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plor
Instructor
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Posted: Thu Mar 12th, 2009 03:05 am |
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Initially I would think about how much time I have to work with this child: # of weeks, times per week or per day etc. Then I would analyze their current fitness level, both cardiopulmonary and neuromuscular and figure out what goals are within reach in the given time frame.
In my experience bodyweight support often frees a child to move such that tone limitations are significantly reduced. My initial inclination when working with a spastic with extensor tone would be to go 30-40% unweighted, without AFO's, using my hands on skills to faciliate a normalized gait pattern at 80-90 steps per minute; then removing my facilitation as they are walking, giving reinforcing verbal (and if necessary physical) cues to maintain the normalized pattern: to stimulate the CPG key items are hip extension that causes a stretch to the hip flexors and dorsiflexion that causes a stretch to the triceps surae.
Variables would typically be amount of weightbearing (or %age of weight supported by the equipment), speed and time. Speed and time combine to give distance. A rule of thumb would be that you don't want to increase the work done by more than 10% total each week in order to challenge but not overtrain your client. Which parameters you would choose to increase are really dependent on that particular client's needs and the goals you set for them. You might concentrate on increasing the client's endurance (time) for several weeks and then move to increasing their speed, or vice versa. Remember if you decrease the amount of weight supported you are also increasing the work load, so you might stay at a constant speed/time if you are working to decrease from 40% support to full weightbearing.
If you have stimulating the CPG in mind it is always desirable to use your talents to give the client the perfectly aligned step (and I am purposely avoiding discussions regarding philosophies of assistance, facilitation etc here, you can find that in detail in other threads) with timely pacing.
That said, depending on the client you might have a goal to have them be able to stand for transfers or you might have a goal to have them running a certain speed or distance independently. The breadth of client application for this system is huge!
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Ginny
Instructor
| Joined: | Sat Mar 24th, 2007 |
| Location: | Washington DC, USA |
| Posts: | 3 |
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Posted: Wed Jan 7th, 2009 11:23 pm |
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| What GMFCS Level? If they are II, I like to keep the hands free and walk sideways, backwards, slow and fast. Getthe HR up to 80% max. If they are Level III, I use the hand rails and work on quality issues and endurance
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kdmpt
Instructor
| Joined: | Fri Jul 7th, 2006 |
| Location: | |
| Posts: | 38 |
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| Mana: |  |
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Posted: Fri May 25th, 2007 12:18 am |
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From a customer:
I have a spastic diplegic with extensor tone who I am seeing 2-3 times a week. Any specific suggestions for protocol?
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Current time is 04:25 am | |
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