On January 6th, I had the opportunity to shadow PT on two physical therapy visits with two different boys. I had already shadowed these two boys twice in September, so having a few months in between visits allowed me to really see the progress that they have made with her. These were my observations:
Child A – 14 months old; low muscle tone
At this point, Child A is now able to sit upright unsupported, which is a huge step forward from where he was just a few months ago. He can also reach for objects while sitting upright and even bang two objects together. Once in a while he gets back into a side-lying position, so PT slowly aids him as he pushes to lift back into an upright position. When he plays upright with a toy, Child A mainly uses his left hand to play while he uses his right hand to stabilize himself to stay sitting up.
A big challenge that PT is dealing with now is getting him to move onto his stomach. She shakes a small toy near him that makes subtle noises, such as a plastic maraca or a ball with a smaller ball inside. When he hears and sees it, he slowly moves towards it by reaching his arms outward while lying on his back. From his left side, Child A does not need much support to sit upright when he is lying on the floor. He has to work a lot harder reaching up from his right side.
PT holds up a plastic ring stacking toy while he is sitting upright. She has him reach towards it and pull off the rings one at a time, then has him put them each back one by one. Child A puts on and takes off each one that PT tells him to and stays sitting upright the entire time. After this activity, she puts Child A on her lap while she sits on a floor mat. She places his legs in a 90 degree position and gently keeps them in this position with his feet planted firmly on the ground. As she holds him in this position, PT uses her other hand to place toys in front of him so that he reaches forward and grasps the toys with his hands.
Seeing this progress from the first session I observed really made an impact on me. It showed me that with enough time, patience and attention, children with hypotonia can progress at a steady pace and advance physically over time.
Child B – 2 years (+ a few months) old; high muscle tone
PT holds him and tells him to carefully lean forward into a hands and knees position. He leans forward slowly so that his hands are touching the ground and she carefully lifts him back up. They proceed to do this activity multiple times so that Child B gets used to it.
After this, PT puts Child B’s orthotics on, followed by his sneakers. The orthotics give him added support in the ankle and knee areas. Having a more stable base helps keep the rest of him stable. She then places a weight around his left ankle before trying to get him to walk across the room. He walks across the room towards an iPad playing a favorite song of his while she stabilizes him and slowly guides him there. Once he reaches his goal, Child B sits down on the floor and PT adds a weight to his right ankle. With both weights on, he is aided back across the room and goes into sitting position once again when he gets to the iPad. PT does this exercise multiple times with him, going from one end of the room to the other.
PT pointed out that Child B works more with his right side during every activity. If he pushes off the ground, he always uses his right side as support since it is currently his dominant side. PT is working with him to use his left side too in order to strengthen it so that he has no dominant side and uses both of them equally. Getting rid of this current dominance will help him use both sides during activities.
PT carefully sets him into his walker. He holds on to both sides and walks without the support of PT, but uses the walker to help him. He is able to walk out a fairly long distance on his own. He does not tire easily and pushes himself to keep moving forward for a fairly long time.
Throughout this entire time he has been looking around and taking in his surroundings. As he gets tired, Child B’s legs get less stable and the bottom of his feet are no longer planted firmly on the ground. He uses the walker to hold most of his weight towards the end of his walk. Once he starts fatiguing it is difficult for him to stand up straight. PT makes sure to take short breaks while walking once he gets tired. She continues to give him encouragement and support, telling him that he is doing a great job. She also makes sure that he is holding up his weight with not only his right hand, but his left one as well.
Once again, I was grateful to be able to see theses stages of progress with my own eyes. It showed me that although it might be difficult at times, these children want to progress physically for themselves but do not know how to do so on their. The help of a PT and development tools makes an extremely noticeable difference and I am hoping that my design will have the opportunity to aid in these milestones as well.