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I have a kiddo who has cerebral palsy who is working so hard to walk independently and he’s getting there one step at a time (actually we’re up to lots of steps just with long pauses in between!). One of the things he is having a hard time with is coordinating his weight shift so he can pick up his foot and take a step. Part of this is because his balance is challenged when he’s on two legs so its even more challenged if he tries to rely on one leg, and the other part is that he is trying to figure out how to shift at the hips. He’s really good at leaning his trunk to the side to take the weight off the side he wants to step with, but this doesn’t make his balance any better. In order for him to get even more efficient with his walking we’re trying to teach his body how to shift from the hips so that his head and trunk can stay upright (not tip over!). We’ve found a few techniques that have helped so I thought I would pass them along.
Wii Fit Plus – I love this program (although if you ask my coworkers I am not very Wii savvy – I usually have to get the kids to help me figure out what to click on next!). There are a bunch of games under the ‘Training’ section that are fun and challenge balance and encourage weight shifting. The kids love it because they are playing a video game and I love it because they are working on the skills I want them to. By using the visual cues of the game he is able to work to get his weight from one side to the other. We’ve even been successful with shifting our weight forward several times which is a challenge. So that the focus is kept on the balance and weight shifting I usually have the kiddo work the board that you stand on and I work the controller (if both are required). It makes for great teamwork and we’ve been able to progress from me shouting out ‘left’, ‘right’ to him being able to see which direction he needs to shift on his own. Its a fun and motivating way to work on skills for a longer period of time.
Reaching Overhead – Despite the fun and allure of the high tech therapy, I do have to switch back to good old fashioned low tech too. When my kiddo gets too excited he attempts to reach his arms all the way to one side to shift his weight to that side, or as I mentioned earlier lean his head and trunk to the side. Since we are working on shifting at the hips and keeping an upright head and trunk he has to figure out how to elongate his trunk on the side we are shifting to. We’ve been doing this by simply having him reach overhead on the side I want him to shift to. I put the toy or object just a little out of reach almost directly above his shoulder on the side he is going to weight shift to and I ask him to reach for it. Its been great because in addition to working on weight shifting at the hips he is elongating his trunk on that side and he is working on his balance. The first time we did it he couldn’t even reach to his ear level without losing balance. Now he can stretch his arm above his head and grab the object with only the occasional loss of balance! I will alternate between asking him to do several on one side or alternating back and forth.
Step Up – This can be adjusted depending on the level of the child you are working with. For this kiddo he is just attempting to lift his foot to place it on an Ikea circle (so approximately 1/2″-3/4″ height). Just the lifting his foot enough to precisely place it requires a ton of concentration and control because he can’t just move his foot to any old spot, he has to get the whole foot onto the circle. Because he is paying attention to where his foot is going, and usually looking directly at the circle, he has a harder time leaning his head and trunk or using his arms to generate the weight shift so he has to do a controlled weight shift. Once he gets his foot on the circle he will hang out for a short period and work on maintaining his balance here. This also encourages a maintained weight shift onto the foot that stayed on the ground because his other foot is slightly elevated. This also lets him practice adjusting his trunk so that the stance side is elongated. I will usually let them watch a page or two of a book on the ipad while standing here so they get some reward and motivation while being kept entertained.