We've added some new 'accessories' to Tessa's inventory and I'm just realizing I never posted about them. These fun little things are called knee immobilizers. They definitely are not my preference in color, but they are basically for at home use only, so it's cool ;)
Tessa had an appointment with her physiatrist on July 11th for a regular follow up and then had some x-rays done on the 20th. Due to Tessa's spastic cerebral palsy, there has been (and probably always will be) some concern about the tightness in Tessa's hamstrings. I am no doctor and no PT, but basically it is very important for us to make sure Tessa's muscles get stretched every day because of the high tone/tightness in her muscles, that she experiences from the CP. Tessa needs help with stretching lots of her muscles, because of her lack of mobility, but especially her hamstrings. Stretches are basically a preventative approach. We are trying to make sure Tessa doesn't develop a contracture of the hamstring. Basically, a contracture is the 'abnormal shortening of muscle tissue rendering the muscle highly resistant to passive stretching'.
I did not read all of this article, but I copied in some pictures from it below.
It is titled "Contracture of the Hamstrings in Spastic Cerebral Palsy". I thought it had some good illustrations of what is happening to Tessa's hamstrings because of her spasticity.
Tessa sleeps in one knee immobilizer a night, alternating legs each night. This just helps her keep her leg straight to give her hamstring a bit of a stretch over night instead of having her legs scrunched up all night.
We also use the knee immobilizers during the day. The most productive stretch for Tessa is during long leg sitting. Twice a day, we put both knee immobilizers on her legs and she sits at a 90 degree angle for 20 minutes. This is a more effective stretch than what she gets at night, because at night she is laying straight (like the picture above) and isn't getting the hamstring stretch across her knee. As the illustrations showed, having that tightness doesn't allow Tessa to stand or sit with the appropriate posture...which ultimately can lead to permanent deformities and continued limited mobility.
As long as we stick with the 20 minute max, Tessa tolerates the long sitting very well. She, like any other 2 year old, would much rather be playing than sitting and working hard, but we make the best of it! The other night we pretended like she was having an evening at the spa. I brushed her hair and played with her hair. I gave her a little neck massage and shoulder massage. And then I tickled her back and we snuggled.
Another even more effective use of her knee immobilizers is in conjunction with her DAFOS. As illustrated in Figure 3 above, along with a contracture of the hamstring can come foot deformities. So when you pair these two accessories together, you get a really nice stretch in the hamstring while keeping her ankle and foot in the correct position for the stretch. We use the combination of these two in long leg sitting and when she's in her stander. Again, she's getting a better stretch in long leg sitting because the hamstring is being stretched across the knee. In her stander, the stretch isn't as intense, but the combination does help keep her from cheating and bending those knees to avoid a stretch.
Ok, you've officially been schooled on contractures, knee immobilizers and the importance of stretched out hamstrings. We go back to see Tessa's physiatrist on November 12th. For now, her x-rays look good and there are no immediate concerns. I don't know much about the next steps if things do begin to take a turn for the worst, but I do know there are options, like botox injections, to help with the muscle tightness and contractures. There are also surgical procedures that can be done to help, but my prayer will always be that we can dedicate ourselves to all-things-preventative and avoid the surgical route. Time will tell, but for now, we are going to do our stretches and be creative and have as much fun as possible in the process :)
~Whitney
Ahhhh! Our little (actually, she's growing more and more) precious Tessa works so very hard! Along with her mom and dad and brother! We are so thankful for all the details that you all work with, and that the Dr,'s and therapists work on.... all to make sure that Tessa is well taken care of, and has every opportunity of success presented to her every step of the way! Prayers of thankfulness for you all! Love, Grandma Bynum
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