One of the surprises we got at Bobath was with Speech and Language Therapy (SALT). We had been discharged by SALT when Charlie was 2, simply as he understood speech and was able to make himself understood. I had always maintained he had a few issues, mostly with timing but some articulation when he was tired and/or exerting himself- hence the use of the ForBrain.
Within a few moments of meeting Charlie, Yolly, the SALT therapist, had picked up on some difficulties. These revolved around Charlie’s high muscle tone; the effect on his mouth and a potential effect on his teeth. Much to her surprise she also picked up on a speech impediment in Lou- Lou’s tongue curls on the edges and her chin creases on certain sounds. This is quite important as there may be a potential genetic effect in Charlie’s speech development.
Obviously having also spoken to Athena, the OT, after sitting and watching Charlie eat and drink for a little while at the table Yolly was convinced that his sitting posture was causing him increasing difficulty at meal times specifically but generally for play and activities. Charlie’s muscle tone means he has a relativity weak core and an element of postural scoliosis (curved spine), it means his hips tip backward rather than forward. As a result Charlie arches forward and his arms and head are ‘heavy’ and less easy to move.
With a few simple adaptations and adjustments to his seating Yolly was able to dramatically improve Charlie’s posture, and almost magically, his ability to eat and play at the table.
- A seating wedge. By placing a small sloping wedge on a chair under Charlie his hips are pushed forward and his spine is pulled much straighter. Charlie appears much taller!
- A seat belt. By putting some nustim wrap around Charlie’s legs and ‘strapping’ him to the chair he doesn’t need to actively hold himself into it. This seems a little strange but Charlie’s extensor pattern, coupled with posterior hip-tilt, when he is trying hard to do something increases his tone and almost pulls him out of a seated position.
- Planting his feet. Having a platform to rest Charlie’s feet gives him the confidence of being supported and stops his extensor pattern straightening his legs and arching his back.
- Table height. Forget etiquette- Charlie should support his elbows on the table. Too low and he arches forward and his tone makes his head and arms ‘heavy’ again, too high and his extensor pattern kicks in, increasing his tone. Supporting his elbows makes handled items appear relatively lighter and much easier to manipulate
- Writing slope. A lifted slope platform means Charlie doesn’t have to lean over so much and encourages him to sit up tall.
All these adaptions have had a dramatic effect on Charlie’s ability to perform all sorts of tasks from sitting. He has been able to manipulate pens and pencils easier and he enjoys his colouring much more. It has also helped with learning his numbers and letters. We regularly thought Charlie struggled with motivation when doing certain tasks but adapting his seating has shown him more than willing to do many more things- obviously his tone was having a massive detrimental effect on his ability to do many things and he was avoiding things he found hard. He has also found eating much easier and is able to eat his dinners with much more independence.
Yolly also asked us to be aware of Occlusion on Charlie’s teeth. Due to his tone and struggles with seating, Charlie’s tongue pushes up and forward in his mouth- this is coupled with a tight top lip due which can affect how the teeth come together. It is very common in CP kids and told us that our Dentist should be made aware otherwise Charlie’s teeth may end up arching and splaying outwards.