Observation/Shadowing & Product Scale Testing

On February 5th, I was able to shadow PT on two physical therapy visits with Child A and Child B once again. Having a period of one month in between these two visits allowed me to see even further progress that they have made over a short period of time. These were my observations:

Child A – 15 months old; low muscle tone

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PT spent the beginning of this physical therapy session working with Child A to stay in a hands and knees position. Instead of this being his usual way of moving around, he uses his head to scoot across the carpet while he lies on his back. In this position, he also arches his back and pushes off of the ground to gain movement. PT works with him on lifting upright on his arms and stomach so that it will transition into him moving around on his hands and knees as opposed to the position he currently prefers. She helps support him while she has him slowly move forward on his hands and knees.

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PT places a mirror underneath Child A and holds him in the same hands and knees position that he was in before. Looking down at his reflection, Child A is interested enough to push upright in order to see his face, helping him stay held up on both of his outstretched arms for a longer period of time than usual. He enjoys looking at his own reflection but he needs to be a little further away from it to see it, so this helps keep him from laying down flat on top of it. In addition to the support that she is giving him with her own hands, PT has wrapped a “super wrap” around his hip and upper thigh area. It is a stretchy, bandage-like fabric wrap that holds his legs together and helps him stay a little more rigid.

Child B – 2 years (+ a few months) old; high muscle tone

2-5-15acopyPT started the therapy session by taking out a product called Theratogs and carefully putting it on Child B. Theratogs, designed by a physical therapist for children with neuromotor issues, is a garment that physically aids the child when it is worn. It comes in different parts so that it is easy to put on and remove, as well as so that it can be used on the areas of the body that require it most.

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PT uses the medical device with Child B since it keeps him grounded, which allows him to be more patient during the physical therapy session. He is able to work for a longer period of time and it helps increase his stability throughout the session. It also helps him with his hip rotation alignment when he is put in to a kneeling position.

Product Scale Testing. 

In addition to just observing this session, I was also able to bring my first full-scale foam prototype of the first of the three final designs to test it for scale. The model was created the same way my previous scaled model was made; I designed the form on CAD, split it into stackable layers using Autodesk 123D Make, then used the CNC router to cut the shapes out of 1″ thick sheets of pink foam. I stacked the piecess together using spray adhesive then proceeded to carve and sand it into its final form.

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Child A, who is 28.5″ tall, is the perfect age and size to use as a scale reference for the model, so I brought it to the physical therapy session for him to interact with. Once I placed it next to him, I immediately saw that the model was a lot smaller than I had anticipated it to be. Although I was still happy with the form, I knew that there were a few modifications that were to come so that the scale could be perfected towards its user.

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The first modification to the full scale piece was that the thicker end, which is the end that the child’s head would be leaning on, needed to be widened. This would create a larger surface area that would be resting on the floor, increasing the design’s stability and making it sturdier and safer for a child to interact with. In addition, the entire piece need to be both lengthened and widened so that it could accommodate a child. Seeing it not only in full scale, but also next to a child in the age range of my user group, allowed me to gain a better sense of scale.

One great part of seeing Child A interact with the foam model was when he started crawling around it and playing with it. He was interested in its inviting, curvy form and continuously grabbed on to it. This made me see that although it is designed based on a specific developmental stage, its minimal form allows it to be used beyond that for different purposes during playtime.

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First Observation/Shadowing Session

On September 9th, I had the opportunity to shadow PT on two physical therapy visits with two different boys. These were my observations:

Child A – 9 months old; low muscle tone

PT  has been working with Child A for the past few months. He was born with extremely low tone and when visits began three months ago, he was unable to lift his head, hold himself up, or hold a toy on his own. His only possible position was lying flat on his back with arms laid flat out on either side of him due to his inability to lift his arms upward. A good tactic to help him was ‘side-lying’, which positioned him on his side. It forced his legs together and his arms were in a better position in front of him.

Positioning of the child’s toys are important as well. For example, placing a toy forward in front of the child’s head will make him move his head forward, strengthening the neck muscles. At first, on his stomach, Child A could not pick his head up. It would fall down and he would get frustrated; slowly over time, he had gained the strength to lift it up.

PT uses toys to motivate Child A to reach forward, especially ones that are colorful and noisy to grab his attention- the toys or objects that are used as motivation make all the difference. She helps to hold him up a little bit but tries to get him to do it mostly on his own. One of the issues associated with his low muscle tone is that when he loses his balance and falls over, he makes no attempt to lift himself back up. Also, when he is held up in a standing position his legs collapse. There is no attempt at all to stand or keep them straight.

One product that PT uses with children with low muscle tone is called a gertie ball, which comes in sizes of 9″ or less. It is a ball that comes in different textured surfaces and you are able to blow it up as firm or as loose as you like, which makes it easier to grab and adjust. The child is placed on top of the ball in a sitting position which enhances his posture and gives him the opportunity to bear some weight on his feet. The 90 degree sitting position is really important for them to learn to do on their own- it is great for leg strength, waist strength, and neck/head strength.

Child A can go from his back to his side, but once he is on his side, he lacks arm and shoulder strength to lift himself up on to his stomach. Also, Child A struggles to lift his head so with every turn his head shakes a little, representing how unstable the movement is.

Child B – 2 years old; high muscle tone

PT has been working with Child B for the past few months. He can only stand if he is held since he struggles to stay upright, so she is working with him on lifting off the ground to get into a standing position. His high muscle tone causes him to keep his hands fisted and all of his ligaments brought in close to his body. Instead of crawling, he scoots around with his right leg in front of him and his left leg behind him, using his right leg to pull his entire body forward like this:

crawlingTo help him try to walk in the upright position, PT aids Child B in using a toy with a handle and wheels that he can use to support his weight. Even with the help, he is very wobbly when using the toy for support. He has problems with motor planning and has only figured out how to sit up 2 months ago with the help of physical therapy. Up until this point he can only sit up using the right side of his body; he still struggles to use his left side as support.

Child B is gaining strength in his leg muscles and learning how to move from sitting to a standing position. PT is hopeful that he will eventually be able to walk on his own in a couple of years with continued therapy. Another method she uses to help him stand is supporting him with her arms and leaning him up against a wall cushioned with gym mats to help him gain balance. It is easier for him to stand when he is distracted by visual cues, such as a video on an iPad that is held up in front of him. He is not thinking about what he is doing at that point, but as soon as the video ends and he is no longer distracted, he ends up falling instantly.