HeartSpace Physical Therapy for Children by Shelley Mannell

February 6, 2013

HeartSpace Physical Therapy for Children Logo stylized image of Heart with HandPhotograph of Shelley Mannell PT of HeartSpace Physical Therapy for Children15 years ago I created HeartSpace Physical Therapy for Children in order to provide private, home-based Physical Therapy services for children and families in southern Ontario.  The goal was to create a relaxed atmosphere, where children and families could talk and play, and take the time to build a positive, trusting relationship with me in their natural environment. I have always believed that this relationship was a crucial piece for families in their journey towards their goals.

I serve children with a variety of diagnoses; Torticollis, Cerebral Palsy, Down Syndrome, low muscle tone, Autism Spectrum Disorder, Developmental Delay or Developmental Coordination Disorder.  Many families seek therapy because their children are experiencing generalized difficulty with motor skills that makes it harder for them to keep up with their peers.

When I first began my practice, I struggled to understand the multiple systems that were involved in my clients.  I sought continuing education that allowed me to understand and treat the combined soft tissue, visual, vestibular, emotional and motor control issues that challenged them.

I always begin by asking myself why a child moves their body in a particular way and what is preventing them from progressing.  The answer is found in an in-depth understanding of postural control – the process by which we keep our body upright and stable. I marvel at how postural control underlies every single one of our motor skills whether they be gross motor, fine motor, oral motor, respiration or phonation; difficulties with postural control can affect them all.  Combining my clinical experience with new research provides an exciting understanding of the complexity of postural control and how to treat it.

I have also come to realize that many of my clients are stuck in a stress reaction.  Children often startle or cry easily or shut down when they are challenged.  First and foremost I understand that I need to help them be calm and alert; without this there can be no comfort and no learning.

I now enjoy speaking with pediatric therapists all over the world. There are so many talented people doing their best for the children in their care and I am excited to be able to connect with many of them on social media.  I also enjoy meeting therapists as I teach continuing education courses across North America.

25 years ago I began as a pediatric therapist. But many of the children I have known are now adults and still call me if they require Physical Therapy services; it can be difficult to find a therapist who understands the issues faced by adults with developmental disabilities.  I continue to learn and expand my knowledge base and combine this with my clinical skills in a problem-solving approach. This process allows me to facilitate optimum function for each of my clients.

Shelley Mannell PT



@heartspacept on Twitter, HeartSpacePT on Facebook


ActUpNYC – By Tiffany James, Founder and Teaching Artist of ActUpNYC

January 11, 2013


Act Up NYC is a specialized program for high-functioning special needs children. It is designed with a deep art therapy root providing special needs children an artistic outlet for their emotions and impulses.


Act Up NYC is for children who are already acting up in non-beneficial ways, providing them with a supplemental and alternative therapy so these children can explore conflict resolution and have an opportunity to tell their unique stories in a safe and fun space. The children explore basic acting games and warm ups, visual creative outlets, scene work, story acting, and monologue work. The goal is that under the guise of a character and a story the children will not only find a creative release for their emotions but also feel safe enough to open up about and act out conflicts that may provide insight for parents and counselors into the childs daily struggles.


Founder of Act Up NYC, Tiffany James created the company after working with a special needs child in a summer camp environment. She found that giving this child mastery over his own creative fate gave him the confidence to control himself and even reach out to other children which he hadn’t previously done. He is now regarded as a dear friend and client, as well as the inspiration for her project.


Tiffany James is a graduate of Wagner College who has performed and taught with many venues through out New York City including Galli’s Fairytale Theater, Kick&Play, Astoria Performing Arts Center, The Ascension School and Williamsburg Movement and Arts Center. Tiffany has also volunteered creative time leading therapeutic dramatic workshops to Ronald McDonald House and Sarah Burke House.


Once a week Tiffany holds a workshop for her children to work in a team environment in which they will explore conflict resolution group scene work and the team creation of an original story.


For further information, please contact…

Tiffany James




How My Parents Raised A Diabetic Child by Taylor Jones

November 17, 2012

Blue Circle Diabetes Image

November is Diabetes Awareness Month.  We Connect Now celebrates it by hosting the blog “How My Parents Raised A Diabetic Child” by Taylor Jones 

The 3 things every parent should know –

Dear Parents,

There’s one story I always love to tell people. No, it wasn’t the story of far away kingdoms or of knights in shining armor and princesses in distress. It was something more meaningful, something more real and personal. It was the story of how my life was changed forever. You see, I was only five years old when I was diagnosed with Type I Diabetes (if you want more information about neuropathy or my battle with diabetes, check out my blog at Taylor Jones: Survivor)

I was the only one in the family who was diagnosed with that disease, so my parents were shocked when they found out about it. It was like their daughter was being pulled out of life even before she started living it. The doctors told them that I wouldn’t be able to live long, more so be able to live a normal life. I wouldn’t be able to play with other kids and do the activities people do. Guess they were wrong because here I am now, already 39 years old and still having the best time of my life.

My family, especially my parents, definitely played an integral role in my development in living life as a “normal” kid. Everything they did or said throughout my journey helped mold me into someone who even when physically weak is stronger than most. My Mom and Dad knew they couldn’t do anything to prevent this disease, but believed that there is still hope. Even though their daughter had diabetes, they knew there was still a way for me to live and enjoy life to the fullest.

Of course, there had been adjustments in our family, but my parents tried their best to resume all our normal everyday activities, which still included weekend trips and going out to eat. Instead of altering my life because of diabetes, they taught me how to accept it even as a young child and make it a part of my routine and everyday life. That for me is the best thing every parent could do in raising a kid with diabetes.

Here are the 3 things that I think parents of diabetic children should make sure to do:

1. Never hover. This may sound strange, but if you want your child to live a normal life, not limited by something beyond their control, then do your best to treat her/him like any other child. I remember at first, my parents didn’t know how to treat me. Although, I needed to constantly be watched since I would literally eat anything in front of me, they also knew that they couldn’t follow me around or be with me 24/7, so instead they taught me how to remember to take care of myself. If I fell, they were there to pick me up, but not right away. They would let me learn how to react with the pain and get back up on my own. I was never abandoned or felt unloved.

2. Teach. For instance they would make it easy for me to not eat sweets by telling me that if it starts with a “C” then steer clear from it. Cakes, Cookies, Candy and later they added Carbs. 🙂 Early, on I learned that portion control was the number 1 thing I need to do. As a child, it’s easier to be taught to only eat/take what you need then to not take it all. Sometimes they would need to threaten me with scary stories, but most of the time, they just needed to talk to me seriously. My parents didn’t limit the things that I could do, but taught me how to become more responsible in my actions whether I was at home, at school or some place else. They allowed me to participate in dealing with the disease. They taught me how to do the insulin shots myself and overcome my fear of needles. I also learned how to monitor the highs and lows of my sugar levels and control the food that I take. By sharing with me the responsibility of dealing with diabetes, I was able to slowly accept my situation as I was growing up– that life after all is what you make of it.

3. Cuddle the pain away. My parents loved me and definitely spoiled me more than my siblings (I’m 1 of 3). Since I’m the baby, I was already more spoiled than the rest. There were definitely days of pain usually beyond my control. Sometimes, all you need is for your parent to hold you, and remind you that you are strong and can make it through anything in life. I call this “cuddle the pain away.” It’s not about being overbearing, but responding in how your child needs you. Some children need words, some children need hugs, some children need just your presence, and yes, some children just need to be alone.

Having a kid who has diabetes is frightening and it’s normal for parents to protect your child as much as possible and have him/her enjoy life. The fact of the matter is, that diabetes is never going anywhere. Raising a child with diabetes is not an easy thing to do, but it can be done. If you want to see your child grow up and live a successful and happy life, let them do their part in accepting their condition. Just like what my parents did. Your kid will thank you for it.

Taylor Jones is a Type 2 Diabetes survivor, mother, inspiration and advocate. Email her at taylorjonessurvivor@gmail.com or check out her blog  

Should You Get a Van Wheelchair Lift? by The Mobility Resource

October 14, 2012

A van wheelchair lift can be a great way to increase your mobility and freedom. It’s one of the most common, useful pieces of accessibility equipment. You could consider it the quintessential handicap van feature. But lifts are more expensive than ramps. Some even require structural modifications to your vehicle. So how do you know when it’s time to invest in this accessibility equipment?

Upgrading to a Van Wheelchair Lift 

Maybe you’ve been doing alright getting in and out of your van on your own. Maybe you’ve had assistance from a swiveling vehicle seat. There may have been a little pain or more exertion than you care for. If your condition or impairment is getting worse, if access is getting harder or if you’re becoming more reliant on your scooter or wheelchair, it’s possibly time to install a van wheelchair lift.

Or, perhaps you’ve been making do with a wheelchair ramp for entering and exiting your vehicle. If your chair is manual, it can become increasingly difficult to get up a ramp and to control it on the way down. If a caregiver pushes you up and down the ramp, its practicality depends on his or her continued ability to do so. For aging couples, for example, a ramp can become too much of a strain for the ambulatory person.

Photo of wheelchair van-lift

When to Get A Van Wheelchair Lift

When deciding whether it’s time for a van wheelchair lift, consider how often you need to take your wheelchair or scooter with you. If you’re becoming increasingly dependent on your mobility aid, your life will be much easier with a lift on your vehicle.

Lifts let you skip the struggle of getting in an out of the van or up and down a ramp. They make it convenient and effortless to take your wheelchair with you on every trip, whether it’s around the corner to the store or cross-country. Wheelchair or scooter lifts facilitate maximum mobility everywhere you go when your ability to get around is dependent on an assistive device.

Take Advantage of Free Resources for Bipolar Disorder by Healthline

August 23, 2012

College can be difficult enough without the strain of a mental illness, medication and appointments to keep track of, and having to navigate the world of medical resources alone – perhaps for the first time ever. That is why it is essential to know how to find assistance with managing bipolar disorder at whatever college you choose to attend.

Although large universities often offer comprehensive student health centers (and even limited free counseling sessions with a therapist), many small schools may have fewer services to promote. Whether you attend the nation’s largest state school or the country’s smallest private institution, you can patch together a network of support resources for bipolar disorder. Just keep in mind that in addition to the myriad free resources for managing bipolar disorder, most students with bipolar disorder will still require visits with a mental health professional and a regular prescription medication.

Prepare Yourself for Managing Bipolar Disorder at School

1.    Connect with the student health center. Even if you will remain on private or government insurance and visit an off-campus provider, it   is advisable to familiarize a school physician with your condition and treatment plan. Ask about local support groups, free resources, and emergency contacts.

2.    Search for a local support group through the list of support groups and therapy groups maintained by the MADI Resource Center http://www2.massgeneral.org/madiresourcecenter/moodandanxiety_finding-support_supportgroups.asp. Even if sessions are not available through your university, many local support chapters are offered on a regular basis and are open to the wider community. If one is available near your school, get connected early and ask them for advice about other local resources.

3.    Take advantage of the Internet. The web is perhaps the best way to get free assistance with coping with bipolar disorder during college. Free information hubs, like Healthline’s Bipolar Disorder Resource Center, offer tips on managing relationships, explaining your condition to friends, and even handling your condition at work and school. Furthermore, online resources like this can keep you updated on the latest (free!) therapies for bipolar disorder management, such as creativity therapy and yoga.

4.    Adopt healthy lifestyle habits that are non-negotiable. Part of managing bipolar disorder well involves developing and maintaining healthy habits. This means following a regular sleep schedule with plenty of rest, exercising regularly, and getting involved with a “good” crowd. Developing friendships with people who will help keep you healthy and accountable during episodes of mania and depression can be a critical safeguard for your health and wellbeing (and criminal record!).

5.    Find a dirt-cheap technique for self-therapy. Identifying a free way to manage your emotions, ups and downs, and the stress from school and your illness can literally be a lifesaver. Experiment with creative ways to harness your frustrations and express yourself. Consider blogging, painting, bodybuilding, dancing, cooking, hiking, kickboxing, and other hobbies that allow you to let off steam without spending money or engaging in risky behaviors.

6.    Join an online bipolar disorder discussion forum. Many bipolar help sites offer free online chat rooms where you can discuss your emotions, questions, and experiences with other bipolar students or adults who have struggled with the same challenges that you will experience. Take advantage of their advice and don’t be afraid to ask questions. To make forums even more valuable, commit yourself to a regular time session, with daily or weekly time periods of participation.

Regardless of the free methods you choose to supplement your care plan at college, be sure that your choices work for you and your lifestyle. If you don’t enjoy taking the time to scrapbook or talk with others about your experiences, you won’t really get the advantages out of these free therapy options. Experiment until you find a combination that supplements your treatment plan and fits your tastes and preferences, and don’t be afraid to try new activities on for size. Being a college student with bipolar disorder can actually be affordable, fun, and exciting – especially if you make day hikes and chat rooms a part of the experience!

For more information on affordable ways to manage bipolar disorder during college and adulthood, visit Healthline.com’s Bipolar Disorder Resource Center

The Continuity of Physical, Social, and Cognitive Development

July 22, 2012

By Gavin Broomes of One Giant Leap



Symbol for continuity consisting of intertwined colored images traveling counterclockwise in a circle


I have devoted a great deal of time and words to specific topics, issues, and protocols and have strayed slightly from my overall central message.  Although I resist cliches as much as possible, ¨seeing the forest through the trees¨ is one that is unescapable when dealing with rehabilitation or any issue related to health care and health-seeking.  From a more ¨tangible¨ perspective, the central message should be very clear:  Continuity of all tissues is the overwhelming fundamental understanding that all formulation should be based on. In other words, it is impossible to ¨dis-entangle¨ muscle from tendon, ligament from joint capsule, periosteum from aponeurosis…although most textbooks conveniently separate them with different colours, they are synonymous with each other and therefore function in unison.  Despite this seemingly inuitive statement, I am consistently baffled at the lack (or disregard) of common sense when applying this to the formulation and implementation of treatment protocols.
With this in mind, I introduce a more global and philosophical discussion on continuity and how it relates to any and all those who are directly or indirectly affected by disease or disability (which, by the way, includes almost ALL of us).

Disease and disability are such complex and comprehensive states that it is nearly impossible to objectively navigate oneself while keeping a solid focus on ¨the big picture¨…therefore, society and the medical community have conveniently ¨cleaved¨ off 3 essential branches off of the developmental tree:  Physical Development, Social Development, and Cognitive Development.  I have already stated that the overall magnitude of disease and disability is quite overwhelming, therefore I do not fundamentally disagree with this convenient division…in fact, it permits more efficient ¨digestion¨ of information and priorities.  My main point of contention is the following:  Most consider each of these branches as seperate and distinct objectives.  This applies to both the healthCARE and healthSEEKING population.  Quite often, development strategies are implemented without any consideration as to how it affects the other 2 domains…and the naive assumption is that if you simply add three strategies together, you will get an obvious summation of benefits.  In reality, most people evaluate physical development strategies based on age-appropriate ¨standards¨ while attempting to shield themselves (or their loved-ones) from undue social challenges, and base cognitive strategies on some professionals percieved impression of cognitive performance.  I understand that this may all be dizzying…therefore I will make my central point:  Physical, Social, and Cognitive development are intimately linked with each other and reside within the same continuity.  


Photo of person in a wheelchair playing tennis



Again, for some this may still be intuitive and well understood…therefore I will deconstruct this message further and explore, not only a fundamental reality of existence, but how each relates to the other and how effecting change in one cascades to the others. 

I think it is important for me to point out that I assign EQUAL importance and relevance to all three components…however despite this, the reality and understanding of some fundamental hierarchy should be understood and accepted.  To be precise, the physical state (or status) plays a critical role in the development potential of social and cognitive skills.  

I consider the relationship between social and cognitive development to be much more symbiotic and intimate…meaning that each are very much dependant on each other, whereas physical development exists more as a ¨catalyst¨ for improvement potential as well as sustainability.  In other words, physical ¨competence¨ serves as the environmental and ¨nutritional matrix¨ for the others.

Physical, Social and Cognitive Flowchart


To expand on this philosophy further, we will need to enhance each of the three relationships further.

Social-Cognitive:  As mentioned before, this is the most intertwined and inimate interaction of all.  Much of the cognitive potential resides in the ability to effectively assimilate into some level of social acceptance or recognition.  In addition, the climate / environment on a social level (regulation, social stigma, etc) must be well established and in place in order to promote active cognitive development in a healthy and productive manner.   Conversely, cognitive improvement and success contribute to the development of social parameters such as self-esteem and self-confidence.

Physical-Social:  This relationship is perhaps the most tangible one simply due to the fact that it is quite ¨visceral¨ in both the positive and negative way.  From a negative perspective, physical disability is unfortunately still quite often stigmatized and therefore has detrimental effects on the development of fundamental social skills and confident.  In addition to this, the varied physical limitations themselves often limit the accessibility to social opportunity.  The positive perspective is more straightforward in that physical performance, confidence, and improvement contribute directly to the cultivation of social acceptance, opportunity, and development.

Physical-Cognitive:  This is by far the most elusive realtionship.  Many disabilities, despite the current plethora of information and apparent ¨understanding¨,  are associated with some level of cognitive deficiency…or to be more precise, it is perceived that there is some lower level of cognitive function.  There are many examples that could be highlighted, but I think it is more productive to elaborate on some nuances that are often overlooked and under-appreciated.

-The fundamental ability of proper head control can not be overstated.  In order to concentrate and apply effective focus, the head needs to be consistently level with the horizon…even if the rest of the body is moving.  In other words, the absorption of  information is dependant on the ¨stillness¨of the head which permits effective tracking of the eyes.
-Management of fine motor skills is essential for the use of both standard or technology assisted devices in order to tap maximum potential for learning.  More importantly, the establishment of consistent gross motor function is a fundamental precursor and requirement for basic performance at all educational levels.

Although quite simple in nature, these two examples still go underappreciated.  Engaging in reading and writing activities (at any level) while expending large amounts of focus on maintaining eye contact, head position, and balance is extremely disruptive…and therefore unfairly challenges learning performance and potential.

The final step is to then consider all three as a conglomerate…and therefore base your long-term rehabilitative strategy on the cultivation of the continuity as opposed to addressing each on its own.  When this relatively under-appreciated approach, it becomes much easier to establish short, medium, and long term objectives…formulate some form of ¨roadmap¨ for each person and immediate family to follow…and enable a positive impact that is of IMMEDIATE value as opposed to a ¨defered life plan¨ or objective (¨when he/she is better, things will be ok¨).  

I hope this small rant has been helpful and helps to establish a fundamental philosophy that everyone can understand and resonate with.

 One Giant Leap Logo

One Giant Leap: The Science of Physical Rehabilitation is a blog dedicated to presenting, discussing and debating scientific concepts in the field of Cerebral Palsy, Physical Rehabilitation, and High Performance Training.  The Blog can be found on the web at http://thescienceofphysicalrehabilitation.blogspot.com.ar/ and on Facebook at http://www.facebook.com/pages/One-Giant-Leap-The-Science-of-Physical-Rehabilitation/247330191983662


Q and A with Professor Everilis Santana

June 18, 2012

This is a summary of a recent “Questions and Answers Session” that We Connect Now (WCN) had with Everilis Santana (ES), an Assistant Professor at Bristol Community College in Falls River, Massachusetts, where she teaches courses in Mathematics.

BCC Logo green background

WCN – As a professor, have you had to accommodate students with disabilities, and if so, describe the process that results in the accommodation?

ES – At Bristol Community College, there is a Dean for Disability Services. This is a high level position that works with the issue of disability services and accommodations and gives visibility to the issue within the organizational structure of the institution. At Bristol, the student has to assert his/her right to receive an accommodation by personally delivering the letter of accommodation to the professor.  Personally I think it is good to request this step as part of the accommodation process because it personally involves the student and prompts that the student advocates for herself/himself.  Once an accommodation has been established tests are administered to the student providing for the approved accommodation(s).

At the beginning of my career as a professor I taught at North Hennepin Community College in Brooklyn Park, Minnesota, and there the professor learned about a student accommodation through a notice of an accommodation that came through intra-office mail. At times I did not know who the person was that was receiving the accommodation. At North Hennepin there is a testing center where most of the students receiving accommodations take their exams so the testing environment is more uniform and centralized than if the tests are administered in different spaces on campus.

WCN – What types of disabilities have you had to accommodate in your classroom?

ES – I have had blind students, and students with Asperger Syndrome, traumatic brain injury and general learning disability.

WCN – Have you ever been approached by a student with a disability for him/her to make you aware of his/her needs?

ES – Yes. A student with Asperger Syndrome approached me and gave me a pamphlet about his condition. I think that it is a good idea that helps professors become more educated on issues that affect individual students.

WCN – What types of accommodations have you administered as a professor throughout your career?

ES – For a student with a learning disability, I have given extra time to answer the tests, up to double time.  For a student with Attention Deficit, I have administered tests in a reduced distraction environment and for a student with Traumatic Brain Injury it has been allowed that the student have access to the class notes during the test. I have also divided a test in parts and administered it at different times and tests have been given in Braille. Accommodations during class, and not just for testing, include preferred seating and the use of a notetaker.

WCN – Are there some resources or procedures that you have used during your professional career that you believe are helpful in serving college students with disabilities?

ES – Here at Bristol, we use a form that provides the professor with questions about the performance of a student with a disability that is receiving accommodations.  The professor fills out the form and sends it to the Disability Services office. The filled out form gives them an idea of the progress in the student achieving academic success.  This form gives an idea of the effectiveness of the accommodations in the student’s academic performance.

WCN – In your opinion, are students with disabilities well integrated and visible within Bristol?

ES – Yes, they are visible and vocal in the classroom too.