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Home programmes for children with motor delay
First published in 1997 by Winslow Press Ltd, Telford Road, Bicester, Oxon OX6 OTS, UK
Copyright © Sarah Crombie, 1997 All rights reserved. The whole of this work including all text and illustrations is protected by copyright. No part of it may be copied, altered, adapted or otherwise exploited in any way without express prior permission, unless in accordance with the provisions of the Copyright Designs and Patents Act 1988 or in order to photocopy or make duplicating masters of those pages so indicated, without alteration and including copyright notices, for the express purpose of instruction and examination. No parts of this work may otherwise be loaded, stored, manipulated, reproduced, or transmitted in any form or by any means, electronic or mechanical, including photocopying and recording, or by any information, storage and retrieval system without prior written permission from the publisher, on behalf of the copyright owner. 003-2770/Printed in the United Kingdom British Library Cataloguing in Publication Data Crombie, Sarah Physiotherapy home programmes for children with motor delay 1. Cerebral palsy - Physical therapy 2. Cerebral palsied children - Home care I. Title 618.9'2836'062 ISBN 0 86388 171 8
Page iii CONTENTS Section one Personal Information About Your Child Section two Home Exercises Section three Other Information on Development 1 10 115 .
Inge Gregorius and Helen Farmer. This involves the treatment and management of children with developmental delay and neurological problems. Irene Sclare. When working as a senior physiotherapist at the Centre she was awarded a grant for a two-year project whose purpose was to extend and develop physiotherapy services in the community. Caroline Griffiths and David Crombie for their contributions and to Jonathon Evans and Gail Thurley for the illustrations. Sarah is at present undertaking a Master of Science degree in rehabilitation research at Southampton University. working closely with their families and carers at home.Page iv ACKNOWLEDGEMENTS I wish to thank the physiotherapy staff at the Wilfrid Sheldon Child Development Centre. Thanks go also to Jane Macer. the nursery or in school. London and at King's College Hospital. Sarah Crombie is currently working as a superintendent physiotherapist for the Royal West Sussex Trust at St Richard's Hospital. During this time a further grant was obtained to develop and pilot the programme which is the core of this manual. Earlier in her career Sarah worked as a clinical physiotherapist at the Wilfrid Sheldon Child Development Centre. Chichester and in the community. London. for their encouragement and assistance in the development of this material. especially Rowenna Hughes. .
the major part of this manual. Overall. An illustrated programme can be devised to meet the individual needs of the child and made easy to read and use at home by parents or by teachers and other staff caring for the child. equipment lists and so on. Section 3 provides further information on the areas of play and communication. Section 2. . It promotes easy communication between parents and others involved in caring for the child and ensures that they all work together to share the same goals in the child's therapy and everyday activities. The manual is divided into three sections: Section 1 comprises information sheets on which to enter personal details about the child. individual goals for therapy. The exercises would need to be carried out under instruction from individual therapist. the manual will serve as an important source of information and a reminder of exercises to continue at home. as an adjunct to any treatment and management programme. This programme can be readily revised and updated as necessary.Page vi INTRODUCTION The Physiotherapy Home Programmes for Children with Motor Delay has been designed for use by physiotherapists to compile personalized home exercise and management programmes for children with motor delay or dysfunction. As these are individual sheets. they can be selected and tailored to meet the specific needs of the particular child. contains diagrams with a simple text illustrating exercises which may be continued at home or at school. important information related to therapy.
Page 1a SECTION 1 PERSONAL INFORMATION ABOUT YOUR CHILD .
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Page 10-A SECTION 2 HOME EXERCISES .
. and is always a good exercise to start with. slowly rock the hips back and forth.Page 10 A: Relaxation Techniques A1: Relaxing baby on your lap __ Lay baby on your lap or on the floor. __With your hand gently pressed down on baby's bottom. Make sure the arms are forward and not curled up under the body. __This will help to relax your baby generally.
one on the hips. __ Put one hand under the shoulder. __ Hold the shoulders still and slowly twist the lower part of the body away from and towards you. . __ This is a good exercise to do before others as it helps to relax the body generally.Page 11 A2: Relaxing baby __ Hold baby on their side with their back against your stomach.
. __ The legs will become more relaxed as you do this. Turn them out to help this. keeping the body as symmetrical as possible. that is. and then lift the other side.Page 12 A3: Relaxing the body __ Lay the child on your legs. __This is a good exercise to relax your child before doing others. with the head in the middle. __ Slowly lift and lower the hips to help them relax. __ Try lifting one hip only so the body twists a little. The shoulders should remain still.
as if the child is standing on it.Page 13 A4: Relaxing the body by moving the legs __ This exercise should be done when the hips have already been relaxed. __ Keep the leg turned outwards and slowly move the whole leg up and down in the direction of the opposite shoulder. hold the knee to keep the leg straight. __ With the other hand. that is. . __ With one hand. __ The leg should relax and so relax the hips more. hold the foot bent upwards. __ Do the same with the other leg.
__ Keep the legs apart and turned out. . __Carry on until you feel your child relaxing. __ Slowly rock the child's bottom from side to side. that is with heels towards each other.Page 14 A5: Relaxing over a ball (holding legs) __ Keep the child's arms forwards and place your hand on their bottom to steady the child on the ball. __ Gently stretch one leg out and then the other.
__ Keep their arms turned so that their palms are towards each other. __ This will help to relax the body. .Page 15 A6: Relaxing over a ball (holding arms) __ Hold the child's arms at wrists or elbows. __ Slowly lift the top half of the body and twist to one side and the other. __ Keep their hips and legs steady using your body.
__ Slowly twist the shoulders and top half of the body to one side and then the other. __ This will help relax the body and is a good exercise to do whenever your child feels stiff. __ Hold across the child's chest and under the shoulders with one arm and keep the hips steady with the other. .Page 16 A7: Relaxing your child in the sitting position __ Sit your child on your lap facing away from you.
__ Turn the arms out from the shoulders first and move your hands down over the elbows. __ Gradually stretch the arms out towards you. .Page 17 A8: Stretching arms forward __ Hold the arms above the elbows. turning them out at the same time. that is with palms facing upwards.
Page 18 A9: Opening hands and fingers __ By first straightening and turning out the arm. . you make it easier to stretch out the thumb and then the fingers.
When the arm is more relaxed. as if shrugging the shoulder.Page 19 A10: Relaxing a tight arm __ Hold the arm at the elbow and wrist. __ This exercise can also be done when your child is sitting up. and then down. __Carry on until the arm begins to relax. . Keep it straight. __ Slowly move the whole arm up towards the shoulder. it should be brought forwards onto a table where your child can see it and move it more effectively. __ Turn the arm outwards and keep the wrist flexed upwards.
__ Lift the whole arm up above the head. __ Lift it up and gently straighten it out.Page 20 A11: Stretching a tight arm __ Hold the arm at the elbow and wrist. turning the arm outwards as you do so. that is with the palm to the ceiling. . opening out the thumb and fingers.
for example for nappy changing.Page 21 A12: Helping to separate the legs __ When trying to part the legs. __ Turn the legs outwards as you do this. . do not hold the ankles but the knees.
. as this is often a sign of the whole body getting tight. __ Lay them down flat.Page 22 A13: Relaxing the toes __ Put your fingers under the toes and stretch them out. __ Keep doing this whenever the toes curl up.
Page 23 B: Lifting and Carrying B1: Carrying baby curled up __ Carry your baby in a curled up position with the shoulders forward and the hips bent up. not just the head. . __ Support behind the neck and shoulders.
with their legs around your hips.Page 24 B2: Carrying baby on your hips __ Carry your child as shown. __Support them under their bottom. .
if they are bigger. . with one arm under the chest and shoulders and the other keeping the legs up. __ Try to keep their arms and legs turned out.Page 25 B3: Carrying in the 'aeroplane' position __ Carry the child with your arm between their legs and your hand under the chest or.
. legs bent up. __ Support them under the thighs __ Keep their legs apart.Page 26 B4: Carrying baby facing away from you __ Carry baby with their back against your front.
with you only supporting their bottom with your chest.Page 27 B5: Carrying your child to help strengthen the back __ Hold your child at their knees. __ Keep the legs apart and turned outwards. . __ Encourage them to hold their bodies up.
__ Keep them close to your body. __ Keep your back straight as you stand up. __ Put one foot forward to stand up.Page 28 B6: Lifting your child up from the floor (1) __ Kneel down by your child. __ Curl them up as you lift them from the floor. .
B7: Lifting your child up from the floor (2)
__ Turn your child over onto their front before you lift them up. Put one arm between their legs to keep them apart. __ Hold your child close to you and slowly stand up. __ Remember to bend your knees, not your back.
SECTION TWO HOME EXERCISES
B: Lifting and Carrying
B8: Lifting your child up from the floor (3)
__ Place one arm between the child's legs to keep them apart. __ Roll the child up and towards you, curling them up as you do so. __ Lift them onto your lap and then stand up.
C: Prone Activities
C1: Lying on their front to play (1)
__ Encourage your child to lie on their front to play and to take weight on their forearms. __ Put a toy in front to encourage your child to lift up their head.
__ Put a toy in front to encourage your child to lift up their head. __ Roll up a towel to put under the chest if necessary. . This keeps the arms forwards so that the weight is on the forearms.Page 32 C2: Lying on their front to play (2) __ Encourage your child to lie on their front to play.
Page 33 C3: Lying on their fron to play (3) __ Lay your child on their front to play. __ Play with a toy in front to encourage them to lift their head up. . __ Encourage them to rest on their elbows by putting gentle pressure down through their shoulders.
Page 34 C4: Laying baby prone on you __ This is a good position to help encourage your baby to lie on their front and to lift their head up. .
__ Make sure the hands are open and taking some weight.Page 35 C5: Play over legs __ Lay baby over your lap to play. .
__ Encourage your child to play in this position with their elbows straight. Keep the hands shoulder distance apart. .Page 36 C6: Lying on their front to play (straight arms) __ Put a rolled up towel or therapy roll under the chest. __ Later on they can be encouraged to put more weight on their hands and start to reach out.
.Page 37 C7: Laying the older child on their front __ Encourage your child to play in this position. __ Keep their arms forwards and legs apart (use a towel or cushion for this). __ You can use a wedge instead of a roll to help your child lie in this position.
turning the legs out. encourage them to reach out for a toy while keeping the supporting arm straight. __ Encourage your child to go forwards onto their hands. . keeping the elbows straight. __ Hold the front of the knees.Page 38 C8: Over a roll with weight on the arms __ Place the child in the position shown. __ When they can do this well.
that is heels facing in. . you can hold their things or knees instead. __ Separate the legs and keep them rolled outwards. __ You may want to place the legs on either side of your body. __ Encourage the child to reach out with both hands for a toy. __ When reaching becomes easier.Page 39 C9: Encouraging reaching out from lying on a roll __ Place the child on their stomach lying on a large roll or ball.
that is heels facing each other. __ Slowly rock the child forwards over the ball until the child's hands are on the floor. and keep the legs apart and turned outwards. . __ Encourage the child to take some weight through their hands.Page 40 C10: Encouraging your child to take weight on the arms (ball activity) __ Hold the child's thighs.
__ Encourage your child to reach forward or 'walk' forward on their hands.Page 41 C11: Encouraging your child to take weight on the arms __ Support the child's legs on yours. .
__ Do this by placing your hand on one hip and slowly moving it so that your child is lying on their side.Page 42 D: Rolling D1: Rolling over. holding the hips __ With the child lying on their back. __ Do this to both sides and do it slowly so that your child has time to move with you. . __ When your child is able. you can then carry on to help them to roll right over onto their front. practise rolling from side to side.
using both legs __ Help your child to roll over from their back to their side. . __ Try to dothis slowly so that your child can join in and do as much of this movement as they can for themselves.Page 43 D2: Rolling over. __ Hold the legs as shown.
Page 44 D3: Rolling over. __ Try to do this slowly so that your child can join in and do as much of this movement as they can for themselves. holding one leg __ With your child lying on their back. hold one leg at the knee. This will roll your child over onto their side. __ Reverse this to roll to the other side. . __ Bend the knee slightly and slowly bring it across their body.
__ Slowly bring one arm down and across the body. encouraging the top leg to bend to help roll over. . while keeping the other arm up.Page 45 D4: Rolling over. __ Use the top arm to guide them. hold their hands above their head with the elbows straight. using the arms __ With your child lying on their back. __ Encourage your child to look the way they are rolling.
__ Encourage baby to look at you and move their arms in front of their body. . __ This brings the shoulders and arms forwards.Page 46 E: Supine Activities E1: Getting the hands together (1) __ Support baby behind the shoulders and head.
Page 47 E2: Getting the hands together (2) __ Encourage your child to bring their hands together. __ You can also help your child to take their hands to their mouth and reach forward to touch your face. and play with their hands in this position. .
Page 48 E3: Getting the hands together (3) __ Lay baby on your lap and encourage them to bring their hands together. as shown. .
Page 49 E4: Encouraging reaching for the feet (1) __ Encourage your child to touch their feet with their hands by lifting their legs up. __ you can also help by lifting up their bottom to bring their feet closer and/or by putting theirhead and shoulders on a pillow. __ Encourage them to play like this and learnabout their body. .
.Page 50 SECTION TWO HOME EXERCISES E: Supine Activities E5: Encouraging reaching for the feet (2) __ Place your child on your lap. as shown. __ Bring the arms forward and help your child to reach for their opposite foot.
Page 51 E6: Bridging (1) __ Lay the child on their back. __ Bend both knees up and ask the child to lift up their bottom. .
E7: Bridging (2)
__ Lay the child on their back with one leg bent. __ Put the straight leg up on your lap. __ Ask the child to lift up their bottom and hold this position for a few seconds.
F: Side-Lying Positioning and Activity
F1: Laying baby on their side
__ Place a rolled up towel or blanket behind baby's back to keep them on their side. __ When baby is sleeping, a blanket tucked diagonally across from the shoulder will help to keep them lying on their side.
F2: The side-lying position for play
__ Lay your child on their side to play. __ To stop them rolling over onto their backs, you could lay them against a sofa or large cushion. __ Their head should be in the middle, arms forward and legs slightly bent up. __ You may need to place a pillow in between their legs to keep them apart.
__ Encourage your child to bring their own arms forward and play in this position. .) __ Use the straps to keep the child in this position.Page 55 F3: Using a side-lying board __ Make sure the child's back is flat against the back of the board. __ A pillow under their head should help to keep the head straight. (Remember to support the feet too. __ A pillow between the legs will help to keep the legs apart.
Page 56 G: Moving From Lying To Sitting G1: Getting up from lying on their front to the sitting position __ Lay the child on their front. __ Encourage the child to push up with their hands. __ Move the child's hips slowly over to one side so the child is now sitting. . holding the child's hips. __ Bring the weight backwards over the knees.
__ Bring them slowly up to the sitting position. . __ Make sure that they are looking at you with their head in the middle.Page 57 G2: Getting from lying to sitting: encouraging control of the head (1) __ Place your hands behind your child's shoulders and gently support the head with your fingertips.
Page 58 G3: Getting from lying to sitting: encouraging control of the head (2) __ Place your hands behind your child's shoulders. __ Bring them slowly up to the sitting position. . __ Make sure that they are looking at you with their head in the middle.
__ Make sure that their head is in the middle and encourage them to grasp your thumbs. __ Bring your child slowly up to the sitting position. __ You can help them to go down again in the same way. letting them do as much of the work as they can. .Page 59 G4: Getting from lying to sitting: encouraging control of the head (3) __ From lying down bring your child up to the sitting position. holding their hands. Hold them around the wrists.
Page 60 G5: Getting from lying to sitting: encouraging control of the head (4) __ From lying down bring your child up to the sitting position by holding one hand. . __ Do This slowly so that your child can do as much of the activity as possible. __ Start by tilting them gently over to one side and let them push up with that hand.
encouraging them to look at you. you can move your hands to hold the elbows instead. __ When they are steadier in sitting. __ Place your hands behind their shoulders to bring the arms forward. .Page 61 H: Sitting Activities H1: Encouraging head control when sitting __ Sit your baby on your lap facing you. __ Talk and play with your baby in this position.
__ Hold them around their middle. encouraging them to stay upright.Page 62 H2: Helping your child to sit (1) __ Sit your child on your lap facing you. __ Slowly rock them from side to side. .
Let them grasp your thumbs. __ You can then try slowly rocking from side to side. __ Keep the arms forward and gently bob your child up and down. but needs to be done slowly. .Page 63 H3: Helping your child to sit (2) __ Sit your child on your lap. so that your child can move with you. using your knees. __ This all helps to develop balance in sitting. holding their hands.
Page 64 H4: Reaching out while sitting __ Sit your child on your lap. __ Encourage them to reach out and try to keep their balance. supporting them at their hips. .
__ Support them by keeping their shoulders forward. holding the shoulders __ Sit your child on the floor facing you. .Page 65 H5: Encouraging sitting. __ Play with toys in front of them.
. you can encourage your child to reach for toys on either side and keep their balance. when balance has improved. Hold the hips to give support and encourage play with toys in front of them __ Later on.Page 66 H6: Sitting on the floor (1) __ Let your child sit on the floor to play.
hold the child's knees to give support. that is with heels facing each other. __ Try to keep the legs rolled outwards. __ Encourage them to reach for toys to either side and to keep their balance.Page 67 H7: Sitting on the floor (2) __ When sitting on the floor to play. .
Page 68 H8: Sitting on the floor (3) __ Try sitting on the floor with your child supported between your legs. . __ One leg can act as an anchor for the child's legs. and the other one as a cushion behind. __ Encourage reaching forward.
Page 69 H9: Side sitting __ Encourage your child to sit as shown. __ Encourage them to use the other hand to reach for toys and to play. . __ Make sure they are taking weight through the arm and that the hand is flat.
__ Tilt them slowly to one side and then to the other.Page 70 SECTION TWO HOME EXERCISES H: Sitting Activities H10: Encouraging balance when sitting __ Sit your child on your lap and hold them at the hips. .
either on a low table or on the floor. __ Encourage them to play with toys in front of them. .Page 71 H11: Sitting astride a roll (1) __ Sit your child astride the roll. feet flat on the floor and knees bent.
__ Encourage them to come back up to the sitting position.Page 72 H12: Sitting astride a roll (2) __ Support your child at their hips as they bend forward to reach for a toy. __ Use this position also to play with toys on either side of the roll. .
.Page 73 H13: Sitting astride a roll (3) __ Hold your child's legs. __ Gently rock your child from side to side encouraging them to keep their balance.
Page 74 H14: Reaching up when sitting on a roll __ Hold your child's legs to give support. __ Encourage them to reach up and out sideways for a toy. . __ This helps to develop balance.
Position these slightly forwards of the child. __ Make sure the feet stay flat on the floor. __ Encourage them to reach sideways over to one box for a toy and then to the other. .Page 75 H15: Reaching sideways when sitting on a roll __ Sit the child on a roll between two boxes or chairs.
__ When this becomes easier. __ Encourage your child to keep their balance and keep as upright as possible.Page 76 H16: Sitting on a therapy ball __ Sit your child on the ball. holding them at the hips. . You can try tilting the hips backwards and forwards too. __ Gently bounce up and down. slowly tilt them to one side and then to the other.
. on the floor. __ Play games involving reaching out in all directions: in front.Page 77 H17: Sitting on a stool (1) __ Sit your child on a stool with their feet flat on the floor. to the sides and behind.
__ Encourage reaching out for a toy while keeping their balance. .Page 78 H18: Sitting on a stool (2) __ Sit your child on a stool or low table with their feet off the ground.
__ Support the child at the hip and under one shoulder. __ Encourage your child to move forward and take weight on their hands and then bring their other knee forward.Page 79 I: Moving From The Sitting Position I1: Moving from sitting to the crawl position __ Bend one of your child's legs up and turn it slowly to that side. .
Page 80 I2: Getting from sitting to standing __ Sit your child on your lap. __ Bring their weight forward over their feet and help them to stand up. .
. __ Help them to sit down in the same way.Page 81 I3: Standing up from a low table/chair. __ Bring their body weight forward over their feet and help them to stand up. holding the shoulders __ Support your child at the shoulders.
. holding the elbows __ Hold the arms as shown. turned so that the palms face each other. __ Bring the child's weight forward over their feet and then help them to stand up.Page 82 I4: Sitting up from a chair.
Page 83 I5: Sitting to standing: sitting down to one side __ Stand the child up. __ Ask the child to sit down to one side and then to stand up again. using their arms to bring their body weight forward. __ Do the same to the other side. .
. __ Tap gently down through the shoulders to encourage your child to take weight through their arms. Support their hips with your legs if necessary.Page 84 Kneeling Activities J1: Encouraging the crawl position (1) __ Place your child in the crawl position.
. __ Support them at the hips.Page 85 SECTION TWO HOME EXERCISES J: Kneeling Activities J2: Encouraging the crawl position (2) __ Place your child in the crawl position. __ Encourage your child to stay in this position for a short while.
__ Kneeling against a table is easier to start with.Page 86 J3: Kneeling up against a surface __ Support your child at the hips. using a ball is good for developing balance. __ Later. with the weight supported equally by both legs. __ Encourage your child to stay up on their knees. .
__ Play games involving reaching out. . __ Keep their knees apart.Page 87 J4: Playing in the kneeling position __ Hold your child at the hips. such as pushing or throwing a ball.
Page 88 J5: Kneeling up on one leg __ Hold your child at the hips. . __ Make sure their legs are apart. __ Play games in this position and encourage your child to keep their balance.
__ Legs straight. . __Feet flat.Page 89 K: Standing Activities K1: Correct standing posture __ Head in the middle. __ Weight equally on both legs. __ Shoulders level. __ Hips level.
.Page 90 K2: Support in standing __ Stand your child up by supporting them at their hips. __ Encourage them to take as much of their weight as possible and to balance themselves.
. __Encourage your child to keep their balance. __ Keep their feet apart. holding onto their elbows. holding the elbows __ Stand your child facing you. __ Keep their arms turned out.Page 91 K3: Standing up.
. __ The table should be of a height to allow your child to take weight through their hands.Page 92 K4: Standing against a table __ Encourage your child to stand up against a table.
__ Encourage them to play by moving toys from one chair to another. .Page 93 K5: Standing between two chairs __ Stand your child between two chairs. __ Keep their feet apart.
their knees straight. __ Their heels should be back against the wall. a wall.Page 94 K6: Standing against a wall __ Stand your child with their body flat up against knees straight. __ Encourage them to balance in this position. .
as shown. . __ Encourage them to keep their balance in this position.Page 95 K7: Standing against a high table or bench __ Find a surface that your child can use to help them to remain standing up.
__ Hold their knees and keep their legs turned out.Page 96 K8: Stretching up while standing (1) __ Stand your child on your lap. __ Encourage your child to reach up for toys. with feet flat. . so stretching out the body.
__ Hold the other arm backwards. turned out. __ Encourage your child to reach up for a toy.Page 97 K9: Stretching up while standing (2) __ Stand your child on your lap. __ Hold one leg straight at the knee. .
. with the child's feet facing forwards.Page 98 K10: Encouraging standing: holding the knees __ Stand your child astride a roll. __ Hold the knees. __ Encourage balancing in this position and reaching out for toys.
Page 99 K11: Standing. holding the legs __ Stand your child up against an easel or wall. . __ Hold their legs straight and encourage them to tuck their bottom in to stand straight.
.Page 100 K: Standing Activities K12: Standing with one foot in front of the other __ Encourage standing in this position.
__ Encourage body weight to be forward over the front foot.Page 101 K13: Standing with one foot on a step __ Support your child at the hips. .
__ The child should hold on in front and keep their own balance. .Page 102 K14: Encouraging standing balance __ The child's feet should be apart.
__ Encourage the child to keep themselves balanced on one leg.Page 103 K15: Standing on one leg __ Shift the child's body weight onto one leg. __ Take the other leg out to the side or behind. .
__ Hold the foot that is on your lap and encourage the child to keep their balance.Page 104 K16: Standing with one leg up on your lap __ Stand the child in front of you. with one leg up on your lap. . __ Make sure their bottom is tucked in.
__ Help your child to move their weight from one foot to the other. holding the hips __ Support your child at the hips.Page 105 L: Walking L1: Encouraging walking. .
holding the shoulders __ Support your child at the shoulders.Page 106 L2: Encouraging walking. . __ Help your child to move their weight from one foot to the other.
. holding arms behind __ Hold the child's wrists to keep the arms straight. __ The arms should be turned so that the palms are towards the floor.Page 107 L3: Encouraging walking. __ Help the child to move their weight from one foot to the other.
holding arms up __ Hold the wrists and hands to support your child. __ Keep the arms turned so that the palms are towards each other. __ Help your child to move their weight from one foot to the other. .Page 108 L4: Encouraging walking.
__ The arm can then be brought up towards the ear.Page 109 M: Miscellaneous M1: Shoulder movements __ Hold the shoulder still with one hand. __ Turn the arm as you do so. __ Slowly move the whole arm out and to the side and back again. . the palm facing towards the ear. __ Hold the elbow with your other hand.
Page 110 M2: Stretching for torticollis (1) __ Support the child on their side. __ Hold the upper leg and the lower arm at the wrist. __ Gently lift the lower part of the body so that the side of the neck is stretched. .
__ Hold the left shoulder steady with your right hand. __ Hold the left shoulder steady so that the body will not twist when you move their head. __ Using your other arm.Page 111 M3:Stretching for torticollis (2) For the baby with tightness on the left side of the neck (reverse for the other side). __ Hold this stretch position for a few moments. __ Lay the baby on their side with their back flat against you. __ Sit the child on your lap facing away from you. gently stretch the left side of the baby's neck by moving their head up towards you. . __ Gently turn their head to the right.
. __ Put the AFO on. __ Lastly do the straps up. making sure the child's heel is right back inside.Page 112 M4: Putting on an AFO __ Hold the child's knee and foot bent up as shown.
Page 113 Alphabetical List of Illustrations B Bridging (1) 51 Bridging (2) 52 C Carrying baby curled up 23 Carrying baby facing away from you 26 Carrying baby on your hips 24 Carrying in the 'aeroplane' position 25 Carrying your child to help strengthen the back 27 Correct standing posture 89 E Encouraging balance when sitting 70 Encouraging head control when sitting 61 Encouraging reaching for the feet (1) 49 Encouraging reaching for the feet (2) 50 Encouraging reaching out from lying on a roll 39 Encouraging sitting. holding the hips 105 Encouraging walking. holding the shoulders 65 Encouraging standing balance 102 Encouraging standing: holding the knees 98 Encouraging the crawl position (1) 84 Encouraging the crawl position (2) 85 Encouraging walking. holding arms behind 107 Encouraging walking. holding the shoulders 106 Encouraging your child to take weight on the arms 41 . holding arms up 108 Encouraging walking.
Encouraging your child to take weight on the arms (ball activity) 40 G Getting from lying to sitting:Encouraging control of the head (1) 57 Getting from lying to sitting:Encouraging control of the head (2) 58 Getting from lying to sitting:encouraging control of the head (3) 59 Getting from lying to sitting: encouraging control of the head (4) 60 Getting from sitting to standing 80 Getting the hands together (1) 46 Getting the hands together (2) 47 Getting the hands together (3) 48 Getting up from lying on their front to the sitting position 56 H Helping to separate the legs 21 Helping your child to sit (1) 62 Helping your child to sit (2) 63 K Kneeling up against a surface 86 Kneeling up on one leg 88 L Laying baby on their side 53 Laying baby prone on you 34 Laying the older child on their front 37 Lifting your child up from the floor (1) 28 Lifting your child up from the floor (2) 29 Lifting your child up from the floor (3) 30 Lying on their front to play (1) 31 Lying on their front to play (2) 32 Lying on their front to play (3) 33 Lying on their front to play (straight arms) 36 .
M Moving from sitting to the crawl position 79 .
holding one leg 44 Rolling over. using both legs 43 Rolling over. holding the hips 42 Rolling over. using the arms 45 S Shoulder movements 109 Side sitting 69 Sitting astride a roll (1) 71 .Page 114 O Opening hands and fingers 18 Over a roll with weight on the arms 38 P Play over legs 35 Playing in the kneeling position 87 Putting on an AFO 112 R Reaching out while sitting 64 Reaching sideways when sitting on a roll 75 Reaching up when sitting on a roll 74 Relaxing a tight arm 19 Relaxing baby 11 Relaxing baby on your lap 10 Relaxing over a ball (holding arms) 15 Relaxing over a ball (holding legs) 14 Relaxing the body 12 Relaxing the body by moving the legs 13 Relaxing the toes 22 Relaxing your child in the sitting position 16 Rolling over.
holding the elbows 82 Standing against a high table or bench 95 Standing against a table 92 Standing against a wall 94 Standing between two chairs 93 Standing on one leg 103 Standing up from a low table/chair. holding the elbows 91 Standing with one foot in front of the other 100 Standing with one foot on a step 101 Standing with one leg up on your lap 104 Standing. holding the legs 99 Stretching a tight arm 20 Stretching arms forward 17 Stretching for torticollis (1) 110 Stretching for torticollis (2) 111 Stretching up while standing (1) 96 Stretching up while standing (2) 97 Support in standing 90 T The side-lying position for play 54 . holding the shoulders 81 Standing up.Sitting astride a roll (2) 72 Sitting astride a roll (3) 73 Sitting on a stool (1) 77 Sitting on a stool (2) 78 Sitting on a therapy ball 76 Sitting on the floor (1) 66 Sitting on the floor (2) 67 Sitting on the floor (3) 68 Sitting to standing: sitting down to one side 83 Sitting up from a chair.
U Using a side-lying board 55 .
Page 115-A SECTION 3 OTHER INFORMATION ON DEVELOPMENT .
toys that are too easy will become boring over time and be abandoned. __ Show them how pleased you are when they have been successful. Children use play to express their feelings and to communicate with other people. Your child may lack the strength or energy or simply not have much curiosity to experiment with a new toy. __ Show your child how a new toy works and guide their hands. The trick is to try to find games and toys which interest your child and match their abilities. They do not always need expensive toys to play with. but not too frightening. A loud sound may take some time to get used to.Page 115 Your Child and Play Playing and Learning Go Hand in Hand Children seem to have a natural instinct for play and. even when they are quite young. This is especially true for children who have difficulties with their movement. How You Can Help __ Bring toys within your child's easy reach. through play. Toys that are too difficult will be frustrating. they learn about the world around them. Children who have physical problems often need help to play with toys and games. __ Choose toys which are exciting. __ Make sure that toys are not too heavy to hold or lift. . These children may be slower to understand how toys work or less able to make them work.
especially other children. Help them to share. to expand their experience. Later they become more interested in toys which they can move with their hands. Toys and games are not a substitute for contact with other people. They can be a good incentive for children to move their bodies. You and your child can begin to include teddy in games such as 'pretend' tea parties and even include him in your child's exercises. How Play Develops At first children enjoy toys which are interesting to look at: brightly coloured. .Page 116 __ If your child is not interested or gets irritable when you help them to play. especially if they produce a result such as a noise or music. Try to think of any reasons for the play activity not being right for your child. for example. pop-up toys and toys such as puzzles which make them think. Soft toys also give the chance to play make-believe. Toys are useful for children who need help with movement. do not become disheartened. This is very important for all children's thinking and understanding. Do not forget to encourage children to touch and explore objects. Toys and games often act as comforters. and encourage other family members to include them in their activities. Make sure that your child's play draws in other people. Help them to notice others and to be noticed. Make sure that your child has a teddy or doll around once they are able to hold on to larger toys. Quite often disabled children are left out. or with parts that move. as when reaching for a toy or moving towards a toy.
but do encourage them to pick them up once they are strong enough. keep to what is manageable for you and your child. Talk and explain to your child while you play. They can also advise on the sorts of toys that will suit your child's needs and interests. Keep going. and make it fun for both of you. . build in play times as part of the everyday routine.Page 117 Do make sure that you use everyday experiences as much as you can to help your child play and learn. Be as keen and interested in small steps to progress as in those big experiences with special toys. Your physiotherapist and speech and language therapist will be able to give more practical advice about the sorts of activities that will help your child best at each stage of development. Let them crawl into boxes or under tables to play as often as you would any child. Finally. Let them drop and scatter toys.
Page 118 Everyone Needs to Communicate One of the most important skills your child will learn is to communicate effectively. Some children have a good understanding but have physical conditions which make mouth movements difficult. Communication begins long before your child is speaking. These children have just the same need to express themselves as others and it is important to prevent frustrations by offering them additional ways of communicating as soon as possible. but this early stage of unspoken communication is essential to the development of understanding and relationship. Many children simply need a little extra help to develop skills and achieve their potential. your family and friends are the best people to give the help they need. we communicate with our babies by looking. by crying and making sounds. Some may benefit from simple signing. The type of help a child may need to develop good communication skills may change as they grow. It may be a long time later that they start trying to talk. As parents. others may learn to indicate their needs using pictures and a few will require mechanical aids or computers. Their ability to make sense of the world will affect the ideas they are able to understand and communicate about. Babies tell us a lot about how they feel through movement and facial expression and. . A speech and language therapist should be able to offer advice and decide with you what is appropriate for your child. Whatever difficulties you child may be experiencing at the moment. of course. touching and changing our tone of voice. it is important to remember that you. A child's early experience and relationships with others will strongly affect whether or not they want to communicate.
Songs and rhymes combine sound and movement and can be exciting or soothing to a child who is depending on you. it is important to watch and listen to your child. It is important that early help is available as hearing and visual impairments will affect the child's development and interfere with speech and language learning. Soon they begin to expect these games and may indicate that they want more by becoming noisier or waiting expectantly at times when these games are normally played. They also help children learn about the patterns of speech. Babies soon learn to enjoy this early play and especially like their own sounds being repeated back to them. they rely on you to understand them in order to feel successful and keen to keep trying. What is Your Child Trying to Tell You? However your child communicates. in this way they know they are being listened to. A child who does not have an effective means of communication and is usually misunderstood or ignored may become depressed or angry. . Children listen to the sound of your voice long before they understand what you are saying. gestures or by other means.Page 119 Getting Started From the start. Some parents recognise at this stage that their child is not responding because they have problems hearing or seeing. with spoken words. Playing with sounds while you are handling your child can be very reassuring. Your child is also learning to watch and listen to you. Such children can become dependent on one person to meet all their needs or may develop difficult behaviours.
__ Repeat your child's speech back to them and gradually add to their ideas __ Make your child aware of your pleasure in their attempts to do and say things. Keep your language simple and to the point. __ Help your child to feel successful. give them lots of encouragement. looking at pictures together. __ Let your child know they are understood __ Give your child opportunities to listen and develop their attention: for example. however they communicate. Use your hands and facial expressions to emphasise what you are saying." Things to Remember __ Listen to your child and watch what they are telling you. you could respond to. . even if they are not always correct. It is not helpful to correct your child's efforts all the time. __ Use your face and hands to express yourself as you talk to your child. telling stories. Saying ''yes".Page 120 Show an interest in the things your child enjoys and always talk about what they are doing. however much you want them to progress. Once your child is using words regularly to draw things to your attention. For example. "Mummy bus" by saying. playing with sounds. you can begin to extend what has been said. singing songs with actions. Once your child begins to attempt to say or indicate words. "Yes. smiling and repeating the word back may be all that is required. It's a big bus.
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