Category: Pediatric Physiotherapy

Written by Physiotherapist Emma Bolt

 

“Hey Emma, what’s with those gold suits I see on kids during your DMI sessions?”. Thanks for asking, it’s a TheraTog! This blog post is all about the compressive garment used to act like a second set of therapist hands during DMI sessions. 

What Are TheraTogs?

TheraTogs were designed by a pediatric physiotherapist named Beverly “Billi” Cusick to act as an extra pair of hands to help a child have more optimal posture and alignment while participating in activities. TheraTogs are an undergarment and are meant to be worn under the clothes in direct contact with the skin. 

However, this is not ideal for a clinical setting both for sanitary reasons, but also for the practicality of dressing and redressing children during a 45 or 60-minute session, so we use them on top of the children’s clothing. 

What Are The Benefits of Wearing a TheraTog?

TheraTogs are customized by a therapist based on the child’s unique musculoskeletal, postural, balance, or movement correction needs. Some of the concerns that TheraTogs may be used to address include:

• Leg positioning concerns such as excessive in-toeing, out-toeing, or scissoring walking patterns.
• Abnormal tone (including hypotonia and hypertonia).
• Abnormal trunk postures that can be manually corrected (TheraTogs are not used to address scoliosis).

TheraTogs are compressive in nature, so they provide a high level of proprioceptive input, or joint compression input, to build a child’s awareness of their body. By providing support to the trunk, a TheraTog may increase the quality of movement or level of participation a child is able to achieve while wearing the suit.

For example, a child who has a weak core or low trunk tone may tend to lean on their arms for support while sitting, but is able to reach for and play with toys while wearing a TheraTog. When used daily, a TheraTog provides live-in postural correction so that they move, play, and interact with the world in more optimal alignment. Since the suit is fabric, as opposed to a hard plastic that doesn’t bend or flex, a child will not become dependent on the TheraTog to be able to perform daily tasks.

Are There Any Conditions That A TheraTog Should Not Be Used With?

Yes, as mentioned previously, TheraTogs are compression garments. When compression is applied to the body, the pressure in our blood vessels is increased. A TheraTog should not be used for children with tachycardia or other cardiac arrhythmias, or for children with a VP shunt. Please inform your physiotherapist if your child has either one of these conditions.

How Do I Get A TheraTog of My Own For My Child?

Prior to discussing the potential of a family purchasing a TheraTog for their child, I ensure a TheraTog is supportive and appropriate through assessment and monitoring during DMI sessions. For some children, the benefit is obvious and immediate. 

For other children, the benefit is minimal when considering the financial and time commitment using a TheraTog requires. If a TheraTog is determined to be beneficial and the family would like to purchase one for home use, Peak Kids is able to support families in this process. 

Once a family has received their TheraTog, I provide in depth education on how to apply the TheraTog, store it, clean it, and lots of helpful tips and tricks to increase a parent’s comfort with the TheraTog. 

When I put on a TheraTog for the first time, it took me 15 minutes to put on and 5 minutes to fall off. It is a skill, but with practice and the support of a knowledgeable therapist, families are able to provide their children with live-in postural correction to support improved stability and movement skill capabilities. 

Key Takeaways 

A TheraTog is a compressive undergarment used to improve posture and provide stability to the trunk. It can also improve a child’s awareness of their body. TheraTogs are customized for each child and can be purchased for home use.TheraTogs should not be used as a device to correct scoliosis, or for children with tachycardia, other cardiac arrhythmias, or VP shunts.

Written by Physiotherapist Emma Bolt

As a pediatric physiotherapist in Calgary South who specializes in children with gross motor delays and complex neurological or genetic diagnoses, I am often asked how I treat children with these conditions and how it is different from physiotherapy services typically provided in the hospital and school programs. When I tell them I am a Dynamic Movement Intervention (DMI) practitioner the list of questions tends to grow. Let’s discuss these common questions!

What Is DMI Therapy?

Dynamic Movement Intervention (DMI) is used to treat children with motor delays, big or small, by improving their ability to respond to gravity’s demands on their body in various positions and promote progress to developmental milestones. Children actively participate in the exercises of this hands-on therapeutic technique, and exercises are selected based on each child’s specific needs. 

As children grow and develop, the neural connections in their brains adapt to the world around them and how they move within that world. This neural connection change is referred to as neuroplasticity and is highest during our younger years. DMI uses this neuroplasticity to help create and strengthen neural connections required to achieve motor milestones.

DMI can also help increase a child’s awareness of their body with the integration of primitive reflexes. 

How Do I Know If My Child Will Benefit From DMI?

Many of the families I have worked with over the last few years have frequently commented on the lack of hands-on therapy provided to their children. Parents often feel their child is capable of more than what they are currently doing, or being provided by their current physiotherapist. These families are often eager to learn strategies and tools to better support their child at home or are looking for a skilled and knowledgeable therapist who can provide therapy for their child to take the demand and stress off the parents to provide therapy themselves. 

To take the greatest advantage of neuroplasticity, starting therapy young is ideal. However, this does not mean that older children do not benefit from DMI, just that the benefits could occur more slowly. Ideally, once a child begins to present with delays or is diagnosed with a condition that commonly results in delays, DMI therapy should be started. It is easier to proactively work towards preventing poor habits and motor patterns from happening than it is to alter pre-existing and strengthened neural connections that lead to poor movement habits. 

I have provided DMI therapy to children all along the gross motor development spectrum. From 6-year-olds who are unable to roll without support, to 3-year-olds who are able to run and jump but experience frequent falls. 

What Are the Most Common Conditions Treated With DMI?

Children diagnosed with any type of motor delay may benefit from DMI. Common conditions that I have experience working with include:

• Down Syndrome
• Cerebral Palsy
• Global Developmental Delay
• Hypotonia
• Spinal cord lesions (Spina Bifida)
• Acquired brain injuries

Children do not need a formal diagnosis to receive DMI therapy. Children at risk, such as children who are born prematurely, can also benefit from DMI. 

How Long Does DMI Therapy Take to Work?

Some families have seen improvements in head or trunk control in as little as one session, however for strong neural connections to be formed DMI exercises should be performed frequently and on a regular basis. Exercises are taught to families to be performed at home to support a high frequency of DMI provision to a child. As each child and each diagnosis bring their own quirks and complications, it is difficult to provide a firm timeline for the achievement of particular gross motor skills.

Is DMI Painful for My Child?

While it is not uncommon for tears to be shed during the first few DMI sessions, appropriately and skillfully provided DMI therapy is not painful for a child. Many of the children I treat are either non-verbal or have limited communication abilities. Crying is often how these children communicate that an exercise is hard. 

Many of the exercises are also challenging for the child as the goal is to build strength, endurance, and skill which requires targeting muscles or movement patterns that are weak. As children become more accustomed to the exercises, the therapist providing the therapy, and the expectation of actively participating they often begin to enjoy themselves and are excited to come for DMI sessions. 

A wonderful article written by DMI co-founder JoAnne Weltman on crying and therapy can be found here: https://dmitherapy.com/crying-and-therapy-the-cortisol-learning-debate/

Key Takeaways

Dynamic Movement Intervention is a hands-on therapeutic technique for children with gross motor delays. Children actively participate in exercises specifically selected for their needs and level of function. 

DMI stimulates neuroplasticity to create changes in the brain for more optimal movement patterns and to support the development of gross motor milestones. DMI can be provided at any age, however, greater benefits are seen when therapy is started during the first few years of life.