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Physiotherapy: an alternative approach

It is usual for physiotherapists and occupational therapists to encourage use of the affected arm and hand as early as possible in the baby’s life. There are many ways of doing this: some are more passive (doing things to the arm), others need the child to be active.

Some of these approaches include:

  • concentration on sensory experience, usually combined with language (giving the children an object to feel and using words to describe it: hard, soft, round, sharp, hot and so on)
  • concentration on the affected arm, or on two-handed activities.
  • doing exercises for their own sake, or working on functional activities.
  • using or not using splinting.
  • concentration on the arm alone or treating the whole body.

The majority of therapists probably use all these approaches at one time or another, blending them together to suit a particular child and situation.

In my experience, provided the treatment has started early and has been done regularly, by the age of about three years one can have a fairly good idea of the kind of use of the arm and hand the child will have. It is tempting to ‘therap on’ in the hope that more function will appear, and it may, but whether from maturation or therapy is uncertain.

However, there is always the danger that the child will get fed up with the treatment, resentful of the ‘wasted time’ which could have been used for playing, and upset by being shown over and over again just how ineffective the hand is.

By about nine or ten years old most children are prepared to put a lot of effort into learning how to do something they want to do. I find that if one can channel that drive toward better hand and arm function, one can often get another bite at the therapy cherry, simply because the child has a real, personally chosen aim, quite separate from outside pressure.

I often hear parents say to their children "You want to use your hand, walk, play better football etc., don’t you?" And I see a child’s facial expression reply "No not really, not if this (exercises, physio, OT, etc.) is what I have to do. Those are your hopes, not mine."

The motivating activity will usually need:

  • two hands, but preferably with one having a more skilful or different role from the other.
  • an outsider to teach it (and the outsider should not have anything to do with a hospital).
  • support from parents as a hobby, not as a therapy.

What kinds of things am I thinking of?

Music: any instrument where one hand is more skilled or differently skilled than the other - e.g. a violin or other stringed instrument where bowing with the weaker hand teaches good arm action and better hand/wrist control (N.B. depending on side, might need restringing). Or a keyboard - melody played with the stronger hand and programmable keys for the weaker hand.

Dancing of any type: good not only for the arm and hand.

Fishing, weight training, and snooker - again not just for the arm and hand.

The aim is to build up an enjoyment for the activity itself; then get a professional (someone who the child will respect and take advice from more easily than from their parents) to teach and coach. The instructor should be aware of the hemiplegia, but not be the sort of person who is constrained by it.

It will be really hard work (but the child will not resent that if it is something they really want to do) - and it will take time; but you may be surprised by what can be achieved, not just in that one skill but in a general improvement in function and in the child’s attitude towards his or her hemiplegia in general.

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