STATISTICS REVEAL NEARLY 14 PERCENT OF CHILDREN ages three to 17 have some type of developmental challenge. In 2013, one in 50 children was identified with an autism spectrum disorder. As a profession, doctors of chiropractic understand the benefits of chiropractic care for the neurologically disorganized. We are familiar with the outstanding work being done by specialized treatment centers like Oklahaven and Kentuckiana, but for many families the distance to a specialty center is prohibitive.
Logan Chiropractic and Wellness Center at Austinhaven has successfully integrated care for special-needs children and adults. This article details five practical how-to’s that will equip and empower you to offer treatment for special needs families in your community. You will learn the benefit of a dedicated treatment room, scheduling strategies, frequency of adjustments and proven methods for identifying developmental delays and documenting improvements. In addition, you will learn the value and necessity of reading and responding to patients’ needs.
Dedicated Treatment Room
All patients value consistency of care and knowing what to expect when they visit a doctor’s office. This is even more critical for special-needs families. We strive to make each visit as routine as possible. One of the ways we accomplish this is by providing a dedicated treatment room.
Patients appreciate the familiar space and decor. After a few visits, they know the way to “their” room. Our ideal treatment room has a sturdy table, strong walls and a door or curtain. Use low light, and avoid fluorescent light if possible. Provide books, a wobble chair and small toys for the patients to hold to keep their hands busy. Allow the patients some time to prepare and settle into the environment.
If you use an open adjusting area, scheduling will be critical.
A dedicated treatment room makes patients and families comfortable. Scheduling strategies are all about keeping you, the provider, confident and calm. Special-needs patients are particularly sensitive. They pick up on the energy or demeanor of the people around them. They will reflect your energy and demonstrate it in their behavior. In some cases this is the only way they know to communicate.
Avoid scheduling special- needs patients during prime adjusting times when your energy is at maximum. Rather, schedule them before or after prime time. Take a moment to compose yourself, slow down, move at an appropriate pace and do not rush the patient.
Use a visual reminder of the state of mind you need when you walk into your dedicated treatment room. I have a sticker on the door frame that reminds me to be peaceful and patient. Be mentally and emotionally present and physically alert.
If a special-needs patient acts out, know it is not the doctor’s responsibility to correct behavior. Chiropractic physicians are there to deliver the adjustment and treatment. At times the best strategy is to leave the room, have the parent or caretaker deal with the behavior and then come back in. Consult with the parent or caregiver about the patient’s most receptive time of day. Experiment with morning or afternoon time slots to find the best fit for each patient.
Special-needs individuals can have an array of physical, mental, developmental, emotional and neurological challenges. This is why frequent adjustments are necessary. We have seen great success and results with daily adjustments for the first week, then three times a week for 90 days and twice a week moving forward.
As with many patients, sometimes we see immediate changes. For example, a 17-year-old patient with autism began communicating with intention after her first adjustment. Her caretaker called and told us the patient went into her purse, took out her cell phone and had a pizza advertisement in hand. She just didn’t know how to use the phone. I assured her, “That is normal teenage behavior. This is a good thing!” Another child who had skipped creeping and crawling was able to employ a toe dig after the third adjustment.
Other times it takes longer for changes to be observed. One nine-year-old patient with autism was grossly delayed in visual tracking. When asked to open a jar, empty the contents and then put the contents back in the jar, she could not perform the task. She struggled at subsequent progress examinations. Finally, after one year of twice-weekly adjustments and performing visual tracking exercises, she was able to perform the task.
Our 17-year-old pizza eater was completely non-verbal. After a year and a half of treatment, she began to make the sounds “p” and “w.” On another occasion she was at a group event and communicated through sign language that the leaders were pushing one of the participants in the group too hard, demonstrating that in addition to communication skills, she was also developing compassion.
Adjustments are a commitment for parents, but as they begin to see progress in their child, they understand the value in adopting a chiropractic lifestyle.
Identifying Developmental Delays - Documenting Improvement
We use a developmental chart that has its origins in the Philadelphia School of Human Performance. Categories include motor, language, visual, auditory and tactile, with skills from one to eight years of development. During evaluation we test startle reflex, light pupil response, convergence, Babinski’s reflex, eye tracking and level of stereognosis. Supplies for performing evaluations are best kept out of sight until needed. Take out one item at a time and return the supplies when the test is complete.
Once you identify the weakest link in development, focus on that area with treatment and adjustments. Collaborate with other therapists to address the delay. Ideally re-evaluations take place every 90 days. We use the chart to document improvement and show parents the progress being made. The chart also provides focus and a goal for doctors. Our experience shows that when a patient reaches the developmental goals of an eight-year-old, he or she begins an upward spiral.
Reading and Responding to Patients
Because of the communication delays so often present in special-needs individuals, it is vital that you as the doctor learn to read and respond to each patient’s needs. There are many things that can trigger behavior. If a patient seems agitated, ask the parent or caregiver if the patient could be hungry or tired or if something happened that day at school, at home or on the way to the office that the patient has not had time to process. A patient may need to relax and regroup in the treatment room before he or she is ready for the appointment.
The goal is to maintain a peaceful environment. Too much stimulation in the office can trigger undesirable behavior. Keep distractions to a minimum. Avoid loud music, shredding, unanswered phones, slamming doors, etc. I have noticed that even the clothes I wear can be a distraction.
During a recent Austinhaven seminar, a first time patient presented with severe forward head posture (FHP). His caretaker told us he never lies on his back. Every chiropractor in attendance was concerned about the severity of his FHP. We worked slowly and patiently to ease the patient onto his back using a cervical neck pillow for support. At one point he jumped off the table but then lay back down again. The caregiver supported our requests, and we continued to encourage the patient. He was finally able to put his head back for treatment. Empathy, gentleness and patience helped him relax.
It is exciting to watch patients awaken to life and to help parents find peace in their homes. Confident and compassionate local chiropractic care will bring new life and hope to your community.
Debora Logan, DC, LAT, ACN has been practicing in the Austin, Texas area since 1993. She launched Austinhaven in 2008 to serve special-needs families in the community. Dr. Logan teaches a biannual seminar for chiropractors on the care of special-needs patients. For more information, visit www.Austinhaven.com.