Wednesday, August 19, 2009

A Short Break

I have a very adventurous two-year-old daughter. This week she fell off some equipment at the playground and fractured her right elbow (Type 1 Supracondylar fracture). She now has her arm in a bright red, arm length plaster cast. She does not appear to be in any significant amount of pain and has tolerated the cast well. I on the other hand, am beside myself.

The doctor at the fracture clinic assured me that in three weeks time, the injury will have healed and she should have no long term complications. The only restrictions given were not to get the cast wet or play in the sand.

The past few days have been challenging - mainly because my daughter still insists on jumping on the lounge and hurtling down the hallway either on her bike or on her chubby, two little legs. I am more concerned about her 'good' arm, than the injured one because it's going to take the full weight of any extra falls.

Bath time has been the greatest challenge, as my patient loves swimming in the bath, and has had difficulty keeping very still while I bathed her. The compromise we have reached is that she will keep still if I allow her to use her non-plastic-bagged arm to splash water at me.

The lesson I have learned from this experience is this:
Don't take your child's health for granted.

A fairly obvious lesson I know, and one that I should have already been taught - given I work with children who usually have long term and complicated health conditions. But it's easy to walk out of the practice doors at the end of the day, and travel home to my family where all that has happened earlier is forgotten. So I have been reminded of this important lesson, and will endeavour to remember it - long after my daughter has returned to throwing herself off equipment at the playground.

Friday, August 7, 2009

A Gripping Story

A common request from parents, regardless of the initial referral reason, is for me to assess their child's pencil grasp. From a very early age, most children show an interest in scribbling with crayons, biros they've found lying around, and lipstick tubes! As a child's pencil control improves, they are able to start drawing recognisable shapes and at around school age, are able to form letters and numbers.

Developing a good pencil grasp is essential to mastering writing skills and is crucial to legible letter and number formation. As each school year goes by, children are asked to write sentences and then paragraphs, and the amount of time spent on writing tasks increases. If the child has developed a poor pencil grasp, writing can be an uncomfortable and a dreaded experience for the child.

If a child holds their pencil too tightly, the muscles in their fingers and hands will tire quickly and become sore when writing over a period of time.
If a child uses poor finger positioning on the pencil, the same problem can result.

Does your child shake their hand after writing for a while? Do their knuckles and fingertips look red and taught? Is their writing illegible or does it get bigger and less controlled with writing?

These are the things to look for when watching your child use a pencil. Here's a link with more information - If you would like further help to improve your child's pencil grasp, contact your local OT or talk to your school teacher.

Tuesday, August 4, 2009

Pay Attention!

A young boy, 4 years of age, was brought to me for assessment. He had not been diagnosed with any particular disorder, but was easily distracted and found it difficult to pay attention to the task at hand. He had been seeing a Speech Therapist for some time due to a slight delay in his speech development and he dribbled.

The boy's mum was mostly concerned that he would not be able to concentrate in class when he started prep next year. She wondered what she could do to help him at home, in readiness for school.

I gave the child some activities to complete and observed that he fidgeted in his chair, and was easily distracted, and yes - had difficulty paying attention. One of the first things I noticed was that when needing to apply force or pressure, e.g to mould playdough, he would move to position himself over the table to use all his strength, rather than relying on his hand strength alone. When I asked him to throw a ring or ball, he needed to use two hands to get any sort of distance. Throughout the assessment I asked the boy to complete desk-based tasks that assessed things like posture, attention, and fine-motor skills, and more active tasks that assessed his balance, coordination and proprioception.

During the assessment, the 4-year-old managed to respond to multi-step directions, and complete age appropriate puzzles and games. I found that when he began to lose focus and become distracted, his posture also changed and he would recruit compensatory muscle groups to move or exert force on an object. I asked this child if he ever got tired in the neck, back, arms or legs when sitting for a long time. He thought for a second then answered "Yes. Sometimes my elbows hurt." His mum hadn't heard this before and wasn't sure what he meant by this.

By the end of the assessment, it had become apparent that the attention difficulties experienced by this boy were more likely due to low tone, than because of any cognitive or intellectual dysfunction.

Low tone or hypotonia is explained well in Wikipedia:

"Hypotonia is a disorder that causes low muscle tone (the amount of tension or resistance to movement in a muscle), often involving reduced muscle strength. Hypotonia is not a specific medical disorder, but a potential manifestation of many different diseases and disorders that affect motor nerve control by the brain or muscle strength".

I recommended that the child engage in physical activities that promote muscle strength, balance and coordination, like climbing, running, and bike riding. He was already taking swimming lessons and going to structured gym classes, so he was already on his way.

With regards to desk-based work, I suggested that the boy be given a seat and chair that was appropriate for his size and that enabled him to sit with his feet flat on the floor and his back well supported. When performing desk-based tasks, it was probable that the child would become easily fatigued and possibly develop joint or muscle pain. He needed to be given the opportunity to stretch and change postures frequently.

With these strategies in place, and ongoing review of his progress and awareness of his needs, the 4-year-old boy should have no difficulty keeping up with his peers on commencing prep.