S- We went on a home visit to see a 10yo boy with an ABI. He is a contract client with next challenge so his physiotherapy sessions are covered by insurance. He is triplegic so both his legs and L) UL are affected. his L) UL particularlyhas high flexor tone.
T- The task was to get him moving aorund on the mat and improve ROM and reduce the tone because he is in a W/c for the majority of the day
A-
- Wake up songs--> tapping his legs, L) hand (in flexor pattern) and his stomach
- leaning forward in w/c when tilted back to activate abdominals
- rolling on mat and stretching UL and trunk so reduce tone and improve ROM
- facilitate reaching for toys and using L) hand aswell (prevent neglect)
- in sitting reaching for bubbles and facilitate sitting up tall (tends to slump or lean on therapist)
- posting box: picking up item and reaching up to put in post box
- passive stretching of LL into extension
R
- the intervention was successful because it temporarily reduced the tone in his UL and trunk and also the LL
E
- Pt seeked sensory stimuli so every toy he was gien would put it into his mouth and chew, so we had to very vigilant in discouraging that behaviour (and instead give him his biting toy which was flavoured)
- I think i did well engaging with him and performing the stretching techniques, i found that play time flowed seamlessly with actual intervention so it was more enjoyable
- Next time i see him i will provide more firmer and less stimulating handling (ie. avoid tickling or brief tactile feedback as this confuses him as it overloads his sensory system)
S
- prolonged stretching/rotation of trunk
- reaching for a toy then as reaching apply over pressure to ensure good stretch
- promote awareness of L) UL to prevent neglect
- use sing song tone of voice as he understands it better
- provide firm facilitation rather than quick brisk movements
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