Thursday, October 9, 2008
Today I worked with a high school student and his speech-language pathologist. The student's primary modes of communication are body language and vocalizations, plus a large electronic spinner (approx. 14" diameter) which he activates by pushing the left side of his chin laterally against a flexible switch connected to the spinner.
Gravity and spasticity have forced the young man's trunk and shoulders into various degrees of rotation and his legs into a windswept position. Symmetry is no longer a part of his body schema. However, we positioned his spinner directly in front of him instead of to his favored left side to see if he could keep his head more in midline in order to allow him to release his pressure on the switch when the spinner hand swept over the desired part of the spinner dial.
Positioning the device at his midline was not enough to enable him to control his head movements with greater independence. I actually had to touch him.
First, I grasped his left hand as if I was intending to shake it. Applying firm, steady pressure to the thenar eminence and surrounding palmar area his fingers began to slightly relax. Keeping my pressure on his palm I used the wheelchair armrest and also my knee to gently extend his arm at the elbow. Holding his left hand with mine, I moved on to helping him position his head to face toward the spinner.
My flat right palm was used as a wall to block his involuntary neck rotation to the left and to maintain his head in midline. After a minute or so my right hand was mostly a reminder to keep his head positioned symmetrically. His wobbly switch was easy to maneuver to suit the position of his lower chin. From this starting point the speech pathologist read a story and asked him to use the spinner hand to point to various target pictures related to the story. We found that very large pictures worked best.
This young man has bunches of lateral supports for his trunk, a well-fitting "X" chest strap and a secure head rest with clavicle extensions to keep him in place. What he needed to be successful for this activity was a pair of human hands.
I asked the speech pathologist if she thought she might be able to help him with positioning and she wasn't sure. She's a hard-working person so I might be able to instruct her on techniques I'd show any family member, and win her over. In the meantime I'll schedule my time at the school to coincide with hers, and my PT counterpart will help, too.
It sure was nice to put my hands on a student the way I did years ago in private clinics.