cerebral palsy

Clinical Training a Focus in May and June

Olivia's Place Comments Off , , , , , , , , , , , , , , , , , , , , , , ,

China-US Pediatric Rehabilitation Forum
Over a hundred general and developmental-behavioral pediatricians, pediatric therapists, and pediatric researchers attended a China-US Pediatric Rehabilitation Forum on May 11 and 12 at Kunming LIH SkyCity Training Center. Attendees engaged in dialogue, formal training, and demonstration and clinical observation to improve the quality of pediatric rehabilitation services in Yunnan province.

LIH Healthcare invited Dr. Chuck Dietzen, Pediatric Rehabilitation Medicine, Riley Children’s Hospital, Indiana University School of Medicine; Dr. Francisco Angulo Parker, a well-known pediatric rehabilitation medicine doctor; Dr. Fengyi Kuo, Clinical Manager at Kunming LIH SkyCity Hospital and LIH Healthcare Occupational Therapy Lead; Dr. Ao Lijuan of Kunming Medical University, Vice President of Rehabilitation College; and Ms. Liu Yun, Director of Kunming Children’s Hospital, Rehabilitation Department.

Presenters and attendees discussed together on children’s rehabilitation, weight management in children, children with brain damage, spasm management for children with cerebral palsy, and prosthetics. Advanced techniques and skills were demonstrated through case study, demonstration, and clinical observation.

GDS-C Training Participants in Beijing

GDS-C Training Participants in Beijing

Griffiths Certification Training
Certification training for the Griffiths Developmental Scales-Chinese (GDS-C) was held on 17 May at Kunming LIH SkyCity Hospital and on 24 May at LIH Olivia’s Place Beijing. Over 40 pediatric professionals were certified through this 3-day intensive training, which followed strict ARICD standards.

The training addresses not only theory but also practical skills. In order to be certified, each trainee is asked to test a child under supervision. Training for the Griffiths assessments (GDS-C, GDMS-2) is standardized across countries, which is one of the reasons that the Griffiths assessments have become known as a gold standard in developmental assessment.

Dr. Denise Challis with the GDS-C.

Dr. Denise Challis with the GDS-C.

As the key instructor, Dr. Challis, the former president of ARICD, highly praised this training, and is confident in further development of Griffiths assessments in China. She stated that LIH Healthcare is a reliable partner with an understanding of the depth of the training program and rich clinical experience; making it uniquely qualified as the exclusive distributor the of the Griffiths assessments in Greater China.

Griffiths training will be offered again in the latter half of 2017 across multiple cities in China, including Shanghai and Shenzhen. For more information, please contact Jingyi Wu, LIH Healthcare Training Specialist, jingyi.wu@lih-healthcare.com.

Distinguished presenters at the Chronic Pain Management Summit

Distinguished presenters at the Chronic Pain Management Summit

Chronic Pain Management and Rehabilitation Summit
On 3-4 June, leading Chinese American rehabilitation experts, the present chief of the American Association of Chinese Rehabilitation Physicians (AACRP), Dr. Hong Wu; and Dr. Gloria Liu, clinical assistant professor at Duke University, and Dr. Ao Lijun of Kunming Medical University visited Kunming LIH SkyCity Hospital for a Chronic Pain Management and Rehabilitation Summit. The event covered various topics including evidence-based management of chronic low back pain and current guidelines, application of type A botulinum toxin in clinical management of neuropathic pain, and cervical and thoracic pain management. In addition to discussions, case study, demonstration and practice workshops, special international outpatient services were delivered to the local Kunming community.


Workshop on Spasm Management for Children with CP
Professor Heakyung Kim from the Rehabilitation Medicine and Pediatrics department of Columbia University Medical Center and Dr. Ao Lijuan, the vice president of Kunming Medical University, Rehabilitation College, were invited to present a workshop event including presentation and clinical demonstration on the the topic of spasm management for children with cerebral palsy, including botulism toxin injection. The training was held on 11 June at Kunming LIH SkyCity Hospital. In addition, Dr. Kim provided consultation to patients in the hospital’s outpatient service on 12-13.

New Technology Helps with Decision Making for Surgery for Children with Cerebral Palsy

Olivia's Place Comments Off , ,
Lis Ringrose, Physiotherapist, Chief Therapy Officer, LIH Olivia's Place

Lis Ringrose, Physiotherapist, Chief Therapy Officer, LIH Olivia’s Place

Due increased muscle spasticity, children with cerebral palsy (CP) often develop muscle contractures (shortening) and skeletal malalignment (where bones grow at a slightly abnormal angle or hip joints do not form properly). These can affect the functional abilities of a child. For example, because they are unable to straighten their knees fully they have difficulty balancing on one leg and kicking a ball. Or because their hips and knees are unable to straighten fully they can only walk slowly and with difficulty. Usually these challenges can be addressed by physical therapy through specific exercises and activities. However, it is sometimes decided that further intervention is needed if these contractures and malalignments are too significant to be treated just by physical therapy. The first step to consider is conservative treatment such as Botox. However, at times, surgery is necessary to help correct the muscles and/or bony structure.

Orthopedic surgery should not be decided upon lightly and is a decision best informed with the most amount of information possible. Firstly, the desired outcome of the surgery should be considered. Functional information should also be taken into account; what can’t the child do now that he/she wants to do and will surgery help? Are the child and the family willing to undertake the short-term discomfort of surgery and challenge of extra therapy for a long-term gain? Finally, detailed information about the child’s biomechanics (how they move) should be gathered to aid the decision of whether to proceed with surgery, but also, exactly what surgery to do. This information can be gathered by the child’s physical therapist – length of muscles, strength of muscles, and functional skills using compensatory movements. It can also be gathered through a formal gait (walking) analysis which looks in more detail at the action of walking. From this information, conclusions can be drawn that give more detail about how muscles are working and where the strengths and weaknesses are. Gait analysis is best done in a gait lab with specialist equipment; however, there are also now apps for rehabilitation professionals that can be used on iPads and tablets. Physical therapists (PT) are also trained to analyze movement by observation. Gait analysis both in a formal lab setting and through observation by the PT aims to gather information not just about what movements a child can do but how the child does those movements.

Regardless of the amount of information collected prior to surgery, the outcome of orthopedic surgery for children with cerebral palsy is still not always predictable. Some children respond very well and their function is greatly improved. Others can have little if any improvement which is disappointing for both the child and family given the effort that is put in for the surgery and recovery. Recently, a new piece of equipment has been developed to add even more detail to the information that can be collected and used during the decision making process. It is able to analyze the ‘how’ of movement in even more depth.

walk-dmc‘Walk-DMC’ (DMC meaning Dynamic Motor Control) uses electromyography (EMG). Electrodes are placed on the skin over the muscle groups that need to be analyzed and feedback detailed information not just about whether the muscles are working but also when and how much. Comparing the information collected to a ‘typical’ set of information, it can determine the level of muscle control. This can then inform what surgery would be beneficial and which would not. Through collecting data from over 400 children before and after orthopedic surgery, it has been found that those with better muscle control have better outcomes following surgery. With the information collected from Walk-DMC, a child’s team can have this information prior to surgery to help in the decision making process.

This technological development to help clinical decisions has much potential. Researchers plan to collect more information to help with more objective decision making for different types of orthopedic surgery for children differently affected by cerebral palsy. They also plan to monitor children who have less typical movement patterns to discover if corrective orthopedic surgery allows for change in movement patterns to become more ‘normal’ even at older ages. Other than monitoring the outcomes of surgery, the Walk-DMC could also be used to gather information on other treatment approaches that rehabilitation professionals, such as PTs and Occupational Therapists (OT), use in treating children with CP to discover which are most effective at leading to the best movement control.

Walk-DMC is a new development in the move towards providing more targeted, indivualized treatment for children with CP. It is currently not widely available but as it is using already common technology in a new way, the developers hope that is won’t be long until more people can be trained in its use and it can be more widely available.

Original article:
Schwartz MH, Rozumalski A and Steele K, Dynamic motor control is associated with treatment outcomes for children with cerebral palsy. Developmental Medicine & Child Neurology; Volume 58, Issue 11, pp 1139-1145. November 2016
Other sources:
Langston J, University of Washington Today, Walk- DMC Aims to Improve Surgery Outcomes for Children with Cerebral Palsy. 27 April 2016

Physical Therapy Team Trains Therapists in Kunshan

Olivia's Place Comments Off , , , , , ,

Physical Therapists Ilija Dimitrovski and ZiLi Wang recently trained therapy staff at Kunshan’s Jiajie Rehabilitation Center. The center is affiliated with the China Disabled Persons’ Federation and serves as an important resource for children needing rehabilitation, especially children with cerebral palsy or autism. Staff at the facility include physical and occupational therapists as well as speech therapists and learning support. The training provided by the LIH Olivia’s Place team focused on improving the staff’s ability to plan treatment and introduced new standardized assessment tools, as well as teaching specific techniques for children with cerebral palsy. Feedback from the course was positive, with the center’s president, Dr. Shao Ping, looking for continued partnership with LIH Olivia’s Place, including receiving occupational therapy and speech therapy experts for additional training in the future.


Formal Assessments for 4!

Olivia's Place Comments Off , , , , , , , , ,

Shanghai LIH Olivia’s Place worked together last month with a local cerebral palsy foundation to support a family with quadruplets diagnosed at birth with cerebral palsy. The family is from Anhui province and the four children are now almost 3 years old. Until now, they have had limited resources for assessment and therapy.

Lis Ringrose, Physical  Therapist

Lis Ringrose, Physical Therapist

On the morning of March 29, we warmly welcomed the family and CP foundation staff at Shanghai LIH Olivia’s Place. Our multi-disciplinary team had carefully planned for the visit over the previous two weeks. Speech Therapists Yi Lien and Shirley Zhou, Occupational Therapist Anna Tan Pascual, Physical Therapists Lis Ringrose and Zili Wang, and Counselor JingJing Du participated in the assessment. Led by Clinical Manager Dr. Becci Dow, the assessment of four siblings proceeded in a very orderly way and the children were immediately comfortable with our team. The whole family was relaxed, enjoyed the toys offered as part of the assessment, and interacted well with the evaluators.


quads 2The team used several formal assessment tools including the Hawaii Early Learning Profile (HELP), Rossetti Infant Toddler Language Scale, and the Preschool Language Scales (PLS-5) to gather information about the children’s development. After the assessment, the family’s therapy team met with the parents and the volunteer who accompanied them on their trip to Shanghai. The therapists provided advice on daily activities the family can do to help their children’s developmental needs. A formal written report will also be provided for each child.


A reporter from an Anhui TV station accompanied the family during their visit and interviewed our CEO, Nelson Chow, and the family’s therapy team. Video of the family’s time at LIH Olivia’s Place will be aired in Anhui in the future.group quads (2)

Family Education Support through a Growing Partnership

Olivia's Place Comments Off , , , , , , ,

The Neurology Department of Beijing Children’s Hospital (BJCH) is one of the leading pediatric neurology departments in our country, which has been existed for more than forty years. This department has complete professional disciplines with advanced technical skills. They have accumulated rich clinical experience in both common and rare diseases of pediatric neurology. The outpatient service is filled with patients of varying difficult cases. In 2013, there were more 110,000 outpatient visits to the department. . This Department is responsible for training and teaching doctors of pediatrics for Capital Medical University and the Inpatient Department of Beijing Pediatric Hospital. To provide parents with more knowledge and improve the communication and exchange of information between BJCH and LIH Olivia’s Place, we decide to carry out joint training for parents.

LIH Olivia’s Place specializes in children’s development, behavior, and rehabilitation for children and adolescents ages birth to 18 years of age. The Beijing clinic offers an international multi-disciplinary team (developmental behavioral pediatricians, pediatric neurology, pediatric rehabilitation physicians, clinical and educational psychologists, and an therapy team composed of physical therapists, occupational therapists, speech-language therapists, and behavioral therapists.

In order to give full play to the respective advantages of both BJCH and LIH Olivia’s Place and provide the highest quality medical services for children and parents, we established a team of experts to organize public scientific knowledge training, take advantage of technical experts, create a platform to provide parents with training and knowledge about their child’s diagnosis, how to support their child’s independence and education, and other aspects of growth and development. This training model allows for organic interaction between medical intervention and family education support for children.

BJCH Partnership 1In 2015, the partnership successfully implemented three training activities. The first was a physical therapy presentation in March by Dr. Lisa Kenyon(PT, associated professor, Grand Valley State University, who provided case-based teaching with three children. The second was for parents of children with autism spectrum disorder (ASD) in April; the presenter was Edna Elisabeth Nyang(CCC-SLP, Speech- Language Pathologist, LIH Olivia’s Place), Finally, Dr. Mease (Developmental-Behavioral Pediatrician, LIH Olivia’s Place) presented additional information for parents of children with ASD in June. The initial three training events were very successful, with both doctors and parents speaking highly of their experience.

In 20016, LIH Olivia’s Place and the Neurology Department of BJCH are planning to continue this partnership to empower parents through training. The training plan for the first six months of 2016 includes 21 training sessions, with topics covering autism spectrum disorder (ASD), attention deficit/hyperactivity disorder (ADHD), and cerebral palsy.

To learn more about this program or to obtain information on the training schedule and registration, please contact Yangshaoun at yangshaoyun@lih-invest.com.

Success and Celebration for 12-Year-Old in Beijing

Olivia's Place, Physical Therapy Comments Off , , , ,
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.

Eliott’s Corner PT Presents on Orthotics and Children with CP

Olivia's Place Comments Off , , , ,

In September, Eliott’s Corner Physical Therapist Marc Innerhofer was invited to speak at an event hosted by Ottobock, a leading international provider of orthotics and prostheses, at the 2014 China International Rehabilitation Equipment Exhibition in (Zhengzhou).  Over 100 Chinese rehabilitation specialists attended the presentation.

Orthotics are supports, braces or splints used to support or correct the position of a foot. Marc talked about the significant role orthotics play in enhancing the quality of life for children with cerebral palsy. By enhancing mobility, orthotics improve children’s physical independence; furthermore, they allows children to take the focus off mobility and onto family time, play time, building relationships and pursuing interests.

Some ways orthotics can help children with CP include:

- Improve independence by enhancing mobility

- Correcting and or preventing future skeletal deformity

- Reduce fatigue by improving energy expenditure during functional movements

- Reduce the likelihood of a fall, or an injury

- Take the focus off mobility and onto family time, play time, building relationships and pursuing interests