One of our major goals is for Joshua to sit unassisted, and we are making good progress. Initially, for him to sit, I had to provide hip support and continue to maintain that throughout the session. We are getting to the point now, where I am able to provide hip support after initially placing him into a seated position, and then withdraw it after a minute or so, leaving him sitting unassisted. His posture is not 100%, but he is getting there. One of the main challenges that I face with Joshua and independent sitting is the fact that he is a very "oral" kid. He wants to lick and mouth everything. If I place a toy on the floor in front of him, he simply leans down to the floor so that he is folded in half and able to suck on the toy. If I don't give him a toy, then he does this with his foot! I needed to do something to position an activity directly in front of him rather than on the floor to encourage him to keep his back up and straight while playing. I tried using a shelf that I could place over his legs and use it as a table for toys. This didn't work for us. It caused Joshua to extend backwards away from it. So.... enter the "Elmo Sit me up" and the "Fisher Price Brilliant Basics Activity Walker. " With the walker set in the "Busy baby" mode for floor play, I stuffed Elmo's head through the handle (Sorry Elmo!) and created the perfect vertical activity centre to keep Joshua's attention focussed in front of him, allowing him to concentrate more on sitting and less on licking the floor. After I position him, and withdraw my hands, I place a feeding pillow behind him. It provides him with no support in terms of sitting, but it does kind of fool him into thinking I am still right there, and it offers a cushioned surface for him to land on when he inevitably topples over. He can sit like this for about a minute now.
|Joshua sitting unassisted while playing with the toys on the activity walker|
|Looking a little bit less than impressed about it!|
Another one of our major goals is to encourage weight bearing on his arms. In a typically developing child, this usually naturally happens during tummy time with little effort required on the part of the parents. They push up on arms while using the other to reach for a toy, and eventually they push up on both arms and begin to move into a hands and knees position for crawling. For Joshua, his high muscle tone means he naturally prefers to keep his arms in a flexed position and he resists bearing weight on his hands. If you try to place his hands on the floor, his typical response is to pull them up away from the floor. We have to make a conscious effort to get Joshua to do this. It is important. Firstly, Joshua is lacking what some people call a "parachute" reflex. This is usually evident from about 6 months of age, and is essentially what causes people to put their arms out to break a fall. It is an important safety reflex that remains for the rest of a person's life. Typical children, who fall over while sitting are able to break their fall (or try to) with their hands from about 6-8 months of age. Joshua makes no attempt to put his hands out when in a simulated fall of any kind. This reflex needs training and can be achieved with hard work. Weight bearing on arms is also obviously needed for crawling, another important milestone. Joshua also rarely rolls from stomach to back, because this requires him to push up with one hand (though he seems to be starting to do this lately, as he has rolled that way twice in the past week). We have a few different approaches to encouraging weight bearing. The first requires no parental input apart from the initial placement, so it is a good one for independent play. It merely involves propping his chest up to give him that little bit of extra help (He can push up, without having to bear ALL of his own weight). You can basically use anything for this, such as a rolled up towel, a small cushion, a foam wedge, or, like in my example here, a feeding pillow. You can place toys in front of the child and pretty much leave them to it.
|Joshua making a reasonable attempt at pushing up on his arms, though you can see |
by the look on his face that he is not very pleased about it.
One of my favourite weight bearing activities is using a roller that Joshua was giving for Christmas. It is essentially an inflatable barrel intended for crawling children to push along with them. Joshua doesn't crawl obviously, but it has been extremely useful to us. We are able to place his body over the barrel and roll him forwards, encouraging him to take his weight on his arms. On a good day, he can hold himself there in a wheelbarrow position only needing my hand on his bottom for stability. He refused to role model this in a photo, but I did get one of him demonstrating another use for the barrel, which is sitting in short kneeling. He is able to kneel while supporting himself on the barrel. Joshua being Joshua, likes to bounce around in this position also, and usually eventually falls to the floor, but short kneeling is another position that is beneficial.
|Kneeling- using arms to support the upper body|
Another activity that we have only recently added to our repertoire is weight bearing on the legs. Of course, we were doing this informally, holding him in our lap in a standing position etc, but the PT has given the go ahead to start paying more attention to this. Children with high muscle tone have a tendency to stand on their tippy toes, so the key to good standing is that the heels are nicely on the floor. I have to assist him in positioning his legs well (feet apart to provide stability, with the feet straight or slightly outwards) Ideally, he will be able to support himself on an object using his hands, but for the moment he often leans his chest against the activity tables and thats ok, you have to start somewhere. He thinks he is pretty clever and for some reason I keep setting the tables near the curtains so it gives him a bit of a thrill to pull on the curtains too!
|Hello Clever Bum!|
|Playing while standing up|
These are just a few of some of the many things we have to do every day in order to work towards the kind of mobility that most people achieve with minimal effort. Sometimes it can be tiring, and sometimes I get to the end of the day and feel that I haven't done enough with him that day and so I feel guilty. Sometimes I wish the words "He will do it when he is ready" was in my vocabulary, but it is just not. And so we push on - hard work for Mummy and hard work for Joshy - who is a super kid through it all.
|Blurry Baby of Steel :)|