Innovations in Treatments and Services
At Leaps and Bounds, our pursuit of knowledge and innovation in physical therapy knows no bounds. This year, our therapists undertook and excelled in various courses, such as the Dynamic Movement Intervention (DMI) technique and courses at APTA CSM in San Diego.
These courses, complemented by enlightening in-service sessions led by esteemed local medical professionals—ranging from insightful discussions on nutrition with Carla, business growth strategies with Dr. Nasri, to vital insights on oral health by Dr. Joe from Sweet Tooth Pediatric Dental, and the invaluable Tummy Time method with OT Christine Pollack, arm care for pitchers from Dr. Mazzone—have greatly enriched the experiences of our patients. Our commitment to continual learning and enhancement has spurred us to expand our service repertoire, ensuring that we comprehensively can cater to the diverse needs of our community.

Community Engagement
​Beyond the clinic walls, our passion for community engagement thrived in 2023! Leaps and Bounds hosted a medley of events including vibrant dance and art gatherings, educational "Baby Boot Camp" sessions for parents, invigorating yoga classes, and active participation in community events such as the Red Bank NJ 5K, the Fall Festival alongside the Healthy Path Foundation, and the spirited Crafty Kids Trunk or Treat. 
Collaborating with local organizations, hosting events, and participating in community events has allowed us to extend our expertise and network beyond treatment rooms. Developmental milestones in children, injury prevention, wellness, and the benefits of physical therapy have all been key topics in our outreach efforts.
Expanding our business and personnel! 
This year marked monumental progress for our organizational growth as well. Leaps and Bounds:

• Expanded its offices to Holmdel, NJ, appointing Dr. Lindsey Otteson as Clinical Director, bolstering our commitment to excellence.
• Welcomed Julianna, a stellar addition as our newest Physical Therapist, and Julia, who brings her exceptional skills as our receptionist—fortunate to have both of you!
• Continued to welcome several PT students from programs across the country to learn and expand their pediatric knowledge with our physical therapists.

Looking Ahead: Commitment to Excellence
As we step into 2024, our goal to serve our patients with unwavering dedication stays unchanged. We're committed to celebrating our patients, embracing innovation, and continuing to evolve our practice to provide the highest standards of care. In serving our community, we hope to be a source of support, guidance, and healing on every individual's journey towards improved health and well-being.
The past year was adorned with inspiring moments and shared triumphs. To our patients, staff, and the wider community, thank you for being integral members of our Leaps and Bounds family. As we venture into the new year united, we eagerly anticipate another year filled with growth, well-being, and collective accomplishments.

We are so excited to announce that Dr. Bassem will be taking on the role of Clinical Director for our North Shore office as well as Dr. Brianna for our South Shore office. Aside from the amazing clinicians they are, they have truly shown what it takes to be leaders and mentors and we can't wait to see the success and growth they bring to our offices.   

If your child was treated here at Leaps and Bounds, please feel free to leave us a review!
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The holiday season is upon us, and what better way to celebrate than by incorporating
the joy of the festivities into pediatric physical therapy sessions? Engaging in holiday-
themed activities not only adds a sprinkle of cheer but also makes the rehabilitation
process more enjoyable for children. In this blog post, we'll explore creative and festive
exercises tailored for Christmas, Hanukkah, and New Year's, designed to make
pediatric physical therapy sessions both effective and enjoyable.
​​
1. Jingle Bell Movement:
*Objective:* Enhance gross motor skills and coordination.
Incorporate jingle bells into exercises to create a festive rhythm. For example, have
children shake jingle bells while walking or jumping to encourage rhythmic movement.
This not only improves motor skills but also adds a musical touch to the therapy
session.

2. Gingerbread Balance Challenge:
*Objective:* Develop balance and core strength.
Use gingerbread cutouts or mats with gingerbread designs to create a balance
challenge. Ask children to stand or walk on the gingerbread shapes while focusing on
maintaining balance. This activity adds a holiday twist to traditional balance exercises.

3. Snowflake Catch
*Objective:* Improve hand-eye coordination and fine motor skills.
Cut out snowflake shapes from paper or use snowflake stickers. Have children catch
the snowflakes using soft fabric balls or beanbags. Vary the difficulty by changing the
size or distance of the snowflakes. This activity is not only enjoyable but also effective in
honing fine motor skills.

4. Dreidel Dice Roll:
*Objective:* Enhance motor skills and hand strength.
Incorporate a dreidel-themed dice into therapeutic exercises. Each side of the dreidel
can represent a different exercise. Children can take turns rolling the dreidel dice and
performing the corresponding exercise.

5. New Year's Countdown Stretch
*Objective:* Increase flexibility and muscle strength.
Create a countdown routine with stretching exercises representing the numbers from
10 to 1. As you count down, encourage children to stretch different muscle groups. For
example, countdown lunges for legs, arm stretches for upper body, and toe touches for
overall flexibility.

​Integrating holiday-themed activities into pediatric physical therapy not only brings joy to
the season but also enhances the overall therapeutic experience for children. These
creative exercises not only target specific physical therapy goals but also make the
sessions fun and engaging. By combining the spirit of the holidays with rehabilitation,
we can ensure that children not only recover but also enjoy the journey towards better
health. Here's to a festive and fulfilling holiday season filled with laughter, progress, and wellbeing!

Walking is one of the major milestones in a child's development, marking the transition from crawling to becoming more independent on their feet. However, for some children between the ages of 12 to 36 months, a pattern of walking known as toe-walking can emerge. Toe-walking is when a child primarily walks on their tiptoes rather than with a typical heel-to-toe stride. While it's not unusual for toddlers to experiment with toe-walking occasionally, persistent toe-walking might raise concerns for parents.

Understanding Toe-Walking​
Toe-walking can be observed in children for various reasons:

​Developmental Phase: Many children start walking on their toes during their initial attempts at walking. This is usually a phase they outgrow as they develop their walking pattern and gain better control and balance.

Muscle Tightness or Weakness: Tightness in the calf muscles or weakness in the ankle muscles can contribute to toe-walking. Conditions like cerebral palsy, muscular dystrophy, or other neurological issues can lead to toe-walking.

Sensory Processing Issues: Children who have sensory processing challenges might find the sensation of walking on their toes more comfortable.

Autism Spectrum Disorders: Some children on the autism spectrum may exhibit toe-
walking as part of their sensory behaviors.

When to Seek Professional Help
It's essential for parents to observe the duration and frequency of toe-walking in their child. If toe-walking persists beyond the age of three or four, or if it seems to be impacting their
mobility, balance, or causing any discomfort, it's advisable to seek professional guidance.
Physical therapists play a vital role in assessing and addressing toe-walking in children. They conduct evaluations to determine the underlying cause and develop appropriate treatment plans. These plans may include:

Stretching and Strengthening Exercises: To improve muscle flexibility and strength in the
calves and ankles.

Orthotic Devices: In some cases, orthotic devices like braces or splints might be
recommended to help maintain a proper foot position while walking.

Sensory Integration Techniques: For children with sensory processing issues, therapy
might focus on providing sensory input through various activities to encourage a more typical walking pattern.

Gait Training: Therapists work on correcting walking patterns through various exercises
and techniques to encourage heel-to-toe walking.

Preventive Measures:
While some cases of toe-walking are due to underlying conditions, there are some measures parents can take to encourage a healthy walking pattern in their children:

• Encourage a variety of physical activities that involve different movements and positions of the feet.
• Ensure proper footwear that supports the feet and allows for normal movement.
• Regularly engage in stretching exercises with the child, focusing on the calf and ankle muscles.

In Summary:
Toe-walking in children can be a cause of concern for parents, but with timely intervention and appropriate therapy, many cases can be addressed effectively. If you notice persistent toe-walking in your child, it's crucial to consult a pediatrician or a physical therapist for a comprehensive evaluation and guidance. With proper care and support, most children can
overcome toe-walking and continue their development with improved mobility and confidence.

What is DMI?
Dynamic Movement Intervention (DMI) is a therapeutic technique that emphasizes proper posture through a series of exercises and positions aimed at guiding children towards more effortless and automatic movements. This approach is grounded in stimulating neuroplasticity, the brain's ability to change and adapt in response to specific and repetitive movements and techniques.

The Science Behind DMI:
DMI's effectiveness lies in its ability to stimulate neuroplasticity in the developing brain. Neuroplasticity allows the brain to create new neural pathways and connections based on the movements and positions experienced during DMI exercises. As a result, children can develop improved postural control, coordination, and motor skills, addressing motor delays and related challenges.

Can your child benefit from DMI techniques?
Children experiencing motor delays, low muscle tone, torticollis, genetic syndromes, developmental delays, or prematurity can greatly benefit from DMI interventions. DMI offers a personalized and adaptive approach, making it suitable for children across a spectrum of activity levels and abilities. The exercises are designed to challenge the child and help them progress in stability and mobility.

DMI Sessions and Availability:
Physical therapists in all three of our locations have been certified by co-founder of the DMI technique Jake Kreindler. The frequency and intensity of DMI therapy sessions may vary based on your child's needs and progress. Intensive DMI programs have shown to yield quicker and more significant responses, but ongoing, weekly sessions are also available for continued progression and challenge. Our therapists will be able to educate parents and guardians on techniques to compound progress at home.

Dynamic Movement Intervention (DMI) is a specialized therapeutic technique designed to enhance physical wellness and motor skills in children with various challenges. By leveraging neuroplasticity, DMI empowers children to achieve better postural control and movement patterns, improving their overall quality of life. If you would like to learn more about DMI or talk to one of certified therapists, please call us at the phone numbers below.

​Physiological Changes and Repetitive Throwing:
 
It is easy to understand how repetitive throwing can place an increased strain on the shoulder girdle and elbow joints of all athletes, and research suggests that these effects are often exacerbated in youth baseball players. Children and adolescents that participate in repetitive-throwing sports have an increased risk of becoming injured due to the immaturity of their musculoskeletal systems, and the rapid physiological changes that occur during growth spurts, puberty, etc.  Radiographic images indicate that 56% of youth baseball players displayed changes at the growth plate in their dominant throwing arm. This study also states that over half of these participants with boney changes never reported any symptoms like pain or arm fatigue. (Mair et al., 2008)  Another study suggests that after just one 12-week little league season, approximately 50% of players had elbow/shoulder abnormalities that were severe enough to be seen on MRI images. (Pytiak et al., 2017) Experienced medical professionals agree that although muscle soreness is normal and necessary in the development of a pitcher, complaints of joint pain is not. Therefore, shoulder and elbow pain should be considered a warning of the potential development of an overuse injury. (Manzi et al., 2022)


Proper Throwing Mechanics:
 
So, you’re asking yourself… what can we do about this?!? First things first, focus on proper throwing mechanics. This doesn’t just mean keep throwing that ball every day, over and over, until you can throw it faster and farther than anyone else on your team. Having an efficient and effective throw requires the engagement and strength of certain muscles, and proper flexibility and stability in others. Learning early on to engage your deeper core and abdominals to help stabilize your trunk, while also activating the larger muscles throughout your hips and legs for power, can help reduce the strain on your upper body and lead to less injury at your shoulder and elbow joints. Working with a local physical therapist or pitching coach can ensure that your kids maintain good all-around strength and global flexibility, in order to help minimize injury and reduce muscular strain or fatigue.

Pitch Count: Why it Matters


Pitch count is the number of throws performed by a pitcher within a certain amount of time. Numerous studies have been conducted that demonstrate the positive correlation between increased pitch counts and shoulder or elbow pain and injuries. Below you can find updated recommendations of these numbers based on a child’s age and pitching window:
 






It is important to understand that these players should not be allowed to exceed or bypass this “throwing max” by participating in more than one league/ team at a time, practicing with friends or parents, or even engaging in other sports that require a lot of throwing such as dodgeball or football. All organized throwing should be monitored closely by parents or coaches in order to ensure adherence to the suggested numbers. Not only does pitch count help reduce injuries, but it also can help players reduce the onset of developing fatigue. Sometimes it may be difficult for children or adolescents to explain what true muscular fatigue may feel like; this age group often described this as their arm feel “tired” or “off.” This can be a vital piece of information to further ensure their upper extremity health in years to come. Research states that a pitcher who regularly pitches despite feeling arm fatigue can be 36x more likely to develop a serious injury requiring shoulder or elbow surgery. Therefore, complaints of being tired should be taken seriously as they could indicate potential injuries in the future if ignored or played through.
 

In summary, children that engage in sports that involve a lot of over-head throwing and repetitive movements are more at risk for developing poor body mechanics and overuse injuries. Ignoring complaints of pain and fatigue places each child at an increased risk for developing serious injuries in the future, and potentially limiting their ability to participate in sports as they get older and enter into adolescence and adulthood. Ways to mitigate these risk factors include ensuring your child is using proper body mechanics while pitching and participating in sport, and paying close attention to the amount of throwing your child is doing overtime. For any further information or questions on this topic, please feel free to contact our office via our social media page or contact information below.
 
 
References:
1.     Mair, S. D., Uhl, T. L., Robbe, R. G., & Brindle, K. A. (2004). Physeal changes and range-of-motion differences in the dominant shoulders of skeletally immature baseball players. Journal of Shoulder and Elbow Surgery, 13(5), 487–491. https://doi.org/10.1016/j.jse.2004.02.008
2.     Pytiak, A. V., Stearns, P., Bastrom, T. P., Dwek, J., Kruk, P., Roocroft, J. H., & Pennock, A. T. (2017). Are the current Little League pitching guidelines adequate? A single-season prospective MRI study. Orthopaedic Journal of Sports Medicine, 5(5), 232596711770485. https://doi.org/10.1177/2325967117704851
3.     Manzi, J. E., Kunze, K. N., Estrada, J. A., Dowling, B., McElheny, K. D., Dines, J. S., & Carr, J. B. (2022). Variability in pitch count limits and rest day requirements by state: Implications of season-long pitch counts in high school baseball pitchers. The American Journal of Sports Medicine, 50(10), 2797–2804. https://doi.org/10.1177/03635465221111098
4.     Safety Tips for young baseball pitchers: HSS sports rehab. Hospital for Special Surgery. (n.d.). https://www.hss.edu/conditions_tips-for-young-baseball-pitchers.asp 

​Excited for another fun summer? So are we! We’ve put together a list of fun, easy, and enriching activities to do together with your child, all while incorporating physical therapy techniques and insights. Get creative with the below activities- and if you ever need any additional help — please reach out to our staff at Leaps and Bounds all summer long!

1) Animal walks - Bear crawls, penguin walks, kangaroo hops, crab walks, and flamingo stands are all fantastic, dynamic exercises that strengthen the full body and improve coordination in children.
• Bear crawls are great for strengthening the arms and legs in unison while improving coordinated movements of the extremities and promoting core stability. Bonus points for the scariest bear roar!
• Penguin walks, walking while keeping the toes pointed to the sky, are a great exercise to strengthen the lower legs and ankles. And this is especially great for kids who show any tendency to toe-walking.
• Kangaroo hops, standing on your tippy toes and jumping forward, are another great activity that challenge dynamic balance and promote leg strengthening, this is especially beneficial for kids who show a tendency to walk with their toes in or toes out.
• Crab walks, starting on your back followed by lifting yourself so that only your hands and feet are touching the ground is a great gross motor challenge that exposes children to using their muscles in a way they may not be used to. This activity improves coordination and strength of the full body.
• Flamingo stands, while standing up tall, lift one leg and balance it against the standing leg, now try to hold this position as long as possible. Notice if your child has any difficulty standing on one side compared to the other.

Now head to the zoo or aquarium to see how close your animal walks are to the real thing!

2) ​At the playground, your child can improve their coordination, strength, and core muscle endurance as they climb ladders and cargo nets and play on the monkey bars. Hop on the swings to increase proprioceptive input in all planes of motion. Climb UP the slide before making your way down to strengthen the upper extremities and core. Visiting a playground is a classic way to keep your child active, while promoting safe social interaction with other children!

3) In the water: swimming is an amazing activity that promotes sensory integration, motor planning, coordination, spatial awareness as well as cardiovascular health. Make swimming fun with your child by incorporating games such as tag, follow the leader, Marco Polo, mermaids, or make up your own games! If your child seems increasingly apprehensive about going in or out of water, reach out to one of our therapists as this could be a sensory processing disorder that needs a little extra support.

​4) Riding a bike is an essential summertime activity that also helps your child develop their leg muscles. Riding a bike just around the neighborhood or down the boardwalk will help elevate their exercise endurance and cardiovascular ability along with their coordination and balance. And if your little one is having any difficulty or fear with getting on a bike for the first time, reach out to our office as we offer bike learning classes!

5) Playing with a ball! This is a timeless and simple activity that will help improve hand to eye coordination. Some ideas are: throwing and catching, kicking, and bouncing, but feel free to freestyle and come up with fun new games that your child will love! Throw a football, kick a soccer ball, bounce a handball, and even embark on a new adventure together like juggling (pro tip: practice juggling with plastic bags first). 

6) Sidewalk Chalk: Playing with chalk promotes new sensory experiences while working on colors, shapes, letters, and numbers. Draw a hopscotch board (and other doodles) and work on single leg hops, draw a line and work on balancing, or draw an obstacle course and incorporate other elements, such as walking along a narrow line without losing balance and stomping feet on spots drawn on the ground. 

7) Kids yoga:  Yoga is a great way to wind down after any of the other summer activities you have planned. Find a nice spot (the beach, your backyard, or just the living room) and pull up a short YouTube video to follow or craft your own routine. The benefits of yoga are plentiful for kids and adults alike, including: improving focus, flexibility training, breathing practice, and muscle recovery.  And keep an eye out for one of the Leaps and Bounds Yoga classes happening this summer near you!

8) Building a fort: Spending more time outdoors during the summer is awesome, but it is also important to take a break indoors. Watching a movie or having story time inside a fort made with blankets and pillows can help reduce and integrate sensory input, spur creativity, and allow your kids to reset their minds and bodies alike. Bring puzzles or Legos inside the fort to have an equally cozy and stimulating activity. 

​BONUS!
Consider a scavenger hunt! This can be incorporated into most of the above activities and can help keep your child remain focused and eager throughout the exercises. Consider writing riddles to get your kids thinking or hide treats for a simpler approach. This can be both an outdoor and indoor activity (for those rainy summer days!)
 
Planting flowers is an enriching activity that you can work on together with your child. They can connect with their community and earth by sowing seeds and watching their creation grow over time. It’s great for the younger kids to develop motor skills in a fun and different way!
 
As always, if you have any concerns regarding your child’s development, please reach out to our office to speak with one of our licensed physical therapists.