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October 2009

Before ABR -Sitting Challenges in a Quadriplegic CP - Fundamental Analysis

FULL VERSION: Before ABR -Sitting Challenges in a Quadriplegic CP - Fundamental Analysis.

Well, finally we have a chance to zoom in -- from the overviews, which are no doubt, -- inspirational to the educationally meaningful substance -- the actual analysis.

This video is 20 min long and it goes over all the typical manifestations of poor segmentation as well as re-iterating and illustrating the discussion about the support level evolution in sitting.

There is another important component that I did not emphasize enough before but certainly do now -- that's the connection between the suspended arm support and the proper ground reaction support. The two are inversely related, which gives an important prognostic tool of progress even when facing some transitional challenges -- sure better understanding of such a link will emerge after the next video -- Stage 1 of progress that I will describe in details in a few days.

Meanwhile, I believe I need to emphasize one important aspect -- some of you, although inspired by a progress of this particular quadriplegic boy, have difficulties in connecting/ relating to this particular example telling yourself: "My son is much older" or "My daughter is floppy" and so on. Yes, to certain extent you are correct, -- there are nuances and specifics between ages, types and so on. And you'd know that I am the person who is extremely detail and finesse oriented -- usually I bore everyone to a state of being drowsy by digging into yet further case specifics under the bright lights that make your eyelids close involuntary :-) .. However, I'd like you to think about these videos in a truly educational context -- looking at the elementary building blocks of the large "cerebral palsy" problem. Cerebral Palsy is a disorder of posture and movement -- tangible physical aspects that depend on the mechanics of the elements -- the building blocks, These elementary components are pretty much the same -- spasticity, rigidity, instability, lack of segmentation, inability for counterbalancing and so on... They are very much the same whether it is a younger or an older child; a boy or a girl; spastic or flaccid or athetoid; milder or less severe and so on. For sure, these elementary problems come in different combinations and in different magnitude depending on the type of cerebral palsy or specifics of developmental challenges. Nonetheless, the better a parent knows the elementary blocks -- the better understanding of the larger jigsaw puzzle becomes possible otherwise everything blurs -- emotional; physical; quantitative and qualitative ... -- bringing stress.

That's exactly the case where knowledge is power -- because you , my friends, have the rest -- love, dedication and a selfless desire to help your kids... That's why I'll keep encouraging you to learn...

Thanks for reading ... please stay focused -- there is a pretty long video coming .... :-)

P.S. By the way -- for those of you who have challenges with a streaming video -- please go ahead and download them -- that will save you the discomfort of unexpected frozen frames etc.


SITTING Progress & Evolution Overview in a Spastic Quadriplegic Boy

If the previous video "Motor Development  Progress  ... Cerebral Palsy Quadriplegic Child"  -- http://www.vimeo.com/6671771 -- was more inspirational than educational  this video "Sitting progress in a Quadriplegic Cerebral Palsy" has already much more of an educational value .

The case of this quadriplegic spastic boy is so classic that each and every parent of a child with cerebral palsy will find important illustrations and clarifications:

  • Levels of support in sitting - evolution from high to low
  • Specifics of tailor sitting
  • Suspended support by the arms -- 1 handed support and 2 handed
  • Sitting platform configuration
  • Segmentation and selective mobility between the head, shoulder girdle, pelvis

I am very much aware-- you have already heard it from me and probably  telling yourself : "I know, I know , I know..." but nonetheless I do recommend you to watch it and visualize these stages because the better you visualize them on the examples of the other brain injured kids the more meaningful specifics you will be able to notice in yours.

And that's the key for your own motivation, piece of mind and confidence-- your ability to notice the increments of improvements in your own child.

I want to emphasize once more -- We are posting these Progress Overview videos with an educational and not a promotional purpose. The goal is not say: "Look what a wonderful progress with ABR in just 2 years of work..." That would be a wrong message because some children respond slower and some faster, some parents have more opportunities for the ABR homework and some have less. These are realities and I do not want you to be stressed and ask yourself 'Have we achieved as much or less or more in 2 years?' I would much prefer you to focus on the stages of transformations that, for example, this quadriplegic boy had through ABR because these stages are very much typical. Therefore, even if different children respond at different rate -- the fundamentals and stages are very much the same.

And another really important aspect -- these changes are not accidental, the progress of this Qudariplegic boy, GMFCS Level 5, is not a fluke -- it's a result of systematic transitions that were methodically addressed through  Advanced Biomechanical Rehabilitation.

That's why – I am really trying my best to pre-warm you about the oncoming videos which analyze in details each of the stages of progress during 2 years of Advanced Biomechanical Rehabilitation --sitting, hand functions, crawling.

Please look at it as an illustrated textbook intended to enhance your knowledge not as see-and-forget promotional videos. That's why I will encourage you to return back to these videos several times and ideally even show them to some of your friends and family, -- watch their reaction, look at their level of understanding and try to clarify things for them. Become an educator yourself -- for one selfish reason: there is no better way to learn yourself than by teaching the others. 


Motor Development through ABR -- Quadriplegic Cerebral Palsy Boy Case Study

I've been thinking for a while on a presentation format of key ideas of ABR that will be of the most educational value. Apparently it's not as easy as it sounds. There are quite a few challenges.

A number of parents do not want to go beyond a quick before/after loking for just enough to feed the imagination as a "miracle progress in cerebral palsy treatment'. Obviously, at ABR -- even though we are actually the only cerebral palsy rehabilitation method who do have systematic before/after progress reports for brain injured kids -- we want to avoid encouraging the 'quick wow super progress' seekers. But at the same time -- my theoretical rants even when they are perfectly relevant like http://www.youtube.com/watch?v=dSok3q_jmsU -- often seem to be not clicking...

Unfortunately... :-( Since I do believe firmly that the proper MINDSET is more important to success than Skillset or let alone Toolset...

So I was looking for the other avenues and then decide to do it in a Case Study form -- to just take a more or less typical case with a typical progress rate and explain the stages with illustrations of key motor functions: sitting, crawling, fine skills of a hand. The hint came from a strange fact that all of us at ABR Teams worldwide have been observing for a while: Every parent of a special needs child sees the progress a lot more readily in another  special kid. I guess, it's the emotional bond to your own one that  blurs everything together -- not allowing to concentrate on studying and recognizing the stages essential for any case of cerebral palsy, spasticity etc. ;

That's why I decided to try this new format -- taking a single case and illustrate the universal truths for any child with a brain injury. I started from a spastic quadriplegic case as the most typical for us -- but, sure, there will be other types as well:  flaccid; athetoid; hemiplegic etc.

I hope this avenue will work better -- but obviously the ultimate judges are the 'collective you' : I'll only know whether this avenue is worth pursuing further if you give me the feedback through your comments and mails.

Altogether -- there are 28 videos (10 min to 30 min long) -- 1 General Progress Overview; 3 x 1 = Progress overviews for each of the domains: Sitting, Hand Function; Crawling; and another 4-5 videos per domain covering the transitions from the initial condition before ABR and then the changes every several months. All in all -- the period covered is 24 months.

I've learned from my mistakes (somewhat :-)) -- and I am not going to dump them all on you at once.

Right now you can watch 6 videos -- Motor Development Progress overview (Quadriplegic Cerebral Palsy Boy Case Study) and 5 more videos zooming into the domain of sitting as the core representation of weight-bearing progress.

I am starting with the  first one:  Motor Development Progress Overview - Quadriplegic Cerebral Palsy Child GMFCS 5 -- I will be posting the other ones with regular intervals and with extra comments.

I hope that avenue will prove educational and I am looking forwards for your response.

Thanks a lot.


Back to Blogging ....

It's always difficult to get back to writing after such a long time off… Too many thoughts and too many subjects to cover.

On the other hand, that’s a perfect example of the momentum importance – once it’s lost it’s incredibly hard to gain back. Hopefully with your helpcoming through your comments and subscriptions to this blog’s “feed” – I’ll manage to get this sharing momentum back. As everything in ABR it should emerge through micro-improvements and consistency J

Well, I hope that you keep your daily working momentum going with your kids. As I said – there are tons of things I’d like to share:

  • ·         Inner workings of the Cerebral Palsy conferences – things no one wants to share with you in a doctor’s office;
  • ·         GMFCS – the universally adopted prognostic ‘curves’ explicitly pointing out that a quadriplegic child of GMFCS 4 and 5 (poor head control, none/minimal self-mobility on the floor) is not expected to progress beyond the age of 3 with whatever mainstream treatments are being applied
  • Case studies of ABR kids analyzing the specifics of initial condition and the phases of evolution through ABR including the challenges

  •         The recent developments in ABR and what we are working on (Yes, I am not on a prolonged  vacation despite the prolonged absence in this blog )

And much much more …

BUT ... That only makes sense if it’s needed.  So, unless you, the ever-super-busy special parents, are going to find some time to read, listen and watch – all this information won’t make any sense and wouldn’t worth the effort to produce.

The response to my New Year video messages has been both encouraging – people telling me how they appreciated the extra scope and venturing into the issues larger than specifics of ABR exercises; and discouraging – a large number of parents telling me that there is no way on Earth that they have time to watch these long chunks and being stressed by this inability adding to guilt feeling.

I know – at least in theory :-) – that the best communication is done frequently and in small portions… Unfortunately – that’s not my style :-( Frequent or infrequent – I dump the large chunks…

Well, anyway – I am trying to adjust and learn to stop, feeding it one thought at a time but it’s difficult and I’d appreciate a benefit of the doubt. Please do not get stressed – voice it, suggest forms of delivery: if you have troubles with videos – ask for audios, transcripts, conference calls – whatever. Unless you tell us we wouldn’t know. ABR is very much all of my life – you, on the other hand, have a lot more things to juggle to have a balanced family life while still being able to find time and courage for day-in-day out hands-on ABR. So your help – through the comments to this blog, through e-mails to the centers – whatever, is most appreciated.  

As a re-start of the ABR blogging I am going to post a number of videos that are based on a case study and … I’ll appreciate your feedback (Well,  being repetitive is another well-known flaw of mine :-)

PLEASE SCROLL FURTHER AND WATCH NEW VIDEO(S)  from October 1, 2009

P.S. There are couple of NEW BOOK REVIEWS for you to look at.