11 Questions for a Pediatric Physical Therapist

Santioni Daniel PT_SJA4974_resizedA pediatric physical therapist specializes in treating and caring for infants, toddlers, teenagers and young adults, and can treat conditions related to genetic, neurological and orthopedic disorders. In this Q&A, Daniel Santioni, Director of Pediatric Services, Probility Physical Therapy, answers some of the most common questions parents have about their child’s development.

    1. What kind of physical therapy does a young baby under 6 months need?
      Physical therapy (PT) can address several issues that are common under 6 months. In fact, early diagnosis and treatment is key to continued success in growth and development. Often PT at this age can address delay in motor skills, orthopedic concerns such as joint deformity or torticollis, feeding concerns and their inability to self-console.
    2. How do you know if a baby under 6 months is delayed?
      Often experienced mothers and fathers know that “this” baby is just not doing the same things their other babies did. First-time parents should pay attention to published milestones they may find at their doctor’s office. There are standardized tests to evaluate for delay, but generally, by 6 months your child should be rolling and working on maintaining sitting by themselves.
    3. I feel my child is impaired. I am an experienced parent and I know something is wrong. My child is only 8 months old, but what can I do?
      The first thing you should do is address  your concern with your doctor. Asking for a pediatric therapy referral would be a good start in trying to figure out if there is anything wrong. Your physical therapist can perform developmental , orthopedic and neurological testing to assist with any diagnosis your doctor may want to pursue. Physical therapy can often help prioritize what to focus on in terms of treatment, and help you stay focused on what you can do to help your child succeed.
    4. My baby is having a hard time feeding – they are biting instead of sucking. It takes them a long time to feed, and my baby seems exhausted after feeding. Can physical therapy can help me with this issue?
      Feeding issues and concerns are common with a young infant. Often biting or chomping instead of sucking may mean there is a physical restriction to the normal suck, swallow and breathe pattern. A physical therapist can address the physical restriction to mouth opening and closing, and can help steer you to other professionals, such as a speech or occupational therapist,  who can focus on teaching the normal feeding pattern.
    5. My baby just turned 12 months old and is not walking or even pulling up to stand. Should I be worried?
      Pulling up to stand at a surface is a 9-month skill and taking the first few wiggly steps is a 12-month skill. Having said that, you must remember there is a range in which development is “normal.” Not all children walk at 12 months. With walking there is a “normal” range of 11-14 months. Pulling to a stand also has a “normal” range of 8-11 months. If your 12-month-old child is not pulling to stand, a physical therapy evaluation may be warranted. You may find, with the right intervention, your child may catch up very quickly.
    6. I have been told my child has Torticollis – is this permanent and how can physical therapy help?
      Torticollis is usually due to tight neck muscles which prevent the baby from turning their head in one particular direction. Physical therapy is a very successful tool in resolving torticollis through gentle stretching and developmental play. The sooner torticollis is addressed, the faster it is resolved. Torticollis, if caught in time, usually is not permanent.
    7. My child had torticollis and they look better. Now I notice their head is not round. Can therapy help this?
      If your child had torticollis, the resulting misshaped head is called plagiocephaly. Physical therapy can address this through positioning, developmental play and manual techniques. If the misshaped head is not corrected in 4 to 5 months, the recommendation is to get a helmet to assist in reshaping your child’s head. This would require you to meet with an orthotist to fabricate and do frequent fittings of the helmet.
    8. My child is 3 years old and has walked on their tip-toes since they started to walk. Everyone is telling me they will “outgrow” this. How long do I wait before I get help, and what kind of help can I get for this?
      Generally, as children learn to walk, for the first few months (12-18 months) they will “play” with coming up on their toes. This means they may walk flat-footed for a few steps then up on toes for a few and then back down. If your child is exclusively toe walking after the age of 18-24 months, I would recommend bringing this to the attention of your physician and get them into physical therapy.  A pediatric physical therapist can help figure out why the child is toe walking. Once the evaluation is completed,  the physical therapist  will  provide a combination of stretching and strengthening exercises to get your child walking in a normal heel-toe pattern.
    9. My child has been toe walking for years and is now “stuck” on their toes. They cannot at all get their heels on the floor. The doctors are looking at referring me to a surgeon. Can physical therapy help me now?
      Working with your doctor, a physical therapist may still be able to help in this situation. Being “stuck” on their toes may mean that their heel cord is contracted. A physical  therapist can provide a treatment called serial casting. This would involve casting the ankle and progressively lengthening the heel cord until they can move their ankle again in all directions. Once the ankle is loosened the physical therapist can then address strengthening and retraining your child how to walk with heels down.
    10. When observing other children on the playground, I am noticing my child is always falling. They are usually asking the other kids to wait for them, and at times just doesn’t want to participate. As a parent, I often wonder if there is anything I can do to help. Can physical therapy help?
      A pediatric physical therapist can perform standardized testing to see if your child is truly developmentally behind. If your child is delayed, the physical therapist will design a custom program to address the areas of development to help your child “catch up” with their peers.
    11. My 9-year-old son broke his leg. He was casted and is favoring that leg. Everyone said he would be fine, and told me to encourage him to just be himself. No matter what I try, he resists. Can physical therapy help with this?
      Yes, often after being casted, muscles  become weak, tight  and need  physical therapy to get strong again. Often children have a fear factor to overcome as well. The pain that they experienced at the time of the injury  can affect them for a long time. A physical therapist can help your child physically work out his fear while strengthening his leg. The goal of physical therapy would be to normalize his walking pattern and eliminate this “favoring” of one leg over the other.

Dan is accepting established and new patients at Probility Physical Therapy, 2058 S. State Street, Ann Arbor, MI  48104. Call 734-913-0300.

The Farm at St. Joe’s Hosts 2018 Bark for Life – Aug. 25

barkforlifeANN ARBOR – Join us Saturday, Aug. 25 for the American Cancer Society’s 9th annual Bark for Life event at The Farm at St. Joe’s. See flyer.

When: Saturday, Aug. 25, 2018 from 8:30 – Noon
Where: The Farm at St. Joe’s – St. Joseph Mercy Ann Arbor
Register: www.RelayForLife.org/BarkAnnArborMi
More Info: barkforlifeannarbor@gmail.com or 734 834-3454

Costumes encouraged and prizes available.

What’s good for your gut is good for your health

Your body contains a complex digestive system made up of the gastrointestinal tract (esophagus, stomach, small intestine and large intestine) as well as the liver, gallbladder, biliary tract and pancreas.

Naveen Reddy, MD

According to Naveen Reddy, MD, a St. Joseph Mercy Oakland gastroenterologist, “While these organs work in conjunction to metabolize, digest and absorb nutrients from our diet, they also have numerous other functions to maintain health. For example, the pancreas produces insulin to help control a person’s blood sugar. The liver is responsible for metabolizing toxins and numerous types of medications a patient may be taking. And the large intestine contains billions of healthy bacteria which help with digestion and help maintain normal, regular bowel movements.”

Any one of these organs failing to function properly can cause health concerns. According to Dr. Reddy, “Symptoms can range from a minor discomfort from acid reflux or mild constipation, to severe, life-threatening issues such as unintentional weight loss, vomiting blood or jaundice (which is a sign of severe liver disease). Some digestive symptoms can become life-threatening if not addressed early.”

If you notice a change in your bowel habits, bleeding or any other digestive issues, Dr. Reddy advises you to discuss your changes with your primary care physician and ask if a referral to a gastroenterologist is necessary.

According to Bashar Okka, MD, a St. Joe’s internal medicine physician, “A healthy digestive system begins with a healthy diet and maintaining a healthy and a well-balanced caloric intake that includes five or more servings of fruits and vegetables a day.”

Dr. Okka says that most people who follow simple, healthy lifestyle choices can avoid disruptive digestion problems. If you do experience digestive issues due to a specific food, avoidance of digestivesystemthat food is a key, says Dr. Okka. He says that treatment for a simple upset stomach triggered by certain foods or alcohol can begin with an over-the-counter antacid. However, he warns that patients should not use an over-the-counter antacid for more than two weeks.

Any upset stomach or heartburn that lasts more than two weeks or does not respond to simple over-the-counter treatment should prompt a consultation with a physician.  Dr. Okka also recommends that any upset stomach with other symptoms, such as nausea, vomiting, diarrhea or fever, should prompt a visit to your physician’s office as soon as possible.


WAM Day Three – The Last Hurrah and Wish Kids for the Win

Members of Team Joe’s assemble at the finish line following their 300-mile tour of the Wish a Mile Michigan. Through their remarkable efforts, 28 Michigan kids will receive wishes from the Make a Wish Foundation.

By Rob Casalou

The morning of day three at Grand Ledge High School was dark (we get there about 5:30am) and cool.  The emotions are running high from both excitement to be on the final leg of our journey… and also a bit of anxiety since the legs are feeling a bit worn from the tough 206 miles it took to get here.  But our Team Joe’s riders were ready to go and hit the road before 6:30am.  Today’s goal…Hero’s Hurrah at the finish line where family, friends and all our wish families would be gathered to celebrate with us.

The route today was all-new because of the change in venues of our start and finish.  Grand Ledge High School was simply awesome and we cannot thank the school and staff for making us feel so welcome and providing an overnight home for us.  Eaton Proving Grounds was our finish (replacing MIS Speedway) and words will not do justice in how much we thank Eaton for their generosity and all-out effort in putting on a great beginning on Thursday and a great finish today.  Now, in between those two venues was some adventure.  Remember, we live in Michigan and the roads ranged from newly paved and perfect, to a hot mess of potholes and cracks.  But we saw another day of scenery of our great state and it was great to see the waves and encouragement from people as we passed through their towns – some we had never heard of!

Halfway to the finish line, we welcomed several new riders to our team – the 50-milers! I was so happy to see fresh, smiling faces ready to share our journey to the end.  Now, I speak from experience that a 50-mile ride is no joke. If the 300-mile ride seems overwhelming, the 50-mile, one day ride is a great option to support wish kids and test your endurance.

Dr. Ro Tocco-Bradley and Patrick Hoban, all smiles at the WAM finish line.
One of our 50-mile cyclists was my dear friend and colleague, Dr. Rosalie Tocco-Bradley. She’s been the light and soul of our WAM rides for the past several years. This summer, however, Ro fought her own battle with breast cancer, but less than two months after surgery, she was back on the bike, riding alongside us and cheering us on. Her unstoppable spirit put surge in our wheels and carried us to the finish line.  

Our team broke up into about four or five different groups with some very fast (our Probility team members) to everything in between.  But we all ended up at the meeting place inside the grounds at Eaton where we gathered as many members of our team as possible before heading to the Silent Mile and then onto the track for a final lap to the finish. 

The Silent Mile is special.  It really isn’t a mile but a small grassy hill that is strewn with stars bearing the names and pictures of loved ones lost too soon and in whose memory riders had dedicated their ride.  A few members of Team Joe’s had placed stars so it was time to pick them up, pause in reflection and take the star across the finish line.  I love this moment.  It is sacred and important and I can think of no better way to end our journey.

Watch video of Team Joe’s crossing the finish line –

img_0817After the silent mile, we headed out as a team to the final lap and to the finish and it did not disappoint.  Hundreds, if not thousands, of well-wishers were cheering loudly as we crossed the finish line.  What an accomplishment and a feeling of euphoria came over all of us.  It made all those moments of fatigue and pain over the last three days disappear.  In fact, shortly after we put our bikes down, most of the team members were committing to next year!

After we finished it was time to meet our wish hero, Emily, that was given to us at the beginning of the ride and we rode every mile with Emily’s name on our wristbands.  Unfortunately, Emily was not feeling up to being there today but we had another wish kid, John, who was just great and was so happy to put medals around our neck and patiently pose for pictures.  This was a special moment for him and for us.


After seeing our Wish Hero, most of us grabbed something to eat, packed up our stuff and headed home.  We hugged, we thanked each other and it felt kind of strange and sad to me that I would not be seeing this great group of people in the morning.  I feel a special bond with my colleagues on Team Joe’s both past and present.  I can’t wait until next year.

God Bless.


2018 Team Joe’s Roster

Robert Casalou
Ethan Andresmooi
Sarah Bahnke
Lisa Belleperche
Lee Benjamin
Andrew Blank
Diane Charles
Thomas Chouinard
Jonathan Ciani
Scott Dornbrock
Kris Eckman
Dylan England
Kathleen ENGLAND
Jodi Graham
Nick Graham
Jeffrey Hamilton
Steve Harwood

Gabriel Hoban
Patrick Hoban
Greg Hodder
Jena Hoffman
Susan John
Marvin Jolly
Ed Jones
Laura Kordick
Lila Lazarus
Brandon Lorenz
Dave McNeil
Chad Melchert
Dervla Mellerick Dressler
Eric Metzendorf
Russ Olmsted
Sarah Opdycke
John Parmentier

Jonathan Peitz
Tim Peterson
Dan Phelps
Kelly Poppaw
Mathew Ridley
Kortney Roof
Daniel Sestak
Eryn Smith
Jeff Stange
David Steinberg
Kate Sullivan
Mark Sundling
Abbey Wills
Bo Wright

WAM 2018: Team Joe’s on the Road Again

Day 2 – Big Rapids to Grand Ledge

This is the long day.  While the Wish-A-Mile is called the WAM 300 for the 300 miles we ride over the three days, we do not ride 100 miles per day. The first day we ride 99 miles, the second day we ride 107 miles and then we end with 95 miles tomorrow. Actually, doing the math, we ride a total of 301 miles. Guess it wouldn’t be as cool to call it the WAM 301…😀

We followed the same routine as our first day with a 5:30am breakfast and wheels on the road by 6:20am. It was a very cold morning so many of us wore jackets or used arm warmers to cut the chill. But it was a beautiful morning with a spectacular sunrise. In fact, we had sun all day and the temperatures and winds were favorable. It was simply a perfect day to be on a bike.

We cruised quickly for the first 45 miles and landed in Greenville for lunch at 9:30am.  Yep, I said lunch. By the time we got to Greenville we were starving! But waiting for us at our lunch stop was much more than food. There were some of the most amazing wish kids coming to the see and celebrate with the riders. We met Bry, Mariah, Dorlan and heard all about their awesome wishes. What was going to be a 15-minute lunch stop ended up being over an hour as we enjoyed talking to the children.

The second half of the ride after lunch was a bit more challenging. I think many of us were still tired from the first day. Whatever the case, we rest tonight knowing the best day is tomorrow…shorter and downhill!

The night wrapped up with the WAMmy Awards. As riders fill the auditorium, the night is filled with wish kids and celebration. And, for the very first year, Team Joe’s won the top fundraising award for Top sports teams and many of us won Elite fundraiser awards. That was very special and I could not be more proud of this team. The dollars we raised – more grant 28 wishes!!

After the awards, we all headed back to our hotels so we can get some rest and prepare our bodies for the last day. That is where I am heading now!! Good night.

Team Joe’s Takes On WAM 2018

Day 1 – Traverse City to Big Rapids

The travel day to Traverse City is always full of excitement and anticipation for all the Wish-A-Mile (WAM) riders but especially for Team Joe’s and our 40 WAM 300 riders.  The nervousness of our first-time riders is understandable because the idea of riding 3 days and 300 miles is daunting.  But everyone has trained hard for this moment and they all know that some very special wish children are depending on us to raise the funds for their wishes.

The first day of riding started today (Friday, 7/27). The day began with most alarm clocks going off around 4:00 or 4:30 a.m.  Each rider dresses for the day, repacks their bag and grabs the shuttle to the school if they stayed at a hotel or packs up their tent and sleeping gear if they stayed overnight at the school.  We agreed to meet around 5:30am for breakfast and gather on our bikes around 6:15am for a team photo and then to hit the road.

The morning went off without a hitch.  Temps were cool and it was dry when we started.   Wheels hit the road around 6:25am and Team Joe’s immediately sorted into groups of 6-8 riders of common speed preferences.  The early miles went quickly aided by a nice tailwind.  By 9:15am, our group almost put almost 50 miles behind us and it was time for lunch!  Yes, one feature of WAM is that you lose all concept of time…

Now, there was one unanticipated challenge today and that was the weather.  Although the weatherman predicted only a 35% chance of rain in the forecast, it was really 100% for about 25 miles before lunch and then for the last mile before we finished in Big Rapids!  We were soaked!  But the good news is that there were no injuries during the rain and, in fact, it was a safe day all around.

The first day of riding is our hill day and those 99 miles were chock full of them!  But we all endured and ultimately beat them back.  Having said that, I am just glad tomorrow is more flat…😀

Tomorrow we ride from Big Rapids to Grand Ledge.  The day is Ionger at 107.5 miles but should still make good time with a flatter route.  Same plan tomorrow….wheels on the road at 6:15am. Time to hit the sack.


If You Don’t Have Time, Make Time

by Lila Lazarus

Lila_Bicycle“It must be nice,” my friend said to me with a tinge of resentment as I got onto my bike.  “Having time to ride a bike is a luxury I can’t afford,” she said.  Her words hurt me.  She made it sound like I have all this extra time in my life to ride my bicycle.  The truth is, I don’t have extra time…I make it.  For the last six months, I’ve been deep into training for a 300-mile bike ride with Team Joe’s to raise money for Make-A-Wish to grant wishes to children with life-threatening illnesses.  It’s a three-day journey— 100 miles a day. Those of us making this ride have been training for months. There are dozens on our team who, like me, don’t have time…they make it. They are doctors and CEOs and lawyers and business owners. Husbands and wives, parents and students. Every one of them has a busy life. And none was given more than 24 hours in a day.

So if you’re one of those people who looks longingly at those riding their bikes, or playing with their kids in the park, or sitting and reading a book and thinking “Gee I wish I had time for that,” then these words are for you. Decide what it is you want to do and make a commitment. Continue reading “If You Don’t Have Time, Make Time”

What You Need to Know About the Ongoing Hepatitis A Outbreak in Michigan

MalaniAnuragHepatitis A virus (HAV) is a serious, highly contagious liver disease. Fortunately, it is vaccine-preventable, and the vaccine has been part of the routine childhood vaccinations since the late 1990s. But the U.S. population was ripe for a HAV outbreak, given the large number of unvaccinated adults, and Michigan is home to the largest ongoing outbreak. In this Q&A, Anurag Malani, MD, Medical Director, Infection Prevention and Control Services, St. Joseph Mercy Ann Arbor, Chelsea and Livingston, addresses who is at the greatest risk for HAV, and the most effective means of prevention. Continue reading “What You Need to Know About the Ongoing Hepatitis A Outbreak in Michigan”

Senior Fitness: Leave the Class Laughing

OAKLAND —  St. Joseph Mercy Oakland offers a senior fitness class at 15 locations, three times a week.  Every class is filled to capacity with a waiting list.  Why is this senior fitness class so special?

“I love the class.  I always leave the class laughing.  If I’m not feeling well when I arrive, I’m always feeling better when I leave.  I love the people, the instructor and the facility.  It’s so open and bright,” said 80-year-old Charlene Simmons.  Simmons has been attending the senior fitness class for 10 years.

“Our senior population, as they get into their golden years, often see a reduction in mobility and independence.  The senior fit courses are an opportunity for participants to exercise with  low-impact physical activity and movement.  It also facilitates a cohesive interaction and camaraderie with people in their community and it ultimately reduces isolation,” said David Bowman, MPA, director of community health, St. Joseph Mercy Oakland.

Unique to the senior population, ages 55 and older, bone mass can be reduced as individuals age.  Using low-weights, careful movements, resistance bands and balls helps to reduce wear on ligaments.  The class incorporates floor and chair exercises that build strength and flexibility, as well as improve balance and cardiovascular fitness.

“The class helps me tremendously with my lower back issues.  There are certain exercises that I always look forward to doing.  After the stretches, I don’t have back pain.  The pain may return the next morning, but now I know how to safely stretch my back at home,“ said 67-year-old Beatrice Wright.IMG_1175.JPG

Many class participants have found themselves living more pain-free and healthier lives, since joining the class.  “I had a quadruple heart bypass and I had an Implantable Cardioverter Defibrillator (ICD) inserted in 2005.  My doctor said I must remain active.  After cardio rehab and after I retired, this was the class for me.  I recently saw my doctor and my heart has almost gone back to normal; in July they removed the ICD and didn’t replace it!  I’m sure my ability to work my heart muscle is why I have improved so much,” said 63-year-old Sharon Finley.

The results from the senior fitness classes move beyond physical activity.  As with many of St. Joe’s support classes, the camaraderie among participants is a direct result of the holistic approach to health.  The classes address the mental health, physical and social aspects of each person’s well-being.  “Physical activity and interactive programming addresses loneliness, depression and issues with mental health.  Addressing mental health is a high-bar focus of our senior programming,” said Bowman.

Many participants agreed that if they were not in the class, they would not maintain a regular schedule exercising.  Motivation can be difficult to achieve if you are on your own – but it’s not difficult if you have Beatrice Wright in your class.  When Wright sees the need, she leads the class in a motivating chant she created.

“I love the class.  The one thing I’ve learned in life, is not only do you need to remain physical, but in order to feel better, you have to laugh.  If you don’t laugh, your aches and pains will take you over.  I would recommend this class,” said Finley.

The classes are provided September through April on Mondays, Wednesdays and Fridays.  Bowman hopes to address the waiting lists for the classes by collaborating with additional community organizations.  He is also considering enhancing the classes by integrating senior yoga into the courses.  “Coupling yoga into the senior fitness class will offer a dual utility.  The cardio combined with stretching and meditation reinforces the holistic approach of health we want to offer our senior population,” said Bowman.

“At 80, you begin to look at life differently.  I try to stay as fit as I can.  I see people who are 80, and some of them are broken down.  I’m trying to avoid that as long as possible, I know I won’t always be able to remain at my current level of fitness, but I’ll try as long as I can,” said Simmon.

About Senior Fit
St. Joseph Mercy Oakland sponsors a free Senior Fit program at 15 locations throughout Oakland County, from September through May.  Geared for adults age 55 and up, Senior Fit is aimed at improving stamina, lowering blood pressure and decreasing the risk of osteoporosis among senior adults through regular exercise. Please click here to view the flyer.

The consent form can be downloaded herePlease click here for Senior Fit orientation information.

Fight Frailty with Bone Health

bone health

New program at St. Joe’s Oakland improves bone health and wellness

Osteoporosis is the condition where bones gradually become thin and weaker with age. This condition can lead to a fragility fracture—a broken bone caused by a low-trauma injury. Both men and women over the age of 50 may experience fragility fractures, making it the most common age-related health problem.

“Fragility fractures can cause great pain, deformity, disability and even death,” according to Bruce Henderson, MD, a St. Joseph Mercy Oakland orthopedic surgeon. “Fragility fractures pose a lifetime risk of death equal to breast cancer, yet less than 25 percent of these patients receive appropriate evaluation and treatment for their underlying disease.”

The St. Joe’s Bone Health and Lifetime Wellness Program offers a comprehensive program that works with patients to achieve optimal bone health while also lowering the chances of other illnesses, such as the cold and flu, and even more serious conditions such as heart disease and cancer. Proper treatment for good bone health also leads to major improvements in a patient’s overall health and lifetime wellness.

Get help to age well

The program includes an in-depth health evaluation and assessment that will look at such things as health history, risk factors and family medical history.

Patients will undergo testing to determine their current bone strength and risk for fragility fractures, including:

  • A basic laboratory evaluation that will measure vitamins, minerals and hormone levels in their body—all important indicators of bone health and strength.
  • An in-depth bone density evaluation. A bone mineral density test can provide a snapshot of a patient’s bone health. The test can identify osteoporosis, determine a patient’s risk for fractures (broken bones), and measure their response to osteoporosis treatment.

St. Joe’s offers a personalized treatment program, including:

  • Lifestyle counseling on activity, exercise, nutrition and smoking cessation
  • Supplements, including calcium, magnesium, vitamin D, vitamin C, and vitamin K2
  • If necessary, proper prescription medicines
  • Coordinated care with a patient’s primary care physician on their treatment plan

Robert Zalenski, MD, a physician and lifetime wellness advocate, emphasizes that many of the same steps taken to help treat osteoporosis are also part of a vital path to overall wellness. Strength training, moderately vigorous walking and good nutrition are important practices that can also treat the epidemic rates of obesity and frailty due to muscle loss.

Learn more about the new Bone Health and Lifetime Wellness Program by calling 248-858-6113 or visit www.stjoesoakland.org/bone-health-program.