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LIH Olivia’s Place Beijing Lead Psychologist Speaks at Beijing Pediatric Forum

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Dr. Lynn Turner, Educational Psychologist and Psychology Lead, LIH Olivia's Place Beijing

Dr. Lynn Turner, Educational Psychologist and Psychology Lead, LIH Olivia’s Place Beijing

The Beijing Developmental Behavioral Pediatric Group Forum was held on 17 December 2016 at Peking University People’s Hospital. This forum is hosted by the Developmental Behavioral Pediatrics Group, Pediatric Branch, Beijing Medical Association (BMA), and organized by LIH Olivia’s Place Beijing, discussing current issues in the field of developmental behavioral pediatrics. Prof. Qin Jiong, group leader of Developmental Behavioral Pediatrics Group, Pediatric Branch, BMA, and professor at Peking University People’s Hospital, acted as the chairman of the forum; vice group leader Prof. Jin Chunhua and Prof. Han Tongli also hosted academic lectures.

Dr. Lynn Turner, a Senior Educational Psychologist from the UK and Lead Psychologist at LIH Olivia’s Place Beijing, was invited to give a lecture entitled “Behavioral Difficulties in Children-Common Causes and Management.” In her lecture, Dr. Turner presented topics including “why children behave in different ways,” “when behavior is an issue,” “causes of problematic behavior” and “advices for parents and caregivers.” She also brought forward ideas and suggestions on parenting situations in China. Her lecture led to animated discussion, interaction, and reflection among the participants and also provided new references to further interventions of behavioral disorders.

Lynn Tuner 1


A New Year, A New Space

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Any families visiting our Shanghai clinic over recent weeks may have noticed how quiet the clinic is and have visited their clinician in new rooms…. Please do not be alarmed we have not all disappeared – we have just moved next door for all non-clinical work.

Our original space on the 19th floor at 35 Yongjia Lu had become something of a challenge for our team and for our families and visitors. Our team has grown considerably, especially as we prepare to transition to a full medical facility. All non-clinical work is now being carried out in our new offices in the building next door (41 Yongjia Lu) where there is ample room for employees and visitors, meeting rooms, and a large conference room. This has also had the benefit of more space in the clinic to work with families and calmer hallways and waiting areas.

Attendees at the December twilight session hosted by Jamie Fanelli were the first to use the new conference room space and we were able to offer far more seats than during previous sessions in our clinic. We look forward to using the space in the future for parents and professional trainings.

We hope you have a chance to drop by to visit us in the clinic or at our new administrative offices in the near future!

A big shout out to Penny Fan for managing the renovations!

A big shout out to Penny Fan for managing the renovations!

We are dedicated to staff well-being at LIH Olivia's Place Shanghai! Physical Therapist Ilija encourages a post-lunch movement break.

We are dedicated to staff well-being at LIH Olivia’s Place Shanghai! Physical Therapist Ilija encourages a post-lunch movement break.

We take pride in being part of the LIH Olivia's Place family.

We take pride in being part of the LIH Olivia’s Place family.

 


LIH Olivia’s Place Shenzhen Hosts China-US DBP Summit of Guangdong Province

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Key Attendees of the SummitLIH Olivia’s Place Shenzhen Pediatric Clinic successfully hosted the first China-US Developmental Behavioral Pediatrics Summit of Guangdong Province on December 4th. The summit was co-organized by the Guangdong Medical Association’s Developmental-Behavioral Pediatrics Society, the Shenzhen Medical Association’s Pediatrics Society, and LIH Olivia’s Place Shenzhen. The summit welcomed over 30 pediatric specialists from all over Guangdong province and promoted academic exchange on key issues of developmental behavioral pediatrics. Professor Zou Xiaobing, Director of the Developmental-Behavioral Center at the Third Affiliated Hospital of Sun Yat-sen University, and Mr. Li Yaopei, Executive Vice President and Secretary General of the Shenzhen Medical Association, addressed the group as keynote speakers. Also in attendance were Ms. Luo Xiaoqiong, Deputy Secretary-General of the Shenzhen Medical Association, and Mr. Sun Changsen, CEO of LIH Healthcare.

During his keynote speech, Professor Zou Xiaobing noted that with the development of society, culture, and economy, pediatric medicine has made remarkable advances in the past few decades thanks to the efforts of pediatric medical staff everywhere. At the same time, with the increasing pace of social development and daily life, comes changes to children’s living environment and increased awareness of mental health concerns. The result is that the medical model is increasingly one that connects the biological, the psychological, and the social. Although many health problems urgently need to be addressed in traditional pediatrics, there are now significant changes to our understanding of the spectrum of pediatric illnesses. Diagnoses of ADHD, learning disorders, and autism spectrum disorder have been increasing among children year by year, and child development and behavioral disorders have become important issues in pediatrics.

Mr. Li Yaopei, Executive Vice President of the Shenzhen Medical Association, addressed the public health implications of developmental and behavioral disorders during his keynote, and why it needed to be on the agendas of medical institutions, academic organizations, and governments at all levels, and to increase scientific and clinical research efforts. Moreover, he stressed that from a social perspective, regarding the families of children with autism as a vulnerable social group, we need to have “three hearts” for them: first is to have “the heart full of love”, from the social, medical, and health point of view, we should care for and love them; the second is to have ” perseverance”, that positive social outcomes are difficult to achieve without long-term sustained attention from society; and the third is “dedication” – dedicated responsibility towards individual rehabilitative treatment.

Dr. Yang Binrang, Shenzhen Children's Hospital, addresses the audience about learning disorders

Dr. Yang Binrang, Shenzhen Children’s Hospital, addresses the audience about learning disorders

After the keynotes, Professor Zou Xiaobing, and Dr. Raymond C. Tervo, Chief Developmental Behavioral Pediatrician of LIH Healthcare, and Dr. Yang Binrang Director of Child Healthcare Department at Shenzhen Children’s Hospital each made presentations. Professor Zou introduced the history of developmental behavioral pediatrics and emphasized the importance of early screening, diagnosis, and intervention in developmental-behavioral disorders. Dr. Tervo presented clinical research on the effects of medication in the treatment of children with developmental delay and ADHD. Dr. Yang gave a comprehensive presentation on the pathogenesis of learning disorders, its early manifestation, and the evaluation, diagnosis, and treatment of learning disorders.

The summit fostered an academic exchange of ideas between Chinese and American pediatric specialists and motivated attendees to promote the improvement and progress of early detection, diagnosis, and treatment of children with developmental and behavioral disorders in Guangdong Province and throughout China.


First Accredited Speech-Hearing Program Established in China

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Kunming Medical University Faculty Give a Thumbs Up

Kunming Medical University Faculty Give a Thumbs Up

In December 2016, professors from Kunming Medical University (KMU) visited the John A. Burns School of Medicine (JABSOM) at the University of Hawaiʻi (UH) at Mānoa to continue an extraordinary collaboration with the medical school. Faculty from KMU toured JABSOM, visiting some of the school’s clinical training facilities and sampling the Health Sciences Library’s new stress-reducing activities (“Brain Busters”). They also were introduced to some UH medical students. Dr. Luo also performed a brief demonstration of tai chi.

 

Earlier in 2016, KMU realized a groundbreaking accomplishment — achieved with assistance from the UH medical school — establishing China’s first-ever accredited academic program in speech and hearing. “There are 1.3 billion people in China and the government is strategically trying to improve the training of health professionals, especially rehab professionals in China,” said Dr. Zhiyong Luo, Director of Rehabilitation Medicine and professor at KMU. “Most importantly, the people really need rehabilitation.”
This partnership between KMU and JABSOM has spanned two years, after department chair and LIH Healthcare Technical Advisory Board Member Henry Lew, MD, PhD, signed a memorandum of understanding with KMU in 2014 to create a speech and hearing program in China. Afterward, professors from the Department of CSD traveled to China to help create the syllabus and curriculum for KMU’s speech and hearing program and to train the faculty in teaching speech pathology.
“Right now, we are proud to say that we have the first accredited speech therapy program in China,” Dr. Luo said.


Getting a Knock to the Head: An Introduction to Concussion in Children

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Dr. Becci Dow,  Clinical Psychologist and  Clinical Manager, Shanghai

Dr. Becci Dow, Clinical Psychologist and Clinical Manager, Shanghai

Falling over and hitting your head is a really normal part of growing up. As parents you will undoubtedly recall many occasions where your child tells you that they have hurt their head, maybe the tell tale lump or redness is there? Maybe you have had to consult a doctor for stitches? Maybe your child has had an injury when playing sports or in rare cases you may have had the misfortune of being involved in a more serious incident?

Serious head injuries
During each of these occasions a decision has to be made about the seriousness of the problem. The following signs are critical:

1. Is there a wound that requires medical attention?
2. Is the child conscious? (Responding to sounds? Aware of their surroundings?)
3. Is the child sleepy?
4. Is the child vomiting or feeling sick?

If any of the above symptoms are present then it is essential that the child is taken to the emergency room and seen by a specialist. This is critical with younger children and babies. With a serious injury to the head the medical team will need to also make an assessment of any injury to the brain.

Brain injuries
concussionThe brain sits within a strong bony chamber (the skull), which does a good job of keeping this vital organ safe from infection and injury. But, did you know that your brain is a soft jelly like blob, “floating” in this space? It is not carefully connected to the skull but linked via delicate fibrous tissues that allow it to move. Now imagine what happens when the head and skull takes a hit? You might want to think about what happens to a brain shaped jelly inside a jam jar? First it will move away from the site of the knock – often the head is hit on the forehead so the brain moves and bangs the back of the skull. Just like a bouncy ball it will then move forward and hit the front of the skull. Depending on the force and the angle of the blow to the head, the brain may bounce and twist and move within the skull.

In serious, traumatic accidents the brain can suffer tremendous damage. It can swell, bleed, sustain injury and essential functions such as language, learning, memory, and vision may be affected. Here medical teams may have to use complex surgical and life saving techniques to repair damage to the skull and try to limit brain damage.

Concussion
Concussion is a mild traumatic head injury where the brain has sustained a blow and the symptoms are usually benign but can vary in severity. The primary signs are:

1. Loss of consciousness for less than 15 minutes – occasionally there is no loss of consciousness but damage has occurred
2. Feeling sick and dizzy
3. Memory loss or confusion (sometimes known as post-traumatic amnesia)
4. Head ache and pain

If you think your child has experienced these symptoms following a head injury, please consult your paediatrician, family doctor or visit the emergency department. It is important that symptoms are carefully monitored and that further brain assessments can be completed. Symptoms are often rapid in onset, with some impairment in neurological function and often these resolve spontaneously. In some cases symptoms evolve slowly over time.

Post-Concussion Syndrome
There is an increasing awareness of the symptoms of concussion in children as there can be ongoing effects both in the short term and overtime. Many sports associations are now active in preventing, identifying and treating concussion.

There are three main types of difficulty, which can vary greatly between individuals and can appear at different times following the initial head injury. These problems can also last for a significant time post-injury.

Cognitive/Thinking
• Memory loss or poor memory – this can be a common after effect to a head injury which will often improve over time but occasionally results in problems that require assessment and new memory strategies
• Attention & Concentration – It can be hard to sustain attention over time or to concentrate on tasks or information. This can be especially important to consider with school age children.
• Planning & Organisation – These daily tasks can be affected, with children appearing to struggle with routines, plans and coordinating tasks.

Physical Symptoms
• Sleep
• Fatigue/tiredness
• Headache or pain
• Dizziness/balance and coordination problems
• Vision & Hearing changes
• Smell & Taste changes

Emotional & Mood
• Anger & Irritation
• Depression & Anxiety

CONCLUSIONS
Mild head injuries are very common and careful attention is needed to ensure that children are assessed medically and any ongoing problems are noted and understood. Support can be provided by an appropriately trained paediatrician, paediatric neurologist or neuropsychologist. Many organizations can provide help and advice – see www.headway.org.uk for details and read this fascinating article from the Children’s Hospital Association about why woodpeckers don’t get concussions and what it means for children’s health.

PLEASE DO REMEMBER:

• WEAR PROTECTION WHEN RIDING ANY BIKE OR SCOOTER
• TAKE PRECAUTIONS WHEN PLAYING SPORTS
• IF IN DOUBT DO NOT CONTINUE TO PLAY SPORTS
• SEEK MEDICAL ATTENTION AFTER A KNOCK TO THE HEAD – EVEN IF THERE IS NO LOSS OF CONSCIOUSNESS
• REMEMBER THAT THE EFFECTS OF A HEAD INJURY CAN LAST FOR A SIGNIFICANT PERIOD AFTER THE EVENT.

In most circumstances the problems with concussion resolve over time.


Clinician Profile: Dr. Sun Xiaomian, Developmental Behavioral Pediatrician, CMO

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Dr. Sun Xiaomian, DBP, Chief Medical Officer, LIH Olivia's Place Shenzhen

Dr. Sun Xiaomian, DBP, Chief Medical Officer, LIH Olivia’s Place Shenzhen

Sun Xiaomian, M.D.
Developmental Behavioral Pediatrician, Chief Medical Officer LIH Olivia’s Place Shenzhen

 

Dr. Sun holds a master’s degree in Developmental and Behavioral Pediatrics and doctorate in Brain Science of Biomedical Engineering from Xi’an Jiaotong University. She was previously Director of the Department of Pediatrics at First Affiliated Hospital of Xi’an Jiaotong University and Director of the Department of Pediatric Health Care at Shenzhen Futian Women & Children’s Health Institute. Dr. Sun has worked in pediatrics practice and health care for more than 30 years. She has extensive experience in diagnosing children with neurodevelopmental disorders (motor, and language/language, issues with social functioning, intellectual developmental delay), and social, emotional, learning, and behavioral disorders (ADHD, autism spectrum disorder, Tourette’s, obsessive-compulsive disorders, bed-wetting etc.), and nutritional problems (malnutrition, micronutrient deficiency, childhood obesity), and growth and development disorders (dwarfism, precocious puberty, etc.). She also has a strong background in intervention and research.

Dr. Sun is a member of the Developmental and Behavioral Pediatrics Group in the Early Childhood Development Society of the Chinese Maternal and Child Health Association. She is the Vice Chairman of the Developmental and Behavioral Pediatrics Society of the Guangdong Province Association for Improving Birth Outcome and Child Development, a member of the Standing Committee of Autism Rehabilitation in Guangdong Province, and a member of the Developmental and Behavioral Pediatrics Society of the Guangdong Academy of Pediatrics .In addition, she is the Vice Chairman of the Shenzhen Child Health Association, a member of the Children’s Rehabilitation Society of the Shenzhen Rehabilitation Medicine Association, and a member of the Shenzhen Pediatrics Society. She is an editorial board member of the Chinese Journal of Woman and Child Health Research. Language: Mandarin

 

Why did you choose your field?

Dr. Sun: My mentor returned from the United States in the early 1980s, bringing the field of developmental-behavioral pediatrics back to China. At the time there were no similar professions, and I had a strong interest in this area, so with my mentor’s advice, I chose developmental behavioral pediatrics as a research direction and as a lifelong career.

 

Why did you choose to work at LIH Olivia’s Place?

During my time as a researcher and as a clinician of developmental-behavioral pediatrics at large public hospitals such as the First Affiliated Hospital of Xi’an Jiaotong University and at Shenzhen Futian Women & Children’s Health Institute, the establishment of developmental behavioral pediatrics has been difficult for a variety of reasons. As a result children with developmental and behavioral issues could not get the support they needed, at a time when the need for such services was growing in China.

 

It has been my dream to establish developmental behavioral pediatrics into a more rigorous clinical medical discipline and to serve more families and children. On the cusp of retirement, I encountered LIH Olivia’s Place, and found that LIH’s international management philosophy, its advanced, multidisciplinary medical technology and team was very consistent with my ideas. I knew that with LIH Olivia’s Place I could achieve my professional dreams.

 

What are some of the most rewarding experiences you have had in your chosen profession?

As a doctor, the most rewarding experience is to see the patient gradually recover with my care and return to society.

 

What’s your favorite thing about Shenzhen?

Shenzhen is a young and emerging city, full of vitality. The city government is efficient, the residents of the city high quality, and the air quality is good. My favorite thing about Shenzhen is its spirit of innovation and its efficiency.

 

What’s your favorite thing about working at LIH Olivia’s Place?

The clinical team. We are united, support each other, have a strong sense of ownership over our work, and have all joined for the same dream, to dedicate ourselves to the cause of improving child’s medical rehabilitation. This gives me a strong sense of belonging.

 

What would you like to be doing in 5 years’ time?

In 5 years, LIH Olivia’s Place should be even more mature of a company By then, if physical health allows, I will continue to contribute my efforts at LIH Olivia’s Place Shenzhen Pediatric Clinic, to help more families and children.


My Experience at Children’s Specialized Hospital

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Dr. Amy Meng, Pediatrician, LIH Olivia's Place Beijing

Dr. Amy Meng, Pediatrician, LIH Olivia’s Place Beijing

Children’s Specialized Hospital in New Jersey, US, was established in 1891. It celebrated its 125th year in 2016 and continue to provide leading healthcare services in children’s rehabilitation. As part of the partnership between CSH and LIH Healthcare, Dr. Amy Meng, Developmental Behavioral Pediatrician at LIH Olivia’s Place Beijing, travelled to CSH to completed an “externship.”

 

 

 

 

Meeting CSH in front of the Maple Leaf

It is said that the maple leaf in the eastern United States enjoys great reputation. The Children’s Specialized Hospital (CSH) Mountainside campus is located among long and narrow two-story buildings. The buildings are on a slightly raised hillside and hidden among maple trees, quiet and peaceful. Walking in to CSH Mountainside for the first time, I could see doctors, front desk, and waiting areas. Everything was in good order. Staff who were busy working greeted me with warm smiles.

CSH Mountainside Campus

CSH Mountainside Campus

The first night I arrived at CSH, I had the honor to attend their quarterly commendation meeting. They shared new rehabilitation therapy methods and presented case studies to explain how to use those methods effectively. This made me feel the strong academic atmosphere of CSH.

Profound Education with Dr. Beckwith

The following days were mostly spent in the out-patient department of CSH Mountainside. This department includes the Behavioral Development Unit, Physiatry Department, Psychology Department, and Medical Department.

My first station was the Behavioral Development Unit, where I spent about 6 weeks. This unit mainly sees children with developmental disorders, learning disorders, social communication disorders, cognitive impairment, and attention deficit hyperactivity disorder.

Developmental behavioral pediatrics is an emerging discipline with only several decades of history even in foreign countries. In China, we just establish this discipline in 2016. There are few behavioral development physicians in China. And the knowledge of most domestic developmental behavioral physicians is limited to common disorders such as autism, developmental delay, cognitive impairment, and hyperactivity. Actually, this specialty includes these conditions but also any diagnosis associateed with intelligence, development, and behavior belongs to behavioral development, such as Angelman syndrome, Williams syndrome and Down syndrome. In China, children with these diseases often visit a Children’s Neurology Unit, Children’s Healthcare, or Children’s Psychology Unit. Physicians in top-level hospitals may have contact with and know about behavioral development, however, the vast majority of physicians in China are not familiar with behavioral development, let alone the best intervention methods, intervention effects, referral opportunities, and referral organizations. For parents of children with special needs, it is hard. They often feel conflicted, confused, and helpless. In the first-tier cities like Beijing, parents can visit some pediatric rehabilitation or behavioral development hospitals. However, compared with CSH, both physicians and therapists in China have great space for improvement.

Most of the time at CSH Mountainside, I followed Dr. Beckwith in an internship program. Dr. Beckwith is a promising young physician who is the Director of Behavioral Development. He has been rated as one the most popular physicians among parents. Ninety percent of patients here are children with autism and ADHD, but there there are also some rare conditions like Prader-Willi syndrome.

Patient-centered CSH

Physicians in China usually have time pressure because there are so many patients; however, It seems that CSH gives abundant time and space for physicians to communicate with children and families. Generally speaking, for a first-visit patient, physician would spend 60 to 90 minutes in the first consultation. Actually, in that “short 90 minutes” consultation, physicians need lots of information, such as ADHD symptoms, complications, learning ability testing, medication, and communication methods. They spend half of the time listening to parents’ concerns. Dr. Beckwith once said that abundant outpatient time is the important guarantee of patient satisfaction. Meanwhile, physicians show great respect to patients’ privacy. Before each of my observations, we requested permission from parents. Over the years, CSH has obtained consistent praise in a nationwide patient satisfaction evaluation (Press Ganey). This rare achievement is based on the 125 years of culture and history of this hospital.Meng 2

What is a Developmental Behavioral Physician?

Physicians who receive American Developmental Behavioral Physician Training (i.e., fellow) must have an American pediatrician background, receive three years of training, and pass a national board examination every year. CSH arranges learning schedules for fellows, for example, following home visits, attending classes and discussion meetings, medical records discussions, etc. As a fellow, they are required to have a good command of common diseases and medications, know the behavioral development characteristics of rare conditions and understand relevant specialties. For example, CSH fellows are required to receive training in the Physiatry Department for three and half months, learn relevant psychology knowledge, and also to participate in research programs.

I benefitted a lot from my experience in the CSH Physiatry Department. The main responsibilities of this department are addressing problems of various kinds of movement disorders, testing movement performance, adjusting appliances, and relieving muscle tension (Botox or surgery). It is beneficial for developmental behavioral physicians to experience all kinds of complex disorders over time. In an interdisciplinary setting, physicians need to be familiar with various complex conditions and symptoms in order to judge when to refer to physical therapy and what kinds of therapy skills should be referred.

In China, it is commonly accepted that the precondition to be a qualified developmental behavioral pediatrician is he/she has to be a pediatrician with general clinical experience. Besides knowing about children’s development and treatment for common developmental conditions, he/she also needs to master knowledge of genetic disorders, nervous system diseases, auditory problems, and movement disorders and other relevant problems, to have certain understanding on psychology, applied behavioral analysis, linguistics, occupational and physical therapy, and how to use common tools of behavioral development.

Summary

I am much honored to have this internship in behavioral development as a representative of LIH Healthcare. I was deeply moved by CSH and their physicians, by their high efficiency and patient-centered service model, professional ethics, modest attitudes, powerful knowledge base, and treatment outcomes. They are not only modest and knowledgeable, but also very warm-hearted. When they knew my eagerness to help children in China, they were very generous to explain knowledge and refer relevant books to me. I understand that I still have a long way to go to be a qualified developmental behavioral pediatrician. With their encouragement and support and hard work on my part, I hope in the near future I can contribute my own efforts in treating children in China.


Winter Nutrition and Maintaining a Healthy Weight

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Ilija Dimitrovsk, Lead Physical Therapist, LIH Olivia's Place

Ilija Dimitrovsk, Lead Physical Therapist, LIH Olivia’s Place

baked-potatoIn the winter months, there is a smaller selection of fresh foods, we more frequently eat foods which are cooked, and the food we choose in the winter tends to be higher in energy value (calories) than at other times of the year. Most of us also decrease our physical activity during the winter, which means that it is easy to gain weight. This leads to two questions: How does this extra weight affect our health? Is it normal to gain weight in the winter?

 

mhrf-cpmh-110691f10If during the whole winter a person gains one to two kilograms, it usually does not pose a health risk. However, complication arise when a person gains this amount of weight every winter and retains it over the year. Most often, weight gain is the result of poor nutritional habits, consuming large quantities of food, and reduced physical activity. A diet that is not varied, skipping meals, and alternating between over and under eating are sure ways to quickly gain weight.

 

How do we avoid a larger increase in body weight and prevent health risks that can arise because of this? First, do not give up on the recommended basic principles of proper nutrition, which are, let us remember: moderation, variety, and regular meals. These are important recommendations for all ages in every season.

 

1z-16789Some additional guidelines can help families to avoid weight gain in winter:
• Eat frequent, smaller meals
• Eat a variety of foods
• Avoid or decrease frying
• Cook meals with seasonal ingredients
• Chew each mouthful of food well
• Do not link your nutrition to emotional states (joy, sadness, happiness, boredom, anxiety, etc.

 

No less important is daily physical activity. Walking, light exercises at home, organized sport/recreation activities, and clearing snow or leaves are some other possibilities, but always keep your current level of fitness in mind.

Reference: Serbian Institute for Public Health


What is “Flatfoot” and How Does it Affect Children?

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Ilija Dimitrovsk, Lead Physical Therapist, LIH Olivia's Place

Ilija Dimitrovsk, Lead Physical Therapist, LIH Olivia’s Place

Pediatric flatfoot refers to a structural deformity that occurs in children, which involves the lack of a developed arch of the foot. This can further be classified as symptomatic or asymptomatic. In the latter, the child exhibits no symptoms. This condition is sometimes called “pronated foot” by doctors and therapists.

Symptomatic flatfoot in children is characterized by pain or tenderness in the foot or leg. There may be an alteration in the child’s walking patterns, with a valgus heel (rearfoot turned outward) and difficulty wearing shoes. The child may also tire easily, seeming to lack energy to participate in physical activities.

flatfoot 1It is important to note that all children start out with little to no arch when they first start walking. As they mature, the medial midfoot plantar fat pad in the foot starts decreasing, leading to the development of a clearly identifiable medial longitudinal arch.

flatfoot 2In some children, however, the force of certain movements (pathomechanical) acts on the foot to cause a host of compensatory movements which affect the child’s gait function. There is noted fatigue of the lower extremity and the child may constantly want to be carried.

One possible reason for abnormal functioning of feet in children is a genetic predisposition to develop the condition. Biomechanical factors can contribute to the progression of flatfeet in children, like torsional problems in the transverse plane such as an adduction of the metatarsus (forefoot pointed to medial line – inside) or femoral (thigh) and tibial (shin-low leg) rotation.

Excessive internal hip rotation, rearfoot and forefoot varus (inversion- inward turning), limitations of dorsiflexion, equinus (foot pointed down- ”horse’’ foot) or pseudo torsion (Rotation) at the knee can also lead to acquired deformities of the foot.

A careful musculoskeletal assessment is required to spot anatomical compensations that signal the presence of an abnormal foot position. The foot needs to be evaluated in both weight bearing and non-weight bearing positions. Apart from a thorough gait analysis, the physical examination must include a detailed inspection for tenderness, severity of the deformity, range of motion, muscle strength, and spasticity. Any family history of foot deformities and medical conditions such as neurological disorders also need to be taken into consideration.

flatfoot 4Based on the results of such a foot evaluation, an appropriate treatment modality can be constructed. Orthotics provide early arthrokinematic (joint motion) care to children to prevent latent disability in adulthood. If not looked into at a young age, the loss of posterior tibialis function can trigger the development of a host of foot conditions as the child grows up. By supporting the child’s foot in its optimal position, orthotics ensure that mechanical instabilities are treated at an early stage, while improving posture and balance.flatfoot 3 This also promotes proper growth and development. Compensatory motions are eliminated and full functionality is restored to the medial arch height while maintaining the optimal structural integrity of the foot. This encourages healthy supination (inversion-inward turn) and functional pronation (eversion-outward turn) of the foot throughout daily activities; orthotics provide for the constant postural adjustments and readjustments the body undertakes on different terrain during the day. There is also less expenditure of energy due to the optimal alignment of the muscles, tendons and ligaments; the child is able to engage in physical activities without the constant feeling of lethargy.

References:
Russell G. Volpe (2012) Pediatric Flatfoot: When Do You Treat It? Podiatry Today: January 2012, Vol. 25, No. 1.
Michelle L. Butterworth (2010) A Systematic Approach To Pediatric Flatfoot: What to Do and When to Do It. Retrieved from: http://www.podiatryinstitute.com


LIH Olivia’s Place Teams Training on Autism Assessment “Gold Standard”

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Beth Rutkowski, PsyD, Clinical Psychologist & Psychology Team Lead, Shanghai

Beth Rutkowski, PsyD, Clinical Psychologist & Psychology Team Lead, Shanghai

LIH Olivia’s Place has always worked to meet the needs of the families they serve. Recently, questions about autism spectrum disorders (ASD) have been among the most common. LIH Olivia’s Place has a strong team of clinicians with training and experience administering a range of assessment measures designed to diagnose ASD. This includes the tool widely considered the “gold standard” of autism diagnosis- the ADOS-2. LIH Olivia’s Place has consistently employed specialists trained in the ADOS-2 over the last six years. However, as demand increases for high quality autism assessment throughout China, LIH Olivia’s Place has responded by increasing the number of trained professionals and the depth of our training program, in turn increasing our ca-pacity to serve families by obtaining clinical information using a widely validated tool.

The Autism Diagnostic Observation Schedule, Second Edition (ADOS-2), is a partially structured observation of children and adults referred for ASD concerns. These observations are “standardized,” or held to a universal quality established through an extensive range of testing and confirmation.

The ADOS-2 has five modules, only one of which is administered at a given time. The determination of which module is administered is based on two factors- the individual’s verbal level and his or her age. Verbal ability can range from no words to fluent speech. The test can be administered to children as young as 12 months through adulthood. Each ADOS-2 module consists of talking or play activities using the same standardized materials every time it is administered. The algorithms used to diagnose autism spectrum disorders through the ADOS-2 have been consistently demonstrated to accurately identify autism spectrum disorders in toddlers, children, teens, and adults.

The ADOS-2 is widely used around the world and is the best fit for our team as we provide diagnostic assessment for children from China as well as expatriate children. Therefore, both Chinese and English speaking clinicians are presently being trained to administer the ADOS-2. LIH Olivia’s Place is utilizing the training system established by WPS, the publisher who has developed and distributes the ADOS system. The training is extensive and includes studying the administration of the modules, practice with the tool, and experience with scoring video examples of cases.

In December 2016, training on the ADOS-2 began with our Shanghai team. It will continue in Beijing, Shenzhen, and Kunming during early 2017. As individual clinicians complete the training, they will administer the assessments and work together to ensure the most accurate and comprehensive diagnoses possible. The ADOS-2 will be utilized alongside a variety of other tools from an inter-disciplinary team including psychologists, behavioral specialists, speech therapists, occupa-tional therapists, and physical therapists. With our increasing levels of skill and expertise, our teams continue to set a high standard for diagnosis and treatment of developmental disorders.

Dr. Beth Rutkowski is the Lead Psychologist at LIH Olivia’s Place Shanghai. You are welcome to contact her directly at ber@lih-oliviasplace.com or the Shanghai LIH Olivia’s Place team at (8621) 5404-0058.


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