Creativity

I have seen this patient for several times and was excited to see the improvement each time this patient came. One biggest problem on this patient at the moment is fluctuating trunk muscle tone. The motivation in movement on this patient is very high, but the fluctuating muscle tone interrupts as this patient tries to do something. It is difficult in coordination and co-contraction of the muscles in this patient, thus most of activities or movements become hard for this patient to control. There are older siblings in the family and this patient wants to join them in play, but extensor tone kicks in most of the time as this patient moves. This patient’s mother tries very hard to give all the siblings enough needs, however it is sometimes challenging for everyone in the family.

I have been thinking how I could possibly help this patient and also the family to have enjoyable time at home without difficulty. Because of this patient’s fluctuating tone, someone has to hold or give this patient appropriate support in sitting or standing if this patient wanted to be in the position. My plan for this patient was regular Rx such as muscle strength, wt shifting and transferring, but also I started to think the various positions for this patient in play at home. Kneeling position was the one of the challenging position for this patient to be held and thus less practicing in, so I thought it would be great if this patient could have kneeling equipment at home. Has anyone seen it before? I personally have never seen it so I did not have any luck to find the equipment where I am at, of course. We as physio students are able to put a patient into this position and hold manually in physio session, however it is always nice for mother and a child to play together face to face at home. Hence I really wanted to find an easy way for this family w/out any difficulty. I used a standing table to make it to be a kneeling table for this patient with cushions and rearrangement of Velcro, and tried it in the Rx session. Excitingly, it worked on this patient. This patient played for 20 mins with toys in both hands which never happened before in kneeling position without fluctuating trunk. Head control was beautifully in midline and never flipped backward and hip extensors were activated most of the time to keep in this position. Also, WB on hands and elbows were occurring and both hands never went to this patient’s mouth during the activities. Both this patient’s mother and I were very excited regarding what was happening in the session. Fortunately, this patient got permission to borrow this equipment for practice at home and mother was very happy to be able to play with this patient in up-right position without being held by mother. Also this patient will be able to play with other siblings as well.

What I have learnt from this session is we need to be creative not just only in treatment activities, but also in equipment wise. Some equipments are customize made and it is limited in some facilities. Making appropriate equipment for patients ourselves with whatever equipments we are allowed to use in the facility is one of our tasks as physio students.