Frequently asked questions
Our Client Care Coordinator schedules all initial evaluations and therapy sessions.
Please bring your driver’s license, credit card, insurance card, completed paperwork, Individualized Education Program (IEP) or 504 Plan (if applicable), any other medical records, and doctor’s order. As a reminder, we are a shoe-free clinic so please bring socks or slippers. For infants, be sure to bring their blankie!
Generally, we can get new patients scheduled for their initial evaluation within about three weeks. However, specialized services, like orofacial myofunctional therapy, may take longer.
No. Photography, videotaping, or recording of any type is not allowed.
If you have sensitive information you’d like to discuss with the therapist prior to the evaluation, please let our Client Care Coordinator know your concerns and, if necessary, a special accommodation may be arranged. After the evaluation, the therapist should be able to tell you whether or not your child qualifies for services. Specific scoring, goals, and plan of care will be further discussed at their first session. Questions can be addressed at that time.
No, in most cases we do not require a referral, as they are generally associated with HMO plans; we are not a provider or in network with any HMO plans. However, we do require a written doctor’s order for therapy services, especially if we are billing insurance and need to justify medical necessity.
Standardized tests are typically completed to identify strengths and needs of your child’s skills. If other concerns like oral motor deficits or atypical oral functioning are present, those areas will also be assessed. It takes about two weeks for a full written report to be completed. Therapy can begin immediately if the patient qualifies. Most patients leave their appointment with at least one strategy or exercise so you can begin your therapy journey without delay.
If there are any articulation, breathing, oral motor, or feeding concerns, we typically begin each session with therapeutic exercises and neuromuscular re-education so we can establish a strong foundation to support the motor and muscle-memory skills that are needed to advance your child’s plan of care, then follow with the specific areas of need like speech sound production to integrate oral placement or feeding skills.
Keep the mood upbeat and positive. Let your child know they’ll be meeting a friendly therapist who will work with them to help them talk, express themselves, and/or eat better with their family and friends. Families will get a quick tour, evaluations are typically conducted with the child and therapist, and at the end of the session we will bring the parent back in to discuss general concerns, make a recommendation if the child will likely qualify or has a need for services, and determine a plan.
The therapist who evaluates your child is not guaranteed to be the same therapist who will treat your child. Some therapists specialize in evaluations and establishing a plan of care; all others do a combination of evaluations and therapy. After the patient’s evaluation, when we have a better idea of their specific needs, we always do our best to match each patient with the best therapist for them. However, if you enjoyed your experience and prefer the evaluating therapist, please feel free to let them know and you can make a request with our Client Care Coordinator.
Most children who need services are seen for at least a year, but depending on their unique needs, they may need to be seen for a shorter or longer time. The type of service we provide is called diagnostic therapy. We are constantly reassessing and pivoting depending on progress week to week and how long it takes to meet their established goals.
Once you qualify for services and commit to a time slot, that time is yours every week with the assigned therapist. To maintain your spot, you will need to comply with our attendance policy. If we are billing insurance due to medical necessity, we need to demonstrate that you are committed to the program and there is steady and consistent progress. Also, during high-volume times where we have a waitlist, we want to ensure we offer opportunities whenever possible to all prospective patients, so showing up to your committed time spot is required.
We do not recommend specific amounts of sessions; rather, we look at the diagnosis and functional deficits and then determine a plan of care. We typically do not offer group sessions, as we focus on the individual needs of each patient and work one on one to target their specific goals.
No, we only provide in-clinic services.
No, we are not.
No. Our therapists can communicate with other team providers via email or phone if a signed release to authorize such communication is on file with our clinic.
We do have therapists who are multilingual. Languages currently include Spanish, Hindu, and Arabic. If there is a need for a multilingual therapist, please let our Client Care Coordinator know during your initial intake process.
We highly recommend you call your insurance company directly to know and understand your insurance benefits. The following are important questions to ask so that you understand your financial obligation prior to services starting.
- What is a deductible?
- How much is your deductible?
- Is your deductible met, and if not, how much is left to meet it?
- Do you have a copay or co-insurance? If so, how much is it?
- Are speech/occupational/physical therapy services covered under your insurance plan? Is there a maximum number of visits covered per year? For the maximum, is there a soft or hard limit?
- Do you need to have pre-authorization for services to be covered? Most pre-authorizations must be approved before you begin therapy. In Chicago, most labor unions as well as the City of Chicago health insurance plans have some type of required authorization. Make sure you ask your insurance company to clarify if a pre-authorization is needed. If you call your insurance company for any information, take a record of:
- The name of the person you spoke to
- Date and time you spoke with the person
- Reference number for the call
- Phone number of the pre-authorization department
- Case number to request a new case to approve services
- Fax number to submit case
- What documentation is required to submit for pre-authorization to begin or continue with therapy
Most insurance plans restart annually on the first of January, but some have unique start dates. Be sure to check with your provider.
Every insurance plan is different; that’s why it is very important to know your benefits prior to starting services. Claims will be billed following each session.
The patient, parent, or guardian is always financially responsible for payment. However, Trestle is in network with several insurance plans, and we will bill your insurance company directly to get reimbursement whenever possible. We also have an Insurance and Billing Specialist that can assist with most billing questions, but ultimately, it’s your insurance policy that will determine if services are covered, how much they will cover, and how many visits they will cover. All balances should be resolved within two weeks. Private-pay charges are usually run weekly after each service date.
After each visit, claims are submitted via electronic medical records systems with most insurance companies. Once the claims are processed by insurance, our Insurance and Billing Specialist will clear the remaining balance every two weeks with the credit card on file. If no credit card is on file, we will bill you, and your balance should be paid by cash or check within two weeks.
We accept Visa, MC, Discover, AmEx, cash, check, and HSA or FSA debit card payments.
Speech-language pathologists who have completed advanced training through the International Association of Orofacial Myology (IAOM) are Certified Orofacial Myologists (COMs). Trestle founder Maureen Cooney is one of Chicagoland’s most experienced COMs. In addition, several other Trestle therapists have completed OM training under either Mary Billings, Dianah Davidson, or Kristie Gatto, some of the most accomplished COMs internationally.
Orofacial Myofunctional Disorders (OMDs) include abnormal breathing and oral development, which affect how you breathe, sleep, eat and speak. An OMD can be the cause of speech disorders, like feeding and swallowing issues, speech disturbances like lisps, and voice disorders. Language delays, cognitive disorders, and behavioral concerns are also associated with OMDs due to poor sleep quality and atypical breathing related to reduced attention and the ability to participate fully in everyday life.
Orofacial Myofunctional Therapy (OMT) uses neuromuscular re-education, pre- and post-surgical frenum protocols, and specific techniques to retrain breathing, oral motor patterns, and swallowing. When we can identify the causes relating to the dysfunction and eliminate compensations, our patients report greater outcomes and overall improvements in their quality of life.
OMT can assist in developing a healthy orofacial muscle matrix by normalizing rest postures of the tongue, lips, and jaw, retraining nasal breathing, supporting diaphragm activation, using neuromuscular re-education to strengthen and balance orofacial muscles, and correct atypical chewing and swallowing patterns.
Noxious habits of the mouth, including thumb sucking, nail biting, and extensive bottle use can change the way the palate is formed and how the teeth come together. When the mouth is developing, the palate is very soft and can be manipulated via pressure from the thumb, pacifiers, bottle, or sippy cup, causing the palate to become very high and narrow, reducing the oral volume in the mouth. When there is not enough room in the mouth for the tongue, the tongue’s rest posture and motor patterns can also become altered, further exacerbating the negative oral structure changes and function during breathing, speech, feeding, and swallowing.
The tongue is not only a muscle but also an organ. The tongue plays a major role in breathing, chewing, swallowing, and speech. To fully understand what a tongue-tie means, you have to understand the normal range of motion of the tongue and why the tongue needs to be free to move to support healthy oral function. The tongue must be free from the tip, as well as the back, to safely collect food, swallow, and make clear speech sounds without compensatory movements that can over time lead to facial asymmetry, orofacial pain, and Temporomandibular Disorders (TMD).
During breast or bottle feeding, the tongue has to have full posterior (back) elevation and contact with the soft palate around the nipple in order to get a complete seal to express the milk, like a vacuum, and swallow correctly. If the tissue is tight under the tongue, feeding and swallowing will be less efficient and may be a negative experience, as the baby will often develop an atypical motor pattern through using their jaw to chew the milk out of the nipple as opposed to sucking the milk out. When this occurs, babies usually fatigue early or feel as if they are choking due to poor oral control, and mothers can end up with nipple damage and pain.
During conversational speech, the tongue has to stabilize from the back of the mouth up along the upper molar region so the tongue can make its superfine motor movements going from sound to sound in connected speech at a very fast rate. If the tongue cannot correctly anchor from the back, the movements will be compromised and speech can sound distorted.
In conclusion, there’s no such thing as a mild tongue-tie. The severity should be determined by how severe the symptoms are and if the functions are compromised. At Trestle, we are experts at retraining the tongue to restore normal function without compensation.
The tongue is often referred to as an antagonist, as it is a very strong muscle capable of causing teeth to shift and bites to change if it puts too much pressure on the teeth. Tongue thrusts can influence negative changes to the oral cavity and dentition, creating malocclusion and high, narrow palates. The goal of orthodontics is to correct the alignment of the teeth, but if your child has a tongue thrust, the long-term oral stability can become compromised if the tongue thrust is not eliminated prior to finishing orthodontics.
Mouth breathing and hyperventilation are often associated with increased symptoms of allergies, asthma, high blood pressure, high cholesterol, reflux, etc. OMT can support the reduction of symptoms and reduced need for medication when breathing and swallowing patterns are improved, the orofacial complex is balanced, and oral habits are eliminated.
Through establishing lip closure and nasal breathing your patients can have fewer symptoms and may need less medication if their breathing and OMDs are targeted.
Did you know that mouth breathing and other atypical oral muscular patterns are associated with dental caries (cavities), periodontal disease (gum disease), halitosis (bad breath), and atypical chewing patterns associated with poor diet? Retraining nasal breathing and oral rest posture may lead to healthier mouths with less risk of dental disease, improve oral hygiene, develop better smiles, maintain dental stability, and improve nutrition and digestion. OMT can teach correct chewing so you can safely and efficiently chew a variety of hard and chewy healthy solids.
Atypical chewing patterns are often associated with poor nutrition and diet. OMT can support your nutritional needs by using neuromuscular re-education to improve chewing skills. This helps you to safely and efficiently chew a variety of hard whole foods (nuts, raw vegetables, meats) and reduce intake of soft processed foods and smoothies. By retraining how to swallow and reducing air intake, reflux can be better managed. And digestion can also improve through OMT, as correct chewing skills can increase the production of digestive enzymes.
OMT can support stable, long-term orthodontic results and decrease the risk of dental relapse through normalizing the rest posture of the tongue, lips, and teeth and by removing atypical muscular forces and patterns of the tongue. OMT can also reduce the overall time in fixed appliances by removing atypical muscular forces and patterns of the tongue.
Ninety percent of TMD is muscle-based and related to incorrect oral muscle patterns. OMT retrains the patient to use their orofacial muscles, which support breathing, speech, chewing, and swallowing without compensation. Because the orofacial muscles are all interconnected, when there are abusive oral habits, atypical rest postures of the mouth, or compensatory patterns with those muscles, they could put strain on other smaller muscles or the TMJ, causing pain, reduced range of motion, and dysfunction. Normalizing the oral rest postures and motor patterns could help reduce tension and aggressive forces on the jaw joint and other muscles, establishing harmony and balance.
OMT can be another intervention to support the treatment of SDB, as OMT retrains and normalizes the muscles of the orofacial complex to improve rest postures, retrain nasal breathing, stabilize the dental freeway space (vertical dimension of the mouth), and optimize functional skills to improve breathing, reduce tension, and decrease symptoms that can exacerbate SDB. OMT can also reinforce compliance with CPAP and oral appliances.
Schools’ primary focus in speech therapy is related to educational needs. We differ, as our therapy is more clinical in nature. If your child has challenges with chewing or swallowing foods, breathing, sleeping, or speaking, we can offer a different perspective and therapeutic training that can improve their overall functioning and quality of life. After our services, parents frequently report their kids feel better; are more rested; are less sick; perform better in school, as they are more alert and attentive; increase oral intake; eat more foods; are better understood by their peers and teachers, as their speech is clearer; and have fewer behavioral concerns.
There are many adults who haven’t found solutions to correcting a lisp or speech distortion. Trestle’s expertise can identify muscle and motor dysfunction, which may be the cause of the speech disorder. Then we can use our integrative techniques to retrain the tongue muscles and normalize the motor patterns of the tongue to improve speech clarity and eliminate distortion. It’s beautiful when we see our clients go into a job interview or business meeting, or present in public speaking events, with the confidence they deserve.
Airway disorders can affect overall development and exacerbate cognitive-linguistic challenges, including difficulty attending and participating in school and home routines, difficulty with emotional regulation, challenges with memory, and behavioral breakdowns.
Tethered oral tissues of the tongue and lips can negatively affect speech and swallowing. If there are speech or swallowing concerns, tongue- and lip-ties should be identified early on and ruled out as they can contribute to the causes of the speech and swallow disorders.
Ear infections can be one of the main causes of a speech or language delay. We highly recommend completing hearing screenings with most of our patients early in the evaluation process to rule out hearing loss. If a child cannot hear sounds and words, or speech sounds distorted, they will likely have challenges learning language and have more communication breakdowns. Hearing screenings are non-invasive and very easy to complete. If a hearing loss is identified, intervention is necessary, and it should be treated as soon as possible.
Speech therapy can also help through improving attention, memory, sequencing, and turn-taking, so your child can attend better in school and do better with transitions at home, effectively reducing breakdowns throughout the day.
Speech therapy can also increase their ability to put words together and produce clear sounds, so your child can communicate more efficiently with others, improving their self-esteem and confidence. Our goal at Trestle is to empower each child to independently express their thoughts and feelings.
Occupational therapy (OT) is the practice of evaluation and treatment to improve a patient’s ability to complete their daily activities (occupations) as independently as possible.
Pediatric OT is the evaluation and treatment of children in order to improve their independence and participation in their daily activities including play, school, dressing, handwriting, social interaction, and sleep.
Proprioception is the body’s ability to sense its location, movement, and actions. It’s another one of our senses and allows our bodies to feel input through the joints and relays a message to our brain about where that input is located and how much pressure is being felt.
The vestibular system is our movement sense. This is how our body accepts and interprets any type of movement such as swinging, walking, sliding, and rolling. The vestibular system helps us maintain our balance and posture in response to our body moving.
When typical, everyday activities, including transitions from one activity to the next, are frequently difficult or result in meltdowns. A child with sensory processing difficulty may appear to over-respond to most stimuli in their day, or they can appear under-responsive to stimuli.
A child will require a formal assessment from a neurodevelopmental pediatrician in order to rule out a true diagnosis. An OT evaluation can provide more information, including a treatment plan with weekly therapy.
This can be a typical response for some children. To identify whether it is typical or it could indicate a difficulty with sensory processing skills, you can observe their response to getting their hands messy. If they can wipe their hands off and carry on with what they were doing, then that is typical. If they’re going into a meltdown and cannot move forward until their hands are clean, then this could indicate that it may be a sensory issue. Although, typically, a sensory issue involves more than just one specific sensitivity.
Typically, when a baby this young is receiving OT, it is to assist with breathing and feeding. Babies who spent time in the NICU may need OT in order to provide age-appropriate sensory input to help with positioning, range of motion, latching, self-regulation, and social and emotional bonding. Babies who are born with a physical condition may begin OT this early to work on meeting developmental milestones.
Formal testing using standardized assessments will be used to assess fine motor precision and integration (including grasp), manual dexterity and upper limb coordination, visual motor skills, and gross motor skills. A sensory profile can also be completed with the help of the child’s parents/caregivers to determine how a child responds to everyday sensory input. Clinical observation is always incorporated in the testing/assessment portion as well.
Your child’s evaluation will be completed during the first session. It will include fun and functional activities and tasks that specifically pertain to the skills the child needs help establishing. Clinical observation is usually carried over into the first session to get the best understanding of where each child is developmentally. Common activities during OT sessions include obstacle courses, puzzles, coloring, writing, and sensory bins.
Our thorough evaluation takes about 45 minutes to complete.
Some of the results will be discussed by the end of the evaluation. For the formal testing, the scores will need to be calculated and scored meticulously, and these results will be relayed at the first therapy session, usually the following week.
Occupational therapists are required to have a master’s degree, which includes six full months of clinicals. At Trestle, our OTs are board-certified by the American Occupational Therapy Association (AOTA) and have pediatric experience.
The length of therapy sessions is dependent on the child’s needs and established plan of care, but usually are about 45 minutes long, give or take.
Fine motor skills involve coordination and strength in small muscles in the hands to complete tasks such as writing, eating, and playing.
Sensory integration therapy is a specific type of OT that focuses on treating sensory processing skills in order to regulate the sensory system and improve patients’ ability to participate in daily activities. This therapy includes creating unique and specific home programs of sensory diets in order to gain or maintain regulation each day.
Sensory processing disorder, developmental delays, autism spectrum disorder, hypotonicity, dysgraphia, motor delays, ADHD/ADD, and cerebral palsy.
Trestle does not specialize in rehabilitation, specifically after trauma, stroke or injury, but our therapy is more specific to pediatric delays and disorders. We do not use RAs or OTAs, as we want to ensure the highest quality of services and only hire therapists with master’s degrees and several years of professional experience to treat your child.
Physical therapy is the evaluation and treatment of various impairments and functional limitations like pain, decreased range of motion, decreased strength, poor balance, and decreased functional mobility.
Pediatric PT is the evaluation and treatment of patients who are less than 18 years old. It is different, as it is provided in a one-on-one situation where play is a main component of the sessions. Pediatric PT is often more habilitative, meaning it is used to help children master skills that they have never had before. Compare that to rehabilitation, which helps people to remaster a skill that they have already acquired in the past.
Physical therapists use exercises to help patient achieve functional skills. An example is a baby that is not yet able to crawl. A PT will use a combination of strengthening and mobility work to help the baby achieve the skill.
Physical therapy can help with strength and overall mobility independence for patients.
Physical therapy works more with gross motor skill development, while occupational therapy works with the sensory system and fine motor skills. PTs and OTs often work together to co-manage patients who have needs in multiple areas. A co-treat is a session in which an OT and a PT can see the patient at the same time, each tapping into the other clinician for assistance to facilitate a well-rounded session for the patient.
Pain, decreased strength, decreased balance, and delayed motor skill development.
Back pain, hip pain, decreased balance, shoulder pain, sport injuries, along with spina bifida, cerebral palsy, Down syndrome, infant prematurity, toe walking, torticollis, and poor movement patterns.
A typical PT session is a one-on-one experience with the PT and the patient. It can be anywhere from 45 to 60 minutes, often depending on the stamina and motivation of the child. Play and games are a main component of each session to gain rapport and allow the child to have fun. It is typical for a session to include blowing bubbles, coloring, or putting together a puzzle.
There are many treatments that can be provided by a PT. Some, to name a few, are stretching and range-of-motion work, either through exercise or through manual work by the therapist; strengthening with or without weights; balance training with mirrors for visual feedback; and coordination skills like jumping. Often PTs will use exercise balls to help with core strength and overall stability. Some physical therapists are trained in Kinesio® taping, which is used to help facilitate positions and movement patterns with application of tape in certain ways.
Physical therapists require a bachelor’s degree as well as a Doctor of Physical Therapy (DPT) degree from a graduate school with an accredited PT program.
Many therapists have certifications that allow them to perform certain interventions. These include but are not limited to Kinesio® taping, neurodevelopmental technique, and manual therapy.
Each session lasts anywhere from 45 to 60 minutes, depending on the goal that day and the stamina of the patient.
Some patients will only need six total sessions, while others may need physical therapy for many years. Each situation is different.
Progress is measured by using goals. Goals are looked at each session and can be either not met, emerging, or met. In pediatrics, there are outcome measures that can be used to compare the skills of a child to same-aged peers to see if the patient is performing skills of a typically developing child. There are various tests that can be used depending on the age of the patient and/or the concerns.
In Illinois there is something called direct access, in which you can see a PT for five visits without an order from the doctor. However, if you are using your insurance, the carrier may require that you have a doctor’s order for reimbursement purposes from the start. Trestle always recommends clear communication and encourages you to get an order from your doctor prior to treatment.
A referral may be needed if you have certain insurance plans that require it. Your insurance company can verify this for you.
Physical therapy is an excellent choice because it is a non-invasive treatment option that is proven to be effective for many different patient groups.
Choosing private practice is often a better financial option for patients. Billing and cost can be more at a hospital facility. Private clinics are able to create a culture of treatment that can be more creative and more autonomous.
Physical therapy does require that you move your body. Sometimes, if those movements are new, there can be some soreness one to two days after treatment. If something that the therapist is having you do or doing to you is painful, you have every right to speak up. When
that happens, the activity is either stopped or decreased in complexity. It is important to
remember that you have the right to advocate for yourself. A main purpose of PT is to alleviate pain, not to cause more.
At Trestle, we do not believe physical therapy should hurt. If you ever feel pain during your protocol, stop and let us know so that we can address it. There is a difference between pain and muscle soreness. Often people are unfamiliar with muscle activation and can describe it as pain. If something hurts, that is the body’s way of trying to protect itself, and it should be reported to your PT.
There are many ways that physical therapists can help with pain. Manual work like soft tissue mobilization, joint mobilizations/manipulations, muscle activation, gentle stretching, and exercise are all ways we can decrease pain.
Yes, that can often be the case.
It will help you! Patients who complete plans of care and do exercises that are recommended at home will make progress toward their goals.
We can provide a therapeutic diagnosis. An example would be a child who walks on their toes. The therapeutic diagnosis would be “abnormality of gait.” A physical therapist is not allowed to diagnose a patient with conditions like autism or cerebral palsy.
It can take longer if the patient is not following the recommendations that are put in place by the PT. Sometimes patients try to speed up the process by doing too many activities, and that can create injuries or other problems and increase their therapy time. On the other hand, if a patient cannot or does not perform the recommendations, that can also create more time in therapy. It’s a fine balance, which is why we encourage patients to follow the recommendations as given. As you’re building strength, it will help motor skills. However, there can also be relapses. Every patient moves at their own pace. No need to get discouraged as long as progress is moving forward.
It is up to the clinician, but a typical plan for a pediatric patient is once per week. If a patient is post-surgical, it can be two to three times per week.
Each insurance plan is different in terms of the coverage for physical therapy, but it is covered in most cases. Some insurance plans require a referral from a primary care doctor, and some do not. Some plans have limitations on the number of visits allowed per year. All these things should be checked with your insurance carrier ahead of treatment.
Clothes that are not restricting are best for physical therapy. A perfect outfit is a tee-shirt and comfortable shorts or pants and grippy socks.