In my infancy, toddlerhood, and pre-teen years everything about my day, from my rising in the morning to my going to bed at night was orchestrated by my mother; very rarely, my father, as he was busy practicing medicine (when are the ever-elusive ‘they’ going to get it right!).
From the clothes I wore, to what I ate for breakfast, nap time, play time, going to church and going to school, my mother was ever-present. A big part of my childhood, while growing up with 7 brothers and sisters was ... exercise aka therapy aka "I hate it!" Again, the Mom factor. There would be no escape for thirteen years or so. As a small child, living with cerebral palsy required not only the wearing of orthotics and using crutches, it also involved a lot of pulling, pushing, and stretching of my legs, as they bore the brunt of the effects of spastic diplegic cerebral palsy (one of the lesser forms of this fixed neurological condition).
What follows examines all those exercises that were "done" to me, as I was not able to exercise independently. My mother tried to get in 4 sessions daily – quite a feat considering she was caring for 7 other children, though the older ones were pretty much able to look after themselves.
Should you parents of similarly neurologically insulted children wish to apply this regimen in your own child’s routine, I encourage you to consult with your attending physiatrist or physiotherapist for approval. Though the exercises involve basic movement/manipulation of spastic limbs, it would be important to confirm that what was utilized with me will be appropriate for your child. It was the rigorous, four times a day protocols that got me on my feet and kept me on my feet for almost 57 years. It’s thought by some in the local medical community that I may well be the oldest uprightly mobile and still moving spastic diplegic in Canada.
To avoid unnecessary repetition, I 'd like to point out that each exercise was done in sets of 10. As I grew older, a few other exercises were introduced; ones that I could do independently ... like using a rowing machine to strengthen back muscles, riding a stationery bicycle to tone leg muscles; with time, I would eventually learn to skip rope and ride a two-wheeler :)
But for now, let's get fit! Crank up some tunes to create a rhythm. These exercises are essentially for the cognitively aware child who can respond to instructions as required. But ... they can be modified as needed to meet the needs of the child who is more involved.
1) With the child lying on his back with a small pillow under the head, Mom or other "therapist" raises the left leg, placing one hand over the knee to keep it straight, and the palm of the hand on the sole of the child's foot. Raise gently until slight resistance is met (don't force beyond the child's comfort zone ... that will come with time). Hold to a count of 10, and lower slowly. Repeat 9 more times :) Then do the right leg. If the legs tend to scissor, put a wedge between them, so that the free leg doesn't interfere with the one being exercised. This up-down exercise would help promote arm tone/strength if they're involved. Explore what feels right to you as you work with your child.
2) With the child still on his back, and the wedge between the legs, bend the leg, and gently push the knee towards the chest. Place your palm under the child's foot to stabilize as you gently push the leg into the chest. Ideally, a second pair of hands is handy to restrain the free leg to make the exercise more effective. Again, don't go beyond the child's comfort zone. As he becomes more "flexible" range of motion will increase. Repeat for the other leg. I'm sure this exercise could be adapted for the upper body if involved.
3) With the child on his side, aligning body as straight as possible, raise the leg up, then, forward and then backwards, coming towards yourself as you work from behind the child. Again, use a wedge if spasticity/scissoring is an issue. Repeat for the other leg.
4) With the child still on his side, with wedge in place, bend the leg at the knee until the toe touches the buttocks. Again, do not go beyond the child's range of motion. Pushing beyond his physical limits is almost as bad as not exercising him at all. It will only elevate spasticity.
5) Prop the child, if old enough up against a sofa or other solid piece of furniture. Observe to see if he can balance himself - prop/guide with your hands when necessary. Use verbal cues to guide the child as he attempts to maintain a seated balance. Straighten upper body as required. All the other exercises, over time, will develop back and trunk strength to ensure improvements with sitting posture. Soon, he'll be ready for standing and stepping.Over time, introduce objects for him to reach for, and encourage him to return to the upright seated position. This exercise is also developing eye-hand co-ordination. Helpful when he graduates to sandbox play.
6) With the child on his stomach, again with wedge if required, bend the leg til the toe touches the buttocks. Repeat with other leg.
7) Return the child to the on the back position and gently massage the legs. Return him to his orthotics. if applicable. Now, wasn't that easy :)
These exercises can be repeated after dinner, before bed, either a group of them, or all of them, perhaps for 5 times each, followed by a warm bath. Over time, you can introduce other exercises to the regimen. Sit-ups are good. Holding the child's legs down with one hand, allow him to use your other hand /forearm to pull himself up to a sitting position, as far as he is able. Lower him gently on his back. Repeat 10 times. Follow that with what I call cat stretching. Position the child on his knees, and have him arch his back, if he is able. If not, continue to work on the other sets of exercises til he develops that ability (if he's meant to).
Hydrotherapy (think swimming!) is another great exercise. Range of motion is broader for exercises done in water. Besides, water is relaxing. If you don't have a pool at home, ask the manager of the community pool to consider raising the temperature to accommodate mobility disabled people. Perhaps an organized swim afternoon might be something to consider to ensure that everyone who is able can participate.
As the child matures, you will introduce other exercises that will develop muscle control for standing/stepping. Stand the child up in front of you, and push his feet, one in front of the other, with your feet. You're patterning the "walking" . Do this one a couple of times throughout the day. If the child is cognitively aware, remind him to keep his heels on the floor and avoid toe-walking. Token economy is a good tool for eliciting favorable responses. If the child is able, introduce him to a walker early. Or, if he is less involved, a small table he can push around is useful. Serves also as a great place for him to gather his play gear to move from place to place :) Something that has a raised edge so stuff doesn't slide off is convenient. As his walking/stepping ability improves, encourage him to walk on his own in the house, using furniture or walls as "touch spots" for balance. Over time, encourage him to concentrate on less wall/furniture touching, looking straight ahead and moving his feet, one in front of the other. Stress the importance of not watching his feet. An upright posture will improve spine strength.
Carla MacInnis Rockwell is a freelance writer and disability rights advocate living outside Fredericton, NB with her geriatric Australian silky terrier and a rambunctious Maltese. She can be reached via email at carmacrockwell@xplornet.ca
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