Today’s episode is a fantastic conversation with Jake Kreindler, a Pediatric Physical Therapist and a Level 3 Cuevas MEDEK Exercise Specialist. Jake has traveled around the world, helping children and families reach their goals. He currently works in New York, performing regular and intensive therapy sessions.
Be sure to check out the show notes on our blog at Harkla.Co/Podcast.
Brought To You By Harkla
This podcast is brought to you by Harkla. Our mission at Harkla is to help those with special needs live happy and healthy lives. We accomplish this through high-quality sensory products, child development courses, and The Harkla Sensory Club.
Podcast listeners get 10% off their first order at Harkla with the discount code "sensory". Head to Harkla.co/sensory to start shopping now.
Today’s episode is a fantastic conversation with Jake Kreindler, a Pediatric Physical Therapist and a Level 3 Cuevas MEDEK Exercise Specialist. Jake has traveled around the world, helping children and families reach their goals. He currently works in New York, performing regular and intensive therapy sessions.
Be sure to check out the show notes on our blog at Harkla.Co/Podcast.
Brought To You By Harkla
This podcast is brought to you by Harkla. Our mission at Harkla is to help those with special needs live happy and healthy lives. We accomplish this through high-quality sensory products, child development courses, and The Harkla Sensory Club.
Podcast listeners get 10% off their first order at Harkla with the discount code "sensory". Head to Harkla.co/sensory to start shopping now.
Welcome to the sensory project show with Rachel and Jessica. We're here to share all things sensory, occupational therapy, parenting, self care and overall health and wellness from a therapists perspective, providing raw, honest, fun ideas and strategies for parents and families to implement into daily life. Thank you so much for joining us. Today's episode is sponsored by Harkla, a company that makes high quality products for everyday use. This includes sensory and therapy equipment, and products as well as the owners Casey and Amelia are local to Boise, which make this even cooler for us since their local to us.
Jessica:Harkla is a company on a mission. They donate 1% of each month's sales to the University of Washington Autism Center, which funds cutting edge research and sponsored scholarships for children with autism to attend a summer camp.
Rachel:Stay tuned to hear more later in the episode as well as to get a special discount.
Jessica:Okay, let's get started.
Rachel:Hey, guys, welcome back to another episode of the sensory project show. This is episode 126.
Jessica:And you probably already know we're Rachel and Jessica, and we are interviewing someone today that turned out to be a really fun interview and his name is Jake. He is a physical therapist. He has a lot of years under his belt and he's really, really super passionate about helping the Down Syndrome Community. And so that's kind of what we're going to talk about today along with a couple of other things.
Rachel:Yes and just sit back and relax and enjoy this episode. Jake is super fun and we had a blast chatting with him. So let's get to it. All right. Hi, Jake. How are you today?
Jake:Hey, guys, thank you so much for having me on.
Jessica:Yes. So we're really excited that you reached out to us to be on the podcast. We like it when people do that because sometimes we don't, you know, we can't find people and so when people find us and they're like, hey, we want to come talk to you. We're like, Yeah, let's do it.
Jake:That's right. Initiation.
Rachel:Yeah, put yourself out there. But before we dive into all the nitty gritty, we have five secret questions to ask you.
Jake:Woohoo! Okay, let's do it.
Rachel:Okay, so the first one, would you rather stub your pinky toe on the coffee table or step on Legos?
Jake:Oh, my God, I think I'd definitely rather stub my toe.
Rachel:Oh, really?
Jake:Well, I have five kids on many Lego in my day, and it is no fun. So I think I'll stick my toe on that one.
Jessica:I was gonna say you're probably used to the Legos by now. Right?
Jake:Yes, yes.
Jessica:That's fair. Okay, so this question actually comes from a six year old because we were trying to come up with new questions for people. So this is a question from a six year old and it's what is your favorite color?
Jake:Royal Blue.
Jessica:Oh, very specific.
Jake:Yes, very specific.
Rachel:Okay.
Jake:Yes. I like I love all colors, really. But royal blue. There's something about it. It's just very, very soothing and I think it looks great. So there's no, there's no mistake that it's called royal blue. It used to be that only royalty was allowed to, to wear that color and that's why it's called royal blue. So I think that if royalty throughout the ages were able to have that exclusively for themselves. You know, I'm pretty happy. But that's my favorite.
Rachel:I didn't know that.
Jessica:All right. Very cool.
Rachel:All right. Next one. What is your desert of choice?
Jake:Tough, tough question. I would have to say some sort of pastry. I'm gonna go for a warm, chewy chocolate chip cookie.
Rachel:Warm. It has to be warm.
Jake:It has to be warm, but it's more important that it's chewy than warm. But if it's warm, then total bonus action.
Jessica:Totally.
Rachel:I'm excited for our last question with him.
Jessica:He's already describing the sensory characteristics of the chocolate chip cookie. Okay, if you could travel anywhere, where would you go?
Jake:Wow. That is a great question. I've never been to Thailand. So I think I'd like to go and a close second would be Belize. I want to see that Deep Blue Hole.
Jessica:Yeah.
Jake:Have you ever seen a picture of that?
Rachel:Yeah.
Jake:It's just breathtaking.
Rachel:Yeah. You sound like you talk to you. You travel a lot.
Jake:So I've done a bunch of intensives which we'll get to. I've gone to Israel and Hong Kong and Paris and London. So I gotten around a little bit and it's been such a great experience. I love traveling. It is just amazing. The people and the sights and just just drinking in the culture. And it's just, it's amazing. So I would always, I think if I actually write out the bucket list, I think it's gonna be really long.
Rachel:Check them off.
Jake:Check them off.
Rachel:Yeah. All right. Last question. And our most favorite one. What is your sensory quirk?
Jake:Well that is really interesting. I still bite my nails.
Rachel:Oh.
Jake:Is that a sensory thing?
Rachel:Yeah.
Jessica:Yep.
Jake:Yeah. So unfortunately, it's a habit I never kicked. So I guess that'd be sensory quirk.
Rachel:Do you do it when you're nervous? Or just randomly throughout the day?
Jake:Randomly, randomly.
Rachel:I bet wearing your mask all day has helped kind of wean you a little bit.
Jake:It definitely has. Yeah, that's true. COVID-19 has cured my bad habit.
Rachel:Okay, all right. So now that everyone knows your deep, dark secrets, tell us who you are, what you do, why you do it, and how you do it?
Jake:Awesome. So hi, everybody. My name is Jake Kreidler. I'm a pediatric physical therapist. I'm also a father of five and my wife and I just celebrated 25 years of marriage. It's pretty wild. Yeah, we got married really young and we just said 25 years and it's really awesome. In my free time, I play guitar, and a barbecue and smoking meat enthusiast. I love that. And I just started making sourdough bread about a year and a half ago. So I'm really excited to do those things in my downtime. And yeah, it's that's kind of kind of where I'm at.
Rachel:Let's talk about PT, let's let's steer in that direction. As much as I want to talk about sourdough and how to make it gluten free. Tell us about your PT adventures.
Jake:Sure. So as I mentioned, I'm a pediatric physical therapist, I graduated Touro College out here in New York in September of 97. And in 2004, I became a level three specialist in Cuevas MEDEK exercises.
Rachel:Okay, hold on. How did you hear about it? What got you interested in the MEDEK exercise?
Jake:Okay, that's a great question. So basically, I when I graduated, I wasn't sure which way I was going to go. I was Wow. already working for the New York City Board of Education as a
Jessica:That's incredible. staff physical therapist in a public school. And over the course of the first two years of my practice, I was also doing traumatic brain injury coverage and skilled nursing facility coverage and adult home care. And I also started to dabble in pediatrics, which was really my passion. But I was doing both.
Rachel:That is so cool. So I was doing some EI, some early intervention and what happened was, I was at a New York City Board of Ed, like symposium kind of course, where they had a panel of a PT, a pediatrician, some other specialists who were discussing
Jessica:Like just in the right place at the right time. different topics related to physical therapy. And when the PT got up to do some demonstrations, on physical therapy on a specific child, everything she mentioned, I was there with two friends and they kept saying Medek, Medek, and they were saying that Medek could do it better, or that Medek it could address this issue in a better or more efficient way. And afterwards, I asked them about it and they started to explain the theory to me, and immediately it just resonated with me. It made so much sense in my brain. The way I am as a person, the way my brain thinks, and how I like to work, the whole thing just made total sense to me. And in July
Rachel:Yeah, no kidding. of 99, Ramon Cuevas, the CME creator was coming to New York
Jake:Okay, so you mentioned before we started recording that to give a course in Long Island. I took that course and I immediately followed him. I was very lucky because the way the you do a little bit of water therapy, and I've always been CME that well back then it was Medek, and later became CME Cuevas Medek exercises to include his name. But at the super interested in that. Can you talk a little bit about time, it was known as Medek and I was very lucky because CME courses are designed to have live models. There are children who you actually practice on and that makes it super unique in the pediatric continuing education world. And one of the children who I draw to the course to be a model ended up hiring Ramon to work with their child's medical needs and because I had made that connection, Ramon allowed me to observe. So I went from a level one experience, which was just the introductory experience, to following him for the next three months, watching him two to three times a week and it just really propelled me to way higher levels than people who take the typical first course. And I was really just yearning and thirsting for more. So in 2002, I became the first person to do what was known as a sort of like an internship where I came and I observed Ramon, it's called a tutorial. That's how it's called in the CME world where you go and you observe Ramon, as he's treating his patients. So I became the first one to do that and then in 2004, I went on to the level three certification or the Specialist certification, which is by invitation only and at that point, Ramon had invited me to come to he was in Toronto at the time. I traveled up to Toronto, and he invited me to take my level three certification and coursework to finish up. And I did and became the seventh person to get that sort of certification. that? Sure. So aquatic therapy is a great modality. Excuse me. I's a great modality. Hear in New York, I really only could do it in the summer, because I don't have my own pool and you know, weather is a huge factor here. There are huge swings and basically, you can only use a pool here from May through the beginning of September. So unfortunately, it's very limited, but I do try to maximize it when I can. What's really wonderful about aquatic therapy is that there's this duality of what you could use it for. So for our kiddos with special needs, different diagnoses, things like cerebral palsy, who was most of the population of the kids who I work with in the pool, the best thing about the pool is the flotation and the, the fact that gravity is eliminated. They're able to experience things in the water that they can experience on land and therefore, when we expose them to this, besides being super fun to be in the water, and getting around and splashing, and maybe using their limbs in a way they can't on land. They also are able to experience things like sitting with the right equipment in the water. Standing resistance through the water to give them you know, to strengthen them and also we could do stretching in a lower impact environment. So that's, that's really what I do and I use a few different things, pieces of equipment in the water, different kinds of mats and tubes and, and noodles and things like that, to really maximize what I get out of it. I don't do this, but there are a lot of people who use aquatics for the other side of it, which is the hydrostatic pressure or the resistance that can be created in the water and that's really for athletes and for, you know, for kids who have kids or adults who have injuries that need to be worked on in the water. I don't. I don't stick to that side, I stick to the kids with neurological delays and thank God it's been really a great experience and a lot of fun for me and really awesome for kids to really just get out there and just have that freedom of being in that medium and it's it's really exciting to share that.
Rachel:Alright, so let's shift gears a little bit and chat about Down syndrome. So again, before we started recording, we were talking a little bit about that population and you're passionate about that population and just there. What is your call it spunky or sassy? Sassy little selves? Yes. Yeah.
Jake:Some of them are sassier than others.
Rachel:Oh, for sure true.
Jessica:What made you take a special interest in the Down Syndrome population?
Jake:So before even jumping to Down syndrome, I'm in my 24th year of practice. I've worked with kids across every diagnosis of neurological delay and metabolic and genetic things. and there's something about kids with Down syndrome. They've always had a very special place in my heart. There's some some of my favorite kids to work with. At one point, my wife and I were actually considering adopting a baby with Down syndrome and it didn't actually come to fruition because our kids were really little at the time and we felt we had to focus on them at the time. Kids with Down syndrome are just really adorable people, they have a super happy disposition, there's a beautiful innocence about adaptive, and they just, they're super social, and they're just really good people to be around. The people are really great. But so I just enjoy spending time with them and connecting with them. Obviously, I make a lot of them cry because of treatment. But still, they're just really beautiful people and there's something very special about them.
Rachel:For sure.
Jessica:I agree. Okay, can you clarify what you mean by when you said, "you make the craft and the treatment?." Let's, let's clarify that really fast.
Jake:So, I mean, from from a PT perspective, I feel acutely connected to kids who society doesn't understand and they're perceived to have the odds stacked against them. And I love working hard with kids, so that they can beat the odds. And with kids with Down syndrome, I think that the odds that are stacked against them are things like low muscle tone, ligamentous laxity, a huge risk factor for gross motor delay. A lot of them have cardiac issues, but treatment is really, it's really hard and overcoming those obstacles, is a challenge. And when kids are not able to tell you, hey, that's really tiring, or that's really challenging. The way that they're able to express themselves is through crying, just like so many kids within Pediatric Physical Therapy, they cry during therapy. Not because it's painful, and it's just their way of protesting the challenge. And that's just unfortunately, the soundtrack of my career is crying babies. I wish that kids didn't have to cry and it happens to be the Down Syndrome as as a general population, they're usually happier, go luckier here. So not as many kids with Down syndrome cry during therapy. But it definitely does happen.
Rachel:Okay, it just means you're doing your job, right? But let's go a little bit deeper about what makes you frustrated about how society views Down Syndrome and kind of just puts them in that box? We hate that box
Jake:There are really so many things about how society views Down syndrome that are frustrating and I think what really stands out to me is this artificial stigma against Down syndrome and unfortunately, it is so pervasive. Here in the US, most families we're finding out that they're pregnant with a child with Down syndrome will be asked by the doctor if they want to abort the fetus and if you look on social media, and you look at these, these, these groups of moms get together, they all say it. They're all talking about why the site asked to abort a baby and while families are free to make choices for themselves, if people could see what I have seen, they may think differently. And I think that part of eliminating the stigma is understanding how children with different abilities, or how children with diagnoses fit into the human experience. If we look at humanity as a bell curve, you'll have 60% of the population who is normal or typical. Quoting and unquoting. For those listening at 60% of the population will be typical, 20% of the population will be gifted in some way with either higher intelligence or higher abilities, or were some other way, and 20% of the population will have some sort of diagnosis, diagnosis or some sort of challenge. But yet we're all under the same bell curve. We're all part of the same human experience. And it's a shame, I believe such a crying shame that children with diagnosis and especially with Down syndrome are put into this negative association that maybe they don't, they don't deserve the same beautiful life that the rest of us are given are afforded the opportunity to do. And I believe that instead of that stigma, what we need to do is start training the medical community. Tells doctors that, yes, you know, abortion might be one thing on the table and I hope I'm not getting political by saying this. But I think that doctors should be trained in the abundant resources that are available to families with kids with Down syndrome. And they should be shown the beautiful and rich community in social media and the online presence and how we all help each other and they should be taught how much treatment has improved over the past 50 years. And they should meet children and adults with Down Syndrome and see how well they function in society and they have happy and productive their lives. I believe we need so much education and awareness in the medical community and in the public and even in the special needs community. People need to hear this message. They need to hear that everybody we are all together. We're not separate, and they're not different. They don't deserve to be in a different category. We are all together existing together on this planet and we need to educate these people that children with Down syndrome these kids can have a beautiful and productive life if we left them.
Jessica:Chills.
Rachel:Yes. Preach it, please. I love that I could not have said it better. Seriously. So, so good and such important message and I think that you're right. It starts with awareness at the doctor's office, when you're getting your anatomy scan. I mean, I just went through all of that, you know, and the doctors, they should, they should say, hey, you know, your child looks like they could have Down syndrome. That's a blessing. You're so lucky. These kids are beautiful and wonderful and magical. Let's not immediately say, Would you like to abort your child or what resources can you point you into the direction of? So I think that's so important. Thank you.
Jake:Yeah. And I think that the second thing that frustrates me is, there's this assumption, and almost like a prognostication, like a prediction that the medical community makes when it comes to Down syndrome. Parents are told early on, as soon as they have that child, or as soon as they even know they're pregnant, you have to expect a 50% gross motor delay, okay?. And let's just put that into perspective, what a 50% delay of gross motor delay means. That means that a child, your child will be rolling over at eight to 10 months, instead of four to five months. That means that your child is going to crawl at 14 to 18 months instead of seven to nine months and it also means that your child is going to be walking between their second and third birthday, instead of 12 to 18 months. That is crazy. And that is what they tell you to expect. And it has become the norm. And Now historically, that has been accurate for so many kids with Down syndrome. But it doesn't have to be that way and I wrote this article and what I reached out to you guys with was with this article that I wrote about Down syndrome, because I want to change this norm. I believe that given the correct input, and with the right mindset on the part of the parents, parents can help their kids achieve their milestones so much closer to typical gross motor ranges. And before you can think I'm crazy, which you probably already do.
Rachel:Not even.
Jake:Before anybody thinks this is impossible, I want to tell you about to quote unquote, I'm doing the thing with my fingers. Two clubs that I have, okay? I'm working 24 years, I have had three kids with Down Syndrome who have walked 17 months. I have had multiple, I don't even know how many because it's been so many, so many kids with Down syndrome a walk by 18 months. And even for the kids with Down Syndrome who have not walked at 18 months, they have generally walked not later than 24 months, which beats the average of around 30 months. Therefore, the kids who are in my clubs, which who have walked by 17 or 18 months have been within the normal range for typically developing children, because the normal range of tip of walking for typically developing children is 12 to 18 months, and kids with Down Syndrome have reached that milestone multiple times in my career. And I want parents to understand that the plan I laid out is not impossible. It is so attainable, as long as you have the right mindset and you get started early and diligently.
Rachel:Yes, I think those two words are very important. Getting started early, and carrying out the plan diligently and consistently.
Jake:Yeah.
Rachel:Makes a big difference.
Jake:I think that's that's the scary part for people. You hear of something and this is not some infomercial of a product that's like a flash in the pan. This is tried and true. over so many years of doing therapy, and so many families that have seek me out because they know that when it comes to their child's development, I'm gonna push their child harder. And in this article, and in our conversation today, I want to share that information because if you have the heart of a fighter, and if you know that getting your child their gross motor milestones early, will set them up for success in life by by byte by setting them up on the springboard of development for their future skills, then you're my people. And I want you to jump onto this because it will change your life.
Rachel:Well, we'll make sure that we link that article that you shared with us. We'll link that in our show notes as well as anything else that we chat about today that we want to include. Just so everybody has these this little nuggets of information to carry on and incorporate. I don't know if you can go into more detail on this but what kind of the plan of change that you've laid out for the Down Syndrome Community?
Jake:Sure. So I think that to start off, it's important that parents understand that for this to work, there has to be a paradigm shift. You need to adopt a new way of thinking. You need to put aside what you've been told and understand that the new way of thinking is something that's going to help your child. And one thing when it comes to gross motor movement, and this is somewhat semantics, but it's also something that I think is profound. The the primary modality for Pediatric Physical and occupational therapy for the past 50-60 years has been NBT, neuro-developmental treatment and one big you know how button word in NDT has always been facilitation. And facilitation means helping, guiding the child through a movement, and unfortunately, the, the implementation of facilitation has been somewhat passive. It's not an active process and I think that's the first thing that parents need to consider. And again, I'm not knocking NBT I, I've done it for a long time. You know, prior to doing CME, and I have a lot of friends and colleagues who that's who they are, they're just wonderful. And they do, they do. But I think the first thing we need to start thinking about is provoking gross motor change rather than facilitation, provoking rather than facilitating. And when we make our kids do more of the work, when it comes to gross motor movement, we turn movement into an active experience instead of a passive one. Now, this is something that really has been highlighted to me through my CME training. It's something that CME is really great at. But parents can easily implement this kind of strategy and older interactions, and throughout the daily routine. The way it would work, we're gonna get into a little bit more as I discuss more of the, you know, this plan. I think something that's really important in the Down Syndrome Community is also that there are so many products on the market designed to quote unquote, help children, but actually further delay the kids by giving them artificial support, or placed them into various containers, quote, unquote, and container syndrome.
Jessica:Oh, yeah, we talked about that before. For Sure.
Jake:Yeah. And it was like, you know, now it's finally you know, we're making a movement. This is something that's been a problem forever. And as technology improves, and so many more products are coming to the frontlines of, of, you know, they're being passed on to the parents as the new hot product. We have to be ever more vigilant and telling parents that these things are not good for your kid. They might look great. They look nice in your living room. But unfortunately, they're not helping your child develop and in fact, many of them are stopping your children from developing. And that's something that we need to really be very on top of, especially in the Down Syndrome community, because they do have issues of low tone, they do have issues with ligamentous laxity and risk factors for gross motor delays. So putting them into these containers, is going to exponentially increase the delays. It's not just going to do it a little bit, it's going to make it really much, much worse. And part of helping parents make the kids stronger and better prepared for life has to include education on avoiding these kinds of pitfalls and that's something that I'm very passionate about. And I know you guys are as well.
Jessica:Yes.
Jake:Just moving on with kind of the thought process. Another crucial factor that is going to help your baby is early development of head and trunk control and I can't overstate this enough. I'm going to get into a kind of a case study of what I'm describing and how it how it all worked out. But I'm gonna I'm gonna leave that as like a little bit of a teaser for later.
Rachel:Uhh, man!
Jake:It is going to be worth the wait and see what's worth the way it's worth doing. Now, when it comes to early head and trunk control, that means that from an early age, you make tummy time your default position. And this is extremely important because head control usually precedes trunk control and trunk control is foundational. And that means that it's the foundation of all other movements. And we need to work on that in a really big way. We're looking to get head and trunk control perfect. I remember something that we were taught in PT school that always resonated with me and I always tell people, we were taught that you need proximal stability before distal mobility. And that means that we need the core to be strong so that all the other milestones have a strong foundation to anchor them. And I tried to explain this to parents through an analogy. If I want to build a stack of blocks, if I build it on a strong straight floor and it will stay standing, but if I build it on a bowl of jello and even If the stack of blocks is perfectly straight, it will fall over because the foundation is low. And it's so true with the trunk. It's so true at the trunk. You guys know if trunk control is strong, and the arms and legs, strong foundation for stability and mobility skills, and it's especially true you guys are Cotas, right? So when you're doing your fine motor skills, the kids who have a strong trunk are able to do their fine motor skills, so much better than the kids who are still dealing with the low tone and the weakness and the core instability and having trouble with the co-contraction of the trunk. The trunk is weak, the child will have a much harder time. If the trunk is strong, they're going to have an easier time doing everything else.
Rachel:Absolutely.
Jessica:Definitely.
Rachel:That is that's I love the jello. I mean, that makes perfect sense. That's a great way to have a visual Yeah, coordinate.
Jessica:Yeah.
Jake:We all love jello.
Jessica:The flavor of jello.
Jake:Who doesn't love jello? So my second point is that we need to address the kids current gross motor skills, as well as working on the next set of skills and this is something that's very unique to to CME. When we look at the developmental at development and the developmental sequence, it's laid out like a blueprint, right? If I take a kid from you guys are in Idaho, correct? So if I take a kid from Idaho, and I take a kid from here in New York, and I take the kid from Hong Kong, and I look at them at the same age level, I could expect that they're going to be doing similar milestones within a certain range of time. Okay, and that is because the developmental sequence or the milestones that kids hit, are generally following a specific sequence and while kids can do things in a range, they're generally doing things in the same range. So certain milestones happen at certain ranges. But when kids have a significant risk factor for delay, like our kids with Down syndrome, it's not enough to work on the current skills, because kids with the risk factors for delay, have a neurological maturity that further delays things. So when we wait for them to do things naturally, and we don't push them the way they need to be pushed, then we end up with the delays in the 50%, delayed range. And that's kind of what they're being told. But by working on the highest age appropriate skills, we can stimulate the brain at the highest executive function and motor cortex order levels. So not only will the children make faster gains, but when they get to the finish line, wherever that finish line is for them, they're going to be stronger and more coordinated, and have more effective gross motor strategies to tackle the world. And I think that is that just can't be understated.
Rachel:No, kidding. Yes, we have to push our kids.
Jessica:Absolutely, yeah.
Rachel:Let them sit back and develop and go through these milestones on their own, we got a push them.
Jake:So let's talk about how to get parents started because this
Jessica:Yes. is really my third point is that if I'm telling you, as a parent of a child with Down syndrome, that you need to work on the current skills, let's say the child is eight months old, and they're only rolling. So you're going to be working on rolling. But I also want you to work on what would be age appropriate for typical kids at an eight month range. Then you have to know what to expect, right? You have to know what's supposed to happen at eight months, so that you could push that level, right? So people have to educate themselves on what happens at each range of development. Now, I wrote in my article on Down Syndrome that's on my website, you could find a brief overview. But as I mentioned, it's not enough to work on what the child is up to now, people need to educate themselves on what their child should be typically doing in normal development or as close to as close to it as possible. So we need to give kids and one more point, and then I'll kind of wrap it all up with an example. Excuse me. We have to give kids a lot more exposure to gravity. Exposure to gravity and typical typical treatment strategies because we all bring in the ball, right? We bring them the ball. Now the ball is great. The ball helps us both prevents injuries and for us, and really gives the kids great writing experience, right writing reaction experiences, but between you and me, the goal is the only time you're going to be sitting on the surface of a ball is when you're sort of sitting on a surface of a ball, right? It's not a real world experience, right? It's, it's sitting on that bouncy surface, and it's never gonna happen again. So we're giving kids a very limited exposure. But if we could give kids an exposure to gravity, we could provoke change. When we put them into positions, we could expose them to gravity and it seems like the exposure to gravity is the magic ingredient that provokes neuromuscular responses. So, what that means in plain English is that when we expose kids to gravity or when we put them into a position, or we're doing an exercise where we're presenting the dilemma to the brain. The dilemma is, how do I re establish balance? Right? Rachel just took me and she tilted me and now how do I re establish balance? How do I get back to midline? How do I achieved homeostasis when now you kind of mess up my whole world? And the answer the brain has to give when you expose the child to gravity is I need to do it myself. Because I presented a cue, and I'm not doing it for you. Here's gravity, welcome to the real world. Now I need to do it myself and when a child is in that position, you tilted them off center on your lap, and they come back to center, the brain just made a new connection. That connection says screens from the rooftops I can do it and if I was put at a risk of falling or perceived risk of falling, and I did it the next time, I could do it myself, but I could do it faster and stronger and more coordinated. Yes.
Rachel:Beautiful.
Jessica:Yeah, you're talking about the vestibular system, which is one of my favorite systems, because I love vestibular. And so yeah, absolutely.
Jake:Yeah. And it's amazing how, you know, we, as clinicians, we so often compartmentalize the different systems of the brain, right? You know, somebody who will be a master at sensory, and somebody will be a master at the vestibular stimulation, and then the other person will be a master at fine motor. The truth is, we're all connected. There is no separation between the two. We are only separated by our personal approaches to it. But the truth is, it's all it's this cohesive symbiotic relationship and if we take the ingredients of one thing, then everything improves, right? When we get or when we provoke a response and we get that response, we're provoking everything. Something I always see in CME is that people ask me, Well, how do you address sensory? And I say, Well, I don't address sensory, the brain addresses sensory. Because when I'm improving brain function, and the child is getting all these new experiences, I'm eliminating a lot of that brain immaturity that really held the child back. Part of that immaturity is, well, what do I do with all the sensory information? So when the motor cortex is now exploding with positive with a barrage of positive gross motor information. Yes, the sensory system and the vestibular system and all the systems are going to have this beautiful improvements as well. So I don't need to work on everything. I need to focus on what I'm good at, and then let the brain sorted out.
Jessica:And I think that that's like a big misunderstanding in the world is that like, sensory integration is separate from other things, when really, it's not like, our everything we experienced throughout the day is sensory, and we just, we don't realize it until it's brought to our attention.
Jake:Yeah, I think that's such a great point. That's such a good point.
Rachel:All right, I am dying to hear the case study.
Jessica:You've just been sitting here thinking about it.
Jake:Okay, I'm gonna give you first an example about kind of bringing all of the things that I just threw at you an example to bring it all together, but I promise you, I'm gonna get to that case study. I'll even give you the mom's number on it. After I tell you the case, that you're gonna want it okay.
Jessica:Well, we need to interview them. Her? The mom?
Jake:You can she she sassy as hell, the mom. So you're gonna love talking to her?
Jessica:Oh, We will need to. Okay.
Rachel:Yeah.
Jake:Okay. So let's look at an example so we have a child with Down syndrome, who's now eight months old, he just mastered had control and now he could roll prone to supine from his belly to his back. So traditionally, PT would approach his child and they would say, okay, the child is rolling from his belly to his back. So what's the next logical thing? Let's work on rolling back the belly, because that's the next thing and we're going to keep working on them until the child masters that because as the next skill, that's kind of what we're going for, right? And the PT is also going to bring their ball and they're going to put the child on the ball and they're going to work on trunk control through writing reactions, and giving the kid a lot of trunk support when they're doing that, because after all, the child has Down syndrome, right? So we have to be careful of, you know, their, their cervical spine, and we have to, you know, be careful with all those contraindications and things like that. Okay. Now, the approach that I'm laying out today, it differs. Now, of course, I would agree you have to work on rolling supine to prone from their back to their stomach, but I'm also going to work on trunk control, and I'm also going to work on commando crawling. I'm also going to work on rocking quadrapen and crawling and supported sitting, and I'm going to give this kid a ton of exposure to gravity. Okay, so the approach is different. The approach is pushing the child way, way further than what we've been typically taught is the accepted route of, of treatment. and what to expect from the child. And by stimulating the brain in this way, what we're doing is we're pushing the brain to tap into the potential of what's already there. We're creating new neural connections, and we're helping the child achieve much, much more. And I think that parents need to keep a few things in mind if they're going to try to implement this approach, right? Number one, the best thing is early intervention., get on that. Let them know that you're pregnant with a baby with them syndrome, God bless you. Read this article on, jump in, start from the day your baby's born, you're going to be so successful if you do this every day. So start as early as possible. And as soon as your child is able to do tummy time, start with tummy time and make that the default position and do everything you can in your power to help this kid just crush their head and trunk control as early as possible and make sure you work on that until it's perfect. Because everything else comes off of that on the head and trunk controller in place, everything else is going to get easier. So that's number one. Number two, this is not going to work by good intentions alone. You are not going to be able to do this, unless you're going to work. How much time is enough working? Think of your work with your baby with Down syndrome as a therapy intensive. Okay, therapy intensives mean that we need to barrage your baby's brain with as much healthy gross motor information as possible and the way we want to do that is shoot for 20 to 45 minutes, twice a day. And by doing that, we are giving the child not only the exposure to all the things that we're trying to stimulate the brain with, we're also giving the child plenty of time to practice and we're also constantly pushing and provoking the child to do more and more. So as you do this, you're going to find that your baby is going to respond. Now, as I said before, implementing this means that you need to know what comes next. It's extremely important, but you're also going to need to know the hands on skills to provoke your baby properly, you're not going to make this up as you go because you're not a therapist, right? And if you are a therapist, you need help in determining which exercises are appropriate for your child. This is not some cookie cutter approach, you need somebody to help you through it and therefore it's so important that even if you're in a location that your city or municipality does not provide services, you need to make sure your baby has at least PT twice a week. So unfortunately, there's a lot of places I traveled a lot and I see a lot of places in the US and for sure when I've traveled abroad, that there are no physical therapy services being offered. If you want PT, you need to hire somebody, and I'm telling you that for your baby with Down syndrome, I don't care how much it costs you or how many teletherapy sessions you have to do, get on that. Your baby will be so much more successful by you doing that make sure your baby has the right guide. Kind of think of it like the Sherpa climbing Mount Everest, right? You could know how to get you think you know how to get to the top, but unless you had somebody with you, who guides you and shows you how to do it without killing yourself, you're gonna have a hard time, right?
Jessica:Yeah.
Jake:And a fair a great therapist is is just indisposable. So I think that parents really need to do that. I think also that parents need to demand that their PT shows them a great home exercise program. You can have the best PT in the world, but if they can't convey to you what you can do at home between sessions, you're just not going to be as successful. I always tell parents, there's 168 hours in the week, if I come to your house for one hour, you can't expect that your baby is going to respond for one hour if there's another 167 hours in the week. You got to make sure that you're doing the work in between the sessions.
Jessica:Absolutely. If I always I always compare that to going and working out at the gym. You can't work out an hour a week and expect results.
Jake:Exactly, exactly. And it's so important. It's so important. And I think unfortunately, that's something that a lot of parents tell me is that when I've had many times where a parent will have used a different physical therapist, and then they'll switch to me for whatever reason. And they'll tell me oh my god, well, I have a whole home exercise program. Like they, they never they couldn't believe that, Wow, there's so much I could do at home. And it's unfortunate that, you know, sometimes it's not even anybody's fault. It's just people focus on treatment.
Rachel:Yeah. And I think that sometimes parents don't know that they can advocate to get a home exercise program and they need to start asking those questions to say, hey, what can I do while I'm not here with you? And can you give me some activities and exercises to do so I think that just empowerment of parents to be able to speak up and advocate for themselves and their kiddo.
Jake:I think that's a great point. I think also, sometimes parents can get a little bit intimidated because as a physical therapist, they might say well, you know, you're the professional and you know, you're coming here, you're gonna help me fix my baby. But the truth is that there are so many create interventions that parents can do even if your handling skills are not great. and even if you haven't ever tried it before. There is so much you can do, you can the way you hold your baby can make a huge difference in the outcomes for your child's trunk control and, and what they can accomplish. And I really, I think that's such a great point. Parents need to speak up and say, I really need help here. I really need you to teach me something that I can do at home.
Jessica:Yes,
Rachel:Let's take a quick break and talk about the sponsor for today's episode Harkla. Like we said earlier, they make high quality products, things like sensory swings, weighted blankets, lap pads, compression sheets, body socks, all the things you guys know we love.
Jessica:So we had the chance to try out a few of their products like one of their swings and weighted blankets, and they are definitely top shelf, you guys. Their products are great and yeah, you can go buy a sensory swing on Amazon. But when you purchase it from Harkless, you know where your money is going.
Rachel:If you're a therapist looking for new products, if you're a parent, and you need some new equipment for your kiddo, whoever you are, you guys have to check these guys out, ASAP.
Jessica:Okay, we're gonna get back to the episode. But stay tuned, because at the end of the episode, we're gonna give you a code for a discount with these guys.
Jake:And, you know, I want to also give a little caveat here, I know that not every child with Down syndrome is going to be able to achieve the goals that I laid out here. But even if you just use this as a framework to pursue, and you say, this is something I want to start doing. This is something maybe my child's, which my child with Down Syndrome has already, you know, two, and I didn't start early enough, and, and this is something that I can't achieve, I want to tell you, that's not the, that's not the case at al. This is something that you can do and even if your child doesn't do it perfectly, and maybe starts walking at 30 months, the fact that you worked in this way through exposure to gravity, and through working on the neck skills, and through educating yourself, your child will end up moving more efficiently,. Your child will be stronger, your child is going to be more coordinated, and the next time you try to do something and you're walking in the park, your child is going to step over that obstacle, okay? Because you worked on it, and your child is going to be able to walk on that wobbly bridge that every park has and they're going to be able to climb up those steps without holding on, you know, when there are other kids around it. The the potential is immeasurable and I want to encourage parents that even if you think you're getting a late start jump in, because it's going to be great.
Jessica:Yeah, it's never too late to start.
Jake:Absolutely, absolutely. And you know, a lot of parents, when they don't have access to PT, or maybe not as much PT as they want. I encourage parents find a professional who you were you, you know, who you like, find somebody whose work you respect, reach out to them. For me, personally, I have done more teletherapy in the past six months than I have done in the previous 23 years combined. So many people from around the world reach out to me to do teletherapy. I don't think I've ever spent this much time in front of a screen my entire life.
Rachel:Good for you, finding those people and for having them find you and being able to help them. That's amazing.
Jessica:It is.
Jake:It's really It's such a huge blessing. I had a few parents tell me that they learned more and it's gonna sound like I'm bragging, but I'm not. Because parents, I had a few parents tell me in the past couple of months doing teletherapy that they learned more in the one hour with me and teletherapy than they have in the past six months with regular PT.
Rachel:Gosh.
Jake:okay, now, I'm not saying that to brag and the reason I'm bringing this up, is because the point is that what I am giving them as a service is that I am explaining to them how gross motor movement works. I'm explaining to them what the potential is and I'm laying out a plan of action and I don't know if they've done that before. So when I'm laying out this plan of action or any plan of action for any family, and I'm giving them a home exercise program that works that is profound and that is something that parents relate to. So whether you reach out to me to try CME or you reach out to another therapist either found on social media or they reach out to you guys to connect you with somebody or to work with you guys. Whatever it is, don't stop at where you are. It's not offensive to your current PT what you do, after hours to look for more health for your child. You are the advocate. You are the one who is helping your child you are the one you are the mom, you're the dad, you're the one who has to fight like how to make sure that your child reaches their potential and it's only you. Nobody else is jumping in like that. So work on it and fight for it because everything is possible when you do it.
Jessica:Yeah,.
Rachel:I love it. That's like my favorite thing about podcasting is just being able to meet all of these professionals who are so passionate
Jessica:and making a difference.
Rachel:Because it's so easy to just go through the rope. What is it? go through the motions, as a therapist just go to work, go home, but it's people like you who actually put in the work outside of their daily job and really make a difference in these kiddos lives. So
Jessica:yeah, exactly. All right. So we still need to hear that case study before we wrap it up.
Jake:Yes. Okay. I promised it and here it comes. I'm working with a family. I am working with a family from North Carolina, via teletherapy. I have never met this family in person. Okay. They reached out to me through Instagram, when their baby with Down syndrome was three months old. They found me and they I taught them that that I introduced them to the Cuevas Meex exercises approach. I taught them exercises that they were supposed to perform daily as a home exercise program and then after that, we followed up every four to six weeks to update the home exercise program. Now mom was home because of COVID. She is a health professional, but she was home because of COVID. And she ended up working with her baby with Down syndrome about three hours a day. Okay, now that sounds like a lot. But what she really did, she wasn't doing exercises for three hours a day, what she was doing was she was incorporating the strategies and the theory that I taught her into everything that she did. So that everything she did with this child was therapeutic. The baby is now seven months old, adjusted, and she's sitting independently.
Rachel:Wow.
Jake:That is completely age appropriate for typical development.
Jessica:Yea it is!
Jake:That is not typical for Down syndrome. Typical development, this child is sitting independently when you place her down, she sits. She just sent me a picture today actually, she said because we we communicate via WhatsApp between sessions, she sent me a picture of the child standing by an activity table. She's seven months old. So what I'm proposing here, I'm telling you, it can be done and this baby is living proof of it. And this mom is she is the fighter. She has the sassy fighter who said you know what, I'm not going to take what they give me and take that at face value. I am going to take this and I'm going to run with it because I know that the the norms that have been handed to me are not what I want for my child. What I want for my child is I want the best possible scenario, the best chance of success at everything in life starts not when your child is three, and they're learning their ABCs. And it doesn't start when you teach them hold a crayon, and it doesn't teach it's not the first time they sit in a school chair and they sit you know where they sit in the in circle time. It starts when they were a baby, when you're making them strong. It starts when you teach them how social interaction is supposed to look. It happens when their trunk control is strong and their head control is strong and they're reaching their milestones in a great way. They are ready for life. They're ready to tackle the world and this mom is living proof that if she can do it, anyone can do it. There is absolutely besides her her fierce spirit as a mom, that mom spirit that just makes one makes her want to fight for her kid. She doesn't have additional handling skills. She's not a physical therapist, she didn't go to special school to learn how to do these exercises. She simply implemented what she was taught because she took the initiative and took it to the next level and this child is doing amazing. Seven months old, sitting by herself. I'm like, I'm over the moon for this mom.
Jessica:So exciting.
Rachel:Wow. Just little changes in there throughout the day. How big of an impact.
Jake:Oh my god, it's so awesome. I just get because I get goosebumps when I talk about it. Because, you know, I wouldn't be surprised if this kid was way earlier than 17 months.
Jessica:At this point,
Jake:you know COVID-19 For some people, it's been a real blessing. You could I tell you that's a crazy story. You guys would appreciate this, your therapist. So I had carpal tunnel surgery on my right hand and I'm a rightie Okay. You know, doing CME especially, it's extremely hard
Jessica:Oh no. on our hands and you know, working with kids is just really, really tough. We are on the floor, where it's very hands on. It's very manual. Okay. But coming into March, I had a really bad trigger finger that was popping up in my right hand. I would wake up it couldn't open my fist. It would take me you know, maybe an hour to really warm up my hands enough to do my work. COVID-19 hit. I didn't work for eight weeks with one child and I'm all better.
Rachel:Oh my gosh!
Jessica:That's terrible.
Jake:8 weeks of rest, I have never in my entire career had eight weeks of rest. Eight weeks of rest, I was only doing teletherapy and my hand is completely better. It went away and then never came back. Thank god.
Jessica:Oh my gosh, how terrible and funny.
Rachel:I feel like we've seen a lot of improvements in our kiddos with COVID. You know, it's as traumatic as it's been, you know, there'd be kids who we wouldn't be able to see. And they just be able to, like, implement the strategies that we've learned and just live with their families and their peers. And we have kids who are just rocking it, you know, they come back to therapy, and we're like, who are you? You needed that break to be able to implement everything and and process it and then a little bit different. So definitely.
Jessica:We could keep going. But we need to probably wrap it up a little bit.
Jake:Yeah.
Jessica:So what's the best way for parents to find you sounds like Instagram.
Jake:Instagram is great. So about two and a half years ago, I started my Instagram page, my goal was to showcase my work, but also to really showcase what CME is, and how it could really bring hope to families. That's something that I've tried to do. I show a lot of the exercises there and I kind of show parents how even children with severe global delays can really be helped and how they can make significant improvements using the CME method. So Instagram is definitely a great way to reach out to me. I'm so happy I finally launched my website, it was something that I was working on for a while. My website is called GetYourBabyMoving.com and I'm slowly building up the content on my education part, big exercise, the article that we discussed today about Down syndrome was a recent a recent upload. Also, I just uploaded one about teletherapy using the CME approach. There's a few other ones there, you know, CME heavy, but also some other things that's, you know, general information, for PT and for parents to use as a resource. So, those are the best ways to reach out to me and yeah, I hope parents reach out. Feel free to reach out with any questions or concerns and if anybody needs any clarification, I'm happy to help.
Jessica:Perfect.
Rachel:Well, we will make sure to link everything that we chatted about today, in the show notes, so people can not only find those resources, but they can find you and reach out to you. Because it's awesome that people can work with you from across the world.
Jessica:Yes.
Jake:Yeah, it's super cool. It's been a huge blessing to be able to help so many families. And it's really cool. You know, I work with families in Singapore, and India, and all over the US. And I just had a family from Australia, and the kids started doing something during our teletherapy session that they never did before and it's just like, so beautiful. Like, hell yeah. Like, let's, let's try that and the kid just picked up on it right away. And it's just, it's just so beautiful to be able to share that experience with people. And like I said, before, we're all we're all super connected and now being able to share that experience with people around the world is just a huge blessing in my life.
Jessica:I'm really grateful for it.
Rachel:For sure. Well, Jake, we appreciate you taking time out of your evening to hang out with us.
Jessica:After a long day at work.
Jake:Yeah, it's really my pleasure. You guys are so awesome and you know, thank you for what you do. You know, you're you're sharing so much information and you're really connecting to so many professionals and through your podcast, you're really helping so so many people and thank you for what you do, guys. Really awesome.
Rachel:Your welcome.
Jessica:Thanks.
Rachel:All right, we do well, we will stay in touch and we will chat with you soon.
Jake:Thank you so much, guys. This is so much fun.
Rachel:All right, you guys. One last reminder, this episode was sponsored by ha, our newest favorite sensory product company with less opportunity for movement in today's virtual world. And with how much we love obstacle courses. This company is the perfect place to shop for equipment to set up bomb obstacle courses.
Jessica:Okay, so if you're unfamiliar with obstacle courses, let's give you an example. You can use Harkla indoor therapy swing and your child can swing on their stomach to gather in items such as a puzzle piece. Then climb out and jump across a pillow bridge while in their Harkla sensory body sock and place their puzzle pieces on the board, then do a wheelbarrow walk. Super simple, super fun and so many benefits.
Rachel:So if you guys are ready to check them out, go to harkla.co/sensory and you can save 10% on any of their products by using the code sensory.
Jessica:We will link this in the show notes in case it's easier for you to have it in writing and that's it. Okay, you guys, he has so much energy and so much passion. I hope you could hear it while he was talking. I hope that you laughed a little bit and learned a whole bunch of things because we definitely did.
Rachel:We I was gonna say we definitely did. So what's awesome about Jake, he's such a go getter, he had actually reached out to us and sent us his plan for change for the Down Syndrome Community and we absolutely loved that. So just wanted to say thank you, Jake, for reaching out to us and sharing that with us. So that way we can spread your message and we can spread your passion and hopefully just ignite this community to follow in your footsteps and continue to advocate for not only the Down Syndrome Community, but also for the Medex community, and just to really increase awareness in all of those areas.
Jessica:Yeah, so make sure you go check him out on Instagram, check out his research articles, everything will be linked in the show notes and on the blog at the sensory project. So go follow him on Instagram for sure.
Rachel:Yes, his instagram handle is get your baby moving, which I love that.
Jessica:Yeah, it's perfect. It's exactly what we talked about all the time.
Rachel:Yep. All right, you guys, if you have a minute to leave us a review on iTunes not only would we really appreciate that, but we know Jake would appreciate hearing your feedback on this episode as well. So you can pop over there and just take a second to leave your thoughts, if you wouldn't mind.
Jessica:And we will talk to you next week.
Rachel:All right, bye. We are so excited to work together to help create confident kids all over the world and work towards a happier, healthier life.
Jessica:Just a friendly reminder, this is general information related to occupational therapy, pediatrics and sensory integration. We do not know you or your child therefore, we do not know any specific. Therefore you should always refer back to your pediatrician and occupational therapists for more information.