The Children's Institute Blog

National PT Month: Gross Motor Group

Posted by The Children's Institute - Oct 30, 2017

For two of the six years she’s been at The Children’s Institute, physical therapist Jen Brilmyer has helped coordinate gross motor group, which exercises children’s physical skills, as well as their social ones.

Dorian Rice Haigh playing kickball“Really, we serve all different types of children,” Jen told me, “but primarily we’re looking at children who have difficulty in issues engaging in skills with peers, such as ball skills, coordination, endurance skills – things like that.”

In addition to regular physical therapy, the gross motor group engages children – typically ages four to 10 – in groups. But, Jen stressed, she and other clinicians “tailor the activities to meet the needs of each child.”

“The thing that makes gross motor group unique is they’re participating with their peers,” Jen said. “We want them to do things that typical kids their age do.”

For Dorian Rice Haigh – a nine-year-old who is on the Autism spectrum and has Ehlers Danlos syndrome, which causes issues with his muscles and joints – gross motor group was “perfect, not too many people, not too little.” And, true to The Children’s Institute’s mission of engaging children in meaningful, sometimes playful, therapy, it was a lot of fun.


“Whichever exercises the kids chose is what they worked on most,” said Dorian, who liked to pick kickball activities. Others chose basketball skills – or soccer.


“It was pretty helpful,” he said, with a big smile. “I learned to play line-tag.”


Dorian’s mom, Cindy, said he’s been receiving physical and occupational therapy since he was three or four years old.

“They’re tremendous at The Children’s Institute – they get him,” Cindy said.

“Balance is an issue to him and he’s much, much better with that now,” she added. “Standing on one foot, standing on the other foot. Before we knew what was going on, he’d fall and bruise so easily.”

“Now, he’s doing great.”


Rock-Painting at The Day School

Posted by The Children's Institute - Oct 30, 2017

Lynne White stood in front of her students and some waiting rocks at The Day School of The Children’s Institute on a recent Tuesday and gave the instructions.

“We’re going to paint rocks,” she said. “Why are we going to paint rocks? One, because it’s fun. And, two, we’re going to hide them and there’s going to be a message. We’ll hide the rocks and other people can find them. We’ll talk to them on the computer and we’ll make new friends!”

And, with that, roughly 10 students grabbed for tubes and tip-proof cans in a host of colors – pale blue, cactus green – and started painting away.

One girl painted proudly in blue glitter. Her teacher’s aide, Sally Stewart, said she had painted with her before.

“She’s a pro,” she laughed.

Student Mykenzie Brush already had ideas about where she wanted to hide her rocks: the school bus and two nearby Squirrel Hill businesses – Dunkin’ Donuts and Rita’s.

“You think we could find a spot in the garden?” Lynne asked her.

“Yeah!” blurted out Mykenzie enthusiastically.

“I bet we could,” responded Lynne.

Teachers said the students will start by hiding the painted rocks around Children Institute’s Squirrel Hill building, then extend beyond our borders. They expect to start hiding the around Squirrel Hill soon.

Day School Speech-Language Pathologist Emily Kaplan is doing the painted rock project with about 20 students in three classrooms. She heard about the project through the news but didn’t go forward with it here at The Children’s Institute until she was urged by a fellow staffer.

“The older class goes on community-based outings so I thought it would be really fun,” Emily said. “It’s a good way for them to get out and interact with the community.”

Found one of the rocks? Go to to send back a message!


Kayaking and National PT Month

Posted by The Children's Institute - Oct 27, 2017

Pittsburgher Ann Lapidus became blind 10 years ago due to medical complications but that hasn’t stopped her from tandem-biking or water-skiing. In August came a new activity: kayaking.

“I really enjoyed it,” Ann said. “It’s one of those things that could be really relaxing, like moseying down the river, or you could make it really physical. You choose the pace.”

Recently, Ann and her seeing partner, Jason Cade, trekked to The Children’s Institute’s heated, indoor pool to gain more experience with kayaks in a class provided through our partnership with Venture Outdoors. We are highlighting the adaptive kayaking program as part of National Physical Therapy Month.

For Venture Outdoors volunteer Trip Leader Joel Johnston, an American Canoe Association (ACA) certified kayak instructor, who coached Ann and Jason on paddling during a more than two-hour, one-on-one session Oct. 9, it’s a simple equation.

“There are so many great places to paddle in Pennsylvania, so many great rivers,” he said, “and we have just under a dozen ACA-certified kayaking instructors working with Venture Outdoors .”

Future adaptive kayaking sessions will be held on a Saturday morning in November, and then monthly from January through April. The classes aim to provide people with physical disabilities an opportunity to discover what outfitting is necessary to get them paddling comfortably in a kayak. More information is available on the activities calendar at (Interested volunteers also should contact the organization.)

Christy Neltner, a physical therapist at The Children’s Institute, has been leading adaptive kayaking programs like this one since taking part in an Adaptive Paddling Workshop at Bay Cliff Health Camp in Michigan and training with the ACA.

“Water is the ultimate equalizer,” Christy said. “In this program’s boats, you don’t know which people are the staff and which are the people with disabilities.”

Christy started fundraising for the adaptive kayaking program in 2010 and participants took part in a session for the first time in 2014. She says kayaks can be modified for those with physical limitations in various ways – outriggers can help a person with seizure disorders avoid tipping in the event of an incident, or pivot posts can be installed for people who need assistance gripping a paddle or doing repetitive motions.

“Sometimes, we get participants who’ve never been in a pool,” she said.

The level of difficulty for the workshop ranges from easy to advanced based on the ability of the participant, according to Venture Outdoors. Classes are limited to four participants and have a one-to-one or two-to-one Trip-Leader-to-participant ratio based on the participant’s needs. You must be at least 12 years old to participate.

For Joel, the classes are just the beginning. He hopes to see people with physical limitations attending Venture Outdoors public outings and Kayak Pittsburgh rental locations. With advanced notice, the organization can work with an individual to modify a kayak so they can participate on outings or rent a kayak.

“That’s kind of where we’re going with this,” Joel said. “The idea is not to have people segregated.”

From watching Ann get into her yellow kayak and paddle last week, you wouldn’t have had any idea she had physical limitations – and that’s the point.


National PT Month: Learning From Yoga

Posted by The Children's Institute - Oct 26, 2017

Physical therapist Katherine “Kit” Concilus sits on the blue mat, her legs folded symmetrically in front of her, and – with two teenage Children’s Institute patients in tow – she begins the yoga class.

“Eyes closed, lips together, teeth apart. Now, use your mind’s eye to explore the inside of you. Begin by looking at your own brain, imagining that you can actually see it. Now move your attention to your skull, and the muscles of your face, your forehead, softening any areas of tension.” Kit intoned, her voice gentle, even-keeled and, yes, somewhat soothing in this dimly lit room. “You are listening to your body and it will tell you what it needs.”

Kit has been practicing yoga for some 20 years and leading yoga sessions at The Children’s Institute for nine of those years. For patients with chronic pain, in particular, the sessions – held once each week, on Monday afternoons in the Multi-Purpose Room – have proven valuable as a part of physical therapy.

“We practice breath work throughout each session. We have educational handouts to reinforce our instruction.” Kit said. “And we catch patients at all different levels of their pain journey. Our hope is that our patients will learn these important skills and use them for the rest of their lives.”

Yoga instruction includes supervised practice of postural training, breathing techniques, stretching, strengthening, coordination, balance training and guided relaxation, Kit says in a letter she send to participants. Emphasis is placed on coordinating the breathing pattern with movement and paying attention to the details of body alignment. Activities can be modified as for individuals, while keeping a positive, quiet atmosphere.

Who benefits from the classes? People with diagnoses ranging from RND and chronic pain to those with brain injuries, developmental delays, and cerebral palsy are targeted. And the results are looking good.

Dozens of patients took part in the classes between 2014 and 2016, and metrics showed Functional Disability Inventory scores – a 15-item instrument originally developed to assess disability in children and adolescents with chronic abdominal pain – improved by 56 percent, after taking the class, in one year alone.

That’s reason enough for Kit to keep up the classes.

Like she says, anyone can tune in to the messages their bodies are sending them.


Students From Two Squirrel Hill Schools Meet

Posted by The Children's Institute - Oct 25, 2017

Students from The Children’s Institute’s Day School and St. Edmund’s Academy gathered Tuesday at the Halloween-themed party as part of a social-skills program to celebrate differences and learn from each other.

Anthony Pipkin, 10, a St. Edmund’s Academy fourth-grader, ate the candy corn but said it “tasted like wax.” Amiyr Mack, 8, a student at The Day School of The Children’s Institute, wanted potato chips and cookies. Emma Ford, 8, Amiyr’s peer, was more interested in “being with new friends” and less interested in snacks.

But, one thing bound them all.

“My favorite part is certainly the human element,” said St. Edmund’s teacher Robin Colin, who brought two classes of fourth-graders from her school to The Children’s Institute. “They’re the same on the inside – they all want to feel connected, they all want to have friends.”

Friendship played a central role in the Halloween shenanigans, as children from each school partnered up as they sought to bowl over a tower of ghost-adorned toilet paper or play a round or two of “Hot Pumpkin.” And there were more than enough orange-crème-filled Oreos, candy corn, and potato chips to go around.

Just ask Emily Hummert, 10, of St. Edmund’s.

“It’s fun,” she told us, as she scored five candy corns across in Halloween Bingo. “I want candy, more candy.”

“I’m having fun, too,” said Ryleigh Tardy, 9. “This time, we played bingo!”

Stacy Porter Smith, a social-skills therapist at The Children’s Institute, kicks off the initiative by visiting St. Edmund’s – bringing wheelchairs or testing the students’ Alternative and Augmentative Communication (AAC) skills on an iPad with the program Proloquo-To-Go.

“It’s disability awareness,” Stacy said. “When I go to schools, I challenge them and say, ‘When you see that kid sitting all alone on the playground, go over. When you see a kid in a wheelchair, don’t treat them differently. You’re a kid. They’re a kid.’”

Robin said, at the beginning of the partnership each year, some of her students will be a little unfamiliar with children with special needs, and there are “some deer-in-the-highlights moments.”

“By the end of the year, they’re playing together, they’re holding hands, they help with snack,” Robin said. “I really look forward to the comfort level of our students growing as the year progresses.”

Robin said she’s been taking part in the program with The Children’s Institute for all of the seven years she has taught at St. Edmunds, a K-8 school.

“The neat thing is, by the end of the year, the staff is just standing there,” Stacy said, “because the kids, they just grab each other and say, ‘Let’s go!’”


National PT Month: Torticollis

Posted by The Children's Institute - Oct 24, 2017

After launching, in 1994, the Back to Sleep campaign – a National Institutes of Health initiative encouraging parents to sleep infants on their backs to reduce risk of sudden infant death syndrome (SIDS) – incidence of SIDS dropped more than 50 percent. But what clinicians might not have anticipated was a spike in cases of torticollis, a condition – which we are profiling today as part of National Physical Therapy Month – where the head tends to be rotated to one side and tilted to the opposite side. In infants, it is generally congenital muscular torticollis.

Torticollis therapyBecause infants now are sleeping on their backs, muscles in the neck and upper back aren't stretched and strengthened as much as if they were sleeping in a prone position, or on their stomachs.

“We’ve gone from generations of infants who’ve spent most of their time on their bellies to generations of kids who spend most of their time on their backs,” said Theresa Miller-Ferri, a physical therapist at The Children’s Institute. “If they’re staying in the same position all of the time … that can cause other asymmetries in the head and face, and elsewhere in the body that can impact development.”

“If left untreated, it’s not going to go away on its own,” she added.

Laura Caton came to The Children’s Institute earlier this year, when her daughter Eleanora was just two months old. She had noticed there was something wrong about the way her daughter was positioning her head shortly before Eleanora’s two-month well visit with their pediatrician. Four months later, the problem is resolved almost entirely.

“The way I would hold her, her face was always sort of stuck in my shoulder [and] that would make her cry,” Laura said. “Now, she can look over my shoulder – and look both ways.”

“A lot of the therapy is so subtle – [Theresa] seems like she’s playing when she’s working with her – it’s pretty cool,” said Laura, who also is Mom to big sister Reese, 12, and big brother Ezra, three. “I never feel it’s uncomfortable for her and it’s made such a huge impact. Within even just a couple of weeks, I started noticing a change.”

“I look forward to going. I look forward to her progress,” she added.

Laura recently introduced Eleanora to a family friend who works with infants with torticollis.

“She never noticed. She was surprised when I told her she had it,” Laura said. “That’s how much she’s improved …. She looks both ways. She has terrific range of motion.”

Theresa said it’s not uncommon to see those gains – as long as caregivers identify the problem and address it early.

“The earlier, the better,” Theresa said.


Marking Respiratory Care Week

Posted by The Children's Institute - Oct 23, 2017

Brady Lumpkin is set to be discharged from The Children’s Institute tomorrow, the second day of Respiratory Care Week.

Patient Brady receiving respiratory careBut to Brady, a respiratory care patient who soon turns 25, the day is yet another step in a long journey.

The West Virginia by-way-of Oklahoma native was riding April 30 as a passenger on an all-terrain vehicle, or ATV – something he’s been doing his whole life – when his driver hit what he called “a good-size rock.” He suffered a spinal cord injury and lost use of his limbs. But, since coming to The Children’s Institute, he has made strides.

“He came with a trach and on full-ventilator support,” said Respiratory Care Clinical Supervisor Lyndsi Yarkosky, RRT-NPS. “Within a few months, we were able to fully wean Brady off of the vent. Along with his continuous diaphragmatic pacer, he uses a Passy-Muir valve during the day and his trach mask at night.”

Brady, for one, has appreciated each step along the way, he told me as speech-language pathologist Katie Hartman fed him nectar-thick liquids.

“It’s been tough but I’m making progress,” Brady said.

“Really, seeing his progress is awesome,” added Tiffany Oldfield, 22, Brady’s girlfriend.

Katie said much of his progress in being able to communicate is due to the fact that he also weaned off what is known as a cuffed trach.

“His voice was a lot better once we got rid of that,” Katie said. “His vocal folds got more sturdy.”

The goal of the nine-person respiratory care team, in fact, is to wean off those breathing aids, Lyndsi said.

“We’re pretty successful with weaning,” Lyndsi said. “Along with the doctors, we’re collaborating with the patient and the providers for weaning – weaning off oxygen, weaning off a ventilator, and working toward decannulation [no more trach] in many cases.”

The team takes its job – and things like infection control – seriously and it shows. Lyndsi said she cannot recall a single incidence of ventilator-associated pneumonia during her eight-year tenure here.

“And a large part of our job is also to provide education and train the family,” she added.

In Brady’s case, that’s Tiffany, who will care for him when the two return to West Union, W. Virg. this week.

“There’s been tough times,” Tiffany admitted.

But, tomorrow, there’s even more reason for hope.


A Spirit-ed Halloween Bash

Posted by The Children's Institute - Oct 20, 2017

They came to The Children’s Institute of Pittsburgh this week with costumes in every size imaginable – a Lego knight, a Mighty Morphin Power Ranger, Super Mario, G.I. Joe.

They came with pumpkins to paint, stark-white masks to decorate, and lava-lamps to customize, not to mention a giant Kenny the Kangaroo to pose with in selfies.

They came with trendy backpacks, masks, wigs, blankets, and enough nail polish, lip gloss and temporary tattoos to accessorize an army.

“We do it for the kids,” said Spirit Halloween District Manager Amanda Makin, who leads stores in four Pennsylvania communities – Johnstown, Indiana, Lewisburg and Dubois. “We do get a lot of shock, especially from parents when they hear it’s free and we’re giving it away. If you can’t go out and trick-or-treat, kids can get depressed. So, we bring it to them.”

Child-life and therapeutic activities programs at The Children’s Institute of Pittsburgh would be impossible without Spirit Halloween. Its Spirit of Children fund-raiser, which has started for the 2017 Halloween season, has raised $37 million for child-life activities at North American hospitals in the past 10 years.

At The Children’s Institute alone, Spirit Halloween has donated $212,887 fueled by supporters’ purchases to date. In FY2017, that amount totaled $49,476.

You could count Isaac Kohn, 7, among the excited. The Cuyahoga Falls, Ohio boy was set to be discharged this week after taking part in an inpatient feeding program.

But what was the main reason he was excited to be at The Children’s Institute Wednesday night? The Spirit Halloween party.

“He’s been dying for this,” Isaac’s mom, Sierra Hampl, laughed. “It’s going to be very quiet without Isaac here.”

In another corner of Austin’s Playroom, a Spirit Halloween staffer – there were more than a half-dozen of them, from throughout Western Pennsylvania – with bright red hair helped deck out inpatient Madison Johnson in full regalia.

“She just wanted to see what this was all about,” said Madison’s mom, Valerie, chiming in with a recurring “Oh, my heavens!” as the Peters Township, Pa. family walked through a maze of free goodies. “It’s kind of overwhelming. It’s great to give these kids a distraction.”

For Spirit Halloween staffer Jennifer Sigvaldsen, who manages the Dubois store, it’s more than a distraction – it’s a mission.

“This is why I work for Spirit,” said Jennifer, after handing Madison some lip gloss and nail polish. “Spirit is an easy company to love and be passionate about. It’s satisfying. It’s gratifying. Knowing all of this is done for the kids? It’s empowering.”


Profiling Our Physician Assistants

Posted by The Children's Institute - Oct 18, 2017

Ali Kristobak and Kara Malagise started working at The Children’s Institute within two weeks of each other in the spring of 2016. But the organization’s only Physician Assistants, who we interviewed during Physician Assistant Week, hardly see each other and have never worked side-by-side.

“There’s only two of us,” laughed Kara, who covers inpatients on 3W while Ali works in inpatient and outpatient Behavioral Health. “It’s nice to know there’s another one around, though.”

Kara – a Beaver County native with two children of her own, who attended the University of Pittsburgh and then PA school in sunny Arizona – does a broad range of things on our 3W wing.

“It’s hard to summarize what I do. I can’t say, ‘I see patients, I treat patients,’” Kara said. “I’m involved heavily in admissions and dealing with patients as they come and go. And I also support nursing and the therapies.”

Kara has been working as a PA for eight years, previously at a Weirton, W.Virg.-area pediatrics practice.

“Everybody is really great on the team with these kiddos – I really feel our unit makes a real difference in patients’ and families’ lives,” Kara said. “I like that you get to work with other families. It puts things in perspective.”

She also particularly enjoys working with inpatients with feeding needs.

“When they’ve just made such good progress – it’s great to see that,” Kara said.

Dr. Howard Ferimer had high praise for Kara’s work ethic.

“She’s a great asset for The Children’s Institute – a team player who does great work she’s not asked to do,” he said.

Ali is native to Johnstown, Pa. But, by the time she started working as a PA in that city’s Conemaugh Memorial Medical Center, she was commuting from Murrysville – some 60 miles away. Since coming to The Children’s Institute, she and her husband Alec, who met in a Penn State a capella group, relocated to nearby Greenfield.

For Ali, the path to medicine was clear, even from her younger school years.

“I definitely had thoughts about medical school but, to be quite honest, I’m indecisive so I like the flexibility of being a PA,” Ali said. “You can easily switch fields. If I decide I want to practice something other than psychiatry, I could apply for something like cardiology or general practice.”

In her decision to stay at The Children’s Institute, it doesn’t hurt that she’s working on the Behavioral Health Unit with Dr. Aileen Oandasan, with whom she also worked at Conemaugh.

“It’s nice to have the continuity because she was one of the people who trained me [and] our styles of practice really jived right away,” Ali said. “I feel like there’s been really great collaborations amongst the clinical team. They really value our role in these patients’ care.”

And psychological services remain close to her heart, in part because she went through a period in her pre-teens where a family member suffered a major depressive episode.

“I really loved and excelled at the physical health things. I was top of my class. But I was drawn to psych because of the challenge it presented,” she said. “You can’t prepare in the same way for psychiatry as for physical health. It’s not, ‘You have an ear infection. Here’s amoxicillin.’ It’s really an art.”

Dr. Oandasan said Ali has got that art down.

“She’s probably the best PA I’ve ever worked with,” Dr. Oandasan said. “Despite her only being out of school for a few years, she comes off as a very experienced Physician(no ‘s) Assistant. I wouldn’t be able to function without her.”


Marking Mental Illness Awareness Week

Posted by The Children's Institute - Oct 13, 2017

Nearly two years ago, Josh McKivigan was serving as assistant director of a Pennsylvania-based mental-health agency when he heard about The Children’s Institute’s approach to integrative health.

Patients in a behavioral health crisis were experiencing an integrative treatment model, he heard, and doing things like biofeedback, a non-drug treatment in which patients learn to control bodily processes that are normally involuntary, such as muscle tension, blood pressure, or heart rate.

“You really get to see the picture of the whole kid,” he said.

He left that job and has been at The Children’s Institute, working first as a behavioral health outpatient therapist and now as the Clinical Program Manager of Inpatient Behavioral Health, ever since. We talked with McKivigan and his colleagues recently to mark Mental Illness Awareness Week, which runs through today.

“The Children’s Institute is just a very unique place – being able to collaborate, to have all of the disciplines together, and being able to talk to these patients in this customized way.”

That’s Dr. Paula Cerrone, who’s worked for more than three years here as a neuropsychologist and, more recently, as manager of outpatient behavioral health services. Both Cerrone and McKivigan divide their days between treatment and administrative duties.

“[Collaboration] is something that’s really special here,” Cerrone said. “And it’s all under one roof.”

What do they mean? Well, at The Children’s Institute, when a patient is seeking treatment for mental health or help during a behavioral health crisis, they also get assessed by a team of clinicians concerned with their physical well-being.

“I think that’s becoming a huge sort of story in healthcare,” Cerrone said. “A lot of physical problems can affect a child’s mental functioning and vice versa. It goes both ways.”

She cited a child who came to The Children’s Institute because they were grappling with cognitive issues associated with chemotherapy. We discovered the child was on the autism spectrum.

“Because we have multiple services, they were able to have a nice collaboration between services, which is pretty unique to us,”Cerrone said.

“On our inpatient Behavioral Health Unit, we also try to include the caretaker, the guardians and that child’s community treatment team; we look to involve them and bring them together with our treatment approaches,” McKivigan added.

Those services are more in need than ever. Through the third quarter of Fiscal Year 2015 we provided 83% more outpatient services than we did in the same period of Fiscal Year 2014, and 16% over the targeted initiative goal, according to our most recent Community Health Needs Assessment (CHNA).

Approximately one in five adults in the United States—an estimated 43.8 million people—experiences mental illness in a given year.

But treatment, though views of it are improving, still comes with a stigma. The Children’s Institute tackles this using evidenced base approaches such as Cognitive Behavioral Health Therapy and by building a comfortable environment with the patient.

McKivigan said one patient, early in their outpatient treatment asked, “Will this be on my record?” Later, they missed one session and were incredibly apologetic, not wanting to skip out on their time with therapy. McKivigan shared how the working relationship and individualized treatment approaches with each patient help breakdown mental health stigmas.

“Therapy now is shorter. It’s much more focused,” Cerrone added. “And it’s targeted to find a solution.”


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