dystonic cp

[spandanphysio]

hello humera.the child has a more spasticitiy in legs.especiialy addutors and calf.m activating abdutors in lying with guuter splint of knee .can u put more light on activating dorsiflexors and controling planterflexor overtone.his knee goes in hyper extension due to that.i has added u r recoomended exs on wedges.he is able to come on prone on elbow but not on palm on prone.also finding difficulty in learning him creeping and improve his transation by that.eccentric control of movt. is very poor and m concentrating on that.any idea for that?i m confused with world TIP,what's that?is it abbrevation?

[humera]

Hi Spandanphysio,
Yes TIP is the abbreviation for "Tone influencing pattern". I still believe that getting more normal tone in upper limbs and trunk would be helpful to decrease/ normalize tone in legs. What about to take child in supine on ball to start the session, bringing his both arms in full extension above head gradually, with shoulders in abd and external rotation and elbows in extension, controlling shoulder around axilla. His legs must be hanging down the ball. then moving the ball in small amplitudes ant-post and sideways would help to get good stretching of all tight flexors.

Try activating hip abductors in side lying position. But before that , hip flexors and internal rotators would need stretching in side lying. Turning fron side lying to supine, initiating movement from legs would be helpful to activate hip abductors, ext. rotators and extensors.

Can you plz add more detail, in what position you want to activate dorsiflexors and control planterflexors.

if the child is feeling difficulty in coming up on palms in prone, it would be due to lack of extensors activity in lower trunk. Plz try bridging with legs abd and ext rotated and knees extended, supporting the legs at ankles, bit higher in your lap. This will increase extensor activity in lower trunk and legs, required for full trunk extension in prone. Also we can add taking one arm forward to reach for an object, while child is on elbows in prone.

I would suggest you not to work on creeping as it may increase flexor spasticity in the whole body which is childs original pattern and child need to inhibit this pattern.once good trunk extension in prone is achieved, this could be used to get child in all fours position and then on kneeling and half kneeling. These positions then can be use for transitions later on.

In which position you are working to get eccentric muscle control. You can try going in prone with head on floor from prone on elbows as an eccentric work as the child is able to control these positions.