SusanPEDPT
61 posts
Feb 10, 2009
5:55 PM
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Had a child today with hip flexor tightness causing her to stand with center of mass forward and huge lumbar lordosis. The left hip was minus 30 degrees extension in supine with right knee to chest. Had her bring left knee to chest and actively extend the right one with help to go deeper into the range for 3 min. (Sit to Stand Supine) Stood up and almost straight.
Repeated 3 min X 2 after that left hip could extend. Child now able to stand up straight. 10 minutes of therapy as work - then had the whole rest of the visit left for doing fun balance activities, dancing in place and bouncing to use new available range with hip extensors in a new shortened position where they work more efficiently. Boy did she have a big smile after that!
I have come to expect dramatic results as an every day event, but then something happens which makes a child so happy you have to tell the world!
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audreyb
2 posts
Feb 16, 2009
10:18 AM
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Susan, What has been your experience with children with spastic quadriplegia? I am finding restrictions that are significant on both sides and am finding minimal differences between one side and the other. They are all ranging around the 5-20% range. I have been taking the restriction that is the greatest and working from there. So far his posture sitting has improved, and general quality of movement getting in and out of his w/c has become more efficient, but it has not impacted his walking. When I ask for active contractions, I get global responses so have stuck with passively moving him through the Fab5 so far. I am wanting improved range in hip flexors and knee extension for gait with his walker.
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SusanPEDPT
63 posts
Feb 16, 2009
3:22 PM
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Sometimes you have a dramatic change, but sometimes it is 1 or 2 degrees at a time. The important thing to focus on would be what your expectations are. In the past when a child hit a plateau I'd keep on trying, but experience told me not to get my hopes way up. Now with TMR I can get my hopes up and sometimes it happens fast as with this child. That doesn't mean we don't have to plug away inch by inch, it's just we have many more possibilities as the child has the potential to access other muscles previously unavailable due to restrictions.
What was your ST goal pre TMR? Maybe he has to work on more preambulation skills like transitions into all 4's. Maybe he needs to work with more intensity (3 min hold - which I use for almost everyone now after initial visit) and more reps in modified positions. How about modified S to S with supported standing at a countertop or rail and do a sit to stand on one foot only flexing the knee from 0-5 degrees and progressively going into more flexion over many months. How many reps of this can he do? How about doing leg lift in prone - this improved stride length in my webinar child? Maybe the restrictions in the hips is more about needing symmetry in the arm raise. How does this look in supine?
I'm happy to brain storm more on this!
Susan
Last Edited on 16-Feb-2009 3:29 PM
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Tom Dalonzo-Baker
97 posts
Feb 21, 2009
7:24 PM
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Susan - is the peds guru, so I agree with her questions and suggestions.
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