Trying to Kick the Walker

We've been instructed that we need to get rid of E's walker(s). She gets around well with them, but she is never in a good position--she leans into them too much, and she constantly runs with the walker--and then she's on her toes, her heels pop out of her braces, etc. etc. I know she just wants to be able to go FAST and be independent.

Maybe I would let her use her walker more often if she wasn't growing so fast--her heels are getting harder to keep in her braces. We do the stander twice a day (most days), but we can't get a break b/c of her growth spurt. Girl needs to SLOW DOWN!

Anyway, so we're trying to switch the walker out for her loftstrand crutches. E does NOT LIKE THEM. I don't know what it is...she just collapses into a whiny wimpy mess when we take them out. Her knees REALLY cave in, her confidence goes down the drain, and poutyness gets worse. Still, we're going to give it our best effort.



We shot video of her walking down the hallway, but uploading is taking forever...check back for the video feed.

PT Recap: Knees-out Success!

I've posted pictures of trying to get Elena to play in a half-kneel before. Here is her right side again--MUCH better here. She has some of her weight shifted through her hips and is bearing some weight on her right foot, and the knee isn't caving in. WIN!



And the Triumph of the day: Elena pushing her Knees Out! Theresa cheered Elena to have her "knees kiss the ponies". SHE DID IT. Then T had E squat a little and try again. It worked beautifully!!







Then we worked on scooterboard rides. She got to ride with Mommy if she scooted herself (kicked out her feet, one at a time, to help propel the board forward). She did a pretty good job at this--good movement of one leg at a time, even if it was just a little kick.

Same issues, different week

Here is E doing leg lifts on the left...



And on the right...well, not really, but she's trying...



We tend to get the "extremity freeze" when she's either really trying or really frustrated...this PT session was a little of both, I think.

New drill: I call this Superknees! Take a little piece of velcro, and have it *just* fit. Then Elena pushes her knees out to bust through the velcro. SUPERKNEES! (She tends to bust out by moving her right leg out, which allows her to have her weight on her left side, typical for her.)





One way to see how well our Knees Out message is sinking in is to have Elena go up steps. At home, she holds the railing with her left hand and my hand with her right. She has definitely improved her stance, and now has her knee over the heel (more neutral alignment) than before, but she still doesn't transfer weight very well. One problem is she has a hard time remembering to move her hands up the railing before she steps. Another is she doesn't know how to transfer her weight through her hips very well.
At PT, they have a stairwell that is thin enough for E to have handrail support on both sides. She looked pretty good here.





We finished up the session with the kick-scooter, but my camera ran out of batteries. One thing I have noticed in the past week is that Elena is doing more "pigeon-toed" walking, regardless of equipment (walker, loftstrands, hand-held). This was REALLY evident during scooter time, the tips of her shoes were trying to get under the board as she took little scoots. At first I though that this wasn't getting worse, but that I was noticing it more b/c the rest of her gait looked that much better. Now I'm not so sure. I feel like we have to be working harder on her knee awareness...she'll be tripping over her own feet before too long.

Happy 4th Birthday!

Dear Elena,

I know you were very excited to say 'I'm four" instead of "I'm three" on April 30th, 2009. You'd been practicing it for days! I hope you had a great time with your friends at your Ice Cream Chef party. I know we loved celebrating it with you.

You and the rest of the Strawbunch making strawberry ice cream



You rolling the ice cream ball down the hill to mix it




Your Daddy and I are so proud of you, every day. You are the hardest working kid I know. You are more patient, understanding, and focused than a lot of adults I know. Sometimes I feel bad that I have you work so hard...but seeing you grow and change and progress from year to year makes me happier than you can imagine. I know you will be able to run and jump by yourself some day, and I know you will play on a soccer team like you keep talking about. Your Daddy and your sister and I will be your loudest cheerleaders!

We love you always,

Mommy and Daddy and Vivian

PT recap: Weight shifting

Last PT session with Theresa the focus was on weight shifts, while trying to keep the right foot flat and the knee in-line.

Some of the usual (not shown)--stretching, standing with left foot raised, sit-to-stand. Elena's eyes lit up when T took out the Princess Helmet and the pink scooter! We hadn't seen this for a long time, months before E's surgery. We have a scooter like this at home, and I was trying to push Elena around, stopping every so often just to urge E to put a foot off the board and step down to touch the pavement (I was not always successful, she had a very hard time stepping down on the left--her right leg could not support her). Now---check it out!







Theresa also used the Caterpillar (it's like biking while standing up). Elena can propel it herself, although she tends to watch her feet, which eventually slide off the pedals--so you have to stay close. She has started to look up while she uses it, so that's a big change for us. Her posture when she is bearing weight on the right leg isn't as good as the other side.

10 weeks post-op

Sorry for the lag between posts, Jason and I were on vacation (sans kids)!

No real big changes this week...everything seems to be very slow and gradual. I do notice Elena is better able to move her legs independently, and seems to have more control of her trunk while moving her legs. I see this as "her midsection and legs ceasing to move as one unit". For instance, Elena can now take off her shoes and braces (including all the velcro tabs) and socks off herself while sitting (and not falling over in the process). This is pretty new.



Overall, Elena's movements are more fluid, less jerky, and can be done while playing (movement does not take as much mental energy). There is still a long way to go, as her balance is still poor.

The big focus seems to continue to be getting Elena to move around without her knees caving in. At KCRC, Emily started off with E playing "Beanbag basketball", having her squat to pick up a bag, and trying to keep her knees apart.



This squat is actually better--when E reaches forward, she really gets the feeling of having her weight over her heels. Good stretching here...I have to believe this feels different for E, as she normally isn't in this position.



Emily said she "wasn't helping Elena all that much". But, if she were to let go while Elena was in a deep squat, I'm sure she'd fall.

I suggested an activity we'd been doing earlier this week--treasure hunting, where Elena squats down to different heights to pick up treasure. If she picks it up without falling, she keeps it. I had done this with coins, of varying heights--she DID pick all of them up, even the quarter on the floor--but it sure wasn't pretty (no pictures taken). Emily adapted this idea to a "scavenger hunt" where the objects were around the room, hidden under tissues.

Megan helping Elena read the scavenger list



Finding an item



The scavenger layout




Emily also tried to get Elena to do leg lifts independently on each leg. First she strapped ankle weights to each leg as usual, and told her which one to move. Like usual, Elena moved both legs at the same time. Then she took one weight off, and asked Elena to move the foot with (or without) the weight. She still moved both legs at the same time, but was aware they felt differently. Emily used a vibrator to stimulate one leg, while she asked Elena to move the other. It worked, a little. The awareness of moving her limbs/muscle groups independently is slowly coming.





Lastly, I had been inspired from my vacation massage to gently massage Elena's legs/feet after stretching every night. She seems to enjoy it, as long as it is gentle. Emily mentioned a technique called "ironing" (pic below). Starting on the upper leg, press gently on the leg and continue pressure as the hand moves down the leg toward the heel. It's sort of like petting, only a little firmer and in one direction. Emily said to do it before stretching (or before some activity, like therapy) and then again afterwards to see if it feels different or she reacts differently.