dystonic cp

[spandanphysio]

thanx humera for u r kind rply.the chld has improved a lot in siiting.he sits well in stride sitting and cross leg sitting with weight on knees.also can sit independently able to correct in any direction.right now main pblm is flexed upper limbs specially left one which usuually stucks to chest with arm flexed internally rotated ,elbow and wrist flexed.i think he will come from supine to sit wich i s my nearrest goal. also will come prone on hands and also improve in independant sittind once he is able to entend elbow and take wight on it.i neeed u r valuable suggestions for that.

[humera]

Hi Spandan,
Nice to know that child is doing very well. Children having 3 limbs hypertonicity always give hard time. With these children main problem is trunk hypertonicity. Try to improve functions at shoulder first. Try to take arm in tone inhibiting pattern at shoulder. Scapular mobilization is always helpful to start with to bring shoulder in abd and ext. rot. Take the child in sitting on bench, using the shoulder as KPC in abd and ext rot, encourage the child to touch or pat the objects by actively extending the elbow and wrist as much as he can do it easily. Use weight bearing on hand at sides or at back keeping shoulder in abd, ext rot and extension, elbow straight, and wrist extended. As the tone decreases and arm gets active, encourage the child to do bilateral activity in front rather than emphasizing to do much activity with only affected hand. I usually ask parents to mobilize the scapula, keep arm in TIP and than encourage the child to hold the arm in front with abduction while putting on sleeves during dressing. You can use hand painting using affected hand keeping the worksheet in front on board/ wall so child has to stabilize shoulder in flexion and abduction.
Plz let me know if anything you cant understand because of my writing. These days my centre is closed for winter vacations. But will try to post some pic showing some excs once centre is reopen. Let me know if you want anything in particular.

[spandanphysio]

hi humera the child is improving well as he has gained good balance in siting with rare falls.i want to activate his abdominal oblique muscles and want u r suggestion for that he is not able to shift weight to lower extrimities in standing and kneel standing..i will atach his new pics soon.