Tag Archive | physical therapy

Kids these days, part 2

I recently attended a meeting for rehabilitation managers in my community titled, “New Graduates and Generation Y: Training for Emotional Intelligence and Face-To-Face Communications Skills.”  This is Part 2 in a series of posts on the themes of that discussion about the Millennial generation.  Part 1 can be accessed here.

“Students and new grads [Millennials] don’t seem to have the listening skills they once had.  And they don’t have the self-awareness to reflect and correct, and they often get defensive or emotional when criticized.”  This was one of the central themes of the rehabilitation manager meeting I attended last week.  Kids these days don’t listen, they won’t learn, and they get upset when someone with  little more experience tries to tell them how to do it better.  In other words, Millenials are immature and they don’t respect authority.

This is a common criticism of Millennials and one that – as an educator – I certainly understand.  But I think that, when we examine the characteristics of Millennials, it it clear that the problem isn’t that Millennials don’t respect authority.  It’s just that Millennials view authority differently than the generations before them.

It is true that Millennials are confident, and sometimes that confidence can seem arrogant.  It can appear that they aren’t listening or reflecting when they continue to do things “their way.”  Millennials are social and informal.  They get along well with their parents.  Similarly, they want to like their instructors and bosses and have casual, friendly relationships with them.  The boundaries between “work” and “play” are blurry, and Millennials may have difficulty hearing professional criticism from a colleague and not taking it as a personal attack from a friend.  Millennials like teamwork and value open communication.  They believe that others on the team want to hear their thoughts and ideas, and they share them freely.  When they are frustrated about a work situation or don’t agree with criticism, they aren’t afraid to express their feelings.  To a Baby Boomer or Gen Xer, this way of relating to coworkers can seem immature, unprofessional, and just plain uncomfortable.

Here are a few of my suggestions for improving the “authority gap” between Millenials and Baby Boomers or Gen Xers:

  1. Build time into the day for communication.  Allow time after a treatment session for a patient or family to provide feedback about home exercise program instruction.  Schedule time at the end of the day to communicate with a colleague or clinical instructor about an intervention technique.  These will give the student or new grad opportunities to practice receiving (and giving) constructive professional criticism.
  2. Millennials love technology  – use it!  Get permission first, then grab a video camera or smart phone and record a student or new grad conducting a patient interview or education session.  Allow him to view the video and reflect on his performance and communication skills.  Discuss what he did well, and what he should do differently next time.  Again, this gives practices with communication and provides an objective way to self-reflect.
  3. Position yourself not strictly as an authority figure, but also as a mentor and advocate.  Millennials value relationships and are fiercely loyal.  This can be a tricky one – you want to be a guide, not a friend – but once you’ve established a relationship of mutual respect, you may find the student or new grad listening a little more and accepting criticism without defensiveness or emotion.
Have you experienced the “authority gap” in your classroom or practice?  What strategies have you used  to close the gap?
[Creative Commons-licensed image by Flickr user xflickrx]

Kids these days, part 1

Last week, I was invited to a meeting for rehabilitation managers in my community. The title of the meeting was, “New Graduates and Generation Y: Training for Emotional Intelligence and Face-To-Face Communications Skills.”  Uh-oh.  I was invited because of my role as an academic faculty member in clinical education, but – with a 1978 birthday – I’m considered a member of Generation Y (also known as Millennials) according to some sources.  I’d never been to one of these meetings before, but I knew some of the key players were of the Gen X and Baby Boomer generations.  I’d be lying if I said I wasn’t a little worried I’d be spending the better half of the morning defending my students and myself.  But I knew I had an important perspective to share; that I was in the unique position to speak on this issue as an educator and a (maybe, almost) Millennial.

If you’ve spent much time with me, you know that I’m completely turned off by the entire kids these days concept.  I don’t think there’s anything wrong with kids these days or society today.  In fact, I think people and the world generally get better as time goes on.  We are safer and smarter than we’ve ever been.  And, while kids these days may be different (and why wouldn’t they be – the world is different), they have unique ideas and strengths and skills that I don’t possess.  I can learn a lot from people younger than me. And that’s a good thing. Perhaps that is why I was drawn to pediatric physical therapy and education.

Luckily, the meeting wasn’t simply a forum to vent about problems with kids these days.   It was an honest, fascinating, and enlightening discussion, with many of the Gen Xers and Boomers in attendance reflecting on their own biases and weaknesses as well as some of the “differences” they see in today’s students and new grads.  Here are a couple of the central themes that arose during the discussion:

  • Students and new grads don’t seem to have the listening skills they once had.  And they don’t have the self-awareness to reflect and correct, and they often get defensive or emotional when criticized.
  • Students and new grads aren’t as dedicated to the profession. They want to leave as soon as the day is over.  We used to stay 10 or 11 hours if needed to get all our work done.
  • Students and new grads are always texting, playing Words with Friends, and checking Facebook.  They don’t have good professional boundaries when it comes to checking and using their mobile devices.
  • Students and new grads know how to Facebook and text, but they struggle with “real-life” communication and relationships.

This generational divide isn’t unique to physical therapy or health care – the same conversations are happening in many professions.  And it isn’t unique to the Millenials – concerns about kids these days is a tale as old as time.  What’s different this time, I think, is that some of the unique characteristics seen in the Millenials may be less about a specific generation of young people and more about a vast change in the world we live in, the way we do business, and the way we communicate.  In many ways, Millennials represent the role that technology – particularly social networking and mobile devices – now plays in our lives.  We may not be able to just wait them out or ask them to grow up or adapt or change to conform to us.  The Millennials may represent what we need to become in order to stay relevant.  And that can be a frightening prospect for many of us.

Over the next several posts, I’ll tackle these generational issues in a series I’m calling (you guessed it) Kids These Days.  My next post will be about the first item on the list: students’ and new graduates’ ability to listen, communicate, and self-reflect in today’s fast-paced world of health care.  In the meantime, I’d love to hear your thoughts on the next generation of health care providers.  What do you think about kids these days?  What differences are you seeing in your classrooms, hospitals, and clinics?  What strategies are you using to close the generation gap?

[Creative commons licensed photo by Flickr user courosa]

Is the Bumbo a no-no?

The Bumbo baby seat is one controversial piece of polyurethane.  Do a quick google search for “Bumbo seat” and you’ll see what I mean.  Mommy blogs and parenting forums are full of passionate posts of love and hate for the Bumbo.  Many physical therapists and parents of children with special needs have strong opinions about the seat, too, largely because the seat is marketed using language usually used to describe therapeutic equipment.  The manufacturer of the product makes the following claim on their website:

“The seat stabilizes the child into slight hip flexion, placing the pelvis in a slight anterior pelvic tilt which facilitates lumbar extension. This action, combined with the gentle curve of the seat back that matches the natural curve of the rib cage, facilitates the baby around the lower ribs and trunk for stabilization. The Seat allows for active practice of the head and postural trunk control. It also allows a child the pelvic stability needed to get the hands into the midline for play. Upright positioning facilitates an improved visual field of the environment, improved respirations and breath control, assists a baby who needs to be upright after feeding due to reflux and many other benefits.”

Although the statement is in quotation marks on their site, the manufacturers don’t give credit to the individual who provided the quote, nor do they cite any studies.  To my knowledge, there is no research to support or refute the claims made by Bumbo International.

I own one of these seats.  I have used these seats with my own children as well as the children I’ve worked with.  I have recommended parents purchase these seats.  I’m not sure whether the seats accomplish what they claim to accomplish, but I’m not sure I care because – and here’s where I’m going to say something you never thought you’d hear a pediatric PT say – development is about so much more than the position of the pelvis (cue angry comments from every other pediatric PT who reads this post).

The shape and material of the seat sort of “grabs” the baby without the need for any straps or belts.  Unlike infant car seat carriers or bouncy seats – which put the baby in a “C” shape with the legs relatively straight – the Bumbo has a dip in the back of the seat, bending the legs with the knees slightly higher than the hips.  Although the seat curves around the trunk, providing some support for the mid-back, the upper back, head, and neck are unsupported.  This means that a baby who isn’t ready for the seat looks like my oldest son, M,  looked in our Bumbo when he was 2 months old:

Notice that he is slouching with his head and trunk leaned to the side.  You can’t see his pelvis, but I imagine it is tipped backward (although I don’t blame that on the Bumbo – at this age his pelvis would be tipped backward in any form of supported sitting).  At 2 months old, he hasn’t developed the ability to consistently bring his hands to midline and reach for toys in supported sitting, so there’s really nothing he can DO in the seat at this developmental stage.  Bottom line is, If a baby looks like this in the Bumbo, it is a good indication he isn’t probably ready.

But look at what happened when we put him in the seat at 4 months old:

This isn’t the greatest picture of his posture in the seat.  He looks pretty upright, and you can tell that he is even leaning his trunk forward away from the back of the seat rather than collapsing into it.  This makes me think his pelvis is probably tipped forward, but I can’t tell here and I can’t really remember.  What I do remember about this day and this picture, however, is how excited he was to be sitting up and playing with the toy in front of him.  Bumbo seats were pretty new at that time, and the tray wasn’t on the market yet, so I covered a cardboard box with contact paper, cut out one side, and turned it upside down in front of him as sort of a table.  Using a Bumbo seat with a tray gave my son – who wasn’t yet sitting on his own but was very much ready to get upright and see the world – the opportunity to practice his reaching skills and work on his upper trunk muscles in preparation for sitting.  And he was delighted doing it, and I was delighted to be interacting with my infant like he was a real boy.

My children are typically-developing, but the Bumbo has also worked well for many infants and toddlers I’ve seen with developmental disability and delay.  Infants typically begin sitting independently between 5-8 months.  The Bumbo seat can allow a similar-aged child with delays to sit supported on the floor, interacting with his peers, siblings, and/or caregivers at eye-level.  This is so critical for social development, and I’m not aware of any other piece of commercially available equipment at this price point that allows for this.  For kids with cerebral palsy or similar diagnoses who tend to arch with stiff muscles, the Bumbo seat can keep their hips bent and help  “break up” extensor tone and allow them to sit up and play.  For other kids with diagnoses such as Down syndrome that tend to have low muscle tone and difficulty holding themselves up against gravity, the seat gives them the support to sit upright (as long as they do have some head, neck and upper trunk control) for the first time and interact with their environment, peers, and family in a meaningful way.

In my opinion, the Bumbo seat can be very effective when used with the right child at the right time, allowing for good practice of upper trunk and head control – as well as arm use and social interactions – in upright sitting.  It is true that, for some kids, the deep well of the Bumbo seat does lead to a flexed back and rounded pelvis in sitting.  However, for the age children the seat is designed for (pre-sitters and children with emerging sitting skills), a posteriorly tilted pelvis and rounded spine are a typical sitting position.  Once baby is able to sit independently with an upright pelvis and spine, she wouldn’t need the seat anyway.  Like any piece of equipment, the Bumbo seat should be used in moderation.  Floor play (tummy time!) is always best for development and learning.  And certainly a baby who is an emerging sitter should be practicing that skill outside this seat as well.  Part of learning to sit is learning to move in and out of sitting, shift weight, fall and correct, and none of those things can occur in the Bumbo.

I do disagree with the recommendedation that Bumbo be used for babies age 3-10 months.  I think 3 months is a little early for most babies.  And, once a baby is able to sit alone (typically between 5-8 months), there really isn’t any benefit to this seat .  By about 6 months, most babies are starting to learn to move by creeping, crawling, or rolling and aren’t going to want to be “stuck” in this chair, nor should they be.  I’d say this chair is most appropriate for a typically-developing 4-6 month old, and – realistically – most kids aren’t going to use this seat for more than 1-2 months, tops.  For families with infants who are delayed or have special needs, the seat may be used for a longer period of time.  And it is nice in that it is a readily-available and reasonably-priced seat that may also be used by the baby’s non-disabled peers, so it doesn’t look like a piece of “special” equipment.

Of course you should always talk to your health provider or therapist about your child’s unique situation, and – to avoid injury – the Bumbo should NEVER be used on a raised surface.  The Bumbo is certainly not a “must have” for most babies.  But if you think the Bumbo will work for your family and you’re willing to shell out $40 for a seat that may only be used for 1-2 months, I say the Bumbo is a go-go.