Day 53

New PT goals written less than 2 weeks ago...already met and EXCEEDED!!

Here is N in ONLY knee immobilizers, standing in the middle of the floor, engaged in an activity that requires minimal weight shifting. Way to go, N!! Sooooo sooo SO awesome seeing her standing and playing independently!!

In the second video N has one short knee immobilizer on (makes it a little harder) and is doing a more involved (more difficult) activity, so she is standing up against the wall to help her work on her balance independently.

Also, her PT periodically does a knee contracture measurement. This is how it was explained to me on what we are measuring, "how straight her knee can get (she has a knee contracture in addition to hamstring tightness)  The measurement is knee extension in supine." So the measurement is taken while she is lying flat on her back (supine).

The measurements can vary due to human error, her fighting it (or anxiety), or a better leg straightening exercise and "stretch" (in quotes because it is more of a warm-up and loosening) before measuring. In any case, while you will see the degrees bounce back and forth a bit, there has overall been tremendous progress (the goal is 0). I hope to have numbers to post in relation to her hamstring tightness soon.

9 Sept 2012 (Pre PGP)
Right: -16
Left: -28

19 Nov 2012 (PGP Day 11)
Right: (no measurement recorded, oops!)
Left: -18

26 Nov 2012 (PGP Day 18)
Right: -21
Left: -18

27 Dec 2013 (PGP Day 49)
Right: -15
Left: -18

31 Dec 2013 (PGP Day 53)
Right: -10
Left: -14

In retrospect, we really should have taken measurements the night before starting the PGP but we didn't. :( In any case, we are thrilled to see from Sept. through the rest of the year (as shown above), her right leg went from roughly -16 to -10 and her left leg went from approximately -28 to -14!!! Nice!!!

Day 50

Day 50: N stood unassisted with knee immobilizers and snow shoes for nearly 45 minutes!!

Day 49

Day 49: Very exciting progress in PT…N stood all alone for several minutes in knee imobilizers and snow shoes while participating in activities that required turning/twisting in her torso. Great strength improvement in her torso and legs, and impressive balance.

(compare to Pre PGP video when tall kneeling and moving rings!!)

Day 42

Day 42: In therapy N showed continued improvement in core and leg strength.

(compare to Pre PGP video when shooting basket from bolster)

Day 39

Inside the can N is wearing knee immobilizers and snow shoes. This activity requires her to use her own strength and balance to pull away from the wall and not fall foward.

Day 37

Some pics to look back at later in the project to compare to.

Day 36

Showing off by standing with knee immobilizers and ONE walking stick!!
And whose flat feet are those?? Could our huge obstacle of plantarflexion (toes pointed) now become an issue of dorsiflexion (beyond flat foot, over extended beyond the ankle)? Apparently this is signature for kids with diplegia but usually after heel cord surgery!! Did you read that? Her body just may be doing what is typical of someone with diplegia who HAD surgery!! She has had no surgery! Her brain made a switch or something! So time to start working out those calf muscles (which she currently has nearly none). So 36 days of taking minerals and has similar results to what one would hope surgery would achieve. Amazing!!!

 

Day 35

Look who's standing using walking sticks and knee immobilizers! Nice balance!!

Day 33

Day 33: N's hamstring stretch felt easier than ever. Still amazed how good of a stretch we are able to get now.

Day 32

DAY 32: N's core strength in PT was noticeably increased by her ability to continuously hold a tall kneeling position while moving her arms in and out playing Zoom Ball. She also pulled herself up to the bathroom counter and walked her self in closer. She remained there washing her hands for approx 5 min. Her feet were flat and her crouching was minimal. Impressive improvements!!

Day 31

DAY 31: Without braces or shoes, N used the couch and coffee table to walk to me. Yes, she is still crouching some but her feet looked nearly flat and her attempt was very good and improved

During week 4 N stopped wearing AFOs with heal lifts and is now wearing FLAT SMOs. Her therapist has suggested we hold off ordering new AFOs for her because of her rapid progress and use these in the interm. Her therapist also removed the chest strap from stander requiring her to rely completely on her own torso stregnth. She looked amazing in her stander today. So good it brought tears to my eye!

Day 25

Week 4 and N is ready to ditch her AFOs with over an inch heel lift to FLAT SMOs!!

While there is some debate over the use of heal lifts, it is the path we have agreed to take in N's therapy. With N's great spasticity, shortened muscles, and hamstrings, the heel lifts were intended to allow her to gradually be "lowered" as her body was ready. She needed to also learn to shift her weight into her heels while standing, not on her toes. It may seem odd to have heel lifts if it is not how you have known to treat this issue but we often where shoes with a small heel, so it really is not so different than how we often normally stand.

In any case, the goal is to get her to be able to stand with flat feet without compromising her posture and causing her to crouch further than she already had been. This has been an ongoing process working towards this goal, one we saw to not be reached for a very long time most recently...until the PGP project. Within 4 WEEKS, not months, not years, N was ready to lose the heel lifts...not gradually but completely!! We truly could not be more amazed and excited!!

My husband has sent me these pictures, I've been out of the country for a week and therefore have not been able to monitor N's progress through week 4 like I wish I could have. But I will be home tomorrow and look forward to checking her flexability and strength. I will be sure to update!

Day 21

DAY 21: Core strength continues to seem stronger while doing PT. I was shocked to find her turned and sitting up on her bed because she had knee immobilizers on and AFOs, she had been placed in her bed on her belly. She could have never managed that before. Incredible!!

 

Day 20

DAY 20: While doing hamstring stretches she began reaching up and doing crunches up to her extended leg. This allowed further stretching.We tossed the ball back and forth while she was in her stander and she continuously reached over head with both arms (seemingly with ease) to catch the ball. Nice strong overhand throws.

Day 19

DAY 19: Stood in her stander for an hour without difficulty. Later stood assisted (by me helping proper leg alignment) for about 2 min. She sat in the NadaChair for an hour and later we did 45 min of stretching. No complaints from her. She seems stronger.

Day 18

DAY 18: Surprised with her stregnth in her ability to stand while I pulled her pants up after she went potty. Then I tried just correctly positioning her legs while she stood and she did it!! Amazing!!

At PT we were A-M-A-Z-E-D!! She was held into the correct position for standing without shoes and AFOs and her feet were FLAT!! We haven't even come close to this before in the 4 years we have had her!!! When placed into her wheelchair to leave I allowed her to keep her AFos and shoes off...her feet went flat on the foot rests and STRAIGHT forwards!! Just a month ago we placed verlcro on the foot stools so we could strap her shoes into correct position but not she naturally is doing it herself without even thinking about it!! Today I shed happy tears. So excited!!

Day 15

Day 13

DAY 13: Stands with knee immobilizers and AFO's, Can be stretched to almost a full 90 degrees with knee immobilizers and AFO's on.

 

 

Day 11

DAY 11: Left leg measured -18 degrees. Core strength seems to be noticably improved from what I've noticed in PT over the past 2 weeks.

N is trying to do more. She is trying to stand and walk. Pulled up to standing at the fridge today.

Day 8

DAY 8: Seemed like we had more range in her hamstring stretch. Can't be certain though.

Day 7

DAY 7: Left leg measured -19 degrees

Day 5

DAY 5: Possible less tight hamstring, with more leg range.

Pulled herself up to kitchen counter several times times to standing position (feet positioning still not flat)

The Night BEFORE PGP