Lessons in PT

We are always learning new things in therapy. Last night's PT was particularly informative. PT is always a bit of a reality check on how much responsibility is on Darin and me to make sure and anticipate and help eliminate as many issues as we can physically for Tessa because of her cerebral palsy.

The last several weeks Melody has reported Tessa's hamstrings are tighter than normal. We have already been incorporating hamstring stretches during diaper changes and general playtime. I don't do a lot of reading on the different kinds of things that can result from CP, we just tend to roll with what Tessa's therapist and physiatrist tell us she seems to be dealing with. My 'mommy interpretation' of how the CP affects Tessa is that her muscles are very tight and that she has repetitions of flexion and extension which can result negatively on her little body. For example: the elbow is flexed when the hand is brought closer to the shoulder, the trunk may be flexed toward the legs, or the neck to the chest. The opposite is extension, or straightening. Basically, flexion decreases the angle between the bones of the limb at a joint, and extension increasese it. Tessa does not have the appropriate level of control over either her flexion or extension. The repetitiveness of either action can end up causing major issues for her physically down the road. Our goal is to educate ourselves on how to help stretch her and ultimately teach her better control and effective movement.

The latest concern for Tessa is where she has become accustomed to breathing. I learned last night that we are all either belly-breathers or chest-breathers. Tessa is very much a belly-breather. Melody described it that people that tend to sleep on their sides are belly-breathers and those that tend to sleep on their backs or stomachs are typically chest-breathers. For those of us that have had normal physical development throughout our lives, we have the ability to do either, but typically prefer one over the other. Since Tessa's trunk and neck muscles are are tight and weak, the path of least resistance for her to breath is with her belly. Because of this, her ribs have begun to form out a little. So, now we will begin incorporating rib stretches along with Tessa's hamstring stretches. Basically when Tessa is lying on the floor facing me, I will use my hands to follow down the path of her ribs and help stretch out the muscles between each rib. Then I will put a little bit of pressure at the bottom of her ribs and belly to help her shift her breathing from her belly to her chest. Needless to say, Tessa is not a fan! But just like everything else, over time, it will become a part of our routine and her tolerance will improve a little more every day.

The belly-breathing information probably helps answer why Tessa has never been a big fan of tummy time. It's so difficult to ever get her to work on head control during tummy time because she despises the position so much. The stander has made the world of difference in her head control since she loves being up on her legs. If we can help Tessa strengthen her chest muscles and begin to learn to shift from belly-breathing to chest-breathing, things will look a little better all around. The more strength she has in her chest muscles to be able to expand and open her lungs, the better. I'm not sure what all the ramifications are if Tessa isn't able to shift from belly to chest-breathing, but recurring pneumonia is probably one of them.

Another term we learned about last night was, contracture. A muscle contracture is a permanent shortening of a muscle or joint. It is usually in response to prolonged spasticity in a concentrated muscle area like is seen in the tightest muscles of kiddos like Tessa with spastic cerebral palsy. Contractures are basically muscles or tendons that have gotten too tight for too long and end up becoming shorter. Melody said last night that it takes a constant 8 hour stretch to help correct a contracture, otherwise it might be necessary that they be released with orthopedic surgery. Melody mentioned last night that SoonerStart is so invaluable for reasons just like this. To be able to learn how to intervene on things just like this so early on and help prevent Tessa from having to experience something like this.

All we know, is if she needs it we'll work on it! There's really no other way to say it other than it just plain sucks to have to put our sweet Little Miss through this, but as parents, when we know what's best for our kiddos...we do what we must. As a mother I struggle a bit with posting such videos, but they help us share the reality of the struggles for our little girl. She is so strong and so brave and the 3rd video is of her recovery. It's an intense time to do her stretches, but we are working hard to help her be the very best she can be!

Hamstring Stretches

Rib Stretches for encouraging chest-breathing

Recovery from all of the above :)

~Whitney