Dear Vanna,
Per your request, following is a synopsis of Queena’s progress during her TheraSuit program beginning February 25th 2013 ending March 14, 2013. A total of 36 hours of TheraSuit training was delivered.
Changes immediately noted when Queena arrived on day one: She was wearing glasses, had her AFO’s on and her arms were at her sides. Queena appeared slimmer and was sitting taller in her wheelchair. Head position showed reduced extension from previous sessions, though continued to be held in capital extension or flexion with head tilt left and rotation of face to the right. Queena brought her eyes to therapists’ and held the position briefly. Overall tone appeared reduced from previous session. Overflow of extension continues into her mouth and head and neck with excitement or when Queena attempts to activate her muscles. Queena appeared excited to begin her TheraSuit training. Overall affect was more “engaged”. She recognized previous commands and exercises.
Head and trunk activation: Queena did not require use of brimmed hat to bring her head and eyes to a horizontal position after day #2. She was able to maintain her eyes at a horizontal aligned position. Head position: Queena continues to develop control for grading of her head position in space. She was able to bring her head and trunk from 15 degrees off of midline back to midline with control when given cues. Queena battles the weakness on one side of her neck with the tightness on the other. With that noted, her head position when seated in her wheelchair becomes active with her involvement auditorially within her environment.
Greater work began with assisted controlled head lift and rotation in prone. Queena actively assisted with head/neck extension, flexion, rotation and scapular adduction. Spinal flexibility improved with Queena able to sit supported with trunk extended, hips flexed, and knees extended bilaterally. Overall, elevated shoulders were noticeably lowered with further reduction of elbow flexion and shoulder adduction. Queena demonstrated beginning ability to keep elbows extended at her sides, while taking weight on her hands on day #10 while sitting straddle on bench with support. Sitting balance active was challenging, though overall supported sitting was markedly improved with reduced external support provided and markedly reduced extensor tone and posturing seen.
When given the choice of wearing the TheraSuit or doing another activity, Queena chooses the TheraSuit. While in it, her attention is extremely focused and she is quite “intense”. She understands the need to develop “control” over her muscles while fighting the urge to call up her tone which is much more available to her. The difference for Queena is developing beginning muscle strength over encouragement of patterns that represent what she is fighting to change. This is a difficult balance for her to respond with control as she has learned through time that she can create a response with the use of her patterns or tone. We worked very hard to encourage control and discourage tone.
Stance was investigated in a variety of means: TheraSuit on/off, suspension with TheraSuit on, Platform walker with TheraSuit on/off with knee splints on and off and elevated sitting to stand with and without TheraSuit. The repeating mantra was CONTROL and alignment. The positive changes in stance were seen with the final visit to elevated sitting to stand to fire the quadriceps/Gluteals in 3 repetitions followed by a rest with support of 2 adults. Queena fought through this experience showing some overflow orally, yet showing ability to begin to control the degree of pattern through her legs and hips. Grade strength of these muscles is poor at best. Yet, Queena showed ability to fire them after using patterned tone for almost 5 years!
Overall: Queena has improved her overall alignment in sitting and supported stance. Abdominals were worked with Queena assisting movement. The effort to bring her into sitting from supine was reduced by 50%. Clonus was elicited minimally when in supine and in stance Queena was able to overcome it when assisted to push her weight onto her heels and push her hips forward. Standing with the platform walker with knee splints proved to offer Queena the ability to begin to develop weight shifts 15 degrees off of midline.
As always, Queena is wonderful to work with and for…her determination to make a difference in herself is inspiring.
Pediatric Therapy Servicesfeels blessed to have been part of Queena’s journey.
Denise Kilburn PT
Kathy Shufflebarger PT
Karen Volkmann PT
www.ptsbeyourbest.com.
Lakeland /Brandon Fl.
DENISE KILBURN, PT
Denise Kilburn is Queena’s Physical Therapist and is co-owner of Pediatric Therapy Services, Inc. in Lakeland, Fl.
