Thursday, October 6, 2016

Information about the Cold Laser (low level light therapy/LLLT)

In May 2016, I began researching how cold lasers/low level light therapy (LLLT) could help children with special needs.  My daughter, Presley, would turn 5 the following month and like many parents, I wanted to ensure we were doing all that we could to help her reach her full potential as well as assist her body to function optimally.

Children with Down syndrome and other types of special needs are challenged with a variety of issues.   All kids are different, but there are multiple commonalities they can share to include, but not limited to:

delayed growth
delayed cognition
delayed fine and gross motor development
thyroid disorders
decreased vision, strabismus (cross eyed), amblyopia (lazy eye)
mitochondrial dysfunction, low ATP production
MTHFR/detox complications
altered sleep patterns, sleep apnea
decreased social interaction and/or eye contact
apraxia or delayed speech and communication
compromised immune system

In this post, I will provide the information I have found to support the use of cold laser and address some of these issues, as well as our positive experience using the laser.   I will attempt to keep it easy to understand, and I will keep the source visible so you can see these are reputable studies and read further if you desire.  There is also an abundance of personal testimonies using the laser for many other issues available throughout the web.

First, what is low level light therapy (LLLT)?  LLLT involves exposing cells or tissue to low levels of red and near infrared (NIR) light, and is referred to as “low level” because of its use of light at energy densities that are low compared to other forms of laser therapy that are used for ablation, cutting, and thermally coagulating tissue. LLLT is also known as “cold laser” therapy as the power densities used are lower than those needed to produce heating of tissue. It was originally believed that LLLT or photobiomodulation required the use of coherent laser light, but more recently, light emitting diodes (LEDs) have been proposed as a cheaper alternative. LLLT has now developed into a therapeutic procedure that is used in three main ways: to reduce inflammation, edema, and chronic joint disorders; to promote healing of wounds, deeper tissues, and nerves; and to treat neurological disorders and pain.  Within the cell, there is strong evidence to suggest that LLLT acts on the mitochondria to increase adenosine triphosphate (ATP) production, modulation of reactive oxygen species (ROS), and the induction of transcription factors.  (source:   )

We purchased our laser in June 2016 and are using this laser from QRI which addresses using the laser for reflex integration.  Many of our children, as well as most of us, have unintegrated reflexes.  Using this laser has made integration easy with reproducible results.  Many occupational therapists have been trained in reflex integration and utilize the laser specifically for this.  The owner, Bonnie Brandes, was trained in MNRI.  Reflex integration is extremely important with our children with different needs as typical development is delayed, therefore so is typical reflex integration.  Here is an article explaining reflex profiles specific to Down syndrome. You can learn more detailed information about reflex integration from Bonnie's book called The Symphony of Reflexes found here on amazon or here on the QRI website.   

What makes this laser different?  The QRI Harmonic is the only laser that combines the CMT sound frequencies with low level laser, this distinguishes the Harmonic from other lasers. Two low level laser heads are included, the main unit and an attachment. This allows you to complete each reflex integration protocol in one-half of the time and create a synergistic connection between accu-reflex points and primitive reflex patterns. The CMT encompasses the entire spectrum of frequencies that sweep through the laser diodes and through an adjustable sound system.  Low level lasers work at a cellular level for Cold laser has shown to be effective for numerous conditions without side effects in over 8,000 research studies. The QRI Harmonic is practical for both professional and home use. Each head has:

  • 2  5mw red laser diodes 650nm
  • 2  5mw violet laser diodes 405nm
  • 1 5mw infrared laser diodes 780nm

I have previously taken detailed courses on reflex integration and knew that it could take 4-6 weeks to integrate a reflex.  Now, with this laser, I can see integration in one session.  That doesn't mean it will remain permanently integrated, just like one chiropractic session may not be enough, so conducting sessions on a regular basis should prove very helpful and build a more solid foundation.   This laser comes with online training and gives you a book with detailed instructions, which also make this laser very different from others.  You simply go in the exact order it shows you and at the next session, you pick up where you previously stopped.  

How often do you use it?   This varies depending on the age, tolerance, and symptoms of the child.  For children around age 5, it may be a 20 minutes session each day.  For an older child with more concerns, a session could be an hour.  You can conduct these sessions every day, every other day, weekly, etc.. depending on the needs of the child and the issues you are addressing.   Currently, I am able to do our sessions while the girls are awake.  They enjoy watching a movie and frequently yawn during each session.  My neurotypical 6 year old stated "I love the way it feels afterwards", and Presley actually asks for her laser session.  Many parents perform their sessions after the child has gone to sleep. 

Side effects:  I found no documented side effects from laser use.  A few parents made comments about a headache, being tired, vivid dreams, and a temporary increase in negative behavior or emotions.   Bonnie said this was not unusual as the brain reorganizes itself.  I noticed Presley's eye movements worsened for about a week then settled down to less than they were before.   It is not recommended for use over eyes, thyroid, or cancer.  

How can the laser potentially help your family?

1. Cognition:

*  LLLT improves prefrontal cortex-related cognitive functions, such as sustained attention, extinction memory, working memory, and affective state. Transcranial infrared stimulation may be used efficaciously to support neuronal mitochondrial respiration as a new non-invasive, cognition-improving intervention in animals and humans.  LLLT supplies the brain with metabolic energy in a way analogous to the conversion of nutrients into metabolic energy, but with light instead of nutrients providing the source for ATP-based metabolic energy.  A long-lasting effect is achieved by LLLT's up-regulating the amount of cytochrome oxidase, which enhances neuronal capacity for metabolic energy production that may be used to support cognitive brain functions. LLLT via commercial low-power sources (such as FDA-cleared laser diodes and LEDs) is a highly promising, affordable, non-pharmacological alternative for improving cognitive function. LLLT delivers safe doses of light energy that are sufficiently high to modulate neuronal functions, but low enough to not result in any damage. (source: )

*  We have shown, for the first time, that tLLLT can stimulate neurogenesis in both the hippocampal DG and the SVZ in mice with TBI. Moreover, the treatment has been shown to improve spatial memory and learning. The likelihood that LLLT can induce the brain to repair itself after injury suggests that laser therapy may have much wider applications than that previously considered. Many diseases of the brain that are traumatic, degenerative, and psychiatric could be benefited if neurogenesis can be induced by an inexpensive, low-risk procedure without known side-effects. Moreover, tLLLT appears to be a viable and efficient stimulus for enhancing endogenous neurogenesis and to exert a survivability enhancing effect on the neuroprogenitor cells, thus increasing their chance to get functionally integrated into the pre-existing neuronal circuitry.  (source:  )

*  One popular warrior mom within the Down syndrome community is Jane Winans.  She previously used neurofeedback with her teenage daughter Lydia, but stopped while trying the laser.   She had a brain map performed prior to beginning the laser and three months after using the laser.  She had this to say:   "How's this for data?  Brain map Summary from Dr. Abbot:
Decreased beta and improved coherence are probably the most important findings. The beta would be getting in the way of any functioning deficits. (I think she meant benefits) No one does well when overly anxious or stimulated or when the brain is irritated. The improvements in coherence are actually rather exciting as frontal-occipital coherence is associated with reading smoothly, judgement, mood, executive functioning. Improvements in central and frontal locations may be associated with improvements in coordination, and strength.  School testing - Lydia improved 2 levels on a standardized reading test since April. No summer reading program. Just laser." (posted with permission from Jane).

*  Excitotoxicity describes a pathogenic process whereby death of neurons releases large amounts of the excitatory neurotransmitter glutamate, which then proceeds to activate a set of glutamatergic receptors on neighboring neurons (glutamate, N-methyl-D-aspartate (NMDA), and kainate), opening ion channels leading to an influx of calcium ions producing mitochondrial dysfunction and cell death. Excitotoxicity contributes to brain damage after stroke, traumatic brain injury, and neurodegenerative diseases, and is also involved in spinal cord injury. We tested whether low level laser (light) therapy (LLLT) at 810 nm could protect primary murine cultured cortical neurons against excitotoxicity in vitro produced by addition of glutamate, NMDA or kainate. Although the prevention of cell death was modest but significant, LLLT (3 J/cm(2) delivered at 25 mW/cm(2) over 2 min) gave highly significant benefits in increasing ATP, raising mitochondrial membrane potential, reducing intracellular calcium concentrations, reducing oxidative stress and reducing nitric oxide. The action of LLLT in abrogating excitotoxicity may play a role in explaining its beneficial effects in diverse central nervous system pathologies. (source:  )

*  Cerebral hypometabolism characterizes mild cognitive impairment and Alzheimer's disease. Low-level light therapy (LLLT) enhances the metabolic capacity of neurons in culture through photostimulation of cytochrome oxidase, the mitochondrial enzyme that catalyzes oxygen consumption in cellular respiration. Growing evidence supports that neuronal metabolic enhancement by LLLT positively impacts neuronal function in vitro and in vivo.  Experiment 1 verified that LLLT increased the rate of oxygen consumption in the prefrontal cortex in vivo. Experiment 2 showed that LLLT-treated rats had an enhanced extinction memory as compared to controls. Experiment 3 showed that LLLT reduced fear renewal and prevented the reemergence of extinguished conditioned fear responses. Experiment 4 showed that LLLT induced hormetic dose-response effects on the metabolic capacity of the prefrontal cortex. These data suggest that LLLT can enhance cortical metabolic capacity and retention of extinction memories, and implicate LLLT as a novel intervention to improve memory.  (source: )

*  LLLT or photobiomodulation refers to the use of low-power and high-fluence light from lasers or LEDs in the red to near-infrared wavelengths to modulate a biological function.  Cytochrome oxidase is the primary photoacceptor of LLLT with beneficial eye and brain effects since this mitochondrial enzyme is crucial for oxidative energy metabolism, and neurons depend on cytochrome oxidase to produce their metabolic energy. Photon-induced redox mechanisms in cytochrome oxidase cause other primary and secondary hormetic responses in neurons that may be beneficial for neurotherapeutic purposes. Beneficial in vivo effects of LLLT on the eye have been found in optic nerve trauma, methanol intoxication, optic neuropathy, retinal injury, retinitis pigmentosa, phototoxicity, and age-related macular degeneration. Beneficial in vivo transcranial effects of LLLT on the brain have been observed in anoxic brain injury, atherothrombotic stroke, embolic stroke, ischemic stroke, acute traumatic brain 
injury, chronic traumatic brain injury, neurodegeneration, age-related memory loss, and cognitive and mood disorders. No adverse side effects have been reported in these beneficial applications of LLLT in animals and humans. The authors conclude that LLLT is a safe and beneficial approach, based on scientifically sound mechanisms of action of red to near infrared light on cytochrome oxidase, with neurotherapeutic  promise for a wide range of ophthalmological, neurological, and psychological conditions.  (source:  )

2.  Mitochondrial dysfunction, low ATP production -

*  Here is an article from the Journal of Pediatric Biochemistry explaining mitochondrial dysfunction in Down syndrome and Autism Spectrum disorders:

* Radiation of tissue with light causes an increase in mitochondrial products such as ATP, NADH, protein, and RNA, as well as a reciprocal augmentation in oxygen consumption, and various in vitro experiments have confirmed that cellular respiration is upregulated when mitochondria are exposed to an HeNe laser or other forms of illumination.  (source: )

*  The influence of LLLT on the electron transport chain extends far beyond simply increasing the levels of ATP produced by a cell. Oxygen acts as the final electron acceptor in the electron transport chain and is, in the process, converted to water. Part of the oxygen that is metabolized produces reactive oxygen species (ROS) as a natural by-product. ROS are chemically active molecules that play an important role in cell signaling, regulation of cell cycle progression, enzyme activation, and nucleic acid and protein synthesis. Because LLLT promotes the metabolism of oxygen, it also acts to increase ROS production. In turn, ROS activates transcription factors, which leads to the upregulation of various stimulatory and protective genes. These genes are most likely related to cellular proliferation, migration, and the production of cytokines and growth factors, which have all been shown to be stimulated by low-level light.  (source: )

3.  Compromised immune system -

*  Immune cells, in particular, appear to be strongly affected by LLLT. Mast cells, which play a crucial role in the movement of leukocytes, are of considerable importance in inflammation. Specific wavelengths of light are able to trigger mast cell degranulation, which results in the release of the pro-inflammatory cytokine TNF-a from the cells. This leads to increased infiltration of the tissues by leukocytes. LLLT also enhances the proliferation, maturation, and motility of fibroblasts, and increases the production of basic fibroblast growth factor., Lymphocytes become activated and proliferate more rapidly, and epithelial cells become more motile, allowing wound sites to close more quickly. The ability of macrophages to act as phagocytes is also enhanced under the application of LLLT.  (Read entire study here:  )

4.   Hypothyroid -

*  In reference to chronic autoimmune thyroiditis, which is the most common cause of acquired hypothyroidism:  The preliminary results indicate that LLLT promotes the improvement of thyroid function, as patients experienced a decreased need for LT4, a reduction in TPOAb levels, and an increase in parenchymal echogenicity.  (source:  )

5.  Impaired growth -   I mark Presley's height on the door in her room every 4-6 months.   This keeps me aware of where she is on growth charts and if there are spans of slowed growth.   In the six months prior to initiating the laser, she grew 1 1/4 inches, which is 0.052 inch per week.  Seven weeks after using the laser, I suspected she had gone through a growth spurt and measured her again.  She had already grown 3/4 inch, which is 0.107 inch a week.  So, her rate of growth had almost doubled. She also went up 2 shoe sizes. I was unable to find any data supporting this, but many other parents noticed the same result with their children using the laser.  Some suspect it may be do to their child sleeping more deeply since human growth hormone (HGH) is released more during sleep.     (source:  )

6.  Information related to retained primitive reflexes: 

Primitive Reflexes: Reasons Behind Why My Child has Sensory Issues, Poor Balance, and Developmental Delays.  The three most notable reflexes that are frequently seen in later childhood are the Moro reflex (affects sensory issues), Asymmetrical Tonic Neck Reflex (ATNR) (child can’t cross the midline) and the Symmetrical Tonic Neck Reflex (STNR) (poor posture, W-sitting and developmental delays.  (source: )

Why a retained spinal galant reflex can be mistaken for ADHD

*  The Learning Hierarchy by Sonia Story: 
The normal hierarchical developmental system, beginning before the birth of the infant and carrying on through adulthood. If the foundations—the primitive and postural reflexes—are unstable, weak or have gaps in their development, they will undermine all other levels to some degree. The motor, perception, speech and conceptualisation will also be unstable, and breakdown in any or all of these areas can occur, causing the higher-level functioning areas to also be affected. Although these stages do overlap to a certain extent, if a stage is missed, interfered with or not fully integrated, it can prevent full development of subsequent stages. Unfortunately the child will not ‘grow out’ of their learning and behaviour problems. The problems may alter and appear to improve as the child learns to compensate in other ways, but the weakness in their system will remain, causing stress on their system. They may also resurface when the child moves to more intensive learning situations, where the demands of higher learning are greater, and the pressure for academic progress is more urgent.  (See here for full article and picture of hierarchical developmental system:

7.  Speech -   There are many reflexes related to speech and communication.   I used the basic  reflex integration protocol with Presley for the first two months.  We then added the TALK program.  Presley was diagnosed with "severe apraxia" at age 3, and we have worked very hard continuing to input despite the limited output.  However, we can definitely attribute our increase in speech and communication to the current use of the laser. Presley went from 3 word sentences to 5 word sentences within a week.  She handed me a book and said "read it to me please".  Later, when asked about her day, she told her dad about her baseball game by saying "swing, swing, swing, hit ball and run".  She had never described her day to him before. Soon after when arriving at a nearby lake, she immediately said "ocean, dolphins, daddy's big boat" and began looking for dolphins.  These were new words for her and completely unprompted.  We immediately noticed she was also singing along with songs.  She began telling me if her bath water was "too hot" or "too cold".   We had also worked very hard on the letters D, N, and T without success previously, but a month into the TALK program, she just began saying them on her own.  

Here is an example of her spontaneously singing in the car to songs on the radio. 


In addition to the TALK program, QRI offers other products with programs  here such as ASD, THINK, Move & Sensory integration, and UNITY.

Additional uses for the LLLT which could be useful for other family members as well:

*    Stroke, fatigue, Depression:  LLLT has been used non-invasively in humans after ischemic stroke to improve neurological outcome (Lampl et al., ). It also led to improved recovery and reduced fatigue after exercise (Leal Junior et al., ). One LLLT stimulation session to the forehead, as reported by Schiffer et al. (), produced a significant antidepressant effect in depressed patients. No adverse side effects were found either immediately or at 2 or 4 weeks after LLLT.  (source: )

* Hair loss - Studies have shown that LLLT stimulated hair growth in mice subjected to chemotherapy-induced alopecia and also in alopecia areata. Controlled clinical trials demonstrated that LLLT stimulated hair growth in both men and women. Among various mechanisms, the main mechanism is hypothesized to be stimulation of epidermal stem cells in the hair follicle bulge and shifting the follicles into anagen phase.  ( source:   )

Cellulite - Low-level laser therapy using green 532 nm diodes is safe and effective for improving the appearance of cellulite in the thighs and buttocks. In contrast with other technologies, LLLT is effective as a stand-alone procedure without requiring massage or mechanical manipulation. Future studies will assess the long-term benefits of LLLT for the treatment of cellulite.

Accelerated wound healing -

- Tissue healing is a complex process that involves local and systemic responses. The use of low level laser therapy for wound healing has been shown to be effective in modulating both local and systemic response.
The study found that low level laser therapy (II) was effective in open wounds, which showed better regeneration and faster restoration of structural and functional integrity as compared to the control group. (source:  )

-  The reviewed studies show that phototherapy, either by LASER or LED, is an effective therapeutic modality to promote healing of skin wounds. The biological effects promoted by these therapeutic resources are similar and are related to the decrease in inflammatory cells, increased fibroblast proliferation, angiogenesis stimulation, formation of granulation tissue and increased collagen synthesis. In addition to these effects, the irradiation parameters are also similar between LED and LASER.  (source:  )

*  Pain -  acute orthopedic conditions such as sprains, strains, post-surgical pain, a whiplash injury, muscular back pain, cervical or lumbar radiculopathy, tendinitis, and chronic conditions such as osteoarthritis, rheumatoid arthritis, frozen shoulder, neck and back pain, epicondylitis, carpal tunnel syndrome, tendinopathy, fibromyalgia, plantar fasciitis, post tibial fracture surgery and chronic regional pain syndrome are amenable to LLLT. Dental conditions producing pain such as orthodontic procedures, dentine hypersensitivity, and third molar surgery respond well to treatment with LLLT. Neuropathic pain conditions can also be treated such as post herpetic neuralgia, trigeminal neuralgia  and diabetic neuropathy. Due to the wide spectrum of conditions one would surmise that multiple mechanisms can operate to achieve pain relief.  (source:  )

Brain Injury or traumatic brain injury:

-  Clinical application of these levels of infrared energy for this patient with TBI yielded highly favorable outcomes with decreased depression, anxiety, headache, and insomnia, whereas cognition and quality of life improved. Neurological function appeared to improve based on changes in the SPECT by quantitative analysis. (source:  )

- (Using helmet) Researchers at the VA Boston Healthcare System are testing the effects of light therapy on brain function in the Veterans with Gulf War Illness study.The light is painless and generates no heat. A treatment takes about 30 minutes. The light from the diodes has been shown to boost the output of nitric oxide near where the LEDs are placed, which improves blood flow in that location.  The LED therapy increases blood flow in the brain, as shown on MRI scans. It also appears to have an effect on damaged brain cells, specifically on their mitochondria.   These are bean-shaped subunits within the cell that put out energy in the form of a chemical known as ATP. The red (600 nm) and NIR (800–900nm) wavelengths penetrate through the scalp and skull by about 1 cm to reach brain cells and spur the mitochondria to produce more ATP. That can mean clearer, sharper thinking.  Naeser says brain damage caused by explosions, or exposure to pesticides or other neurotoxins — such as in the Gulf War — could impair the mitochondria in cells.  (source:  )

Alzheimer's - Parkinson's - Turning On Lights to Stop Neurodegeneration: The Potential of Near Infrared Light Therapy in Alzheimer's and Parkinson's Disease.  Several recent studies in animal models of Alzheimer's and Parkinson's disease have reported that low-level near infrared light (NIr) therapy not only mitigates the behavioral deficits associated with these conditions but also has neuroprotective effects, slowing the underlying death of neurons.  The first studies to report neuroprotection by NIr after parkinsonian insult demonstrated that NIr treatment reduced cell death, increased ATP content and decreased levels of oxidative stress in rat striatal and cortical cells exposed to the parkinsonian toxins rotenone and MPP+ (1-methyl-4-phenylpyridium) in vitro (Liang et al., ; Ying et al., ). In cultures of human neuroblastoma cells engineered to overexpress α-synuclein, NIr increased mitochondrial function and reduced oxidative stress after MPP+ (1-methyl-4-phenylpyridinium) exposure (Trimmer et al., ; Quirk et al., ). Further, in hybrid cells bearing mitochondrial DNA from Parkinson's patients, mitochondrial movement along axons improved substantially after NIr treatment, with movement restored to near control levels.   There would be several key advantages for the use of NIr therapy over current treatments for both Alzheimer's and Parkinson's disease. First and foremost, NIr has the potential to be neuroprotective. A growing body of pre-clinical evidence indicates that NIr therapy slows or stops disease pathology.  (read more:  )

While the research data is not specifically for children with special needs or the Down syndrome population, they show many ways the laser is being studied to help the body and brain.  The stories on the cold laser private facebook page "Cold laser/LED/light therapy" are endless and nothing short of miraculous.   Parents have reported the following amazing results:

- first crawling movements
- increased distance of crawling
- first steps
- first time to stand unsupported
- increased energy, less fatigue
- increased speech and communication with depth, detail, and meaning
- increased social interaction with family and friends
- increased eye contact
- increased confidence
- detoxification reactions
- narrowed gait (Presley's physical therapist also made comment to this)
- improved balance and coordination, jumping, standing on one leg
- improved vision (noted by their optometrist)
- coordinated eye movements
- first time to walk upstairs or downstairs
- improved reading skills
- improved sleep, less awakenings
- increased growth/height
- decreased or stopped teeth grinding
- decreased anxiety and frustration in neurotypical children
- first time to feed self using finger foods
- first time for imaginative play and appropriate play with use of toys
- decreased sensitivities to sound and touch
- laughing and smiling in appropriate responses
- improved writing ability
- increased attention and focus
- stopped bedwetting

I wrote this post to help parents who are interested in learning more about the benefits of cold lasers.   I am not a consultant or advisor for QRI,  but this is the company I chose to use, and the staff has exceeded my expectations in their customer service and personally taking time to answer all of my questions.  They are not medical professionals and will not give medical advice.  As a consumer, I have seen incredible results, both cognitive and physical, that seem to be shared with every other parent that utilizes this device.  I participated in the online program and in person training class when Bonnie Brandes and Jamie Barker attended the Down syndrome Innovations conference here in Little Rock, Arkansas.   As part of our mission at 3 of 21, I want to ensure parents have the most information at their disposal regarding what we believe to be the most beneficial technologies or therapeutic aids available at the time.  This device and learning program from QRI definitely meet this criteria, and I hope you find this information helpful to you and your family.

Many blessings,

Robin Tolliver

Saturday, July 16, 2016

Potty Training 101 for children with Down syndrome

Image result for a potty for me   

I am not an expert, but I hope this information will give you some ideas and help you with the endeavors of potty training. 

We initially began putting Presley on the potty around age 3 just before bath time.  We just made it part of our routine with no stress about it, sometimes she went, sometimes she did not.  Then when she was four, "I decided" she was ready and went for it.  It went horribly wrong, she became very constipated and refused to make "brown".  After ten days, I called it off and had to work on correcting that issue.  So for starters, encourage regular predictable bowel movements.  If this is an issue, read more here for ideas to help with constipation.  Observe for those subtle clues and predicable patterns, such as going off to another room by themselves, after a certain meal, pulling at shorts, squirming, etc...

Next, establish what you will call going to the bathroom.  For us, we called it "yellow" and "brown" to identify with what color she obviously saw.  Everyone in the family or who works with your child should be aware of your choice of words so there is consistency and your child is not confused by others.   These are also words that Presley could easily say.  If your child is non verbal, then consider using the sign for potty or maybe have a picture they can point to when they need to go.

Our second attempt only a few months later went great and 12 days later, Presley was potty trained.  Below is a list of what worked and what did not work for us. 

*  Buy at least two small children's potties that play music when they sense wetness.  One for the bathroom and one for your vehicle.  Here is an example on amazon.  It gives them a reward to hear and also lets you know when to cheer.

Product Details

*  When you begin placing your child on the potty, try putting their feet in warm water to help them understand what it is that you are wanting them to do.  Give praise as soon as the potty plays music and announce the word you have chosen to use.  We would say "Yay for yellow".   This is also a great trick when you want them to leave the house with an empty bladder and they can't go yet.  Presley would even say "warm water please" when she couldn't go.   I used one of our small plastic step stools and just turned it over to hold water.

*  Plan some time on the calendar to stay home as much as possible.  I am retired, so other than their dance class, piano, groceries, and church, we stayed close to the house.  This is when the children's potty in the vehicle comes in handy. When we have to leave, I have the potty in the third row of the vehicle ready with paper towels, plastic bags, wipes, and homemade sanitizer.   We called it "truck yellow".   We would also use the restroom before we left, when we got to our location, possibly before we left, and again when we got home.  She didn't always go, but we offered often.     I truly believe staying home, watching for cues, watching the timers, being consistent, and keeping it low stress was the biggest key for us.

*  I kept Presley in a t-shirt or just underwear when at home.  Presley is a typical size 4 year old, so disposable diapers were getting tight.  So, I spent money on fancy cloth diapers since I thought we would be using them for awhile.  However, they didn't fit well  either and left a rash on her bottom when used overnight.  Next, I tried Good nites trainers which look like underwear that you place an absorbent pad in.  Again, a little snug around the legs.  Then I bought the lining and water resistant material for a cloth diaper at a local fabric store and sewed it into the bottom portion of some of her panties.  This was ok, but failed at night.  Finally, I ended up purchasing a lot of panties her size with characters she picked out herself.  She knew immediately when she was wet and so did I.  For those  "brown" accidents, well some of those just got thrown away.   I wish I had just gone straight to panties in the beginning.

*  A bidet/diaper sprayer such as these were very helpful to rinse out panties and eventually little bottoms.  It also helps rinse out the children's potty.  A worthy investment and very easy to hook up.

SmarterFresh Cloth Diaper Sprayer, Premium Stainless Steel Diaper Sprayer for Toilet - Diaper Washer Hand Held Bidet Sprayer for Cloth Diapers

Squatty potty - this places your child in an position that encourages full bowel movements and doesn't let them "hold it in" when using the regular toilet. I used a small step stool on the floor to elevate her legs when she was using the children's potty on the floor.  


*  A reward or potty chart.  I made this one, because she loves Minnie Mouse.  I made a word document, added pictures and names, then laminated.   I cut out smaller pictures and put Velcro on them instead of stickers.   I made one for my other daughter (age 6), so Presley could see her using the chart and encourage her to use hers.   I tried offering chips or a special snack when she used the potty, but that has never been a great motivator for Presley.  Some have recommended using a bag of small toys and letting them pick a new one each time they get it right.

Timer or potty watch - I used a small timer and set it for every 15 minutes initially then increased the time.  A few times I tried staying in the bathroom for an extended period until she used the bathroom.  We played on Ipad, watched videos, etc.. but that did not work well for us as I found it difficult to stay still in one room with so many things needing to get done and a 6 year old needing my attention too.  Instead, we ended up going into the bathroom every 15 minutes.  If she couldn't go, I would either use the warm water or just wait for another 15 minutes. I took away all the distractions (ipad, toys..) and we focused on the task at hand.   A friend used the potty watch.  She put it on her daughter and while she went to mother's day out, therapy, or at home, whoever was around her when it went off knew to take her to the bathroom.  I could also see it beneficial for the mom to wear a watch to remind her in case the child is playing in another room when it goes off.

                              Product Details

*  Leave the light on in the bathroom, this encourages Presley to go in there on her own when she needs to go.  We typically turn the light on when we use the restroom, so this invites them into the room even if there is adequate light from a window already.

*  Place your hand on their lower abdomen.  This worked for teaching how to put "brown" in the potty.  I sat on a stool in front of her and put my hands on her lower portion of her belly and said "push that brown out".  She would instinctively push back against my hand and therefore learned exactly how to use her muscles to push it out at her command.

*  Potty videos and books - we read and watched many of these.  Signing times has a cute video here that has catchy songs you can sing together while waiting. We also had a lot of fun making our own videos using her older sister and their doll Minnie. Presley likes to read so we used flashcards to establish a certain routine in the video, but you could use pictures too.   The flashcards were like this:
        - Do you need to go to the potty?
        - Yes
        - Go to the potty.
        - Panties down.
        - Go pee pee or yellow.
        - Wipe.
        - Pants up.
        - Wash hands with soap and water.
        - Dry hands

Here is one of our videos:

Make it fun.  Each time we headed to the bathroom, I would sing a silly song or phrase to try to make her laugh so she would have a positive association with going to the bathroom.  I still sing (imagine Beach boys surfing song)  "Let's go potty now, everybody potty now, come on and go potty with me.   How about "1 little, 2 little, 3 little browns....."  I won't bore you with the others, but sometimes Presley now says "Mom stop".   I also told Presley we were having a "brown party" and she needed to make brown so she could add it to the potty party.  She thought she was a big girl doing this.  Let them flush also since this isn't something they ordinarily get to do.

Auditory processing - a minimal 3 or 4 was recommended by our neurodevelopmentalist at NACD.  This ensures they truly comprehend the task you are asking of them.  See here for more information about auditory processing.

Reflex integration - we initially did rhythmic movements and learned about reflex integration from Play Move ThriveIt seemed to wake up her body and let her feel all the sensations easier.  Some moms are having success using the QRI laser to integrate reflexes and produce results much quicker in many different areas.   Before using the laser, Presley would make yellow in the shower as soon as the warm water touched her, but after a week of using the laser, she stood up and asked to get out and go to the potty instead.  We were not using the laser when she was potty trained though. 

Accidents - I carried extra underwear, pants, and a baggie everywhere we went.  We had lots of accidents in those 12 days, but she caught on that we weren't turning back and we stayed consistent.  One time at a 30 minute piano lesson for big sister, we changed outfits three times.  When she had an accident at home, I would walk her over to get the paper towels and cleaner and she had to help clean up the mess.  She then had to take her underwear off and put them into the washer by herself.  She did not think this was very fun.  I tired my best to be unemotional when there were accidents, but hey, I am human.

*  Some parents have had good results using this 3 day potty training method.  I have best success when I incorporate a variety. and the Bridget Murphy 4 day method seen here.

*  As with everything, keep diet and environment consistent without changes as possible when starting potty training.  Don't add any other stressors to them or yourself.    Always a good, clean diet with adequate sleep.   Good luck!

Many blessings,


Sunday, June 5, 2016

Language Pyramid from Gemiini

In 2014 Laura Kasbar's speech and language program that she created became available to all of us.  Gemiini, which offters educational videos for people on the autism spectrum, brain injuries, Down syndrome and other types of learning disabilities.

After Emma started showing signs of echolalia we thought it would be a great addition to our daily routine.  Gemiini has certainly proven that video modeling intervention is one of the most effective way to promote speech.  Studies have proven that video modeling is a viable intervention.

Video modeling and word identification in adolescents with Autism Spectrum Disorder

To best describe what Gemiini is and why is was created please check out this video.

Recently Gemiini created a series of videos called The Language Pyramid-Growing a Confident Communicator, which illustrates the language development process.  Please take the time to watch these short videos for better understanding.

Video 1:  The Language Pyramid-Growing a Confident Communicator

Video 2:  Sparking Imitation

Video 3:  Animal Noises

Video 4:  Basic Word Labels

Video 5:  First Action Words

Video 6:  Putting Sentences Together

Video 7:  More Action Words-Tenses and Pronouns

Video 8:  Modifiers

Video 9:  Chunking with Phrases

Video 10:  Conversation Builders