Monday, April 20, 2009

Major Walking Update!

On Friday, April 17th, E had her normal PT at school. Her regular PT also attended, so there were two of them working with E that day. I was told by her teacher that E walked 24 steps! That's a new record!

Later that day, I joined the class for a field trip to The Park at UVA. It's a big gated field area, with my new favorite surface, Astroturf. It's flat enough for E to walk on, but textured enough to be challenging, and soft enough for E to have good confidence to try independent walking. She walked several stretches of 6-10 feet!

And yesterday (Sunday, April 19th) E came to the soccer field and walked on grass several times, 3-4 feet at a time--one time even kicking her soccer ball without help (I was behind her to catch her after her kick).

I hesitate to say "we're getting close"...b/c I've felt E's been close to walking for over a year. Still, she's never looked better, and she's improving in movement and CONFIDENCE every day!

More ideas for external knee rotation

At our regular PT appointment, Theresa tried to get Elena to "push her knee out" during sit-to-stand. We are looking for a good voice far this cue is working just okay. She can "push" her knee "out" during sitting, but as soon as she engages to stand, it caves in again.

Here is T trying to show E how to keep her knee out while going down to the mat.

Same position, passive play: have E sit on a low stool, while engaging her in an activity that keeps her knees over her heels.

As always, trying to get E aware of shifting her weight to her right leg (should be easier when she can put her heel fully flat, which we are working on using the Stander and stretching).

More leg lifts

Overall, E is getting stronger. And more-strong willed...this past week she has been more vocal than ever that she doesn't want to do the drill anymore, that "she's trying but she can't do it", or she wants to be "done". That can be hard on a parent/caregiver/therapist...but I know all of this is making a huge difference.

PT recap

The theme of the last 2 weeks of PT has mostly been around getting E's right knee "over the heel" (not caving in), with low to moderate success. Here, the PTs are trying to make Elena aware of her knee position by having her squish play dough with the outside of her knee in standing.

In sitting, they had her hold a ball between her legs, then open up to let it fall. I think she used her left leg more than her right to release the ball. This was tried sitting (shown) and standing. This wasn't a very successful drill for her this day, b/c all she wanted to do was pick up the ball and throw it.

They tried bribing her with play cupcakes--push your knee out, then stand, then you get to assemble a cupcake. This worked better. She paid attention to the position of her right knee much more. Her knees still came together when she stood up, but at least she was somewhat aware of it.

Next, they had E put stickers on the bottom of her right foot. She puts her right foot on her left knee by herself. Good "passive" way to get her knee to turn "out".

The next big objective is working on Elena's gait, aiming for heel-toe strike. She can do this with her left (although she doesn't do it very often). Emily tried ankle weights to give E's legs momentum to swing forward while she walks. I think this is a great idea, but E needs to walk faster for it to work as intended.

She also tried to get E to kick her feet out by trying to aim for tape with her shins. E mainly tried to hit it with her knees. Still...good idea.

Lastly, trying to strengthen hip flexors/glutes while keeping her knees in-line. High knee walking--she can do this for a couple of "paces", and then normally falls forward. She wants to keep her knees wide, but she is getting better. Emily tried to give her knee boundaries with plastic guides.

Play Planks-she didn't mind this so much. Emily had her put a puzzle together in this position. She also likes the idea of the "wheelbarrow".

Walking drills

Wow, things have been pretty crazy lately. I shot this footage 2 weeks ago, but it's taken me forever to put together. I added some text, but some of it is in the wrong place...if I were to fix it, who knows when this would actually get posted!

Note: E doesn't *need* her hands up near her shoulders, so I'm trying to distract her. Also, she really operates on one speed right now.

Tuesday, April 7, 2009

Tap Dancing

We had our weekly PT at Kluge Children's Rehabilitation Center (KCRC) last week. E was awesome.

They were mainly working on weight shifts/extension, focusing on the right side, trying to make Elena aware that she can keep her right knee "out" when bearing weight.
Half-kneel (right), with help. Note she rounds her back to try to "lean" into the movement rather than shift through the hips to bear weight over the knee. Left side (not shown) does this much better.

Half-kneel (right), with not as much help. Knee caves in.

Next they tried to make E aware of her movements by using play-doh. Emily asked E to squish the play-doh with her knee. It worked, a little (squishing not shown).

Dorsiflex practice with play-doh--Elena is supposed to collect the pieces on her toes to make a big ball. She has to lift her leg up, then try to flex her toes to get the pieces.
Left is okay...I think the beans and rice bin worked better...

Right...hmm. Knee lift is good, but the isolated movement in the ankle just isn't there.

The big activity of the session was tap "dancing"! Emily took shoe taps and affixed them to E's shoe heels using sticky tape. The idea was that she would only tap if she landed heel-first as she walked. It worked beautifully...but it is EXTREMELY labor-intensive for the operator(s). Emily would cradle Elena's hips, trying to get her to move the upper part of the leg and then kick the leg straight, aiming for the second Megan's hand. Then she can drop the heel and tap. She did it on both legs, but it was slow going. Elena was much better at it by the end of the session.

Kicking to meet Megan's hand (done every step, shown close-up here):

Zoomout pics

Whew. My back hurts just looking at those pictures.

The Wooden Maiden

A week ago we got a new piece of equipment, a "Stander". I wasn't too excited about another giant thing in the house. The stander helps Elena passively stretch her legs--her tendons, I think, are our big problem right now. If we can't get them stretched, she'll need surgery sooner rather than later in order to get her heels down so she can bear weight properly.

My initial reaction to the Stander: it looks like a mixture of a magician's box and a torture chamber. We call it The Wooden Maiden.

Back view, open, where I fitted it for Elena:

The platform can be raised to fit E to the upper planks. The first plank should hit E right at the knee, or right below the knee, so she can't bend there. The second plank hits her at the hip, so she can't bend there either. Basically this box keeps her standing tall, hips and knees neutral, and keeps her there, with her ankles at 90 degrees (or as close to that as we can get). We give her something to play with on the podium.

The best part: E is a GREAT SPORT ABOUT IT.

We're supposed to have her in it once a day, for 10-30 minutes. So far we have her at 10 minutes or so, twice a day, almost every day. It's been a week...and maybe I'm imagining things, but I already think I see a difference.