cerebral palsy. Like in Australia, probably most of Europe.
It’s very big in South America. And so it’s slowly making its way, but it’s just, it’s really, really cool. It’s a really cool modality. And like I said earlier, it’s a it’s a nice intensive therapy approach that children that are bigger, too big to handle with DMI, they can continue that intensive model benefit from it if they need it after a certain size or age.
Megan Williams (20:52)
Yeah, I’ve seen
kid I was in clinic who it seemed like maybe one of their first days you were working on just standing in the spider cage with the bungees and they were very unsure about it but then by like the end of that week or the next week they are like jumping and getting so much proprioception through their feet and their heels and I’m like holy moly who is this kid they are and they’re laughing and like I have to stick my head in because it’s just you want to see what they’re doing that’s making them so happy.
Franchesca Cox (21:09)
Yes!
Absolutely. you know, one thing that I’ve been really trying to remember lately, I mean, we are children are going to cry at some point in therapy most of the time. But if we can ever tap into that limbic system, and get them excited about whatever we’re doing, whether it includes bringing Miss Rachel in or you know, whatever, like you said, the vestibular system, they’re going to want to do it. And they’re going to learn it faster. They’re going to learn it whether they’re crying or not. But it’s, it’s just so much.
faster and it’s so much more, it’s so much less stress when we can get that child with a regulated calm nervous system and they’re enjoying what they’re doing. So that’s, that’s the, like you said, it’s so fun to watch them have a good time.
Megan Williams (22:05)
Yeah, and I didn’t know specifically the differences between the spider cage versus the UEU, kind of like what they, to know like what they look like and how they’re different. But man, I would love to put on one of these TheraSuits If we ever get one in clinic that is like adult size, I’m scared I wouldn’t even be able to move. I would just lay there.
Franchesca Cox (22:12)
Mm-hmm.
Yes.
Yes.
If you like tons of proprioception, then you will love it because yeah, it is. Yeah, I was claustrophobic in it and I’m not super claustrophobic person, but I think I’m more than I realized because I was in there and I’m like, wow. And it wasn’t like suffocating. It’s just, I don’t know. I’m like, maybe I really do have, I need to work on my posture. So.
Megan Williams (22:32)
I do. I’m very flimsy. I need lots of it.
No.
Franchesca Cox (22:53)
It’s a very neat, it’s a neat experience.
Megan Williams (22:56)
Yeah. So I know there are some other modalities that you’ll use sometime in clinic, so like, are there any kind of offshoots or any modalities that you want to discuss or do you have any that you’re like looking into including maybe in the future, like a little tease of what
Franchesca Cox (23:15)
Sure.
I just recently added task specific electrical stimulation, which is TASES And so I’m just dipping my toes in there. I have done the lower quarter course. I work on a lot of trunk extension with that and then the gastrocs for planting those heels down while we’re stepping and walking and standing. And so I do some of that later this year. I’m trying to get into a course for spinal stimulation with, I know her first name.
Gerdy, I don’t remember her last name, but I will link it in the show notes. And then also dynamic flex casting is something that’s been on my radar for a long time. I just wasn’t able to travel last year for this course. And it’s something that I am almost positive is going to be able to happen this year, Lord willing. But it is from what I see from the results, from what I’ve seen from Maria’s dynamic flex casting course, it’s going to benefit so many of the kids that I see in the clinic because we almost have
We almost always have, I would say 75 to 80 % of the kids that I see for intensives, they have something going on with their ankles, which we know starts usually at the hips, but if we can address some of that supination, pronation at the feet and ankles, it would give these children a different level of independence, for sure. So those are the two things that are kind of hopefully upcoming soon.
Megan Williams (24:37)
Yeah, you mentioned Gertie Motavalli. I think that’s you say her name. Yeah, I’m really interested in, I follow her on social media and learning about how she works the spinal stimulation pieces. I’m interested in it from the feeding perspective of being able to find symmetry in the muscles of the back and the spine and then of course remediating scoliosis and any kind of issues like that. So that’s pretty cool. I’m excited.
Franchesca Cox (24:41)
Yes, that’s her. Yes, she’s brilliant.
I
Yes, that’s going to be a really cool modality to offer with our combined intensives. Yeah, I didn’t know you were excited about that. I think her course is sooner, thankfully, and it’s closer than the other one. So it’s like there’s one in Louisiana coming up, or not coming up. It’s in the fall, but it’s at least close by.
Megan Williams (25:14)
I’m.
Yeah.
Yeah, that’s much closer than going overseas.
Because I think Gertie is from Germany or Austria, so…
Franchesca Cox (25:34)
yes.
Megan Williams (25:36)
I’m excited about the other modalities that you’re looking into. You’re definitely a lifelong learner. You’re always wanting to keep learning. I know. Some people call it a problem. Some people say it’s a gift. So, you know, however you want to look at
Franchesca Cox (25:46)
yeah, I have a problem.
I’m not
a shopaholic. This is my thing. I buy courses. I buy books and I buy courses and that’s my thing. They’re really expensive. It would probably be to be a shopaholic with clothes or something like shoes. I don’t know.
Megan Williams (26:05)
Yeah. Yeah.
At least
the return on investment is so much better with this.
Franchesca Cox (26:14)
yeah, for sure, for sure.
Megan Williams (26:17)
So what do you want parents to know if they’re considering like maybe they have seen these kind of modalities on social media or but they’re like, I don’t know, our clinic doesn’t offer it. I would have to, you know, like seek somebody out and they’re not sure if they want to take that kind of step. Like what would you want to tell parents in that situation?
Franchesca Cox (26:40)
Well, when it comes to DMI, I will say DMI, they’re getting really good at getting it out there. Most of the therapists that are trained are the first level, so you do have to be careful. You definitely want to do some research on the levels of DMI training that is out there and available to therapists and just ask the questions, and even though the therapist may have maybe more training.
are they doing intensives on the regular? And so, like I said in the beginning, I was doing DMI therapy, but I was mostly doing OT, and so I did not have, even though I may have been certified for a while, I didn’t have every kid needing DMI. And so definitely don’t be afraid to ask questions. There’s a lot of cool exercises that we’re seeing on the internet, but most kids don’t need the really cool exercises. mean, you know, obviously there’s some that are…
you know, that we see that obviously if they’re doing it, they need it. Most in most cases, but sometimes I’m adapting exercises that are not even DMI. And so I would be asking questions, you know, how long have you been doing this? How often do this? How often are you doing DMI on a weekly basis? What conditions are you comfortable with? You know, in the DMI training, they just released an announcement last year that they are not recommending intensives for
therapists that are not at least level C introductory trained and so you just want to make sure they have the experience but also that level C training because Even though there’s level a level B as a level a level B you get access to exercises in those levels But you’re not going to give you’re not going to get as many exercises As level C you’re going to have more to pull from as a therapist and also more experience and more time With those exercises to make sure that you’re doing them properly and all that
I have had parents that come in and they’ve had mixed experiences, you know, because they, because if you’re not doing these exercises all the time, you’re more likely to make a mistake. And I’ve had parents in the clinic and say, yeah, this, this, and not my kid, but the other kid, they dropped that kid. And I’m like, my, and this can happen. And we’re not putting those videos on social media. So just making sure that you’re asking the questions and not to say I don’t make mistakes, but
Megan Williams (28:56)
Yeah.
Franchesca Cox (29:05)
You just want to make sure that you’re getting a well-rounded experience, a well-rounded therapist. And also what I did want to say also about DMI is they are getting DMI into the communities through ECI. And so when I have a patient that can only afford or step away from their life for a week out of the year for an intensive, I tell them, at least here in the Harris County, Houston area,
most ECI therapists are now DMI trained and even though they’re the lower level, at least you’re getting something. It’s not an intensive, but at least, you know, ask them for some exercises and they’ll they still benefit from that on a weekly or monthly, whatever they’re doing basis. So you can ask your ECI program if your child is at age. Do you have any therapists that have that DMI training? And so I think that’s a really good
That’s good access because the ECI therapists are usually one of the first people in the therapy world to meet that child with special needs. And so I love that DMI is getting in there. Like I said, here in Houston, they’re training more and more almost, I don’t know, I think every six months or every year it feels like they’re here training these therapists at the ECI. So just ask questions. Definitely don’t be afraid to ask questions.
Megan Williams (30:25)
Yeah, empowering the family to know how to have a part in their child’s therapy versus kind of just taking what is available. It’s so important to help families be able to advocate for their kiddo.
Franchesca Cox (30:46)
Absolutely.
And there’s clinics that offer intensives as a side, as a side, I don’t know, a side thing from their regular clinic. And I tend, I, from my observation, they don’t, again, they don’t have constant, because that’s not their focus, they don’t always have the intensive therapy.
every week and so you just want to make sure, you offer this but you what is the training and then how often are these therapists seeing kids for our intensives? it every week? Is it a week out of every month? And that can kind of give you, you you can kind of weigh your pros and cons and see if it’s a good fit for your child.
Megan Williams (31:27)
Yeah, yeah. And you said that it takes time to kind of like if you’re doing the TheraSuit to have them and place them in the suit and then doing the exercises you have to be really careful and make sure it’s time. Your time management is spent well and maybe you don’t get that in like a weekly appointment versus if you were doing an intensive where you had more time to get more layers of that piece applied.
Franchesca Cox (31:54)
Yes, yes.
If parents come for weekly visits, I just advise them, I can’t, I can’t do the suit if we’re coming for an hour. I understand if that’s all we can do, but it takes about 15 minutes to get it on and get it off. And that’s if I already know where all the placements go. And so it’s not really worth it if we’re only doing together for an hour. So I try to do even two hours every other week is better to me than just that one hour, because it’s going to work eating up time. And so like in our intensives,
we hit the ground running. We don’t spend a lot of time. I do not document during the intensives. I don’t write notes, it’s all in my head. And I’m 100 % focused on what does this child need today. And so, yeah.
Megan Williams (32:31)
Mm-hmm.
Yeah, I have a lot of dry erase surfaces around my room and yeah, I know what you mean, trying to get the most out of your time. And so there’s like shorthand and stuff I write in different places and on Post-it notes and it just, it looks crazy, but yeah, like you said, trying to make sure you spend every minute really focusing on those skills. So we’ve talked a little bit about how social media has really opened up
us speech therapists or parents or you know people who may not be practitioners, OTs and PTs in this kind of world but
So we’re able to see lots of opportunities where these therapy tools are being used. But from your perspective, how have you seen that all of these clinical decisions that you have to make, like based on the child, based on goals, all these little specific things, how have you actually seen it create lasting change for any of the kiddos that you’ve worked with?
Franchesca Cox (33:45)
Yeah, yeah. The cool thing is it can be done in an intensive or in a regular session as long as we have consistency. And so I will tell the families, there’s a lot that’s offered in the clinic, but the child doesn’t need everything. We don’t have time for everything. And so I’m quickly prioritizing when they walk through that door, you know, they’re gonna, and it also depends on the child, of course, and on the day, but there is.
a constant evaluation of the situation and the child every moment, especially when they first walk in through that door. If the parent tells me they did not sleep well, then I know that TASIS is probably not a good fit for them. The TheraSuit’s probably too much for them. We can adapt things in the spider cage, we can adapt things with DMI, but giving them extra proprioception, extra muscle activation on top of what I’m already requiring of that child to do.
with the TASES and the TheraSuit it might be too much for their sensory system that day. And so by being flexible with the approaches that I offer, I have seen changes in the children. So I have a little boy that comes to me once a week for an hour, and he has some very specific goals. And because parents are so consistent with the few things that I give them to do at home, which sometimes changes on a weekly basis because his progress has really been
really nice lately. He has made so much progress and the thing about his situation is we did we started with DMI because that’s what he needed at the time but lately it’s kind of been adaptive exercises, neuromuscular, and neuro education, neuro re-education with him. We even incorporated some a little bit of TASES so it’s constantly changing and so I think being flexible has been the biggest advantage.
and the intensive program and also having a lot of tools to pull from. When I just had DMI, I realized that it is enough if that’s what you want to focus on. If you really want to hyper focus on that zero to five and have very specific motor, motor goals for this child, gross motor goals and even sensory goals. But I realized it, I needed more in my toolbox. That’s when I added the TheraSuit and some other things. And so having a variety, but also being flexible has been
instrumental, I believe, in seeing lasting changes and also giving these families some hope. Some are like, yes, I’m going to go get a e-stem machine for home. And I give them several options because there’s several price ranges out there that are good. And then, and other things too. But yeah, that’s kind of my response to that.
Megan Williams (36:29)
So I wanted to ask just some quick questions, not too thought provoking, just kind of off the top of your head. Are you ready? Okay, we’ll keep it fun, nothing like super philosophical. So what is your favorite go-to song during a therapy session?
Franchesca Cox (36:41)
Yes.
Okay.
my goodness. Well, I sometimes learn what the kids like. Like I had this little girl that she would say happy and I knew that she was talking about if you’re happy and you know it. But usually it’s like wheels on the bus will pop in my head if I have to sing. If they’re OK with the screen, with the kid in the room, then we’re going to put Miss Rachel on because everybody loves Miss Rachel. So it really just depends on, you know, if the parents want the screen on and or if I have to do the singing. We’re going to have.
Megan Williams (37:21)
She is such a good singer.
She’s so better than I could ever be. Like, let’s just let her do what she’s good at.
Franchesca Cox (37:23)
Yeah.
Yeah, yeah, she’s great. She really is great.
Megan Williams (37:31)
There’s so many
times when her songs will get stuck in my head and I’ll be home like picking up laundry and doing stuff and I’m just realized I’m singing about icky sticky bubble gum and we don’t have children so…
Franchesca Cox (37:40)
yeah,
yeah, well I have like teenagers and sometimes I’m like, it’s Blippi. And so it’s yeah, because there’s that episode where they combine forces and like, yeah, my kids are like, what are you singing mom?
Megan Williams (37:48)
Hahaha
What
is your favorite, so you kind of get an option here. What is your favorite sensory tool, piece of equipment, and/ or toy that you feel like you use constantly or you get a lot of use out of in your sessions.
Franchesca Cox (38:18)
Yeah, a sensory tool. Excuse me. Sorry, sensory tool. I would have to say the light this what’s it called the light up wand. So it’s really good for visual tracking. It’s really good for calming the kids and it kind of vibrates. And so some kids really like to hold the end of that and just I have little one little girl that she’ll just hold it with her hands. It’s so cute. And she likes the noise like the subtle
like humming sound plus the little vibration you get from that light up wand And so it’s sometimes it’s calming it, especially when I dim the lights, you can really see that thing light up. The equipment is going to be really low tech. It’s a sheer piece of, it’s a sheer scarf and it’s, I have different colors, but I love it because I use it a lot for teaching reciprocal movement and dissociating the left from the right. So I’m going to slide that foot back and forth in the sagittal plane and then I might slide out, you know, on the frontal plane.
And I can also use that for reciprocal movement with crawling for pre-crawling skills. And so it’s a lot of fun. And kids just like to, you know, put it over their face and, you know, play peek-a-boo. So that’s a fun low tech equipment that I use a lot. And then the toy, I think I would just say the light up one. There’s also a musical drum that kids love. There needs to be more toys like this because it lights up and it’s a big button that’s easy to push and it sings. It’s perfect.
Megan Williams (39:43)
Yes.
Franchesca Cox (39:44)
I think you know what I’m talking about. I have had to replace it several times. Yes, but the really cool part about it, I mean, it’s like 10 bucks or something, but you can flip the handle down and then like, it’s almost like at a tripod position. I’m like, this is a genius toy because you don’t need like a stand or you don’t need to prop it up against something if you need it, you know, kind of vertical. Anyway, it’s brilliant. It’s a really, it was a good investment.
Megan Williams (39:46)
Yes, I hear it in my head right now as you’re talking about it.
Yeah, maybe any parents that are listening, you have any, you know about any of these kind of tools, let us know because these tools and toys are always on the lookout of easily accessible, so meaning it’s easy for the child to activate the toy that doesn’t have lots of little knobs, switches, or little buttons, but let us know, listeners, what y’all like. And your last question.
Franchesca Cox (40:26)
Yes.
Yeah.
Yeah.
Megan Williams (40:37)
What? So this is a little thought provoking. What would you tell, what’s one thing you would tell a new therapist? So maybe a fresh baby eyed occupational therapist who has just graduated and the world is their oyster. Like what would you tell them?
Franchesca Cox (40:55)
I would say don’t stop learning. Because, you know, I think when we graduate, we’re just like, yeah, you never have to study again, you know? And that’s actually true, you know, we don’t really study for the things that we do. We’re constantly learning, but yeah, don’t stop learning because you just get the foundation for what you just, you know, the field that you entered. But if you keep learning, you know, you’re going to be sought out because
Megan Williams (41:06)
You
Franchesca Cox (41:25)
you offer a unique approach to whatever it is, feeding or sensory or motor or whatever, but just keep learning. Even in the traditional therapy world, I seek out outstanding PTs, speech therapists, because people need the people that are in network with insurance.
And so I am always on the radar for like, okay, you like, what’s her name? And I’ve never met these people in person, but I tell them, if you live in this area, ask this company for this person, because I know that those people are going above and beyond in their learning because the parents are getting results. And so never stop learning.
Megan Williams (42:04)
Yep, and I think the technology aspect of how easily it is to find online courses and resources to read more, at least about things that you’re interested in and kind of specialize in what you’re interested in, that makes it easier to, like when I was in school, you know, there were certain things that I wasn’t super jazzed about, but I had to learn about it because you have to have this well-rounded education, but once you get out, you get to kind of figure out.
like what gives you life and what you really want to focus on and then you want to learn about it.
Franchesca Cox (42:37)
Yes,
I remember there was a, before I found DMI, I just hit a point, it was during COVID, and I thought, my gosh, I did not go to school for this. And it was one of those like virtual telehealth OT sessions that I don’t know why they thought that was a good idea. I’m sure there’s someone out there that it’s good for, but it was not for this kid and most of the kids on my caseload. And I thought, my, this is not what I went to school for. And I think that kind of pivoted me, like I need to go into private practice. I need to just go all the way with this. And so.
Megan Williams (42:46)
Yeah.
Yeah.
Yeah. Well, this has been such a really, I always learn every time we sit down and have a chat, like I learned something new or it changes the way I think about something when we chat, Francesca. So thank you so much for sharing your insights and your thoughts and all of your experience. I really hope.
I hope our listeners have learned something new or maybe it’s like sparked something within them based on the information you shared.
Franchesca Cox (43:42)
Thank you. Thank you. This was a lot of fun and thanks for the opportunity to share. I can’t wait till our next episode.
Megan Williams (43:48)
Yeah, so I’m going to encourage our listeners to reach out if you have any questions about any of these specific modalities that Francesca has talked about today. You can contact us through our website or through Instagram. Lots of different ways to reach us. And until next time, keep making those big steps forward.
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