Hi. I'm an OT with 20+ years experience working with adults but 3 months ago agreed to try and help a 5 year old with a diagnosis of cerebral palsy. I'm in North India so resources are limited. However, after 4 x hourly sessions a week Muntaha is now using her left hand/arm, can grip and release, her balance has greatly improved, she can kneel independently and maintain a quadruped position independently and stand whilst holding onto a rail or leaning against a wall. We have achieved a few steps (with a rollator) and I need advice on how to progress to give her greater balance and confidence and ideally independent mobility. I have to use her rollator backwards so I can maintain pelvic stability and use a bit of force to give her momentum but I worry she will fall forwards. I'm also concerned about her developing bad habits. Any advice appreciated. Her mum has given permission for me to discuss her case and to share the video so OT's that are experienced with kids can help us.
I'll try and add the photo of a rollator type frame that may be available to purchase here if we can get some funding... that will be the next challenge!
Thanks in advance, please respond here or contact me via email for the video theoccupationaltherapyclinic@gmail.com
Thanks for the advice. We're having long power cuts and unreliable internet so will attempt to look at facebook page asap. Flickchick thanks for the pics, I had similar concerns about the walking frame. I have a posterior rollator but Muntaha screams and bites whenever we try to use it. We have only managed one successful walk using it backwards with me controlling her pelvis. We have a routine with the gym ball prone, sitting, back & core strengthening and have recently started using the balance board with her sitting cross legged and distracting her with squeaky toys. She has started to copy words but oromotor is poor, she has a visual impairment and doesn't follow anything with her eyes. Hearing is excellent. Left hand function is improving but she still has poor control. I'm not sure how much understanding she has as cooperation is variable. Mobility is so important as she is getting too big to carry but I think it will be a long process. Kavita thanks, I will contact you asap.
Hi Jane. I am a Pediatric Occupational Therapist from India and I have experience in working with children with cerebral palsy for over four years. My team and I focus on righting reactions (righting reflexes) at the mid brain level and aim to integrate that into the program. While this allows us to keep the therapy dynamic and the child moving and active, it also helps integration of important reflexes needed to achieve walking like protective extension reaction. Integrating these will help the child achieve the necessary developmental milestone while also helping the child think and plan the next step- an integral part of motor planning and execution. If you need to discuss this more with me you can reach me at kavitamurthi08@gmail.com. I hope this helps.
Thanks very much for your advice Flick! Here and on Pedi4OT on Facebook.
Jane - whilst I'd (of course) recommend continuing the discussion on the Hub, do also check out this FB group, where I've posted your query. Other responses there too :)
Hope you're a little clearer of where to go with this for Muntaha!
Jamie
Director, The OT Hub.
Looking further at the walker you are considering, whilst it is great you are looking at a walker for this child, this may not be the most appropriate. The girl I worked with had a similar one. Some of the issues were: 1) she had to be lifted in and out. This is ok when she was little but as she grew it got harder on her family. 2) because she has to be lifted in/out there’s no opportunity to learn independent transfers in/out of walking/standing. ie. she can’t walk up to a chair and transfer to sit down on it. 3) the handles are far in front causeing her to lean forward rather than stand upright. 4) the loose ‘ring’ around her promotes ‘laziness’, meaning she is likely to lean forward against it and just scoot along rather than stand erect. These are all issues my client had. With a posterior walker she stood more erect, wasn’t leaning forward, was supported around her hips, could independently transfer in/out and the family didn’t have to lift her. This made the world of difference to her (as I mentioned in my above post) and because she was walking upright in a ‘normal’ position, she developed the strength and ability to walk short distances unaided. I’ve attached some photos showing the two walkers. Sorry they’re a bit blurry, but I hope you can see the difference in posture etc. If you can’t source a walker similar, perhaps someone local could make something for her.
I had a similar client when work in rural India. One thing we looked at was learning to climb from the floor (where they ate dinner) onto the bed (where she watched tv & slept). By using a seat (or wooden) block, she learnt to climb up & down herself. This was a good practical way to increase her independence.
I also managed to get a posterior walker with pelvic support donated from overseas. This got her in a much better position for walking. And now a few years later, she can walk independently around her home using the walls etc for support. It sounds like you’re already looking into this, which is great 👍
Hi Jane,
I have recently practiced in paediatric occupational therapy with children who have learning difficulties. I worked with some pupils who experienced difficulties with balance and core strength. Depending on their specific needs I implemented a number of different therapeutic activities into their OT interventions. These included:
- Prone activities lying over an exercise ball e.g. reaching up, walking hands out whilst OT supports where required
- Lying prone on a scooter board (using arms to pull forward) to develop core strength and postural control. We played a number of games to maintain engagement, and confidence improved with repetition. I understand you have limited resources but I know our department made the boards themselves.
- Child stands with back against the wall and 1 foot is elevated onto a small ball or object
- Balance activities in lying and sitting e.g. lifting arms and legs off floor, pushing a ball away etc
- This resource sheet may also be useful from Royal Free London NHS Trust: http://s3-eu-west-1.amazonaws.com/files.royalfree.nhs.uk/Patient_resources/Paed_occ_therapy/Skills_for_balance.pdf
Hope this is of some help.
Kirsty
Hi Jane,
Thanks for getting in touch and engaging with our Q&A Forum!
Our forum has grown in engagement recently, but there may still be a delay in getting a breadth of responses. We will share your question on our social media platfoms, as this will, for now, generate faster support for you.
If you aren't already following us, search for The OT Hub on Facebook, Twitter and Instagram, where we'll post your query. We'll remove your surname, to promote some confidentiality.
You've provided an in-depth insight into Muntaha's situation - and I hope our Members can help out with this. Warm regards
The OT Hub Team
hubteam@theOThub.com