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Important Things to Know about Feeding Therapy

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Authored by Edna Elisabeth Nyang, Lead Speech-Language Pathologist, Beijing

Authored by Edna Elisabeth Nyang, Lead Speech-Language Pathologist, Beijing

Many families know to consult with a speech pathologist if their child is delayed with their articulation or language skills, but they do not know who to turn to if their child has trouble tolerating certain food textures. As a result, some of these symptoms remain untreated and turn into a more serious issue. According to the Kennedy Krieger Institute, approximately 50% of children experience a form of feeding difficulty, of which 10% develop a severe feeding disorder. If a child has difficulty eating properly, this can result in weight loss for a developing child. For all families, regardless of the issue, the main goal for children who present with feeding difficulties is for them to eat a variety of foods with their family in a fun, nurturing environment.


You should consider seeking out a speech pathologist, if your child is experiencing a couple of the following symptoms: coughing and/or choking during or after swallowing, crying during mealtimes;, decreased responsiveness during feeding, dehydration, difficulty chewing foods that are texturally appropriate for age (may spit out partially chewed food), difficulty managing saliva, disengagement cues, (e.g., facial grimacing, finger splaying, or head turning away from food source), frequent congestion after meals, frequent respiratory illnesses, gagging, loss of food/liquid from the mouth when eating, noisy or wet vocal quality noted during and after feeding, extremely long feeding times, refusing foods of certain textures or types, taking only small volumes or over-packing the mouth, and vomiting (more than typical “spit up” for infants).

If you have concerns about your child and their feeding habits, I would like for you to consider the following:

  1. All therapy starts with an evaluation.

Typically conducted by a speech language pathologist or occupational therapist who specializes in feeding and swallowing difficulties in children, this evaluation can be done in the clinic and generally consists of replicating a mealtime that is similar to one that your child experiences at home. It should it be noted that prior to the evaluation, you may be asked to complete a questionnaire and/or keep a “food journal” over a period of time to provide the therapist with more information.

2. The therapy should focus on the whole child and not only the symptoms.

It’s extremely rare for a child to have a feeding or swallowing difficulty due to one issue.  For example, some children with cerebral palsy present with low tone and have difficulty eating and chewing tougher textures because it hurts. As a result, they may start to eat less or not at all. A pediatrician may prescribe medication to stop the pain, but the learned behavior is still there and needs to be addressed.

  1. Family dynamics and culture should be incorporated into the therapy.

Feeding your child is cultural and emotional as it’s about creating a bond with your child and your culture.  When feeding becomes challenging, it’s stressful and it impacts the entire family on a daily basis and potentially socially as the family may be less likely to socialize during mealtimes. It is extremely important for the therapist to recognize what is culturally important to you and incorporate those objectives into the therapy program.

  1. It will take time.

First, eating is a developmental process. When a child has difficulty eating, it means they have stalled in the midst of learning a new skill.  Regardless of their age, the therapist will begin to teach the step by step process wherever they are having trouble (e.g., chewing) as a means to reaching the long term goal of eating with less restrictions. Therapists also have the advantage of charting every detail of progress and going days without seeing your child. On the other hand, when you are immersed in trying to feed your child multiple meals a day, it’s not always easy to see progress. Your therapist will give you small goals to work on every session and together, we will celebrate every single accomplishment!

  1. Every child will have their own journey

You may meet other parents who describe different techniques and strategies that your therapist uses with their child. It’s important to keep in mind that every child is different and that each approach will be tailored toward your child.

Why Play Therapy? An Overview of this Child-centered Approach

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Authored by Ru-Chi Yang, P.h. D, Clinical Psychologist, Beijing

Authored by Ru-Chi Yang, P.h. D, Clinical Psychologist, Beijing

What Is Play Therapy?

The Association for Play Therapy (APT) defines play therapy as “the systematic use of a theoretical model to establish an interpersonal process wherein trained play therapists use the therapeutic powers of play to help clients prevent or resolve psychosocial difficulties and achieve optimal growth and development.”

This means that play therapy builds on the natural way that children learn about themselves and their relationships in the world around them. Through play therapy, children learn to communicate with others, verbalize feelings, adapt behavior, expand problem-solving skills, and learn a variety of ways of relating to others. In addition, play provides a safe psychological distance for children’s problems and allows expression of thoughts and feelings appropriate to their development.

How Does Play Therapy Work?

Play therapy allows trained mental health clinicians who specialize in play therapy to assess and understand children’s play. In addition, play therapy is utilized to assist children to cope with difficult emotions and find solutions to problems. By confronting problems in play therapy sessions, children find healthier solutions. Additionally, play therapy allows children to change the way they think about, feel toward, and resolve their concerns.

Who Benefits from Play Therapy?

Play therapy is especially appropriate for children ages 3 through 12 years old; however, individuals older than 12 years old could also benefit from play therapy.

Play therapy could be utilized as a primary intervention or in support of other types of therapies for:

  • Behavioral problems caused by bullying, grief and loss, divorce and abandonment, physical and sexual abuse, crisis, and trauma.
  • Mental health issues, such as anxiety, depression, Attention-Deficit/Hyperactivity Disorder (ADHD), Autism Spectrum Disorders (ASD), academic and social impairment, physical and learning disabilities, and conduct problems.


How Will Play Therapy Benefit A Child?

 Play therapy helps children be more responsible for their behaviors and acquire more successful strategies, obtain new and creative solutions to their problems, develop respect and acceptance of self and others, learn to identify and verbalize emotion, develop empathy and respect for thoughts and feelings of others, expand their social skills and interpersonal skills with their family, and improve their self-efficacy.

How Is a Child’s Family Involved in Play Therapy?

Families play an important role in children’s healing processes. Sometimes children develop problems as a way of signaling that there is something wrong in the family. Other times the entire family becomes distressed because the child’s problems are so disruptive. In all cases, children and families heal faster when they work together.

The play therapist will make some decisions about how and when to involve some or all members of the family in play therapy. At a minimum, the play therapist will want to communicate regularly with the child’s primary caregivers to develop a plan for resolving identified problems and to monitor the progress of the treatment for the child. Whatever the level of involvement of the family members, they typically play an essential role in the child’s healing process.

An Illustration of Cognitive-Behavioral Play Therapy Technique: “All Tangled Up”

In this example, the play therapist begins by telling the child, “Everyone has worries and sometimes we have so many worries that they get all tangled up inside. Today we are going to untangle those worries. Let’s start by pulling out one thread at a time and naming it.” The play therapist then gives an example of one big worry and one small worry and pulls some yarn out from a tangled ball. The play therapist helps the child untangle at least 5 or 6 worries. As the child cuts each piece of yarn, the play therapist or the child writes the worry on a small piece of paper and tapes it on the yarn. The play therapist then tells the child that that he or she is going to tie the worries up all around the room until they look like a spider web. The play therapist then talks with the child about ways to cut the worries down and discusses strategies to deal with their anxiety. As the child verbalizes each strategy, he or she uses the scissors to cut down one thread of the web.

How Do We Support Welfare Centers in China?

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Authored by Marc Innerhofer, Phsyiotherapist, Beijing

Authored by Marc Innerhofer, Phsyiotherapist, Beijing

There is ample opportunity for therapists working in China to engage in volunteer work. It is a very rewarding experience and sometimes even the main reason why therapists decide to make the move to the Middle Kingdom.

Since starting to work for Olivia’s place I have visited several welfare centers that all had a great need for therapy and support. No two facilities have been the same, each presenting with new and different challenges. Stepping foot into a Chinese welfare center for the first time can be somewhat overwhelming, due to the high concentration of disability and lack of expertise to effectively provide care. I quickly learned to take a step back and address one problem at a time. The challenge is to find a way of providing therapy and ongoing support with the available resources and staff. Therapists are often required to think outside the scope of their profession whilst keeping in mind that not all problems can be solved.

A large part of the work therapists can do in welfare centers is to pass on their expertise and experience to local staff and caretakers, including giving advice on environmental modifications, alternative learning approaches, as well as teaching impairment specific exercises to help the children reach their full potential. However passing on this information can be a challenge in itself. Cultural differences regarding how to support and care for children as well as longstanding habits can sometimes be a barrier toward implementing new strategies and approaches. I learned how important it is to provide teaching and training in a respectful and culturally sensitive way to ensure that the new information will be well-received by the local staff.

A big advantage of working at Olivia’s Place and Eliott’s Corner is having access to a wide array of experience and skill, as well as connections to local specialists and charities. This support network can be a big help when it comes to accessing information regarding specific diagnoses or specialised equipment. One of the first steps towards solving problems encountered in welfare centers is knowing where to go for help. Thanks to this support network I was recently able to help a girl from a welfare center in Luoyang, Henan province get a diagnosis for a rare inherited connective tissue disorder known as Epidermolysis Bullosa (also known as butterfly disease). Despite the poor prognosis for this condition the girl felt empowered, having been shown by specialists how to effectively care for herself. Having access to information and the right equipment, as well as training to use it, can have a big positive impact in a welfare center setting where regular therapeutic input is often limited. More work is needed to streamline access to available equipment and information to help welfare centers improve the quality of care and ultimately maximise the potential of children living there.

Despite the time and effort that is often sacrificed to effectively support the children in Chinese orphanages, the personal development and rewarding experience that therapists receive makes this kind of volunteer work more than worthwhile.

Yard Sale for Olivia’s Foundation a Success

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Emma Reardon, aged 11, raising funds for future welfare institute trips.

Emma Reardon, aged 11, raising funds for future welfare institute trips.

In anticipation of a trip our therapy staff was planning to a child welfare institute in Anhui, Vicky Reardon, Community Affairs, gathered items from volunteers to take to the children who live there. We sent towels, teething toys, and other baby items for the therapists to use with the children. Any items that could not be taken to the welfare institute in Anhui were sold at a yard sale along with other items donated for the sale. The proceeds will be earmarked through Olivia’s Foundation to fund future welfare institute trips and supplies for children living at the welfare institutes we serve. The yard sale earned more than 1,000 RMB.

University Delegations Visit Olivia’s Place in May

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Olivia’s Place was visited by physical therapy students from Federal University in Juiz de Fora, Brazil and MBA students from Belmont

Nelson Chow with the delegation from Federal University in Juiz de Fora, Brazil.

Nelson Chow with the delegation from Federal University in Juiz de Fora, Brazil.

University in Nashville,Tennessee, USA early this May. Both delegations enjoyed a tour of the clinic and met with staff at our Shanghai clinic. The physical therapy students discussed with our physical therapist Zi Li Wang from Canada, about the parallels of therapy between their two countries, as well as how rehabilitation is developing within China. Everyone came out of the discussion with new insights.The MBA students discussed healthcare management in China  with Carol Ying, Operations Manager, and Zi Li Wang, and had a question and answer period with Nelson Chow, Founder of Olivia’s Place. Carol Y (Operations Manager) and Zi Li Wang (Physical Therapist.

OT and PT Team Up for Kids in Anhui

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In April 2015, two therapists from Olivia’s Place, Irene Zhang (Occupational Therapist) and ZiLi Wang (Physical Therapist) spent 4 days at a welfare institute in Fuyang, Anhui, working to train the staff on various rehabilitation techniques and theories. The center was earlier visited by another member of Olivia’s Place staff, Jasmine Jia (Occupational Therapist), in October last year; this initial visit introduced the local staff to Western screening and treatment techniques and served as an important foundation to the training for this second visit.

The welfare institute is home to more than 150 children, many of whom have diagnoses requiring the attention of rehabilitation professionals. Conditions of children being treated included cerebral palsy, autism, Down Syndrome, and children with sensory needs.

Our therapists gave training on positioning and posture management techniques, adaptive equipment needs as well as specific hands-on techniques such as using upper and fine motor assessment tools and core strengthenin

ZiLi Wang, Physical Therapist, demonstrates positioning at a welfare institute.

ZiLi Wang, Physical Therapist, demonstrates positioning at a welfare institute.

g exercises. A team of 4 local rehabilitation therapists are on site to offer children daily therapy, and our therapists joined the treatment sessions to give hands-on advice in addition to giving lessons when not treating children. The management staff and ayis were also given training on the importance of postural care management.

The experience of working with the staff and children in Anhui was a very fulfilling and eye-opening experience for the team. “‘Working in a welfare center where there are so many children and so few therapists and resources, when compared with the individual treatment sessions I am used to and the comparative availability of resources in Shanghai forces you to change gears and loo at very simple, practical ways in which you can help the children and the staff caring for them,” commented Zi Li, “It makes you really realize the difference you can make in children’s lives.” This sentiment was also reflected by Irene. “To really change the way care is done in China for physically disabled children, one needs to look at the needs of the most disadvantaged – and really there are two worlds that we need to address. I think this was a very good initiative and think more should be done for these types of establishments.”

Giving…and Getting Hope in Shanxi Province

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by Sorcha Ni Chadhain, Occupational Therapist, Eliott's Corner, Beijing

by Sorcha Ni Chadhain, Occupational Therapist, Eliott’s Corner, Beijing

YanYan slowly raised his head; there was a hint of something in his face…..and then it came; a wonderful, joyful smile and giggle straight from the belly! One quick connection of the eyes and the game started over. And that was it. That fleeting moment was enough to make us sure our visit was worthwhile. Thankfully there were many moments just like it throughout an intense but wonderful weekend spent in an orphanage in Shanxi province.

We are two occupational therapists working at Eliott’s Corner in Beijing. We first made a visit to this orphanage in September 2014. We were so taken with the children, the carers, and the great work being undertaken that it took little convincing to get us back on that train again 3 months later in December and again most recently in May 2015. The purpose of our visits have a few layers!

and by Kristi Troutman, Lead Occupational Therapist, Eliott's Corner, Beijing

and by Kristi Troutman, Lead Occupational Therapist, Eliott’s Corner, Beijing

First and foremost, we are there to meet the children and their carers. Many of the children in this facility have various levels of disability and ability. Their carers, who love them dearly, have little training in providing specific ‘therapeutic’ interventions to develop these children’s skills and abilities. They are somewhat lucky in terms of the unique set-up, which allows one carer to care specifically for three children. Carers of course share duties and help each other out, but this means they have a constant, long-term ‘mama’ who feeds them, bathes them, and shares a room with them. For us, this allows a unique opportunity to train a carer to work on improving a particular skill for each child, be that developing eye-contact, learning colors, or just showing enjoyment.

Finding ways to actually provide training that works, to assess children in these environments and provide input that is sustainable after you get back on the train is often the greatest challenge in working with orphanages and other institutions. The best intentions in the world don’t always lead to sustainable change or lasting impact. But one of the factors that makes this place so special to work in, is the unyielding determination of the leaders and management to get the best out of life and provide the best out of life for these children. This means support, encouragement, and expectations for the carers, that they will have time, resources, and training provided so they can give ‘therapy’ on a daily basis for their kids, and see them change and grow over time.

For our part, this means an intense, whirlwind of a weekend. We have faced this challenge in a number of different ways each time we have visited. We have provided assessment, which is basically a process of meeting each child, talking to their carer about their challenges, and figuring out what particular skill or challenge to target, that if improved, would make a difference in that child’s life.

We turn this into a written goal. A goal that can be measured, so that when the child does make a change, it can actually be ‘counted’, written down, and shown to the world! This gives the carers hope, it shows leaders that intervention works, and it shows the world that these kids have potential, much more than they have often been given credit for in their short lives.

We also help to write care plans. These will stay with the children and remind the carers of various ideas and tips that can help them work with the child. It could be a simple pointer like; “My muscles are a little weak. Please help me to sit in a supportive chair when you want me to sit and use my hands.” With these ideas readily available to the carer, they soon learn to provide the best learning opportunities for the kids throughout their day.

Lastly, we try to provide specific training. We show each carer what we want them to work on for their kids and show them how to elicit the responses we are looking for. In YanYan’s case, he seems so detached from the world, uninterested in any toys, unresponsive to words, sounds, touch. But we discovered a little glimmer in him. Plopped up onto a huge therapy ball, nearly bigger than himself, we bounce him around….slowly at first to gauge his reaction….as predicted, it wasn’t much. Then a little faster and a little higher, add in a lively nursery song and suddenly his head is up, he seems alive! So we stop (counter-intuitive though it may seem)…….and we wait……and then we wait a little more…….and just as described, we eventually get it. The smile, the eye contact, the laugh. And that means we have him! He now knows he must use eye contact to show us he wants more, we now know something that motivates him! This is the key for YanYan! This gives him a reason to communicate, something to ask for, to respond to, to share! Showing his carers that there is something in there, and we just need to have the patience and persistence to find it, that is the goal.

All of these children, no matter their ability, their disability, their background, their future, they all have something to give us…..we just need to give first.

At the request of the orphanage, no identifying information has been included in this post.

Olivia’s Place Hosts Augmentative & Alternative Communication Advocate

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Diane Slonim, a qualified speech-language pathologist, Ph.D., and special educator, from the United States is an advocate of Chinese assistive technology and hopes to bring more awareness to the need and use of assistive technology equipment in China.

Diane has a wealth of experience in the field of speech-language pathology. She is currently in private practice in Tarrytown, New York, US, serving children and adults with varying abilities and is a Westchester County Advisory Council, Council on Autism member. She has provided evaluations for Westchester Institute for Human Development in Valhalla, New York and has supervised graduate students and been an adjunct professor at New York Medical College and Manhattan College of Social Education.

During her 8th May visit to Olivia’s Place, she provided professional training in the areas of augmentative and alternative communication (AAC) and reading acquisition and dyslexia. In attendance were Olivia’s Place staff and local doctors and therapists who serve Mandarin-speaking individuals.

Dr. Slonim introduced various types of high-tech assistive technology that successfully serve people with learning and communication difficulties according to her working experience, specifically focused on writing, reading, and speech generating devices. Dr. Slonim also shared several clinical techniques that she feels are successful in helping people learn to read. During the training, local doctors and therapists discussed the differences between English and Chinese language systems and how they could apply the techniques Dr. Slonim introduced when working with people who speak Mandarin.

Inner Mongolia Reflection

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by Joyce Fok, Speech-Language Pathologist, Olivia's Place

by Joyce Fok, Speech-Language Pathologist, Olivia’s Place

Inner Mongolia is a world away from the metropolises that I’ve lived in. This province gave me a sense of peace that I haven’t experienced since moving to Shanghai this winter. Within this province, we visited the special needs classroom at an orphanage. This was the first orphanage I’ve ever visited, as orphanages do not exist in Canada. The orphanage exuded a warmth and love in its brightly colored walls and rooms, and the ayis’ teachable attitudes, however the charm that this orphanage held lay within the bright smiles of each of its children.

After an 8 hour, overnight train ride, our team (2 speech-language pathologists  and an administrative staff member who is in training to be a speech therapy assistant) arrived in the city where the orphanage was located (specific details about this orphanage are not provided at the request of the orphanage). There we met up with our SLP lead from Shanghai and our contacts from the orphanage. Although we had no formal schedule for therapy or training for our visit to the orphanage, we were all eager to meet the children and the ayis… and to determine just how we could be of use to the orphanage.

Within the first 30 minutes of arriving at the orphanage, we had set up an observation and training schedule. The children’s ages ranged from a few months to 8 years old, presenting with cerebral palsy, Down Syndrome, cleft lip and palate, and global developmental delays.

Frangie Yan, a member of our administrative team, works with a child in Inner Mongolia

Frangie Yan, a member of our administrative team, works with a child in Inner Mongolia

We spent the first day observing how the ayis interacted with and taught the children in the two therapy rooms, and observing the foster families. The second day was spent providing specific feeding and early language stimulation strategies and training to the ayis and foster families. The evenings were spent debriefing and planning for the following day. It was a busy two days!

The highlight of my first trip to this orphanage was spending time playing and practicing my early language stimulation skills with the children. As a new speech therapist, I was amazed at how using early language stimulation strategies actually elicits more sounds and interaction from the children. Although all of the children were nonverbal, each of them found alternate ways to connect with me. The key was to find and to elicit the appropriate level of communication, be it a laugh, eye contact, or a sound. It was my greatest joy to see their eyes light up and their joyous laughter when they connected with me and with others.

I am looking forward to returning to Inner Mongolia and seeing the children’s bright smiles again!

Success and Celebration for 12-Year-Old in Beijing

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Liu Rui walking independently out of the front doors of BJURH with the use of his walker and lower leg braces.

Liu Rui walking independently out of the front doors of BJURH with the use of his walker and lower leg braces.

by April Gamble, DPT, Physical Therapist, Eliott's Corner

by April Gamble, DPT, Physical Therapist, Eliott’s Corner

Liu Rui, a 12-year-old boy, stands tall in the middle of the room, with his arms resting lightly on forearm crutches for support. Balloons, music, and cake indicate that this is a party. Liu Rui, his family, and his rehabilitation team have gathered to celebrate his achievements.   Liu Rui has a diagnosis of cerebral palsy. Cerebral palsy is a condition one is born with and which impairs one’s ability to move. As of summer 2014, Liu Rui was spending the majority of the day in a wheelchair and he needed help from his family to dress and take care of his personal needs . Liu Rui’s family sought out physical therapy at Beijing United Rehabilitation Hospital (BJURH) in order to enhance his independence in walking and taking care of himself. Their hope was that rehabilitation would help him develop the skills to one day have the opportunity to live and work independently.   Therapists  from Eliott’s Corner collaborate with BJURH to provide children, including Liu Riu, the highest quality multidisciplinary therapy at the hospital. Our multidisciplinary team at BJURH involves the collaboration of pediatricians, physical therapy, occupational therapy, speech and language pathology, and psychology. Liu Rui started physical therapy with the highly qualified, international team from Eliott’s Corner in July 2014 at BJURH. Liu Rui and his uncle committed to 2 hours of physical therapy, 5 days a week. This high intensity is not needed for all children with cerebral palsy or other difficulties, but was indicated in Liu Rui’s case. For Liu Rui, the goal of physical therapy was to improve his strength, balance, endurance, and coordination in order for him to gain independence in walking and other activities like dressing and bathing.   Liu Riu’s physical therapists from Eliott’s Corner developed a treatment plan for him, which included walking on a specialized treadmill and over the ground, leg and core strengthening exercises, balance activities, and functional tasks like climbing stairs. Every therapeutic activity was chosen specific to Lui Rui’s condition and to facilitate his functional independence. Liu Rui’s treatment plan also included aquatic therapy. In aquatic therapy, the physical therapist used the unique and motivating environment of the swimming pool to engage Liu Rui in activities to build strength and endurance.

Lui Rui works on his walking pattern and endurance on the specialized treadmill at BJURH with Physical Therapist Zili Wang.

Liu Rui works on his walking pattern and endurance on the specialized treadmill at BJURH with Zili Wang, PT.

Physical therapists tailor therapeutic activities to the needs of each child and family. For example, opportunities for play were included in each intervention to ensure Liu Rui actively engaged in each activity and remained motivated. One of Liu Rui’s favorite activities involved standing and reaching in all directions for balls and throwing them at towers of blocks. He often competed against his uncle to be the first to knock all of the blocks down. While Liu Rui focused on the game, he simultaneously was working on standing balance, strength, and endurance. This active engagement in interventions was a key factor in Liu Rui’s successful outcome.   It is also the role of the physical therapist to assist the child and family in attaining equipment appropriate for their needs. Lui Rui’s therapists worked with local suppliers in Beijing to provide Lui Rui with effective, custom fit lower leg braces and a rolling walker. With training and targeted therapeutic interventions Liu Rui was able to use the braces and walker to walk independently both at home and in the community. He even earned a “drivers license” for his walker by demonstrating to his therapists that he could use it independently for tasks like going up and down a curb and moving to and from a dining table.   Surrounding Liu Rui at his party in February 2015 were his physical therapists and administrative staff from BJURH and Eliott’s Corner,  and his BJURH pediatrician, Dr. Song Xiao Yan, MD. Dr. Song expressed gratitude to the Eliott’s Corner team, “ Thank you to your team so much for the great work of Liu Rui! We will make the ‘magic’ affect more kids in the future!”   Liu Rui’s uncle was also honored at the celebration. His uncle participated in most physical therapy sessions and supported Liu Rui by working with him on activities the therapists recommended at home. This was essential in achieving Liu Rui’s excellent progress. At the party, Liu Rui’s uncle shared that he is excited for Liu Rui’s next phase of life. His uncle expressed that with Liu Rui’s increased independence, the family is making plans for him to attend a mainstream school and that he looks forward to seeing Liu Rui make more friends his own age.