As I mentioned in the overview I tried to cover some of the most wide-spread worries and concerns addressing them with as much of a bird's eye view as possible.
Unfortunately, too often there is so much hysteria being pumped up about the hip subluxation issue by orthopedic profession -- that at some point one might get absolutely swirled by all the pressure and scare-mongering.
I hope the video 4. "Hip Subluxation- Why So Much attention? -- The truths and the myths" is going to help you to get out of being scared mode and panicked cries for help -- and towards being able to approach this complex issue rationally and consciously.
I assure you that you have all the necessary intellectual capacity and background to be able to figure out the truths from the myths -- all you need is a bit of help.
I hope these videos will bring you closer to this state of having a clear and rational understanding of what's going on with your child and become confident of your own capacity to deal with challenges should they come your way.
In the previous post I already mentioned that it was difficult to keep this video short -- I couldn't keep myself on the rails all the time and took several tangential educational detours as well.
Hope you do not mind.
So frankly -- I do not know which video is better -- so I put both on. Your feedback is most appreciated and is going to help me to do better videos for you in the future.
Well, that's pretty much it...
P.S. Please do not forget to press Facebook 'Like' button --so more people can benefit from getting a little bit of rational outlook influx towards this emotionally charged issue of hip subluxation.
P.P.S. Do not forget that the best way is to actually to click on the 'ABR on Vimeo' link above -- and then you can actually download this and other videos from Vimeo website. Then you do not need to deal with streaming delays and play interruptions 'that some of you mentioned before
What is the best way to defuse fear and confusion that you are constantly being exposed to by medical establishment? – Knowledge. To be precise – not any knowledge but parent-centered advanced knowledge. I feel it is important to distinguish parent-centered advanced knowledge from a diluted and dumbed down versions of medical textbooks that you find on ‘official’ websites on Cerebral Palsy.
Hip Subluxation Video Series intend to do exactly that –give you a comprehensive perspective on the subject that is exploited most often by fear-mongers.
I have prepared 8 videos – each of them at least 30 minutes long covering a subject of hip subluxation extensively, digging deep and going broad in order to build it into the entire context of your CP child’s development – especially for quadriplegic kids.
Yes, it’s a lot of information and yes, you need to do your homework encouraging yourself on making an effort to absorb and digest it. However, considering all the emotional and financial costs that fear and confusion around hip subluxation and other ‘scary’ issues related to legs alignment and mobility impose on you – I think this homework is going to be a worthy investment of your time.
I am not sure whether all of you have watched the previous video but I can't wait to upload this. I guess one needs to be in my position of spending countless sessions teaching the U-shape and frequently being frustrated by the stubborn V-squeeze and C-squeeze challenges -- let alone the teaching of the rhythmical / oscillatory application... and suddenly I stumbled upon this: a most ordinary styrofoam cup!
I do encourage everyone to practice after watching the video.
For the parent of quadriplegic kids, especially with 'grippable' necks -- I want to remind: U-shape grip applications -- anterior and posterior neck are the user-friendly fixtures of your program -- whether they are in the current home exercise plan or not. These are the applications that you shall be considering as the ones being always with you -- opportunity-based. Think of accumulating U-shape hours on a monthly and yearly time budget -- then even small 5-10-15 min injections of this 'fascia fitness' are going to pile up to a sizeable impact.
But I do encourage everyone to do this practicing -- even if you are not using the U-shape grip per se in your home program. This training tool gives you an amazing clarity of the perception towards oscillatory/rhythmical 3Q application. Perfect this skill with U-shape grip and it is going to boost your efficiency with staple grips like semi- and full "accordions"...
I hope you'll find it as fascinating as I do!
P.S. Some self-promotion :-) In the left-hand column of this blog just under the comments you'll find the small rectangular space that invites you to subscribe to this blog -- don't hesitate, jsut go ahead and do it! :-) Thanks!
Apologies for being away for so long -- the overzooming is my big challenge. I find the proverbial multi-tasking an unachievable feat especially when I am expected to combine 'field' live teaching or assessments -- with writing. I keep trying -- it's still doesn't work. Unfortunately I am unable to write without passion -- even the blog posts -- otherwise I feel I am sort of cheating the audience. But on the other hand, that makes my blogging somewhat irregular...
On the bright side: the ABR training in Montreal went really well -- I concentrated on Super-Soft Ball Rolling Technique. That shouldn't be a surprise -- most of the families were seasoned ABR 'veterans' who are well-versed in the classic 3Q technique. (Please re-read http://blyum.typepad.com/on_abr_and_beyond/abr-classic-technique-3q-principles-illustrated.html -- it's one of the links in the right-hand column). Seeing my immense enthusiasm for SSBR and in the light of my advice of putting at least 50% of your home program into it -- some parents got the feeling that '3Q is out SSBR Technique is in'. Nothing could be further from truth -- in this video made during one of the classes in Montreal I am addressing the issue in details.
To be honest -- I have addressed it over and over again -- for each new group of parents -- so 10 classes on the same subject within less than a month. This is the filming of Class # 9. I guess the need to present the same subject several times in a row -- improves the delivery. Anyway -- in the next few days I'll put the videos of the few other classess -- Class #7 etc. They are about the same subject but I do recommend to watch several of them -- there is enough difference and nuances to make it a good learning tool. The video is 'as is' -- no editing done -- so you are getting the same thing as the ones who were present...
Altogether I am continuously amazed how good the response to Super-Soft Ball Rolling Technique is, partiucularly so because it addresses the 'soft spots' of 3Q-based ABR program and I hope that the video does good enough job of explaining it.
http://vimeo.com/11733691 -- smaller file that should load faster but the picture quality might not be so great.
This one is larger so might take a bit more time to load but the picture quality is better
I tried to write some quick and short comments to the Part 2
of “Cerebral Palsy Peacenick Toolbox: How to use the Standing Frame correctly” –
and it did not work…
I tried for a few days but whatever I began writing turned
out into a long manuscript with tons of facets and angles – nothing short and
punchy Jackie Chan style…
So I have no other option left but to be descriptive.
Part 2 “Cerebral Palsy Peacenick Toolbox: How to use the
Standing Frame correctly” discusses:
·What negatives effects occur when the placement of
spastic individual into the standing frame is done in too ‘hawkish’ way;
·How the negatives accentuate when the angle of the
standing frame is adjusted following simplistic ‘the more vertical the better’ mindset;
·How to get the 1st Win and adjust the preliminary position of fixing a
child with cerebral palsy in the frame – so that a child enjoys the social,
emotional and sensory benefits with minimal or none of ‘biomechanical tax’.
·How to get the 2nd Win and to find the
optimal angle that minimizes the pivotal overload factor and maximizes the positive
axial impact of ground reaction force.
·How to get a Bonus – 3rd Win – shall I keep
some suspense? …
I hope you’ll find the video informative and I also hope that
you will re-watch the 1st video after watching the Part 2 – a lot of
theoretical concepts will be a lot clearer after seeing the example.
the same time I want to highlight that despite the successful adaptation of a
standard standing frame for the case in the video – the exact ways of
positional adjustment of this quadriplegic boy in the standing frame are not universally applicable for the other
do hope that you interpret this video as the illustration of a PRINCIPLE not a
collection of moves that should be ‘copy-pasted’.
Depending on the size of a child; angle of the pelvic tilt;
muscular imbalance in the upper leg and relative position of the feet – the
specific adjustments might vary.
However, the principles of minimizing the muscular loads remain.
P.S. I asked
for questions in the previous posts and did not receive much yet. Scratching my
head while trying to figure out why (that’s how I got bald in first place – too
much thinking and head scratching…)
P.P.S. Here are
the links for downloading:
CP Peacenick Practicalities– Standing Frame: Part 1
CP Peacenick Practicalities– Standing Frame: Part 2
It’s time to move from declarations and outline of the
‘Cerebral Palsy Peacenick’ philosophy to the practicalities.
Since most of the ubiquitous tools for special kids either
come from ‘Hawks’ or from ‘Sensory’ people [who are just plain oblivious to
biomechanical consequences of their ‘stimulating the nervous system and the
brain’ actions] – we need to discuss the possible conversion: hence the
title – “Cerebral Palsy Peacenick
I could have also called it: “Beating swords into plowshares”;
“Turning Tanks to Tractors” or “Morphing Spears into Spades” or anything alike
– I hope I’ve got the point across...
I came of age at the end of so-called Cold War and remember
well the conversion attempts back in the late 80s in Russia – the factories
that made landmines converting into the saucepan manufacturing…
Well, I must
admit, it did not work very well – apparently even ‘a saucepan’ production
requires some specific expertise, which is not exactly sharing the same
platform with a landmine even if machinery is similar…
Anyway, I hope to fare better :-)– and the 2nd Video is very much discusses the
ways how the classic ‘hawkish’ approach to a standing frame could be upgraded
significantly into a ‘peacenick’ version.
However, In the 1st
Part I took the liberty of touching the larger questions that resonate with the
previous post on GMFCS curves – facing the reality in sharp precise
details rather than blurring into a shapeless amorphous cloud.
I used the standing frame use example to repeat the
challenge of any child with Special Needs and Cerebral Palsy especially– ‘A
Obviously this is not an ‘appealing’ or ‘attractive’ name to
begin with, however, I do plan to stick to it since it reflects the reality
I fully understand and accept that at a certain point a
familiar strategy of “let’s keep it vague” might be a helpful one. For some
people this approach works really well – they just look at the facets of a child’s
condition that they are able to relate to and ‘chop away’ anything
However, if you are one of those people you’d be a very
unlikely person to show any interest in Do-It-Yourself home rehabilitation
altogether, let alone being the reader for this blog. These people with a truly
selective vision, capable of culling everything uncomfortable are a rare breed;
and actually, the more studies/education you’ve done in your life – the less
likely you are to be such a blessed one.
For all of you with a significant domain of rationale within
a personality profile – this ‘blissfully unaware’ stance is not available. You wish
you’d stop thinking about dreary expectations – but you really can’t.
So what happens as a result? – You find yourself on a
swinging pendulum – from exaggerated optimism to equally exaggerated concerns
and fears. You are easily excited (especially when a child is still young) but
you are easily scared as well. That’s a heavy emotional tax that zaps one’s
energy really fast; and as the years go – excitement vanishes or translates into
a pure chase of “last hope” while the scares become more and more real,
especially with under consistent ‘hawkish’ pressure.
That’s the cost of ‘blurring’. It’s a universal trait of a
human nature that we are most stressed and demoralized by some vague gloomy
threat, where the vagueness itself makes it seemingly omnipresent and
incapacitating as a result.
On the other hand, we are generally pretty good in standing
up to a well-defined adversary or challenge. That’s why most of today’s
practical psychology is about making those fears and concerns from amorphous
into the clearly articulated ones.
So, once again, I emphasize the same point – I am
strongly “pro-uncomfortable-truth” that clarifies the situation and allows
to devise an actionable strategy of coping, management and approaches to
‘beating the odds’.
If you are sharing the same stance – I hope that you’ll find
the videos helpful and educational…
P.S.Thanks a lot for your questions and comments to the previous
posts made in January. I haven’t answered much yet but do plan to do that in
the couple of next posts. I believe most of the questions and comments are of
value for many parents – so it would be better to answer the questions in a
more public way.
So for the next few days – please send your
P.P.S.The other night I had a ‘Jackie Chan’ dream
– (weird isn’t it? – considering the fact that the last time I watched his
movies was at least 2-3 years ago…) – and woke up very surprised trying to make
sense out of it…
thought was to interpret it as a sign of striving for shorter answer – since
Jackie Chan is known for being extremely quick – but I wasn’t sure whether I’d
be able to live up to his standards of brevity….
Welcome to my blog – and I guess it’s not a surprise that it’s
going to revolve around ABR – since I am a very narrowly focused person having no real interests other than my work. I am realistic and the only
readership I can legitimately expect is the parents of children with special
needs looking for unorthodox insights that might turn out potentially useful. I
am honored by that and will try my best not to disappoint you by going beyond
the technical aspects of ABR and into the wider spectrum of related issues…
Whether I will succeed in that – is up to you to judge.
This blog is going to be opinionated and biased reflecting
nothing else but my personal views, which are likely to be in conflict with the
mainstream beliefs and convictions.As a parent you should approach my musings
with your critical judgment and a grain of salt the size of a decent rock :-) My
only intention is to give you some extra food for thought by facilitating
out-of-the-box reasoning and hopefully helping you with making improved informed
decisions along the way.
I am not a healthcare professional let alone a medical
expert. Frankly speaking, you have no
formal reason to value my opinion beyond your sheer curiosity. As the saying
goes –“forewarned is forearmed”. If you are still interested in reading further
– I am happy to oblige…
Thanks a lot for your patience and understanding –for the
last 5-6 weeks I have not managed to update this blog with any decent frequency
due to the heavy schedule on the road.
I am finally back from the long trip and after few days of
sleep recovery ready to deliver some content, which I hope will be of value to
a parent of a special needs child. Both conferences: Fascia Congress in
Amsterdam and Cerebral Palsy conference in Utrecht (another city in Holland, 20
min away from Amsterdam) provided tons of materials to contemplate and to
were included in the proceedings books of both conferences.
A Global Status
Quo On Cerebral Palsy
As you can see from the titles, these are not exactly ‘ABR’
presentations but the deeper level theoretical works, mathematical models
laying down the framework for the fundamentals of long-term fascia re-modeling,
which is at the core of the ABR technique as specific set of tools designed to
induce that fascia re-modeling in the deep layers, which is especially
important for kids with Cerebral Palsy.
As a diligent conference attendee I have most of the
important presentations recorded on audio with slides photographed. Together
with the notes taken on the spot that provides for a comprehensive coverage and
accuracy of quotes, however, at the same time that means a lot of
post-conference work in order to sort all these piles of info and translate
them into the coherent presentations that will be of value to you.
I must say that taking photographs of the slides turned out
to be a somewhat challenging endeavour.
My beloved Nikon D300 camera (the one we use during ABR evaluations) produces a
loud ‘click’, which I am personally a big fan of – actually that’s the reason
why we favor Nikons over Canons at ABR :-). It turned
out that my fondness of the ‘Nikon click’ wasn’t shared by the rest of
conference attendees – in the big hall of a lecture room the click echoes
amazingly loud competing for attention with a speaker and drawing the irritated
“Shhh-ss” from the crowd. Even though I was initially prepared to brush it off
for the sake of better quality pictures to share with you, at the end I had to
succumb to the public pressure and settle for the pocket camera, which turned
out ok as well, although not as clear as I’d like to have.
Actually, in hindsight, I must concede that ABR delegation
looked as quite an odd bunch: me with 2 photo cameras – because the pocket one
runs out of battery fast, taking notes at the same time with a pile of colored
pens; Sarah Lee (ABR Asia) with 2 digital audio recorders (just to make sure we
do not miss anything) and occasional video recording of most important
presentations; and Marc Driscoll (our biomedical engineer/research guy – if you
haven’t met him yet) taking notes on research methodology.. We occupied 4-5 seats
being really busy. In the afternoons we’d split up and attend the concurrent
sessions, recording them as well – all with a goal of making the most out of
the conference opportunity.
No effort is too much if the goal is to provide the cutting
edge information to the busy ABR families, right? :-)Who cares about looking
like an oddball among the straight-laced professionals as long as we make sure
that we can deliver the information to you in full without missing the pieces
that might turn out being very important?
I expect to start publishing things within a few days but
meanwhile – here is another entertaining and thought-provoking video for you about Amazing Properties of Viscoelastic Structures
It was encouraging to hear your
positive response to the video on ‘Inflatable tensegrity’ and I will definitely
get back to that subject with better details in the future.
This new video is about“Corn
starch experiment” and at first glance one might wonder how does that relate to
Well, the link is straightforward –
this video shows amazing properties of viscoelastic materials that respond
dramatically different depending on what type of impact is delivered at them.
I think that it is very important
for you to realize and especially visualize that anisotropic substances carry
the potential for multiple responses depending on how one addresses them,
challenging that ‘robotic’ view of the world that we all learn at school.
Most of the substances that one
studied at school were a lot more straightforward – a piece of metal, or wood
or classic liquid responded uniformly to a variety of mechanical impacts
varying in magnitude of their response but not changing their properties.
At school you learned about one neat and orderly physical world – solids always
respond as solids; liquids as liquids and so on.
And until today a lot of therapies
(surgeries etc.) address the human body in that primitive way appealing to the
images of this orderly world that you all carry all the way back from school
Fortunately the reality of living
objects is a lot less regimental and omni-potent. The tissues of the human body
and fascia in particular are viscoelastic and anisotropic, hence the same
tissue will respond differently to the surgeon’s/ anatomists knife;
neurologist’s hammer; forceful stretch; hard local pressure etc. (… and to the
distributed quasi-static ABR application as well…).
Amazing isn’t it? Who’d think after
the opening frames of having the presenters’ hands in that corn starch slosh
that the same substance under the same temperature, pressure etc. will respond
as a solid once the fast impact is applied?
Sure, in ABR we appeal to the
opposite property of human body tissues – we want to bypass this “hardened”
response of the superficial layers and we want to have our impact to be
oscillatory not penetrating (ex. ‘sound waves’ vs. ‘wind waves’ ) etc. There
are plenty of specific details to ABR technique and the type of impact we want
to create in order to stimulate fascia re-modeling and strengthening.
However, the message of this video
is simple – details matter. Viscoelastic structures are capable of really
unexpected responses provided that there is a specific enough type of impact.
Small change in mechanical properties of application might lead to a bid
difference in tissue response….
I hope you enjoyed this glimpse at
wonders of Mother Nature. Stay tuned for more :-)
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.
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.