First, Felipe reminds everyone the importance of stretching. It helps get circulation going and helps with the exercises.
1. Massage Lower legs:
Cupping his calf muscle with my hand, but not touching the area in front, just the back, I open and close hands in a wave like motion. 15 sec, 10 times
2. Massage Upper Legs:
Knead the upper legs, quad area, stimulate to get the muscles active and warm. 15 sec, 10 times
3. Tickle tickle and pull in
I place Felipe lying down on the floor or changing table, I tickle his inner thigh, wait for a response. If no response, I pull in his thighs. This causes him to remember sensation and to work on using his abductors (I'm not too sure about the scientific word, maybe I'll just call it the Suzanne summer-tight -master muscle, you know the one you use to pull in your tights)
4. Straight and Flex
Straighten the left leg, lock the knee, cup heel of foot and push back to 90 degree angle. Hold position for 15 seconds. repeat 10 times. Repeat on right foot. Since Felipe is contracted, he can't do the full 90 degrees but the goal is to get his muscles more relaxed slowly to eventually complete the stretch.
5. Bend and Flex
Bend the left leg at a 90 degree angle. Hold one hand under the knee, keeping it bent. with other hand, cup the heel area of the foot and push back to 90 degree angle. repeat 10 times, repeat on right foot
6 Toes flex
Move the big toe up and down. Gentle pull toe up towards his torso, hold position. 10 times for 10 seconds. Since one area of Felipe's muscles are tense, it pulls his toes down and the muscle that would pull it up is relaxed bc there is no stimulation. I have to remember the toes bc too much time in a contracted position can begin to affect the bones. Must be gentle bc too rough and can lead to bone or ligament damage. Felipe won't complain w pain bc he doesn't feel much in either toe area.
7. Toe Splint
Holding left foot in my hand, imagine a divide between the big toe and little toes. About half way in the foot, grab on side (toe side v little toe side) and grab other side with other hand, feeling the bones underneath. Move the bones, slightly, it isn't a very big stretch, like a scissor, up and down. repeat on both feet for 10 times.
8. Sensory stimulation
A big part of Felipe's rehab is sensory: He needs to have stimulation to remember his feet, his legs, his muscles and begin to rely on those muscles. One way to do this is to rub lotion on his legs, so he can feel something on his legs. Right now he feels, but not as sensitive as he would be on his arms. Then following the lotion, I take a bristled brush and rub it on his legs and feet. If there is a reaction then I bring in his legs and try to make them react. Right now, he sees me doing something there and tries to move but if he doesn't see it, he doesn't react. After the brush, I take a little toy with prickly spikes and brush it w his legs. And finally I take a little stuffed animal, very soft, and brush it on his legs and feet.
9. Hip Stretch
Open his legs wide, keeping legs straight. Close his legs. He squirms the most on this one, mostly bc he is so tight in his hip area. Good thing he complaints, it means he has feeling & sensation. 10 repeat on both legs. Then take one leg, keep level with the floor or bed, then take other leg and pull straight up. Feel muscle stretch, hold for 15 seconds, repeat 10 x. today's we did it once...he skipped ahead and tried to kick free....
Now that stretching is done, on to the exercises:
1. The wheel barrel:
I place an enticing toy at one end of the sofa, in the hopes that Felipe will crawl to it. once he starts to crawl, I pick up his feet (kind of like a wheelbarrow) and let him carry the majority of the weight on his arms. The idea is that he has to get stronger in his arms to pull himself to stand. Repeat 10x. Today, he did it for 8 times and then just collapsed into the sofa and not wanting to get up again. This exercise also challenges his endurance.
2. Pulling up
I place desirable toy between my neck and chest, while having Felipe put his hands in mine, and pulling up using his arms only. kind alike a baby version of a pull up. repeat 10x. This one didn't go very well, but we did complete 10.
3. Kicking on his side
Placing Felipe on his side, have him kick at an object and them repeat having him lay on the other side. Felipe has re-learned to roll over, so when I put him on his side, he rolls and crawls in an attempt to escape. Repeat 10x on both sides. I haven't been able to get one of these in as of yet.
4. Kick while sitting on Mami.
Placing Felipe on my lap, on the floor, have Felipe kick an object. This uses a different set of muscles than when he is on his side. Thanks for Tio Danny and Titi Nancy, we have a perfect toy for this exercise, a small toy that rolls on its own, lights up and makes noise. Each leg has to kick 10 times. If he doesn't kick, move his leg towards the object and perform kicking motion. Wait to see if he will then repeat the motion on his own. This we have been successful with, he likes to kick the little rolling ball!
For the following two exercises I have to take an ace bandage and wrap up one knee twice and then loop over to the other knee twice and then in a figure eight motion, wrap up both knees. This is done to lock his knees while he stands so that he can strengthen his knee and hips. ALL STANDING EXERCISES MUST BE DONE WITH BRACES. While the current braces aren't ideal, and need to be replaced, they still work in protecting his ligaments and bones.
5. [ACE BANDAGE] Standing against sofa, face facing the sofa.
While I kneels behind Felipe, having Felipe stand and play with toys on the sofa. Try to keep his knees from bucking and from him from sitting down. Try to lengthen the time he is putting weight on his feet and time in which he is standing. Keep and eye on his posture, he should stand straight throughout, should not bend at the waist or lean too forward.
6. [ACE BANDAGE] Standing against sofa, facing away the sofa (back to sofa).
While I squat, and sit on my heels, keep Felipe in between my thighs. I keep a toy above my head and maintain his good posture. This exercise is a test of my own flexibility, as I have to stretch before hand...it feels like a yoga move!! Felipe has been able to hold this pose, but since I'm not so balanced, I haven't been able to keep him entertained with a toy. I have to work on my own balance. Or have someone else help me by holding the enticing toy.
7. [NO ACE BANDAGE] Pull to stand
I sit down on the floor and place Felipe straddling my thigh. Making sure that both feet are planted on the floor. Put enticing toy on sofa top, once Felipe is interested in the toy, he will begin to push off to pull himself up to the toy. Place my hands on his hips with my thumbs covering his butt. Gently help him stand up. Slowly remove my hands or lessen the amount of weight I help him carry. Over time he starts to stand on his own. while standing he will sway to the left and right. Help him balance out his weight and also shift his weight. he needs to be able to shift his weight from one side to another to stand and to walk.
8. [NO ACE BANDAGE] Kneel to stand
Put Felipe on floor, near sofa, in the crawling position. tap the sofa and show him toy. if interested he will put his hands on sofa and start to kneel. ideally, he will then kneel walk, moving his knees to get closer to the sofa. Once he is close enough, I grab him by pelvis area and shift the weight to his right leg, then tickle his left quad. If a reaction (moving his knee up) allow him to complete. If no movement, move his knee up. then shift weight to left leg (which is planted), while tickling his right leg to bend upwards (putting foot planted on floor) If he doesn't respond, do movement for him. All the while he should be pulling himself up, help him complete the pull up. result, he will stand. this is a hard one bc I have to do it quickly enough and during the period of time where he is pulling himself up! repeat, 10 times, goal is to get him to respond on his own and pull up his knees to plant his foot on his own.
9. [NO ACE BANDAGE] Baby squats
I sit down on the floor, I place Felipe straddling my thigh. He is sitting upright.. I place interesting toy on sofa, he tries to stand, then I move the toy to the floor, where he squats down and sits again. repeat 10-15x. its a work out!!
And that's it!!, I try to get it all done at once, but realistically, the bandaging of the legs and putting on the splints frustrates Felipe and I have to distract him in between those stretches and exercises. And that's all for day 2 for early intervention...more awaits!
No comments:
Post a Comment