Monday, April 13, 2015


How do you address independence with range of motion exercises?

This student has worked with a school-based OT since he was in early childhood special education.  He also has had rounds of outpatient therapy at a pediatric OT department, as well as one surgical procedure to release the wrist contracture.

The school-based OT trained the student and parent in passive range of motion exercises a few years ago and created a home program, with written and video directions.   

With quite a bit of therapeutic handling, the student's thumb can be extended this far from the palm, but the wrist remains slightly flexed.

In schools, we usually use parts of the school environment as convenient stabilizing points for independent exercise.  In this student's case it was difficult to find a suitable spot, due to the limited wrist, elbow and shoulder movement.  Teachers and assistants assist with passive range of motion for students, following training by the therapist, but this student's physical status and need to frequently change between general ed, special ed and resource classes limit the opportunities to perform joint range of motion exercises.

His LUE contractures interfere with ease of donning his coat, manipulation of school materials and participation in PE activities, even though adaptations are in place.

We practiced using a soft traffic cone (in a color the therapist likes...) to allow the student's hand to assume a semi-relaxed position.  In this position he practiced extending his elbow.

Placing the hand higher on the cone allowed for slightly more shoulder flexion.

Working with students, families, teachers and assistants on increasing student independence with ROM exercises becomes more challenging as the students enters later elementary grades.  There is more of a time crunch and the students usually become very self aware of how their bodies move differently from their peers.  They often do not want to be seen performing exercises in school or even leave class to work with the OT. 

My plan for the rest of this school year is to help the student continue to become more independent with the exercises and to add adapted hand-washing to our practice sessions.  This guy needs to know how to thoroughly clean the palmar area, since it is so difficult to open, as well as the ulnar side of his hand, since it is very calloused.

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