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Tuesday 26 March 2019
Derbyshire Healthcare NHS Foundation Trust
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Improving Skills & Preventing Future Problems

Postures and positions

Postures and positions the child adopts are as important in developing the affected side of the body as exercises are. Children soon learn to avoid leaning onto their affected side and using the arm to weight bear through which ultimately affects balance as well as hand skills. Here are a few things you might do.

Elongation of the affected side.

If your child’s leg is also affected then this together with tightness in the muscles around the shoulder can make it difficult for the child to reach out. It is important to place your child in positions which counteract this.

  • When your child is on their tummy keep their bottom still so that they can’t pull forward or move her hips. Then hold objects just above them at arms length and slightly over to the side of the affected arm. Bubbles, scarves, bells, puppets are nice, easy, fun things to use to encourage reach and touch in this position.
  • If your child is sitting with his legs in-front of them hold their thigh on the affected side so their bottom is stable and keep toys high and to the side or in front of them.
  • Alternatively, sit with your child between your legs with their toys placed on a low stool, so they have to lean that way to get the toys but have the security of you there.
  • If your child is walking and likes to hold your hand walk along holding their affected hand so it is raised above their head.

Weight bearing on the affected side.

Often children feel unsteady on their affected side and avoid putting weight evenly on left and right. This can cause muscle shortening, tightness and weakness and lead to further functional difficulties as the child grows. If you start to introduce weight shift activities as early as possible your child will soon become confident.

The following will help.

  • Rolling games -when your child is very small rolling is both a good weight shift and elongation activity.
  • “Horsey-Horsey” – play this with your child on your knee, hold their hands and tip them slightly forward and towards the affected side so they have to weight bear through that arm. Singing the “horsey, horsey” or “row - row -row your boat” song or any other you consider appropriate.
  • Encourage your child to side sit so their affected arm is the one having to support them. Initially they will feel more secure resting their forearm on your leg as you sit together on the floor. Later they could be encouraged to rest their arm on a sofa stool or sit sideways to the sofa resting their arm on the surface and to read a book or watch telly. As they become more able the aim is for the child to be able to lean on their affected hand whilst side sitting.
  • Crawling and crawling games.

Shoulder mobility.

Tightness and limited range of movement at the shoulder can adversely affect the use of a hand and arm (Try putting your own coat or jumper on without moving your shoulder). It is essential that the range of movement around the shoulder joint is good for basic gross motor tasks such as dressing, climbing, saving yourself when falling etc. tightness in the shoulder can also lead to tightness at the elbow joint and a permanently bent elbow. As the muscles of the hand cross the elbow joint, it is important that the muscles of the elbow are capable of being fully stretched out or the hand muscles will remain tight. A lot of the activities to encourage shoulder movements will also encourage straight elbows such as crawling, propping on the affected arm or both arms whilst sitting etc.

Shoulder movements are involved in reaching upwards, forwards, across ones middle, to the side and behind the back. The following activities help maintain good range of shoulder movement and will help your child develop the range of movement required to do things such as putting weight through the arm to help them save themselves in a fall, put on their own clothing.

  • Wrist toys – for the baby or infant who still spends time on their back or in supported sitting. Wrist toys can be purchased from most early years toy shops. Bright and stimulating they encourage the child to lift and move their arm by themselves.
  • Rolling games.
  • Crawling and if your child is walking – crawling games.i.e. obstacle courses, crawling races or pretending to be a lion or another animal.
  • Reaching - sit with your child sideways on your knee with their unaffected arm behind your back held there by your upper arm. Encourage them to reach to your hair, face or a toy you are holding (anything that motivates). Also for this you can include the previously mentioned elongation activities.
  • Catch the bubbles: reaching for bubbles above head level, to the side or in-front, trying to pop them or catch them between 2 hands. • Activities which involve trunk rotation towards the affected side – ie. encouraging your child to reach behind them.
  • Action songs which encourage the stretching out of two arms i.e. The Grand Old Duke of York, Aeroplanes, Incy Wincy Spider, Wind the bobbin. The child could do these with or without adult assistance depending on their ability / co-operation.

N.B. Your child’s physiotherapist will also advise on postures and position and weight bearing through the leg which compliment the advice given here. Remember that the arm can also be affected by the pull on the body from muscles lower down in the hip and leg.

Refer to advice in our second information sheet for information on developing hand skills.