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Physical Therapy Plan: Tanner is seen 30 minutes twice per week for direct intervention at Delbrook Preschool with 15 minutes 4 times per month Support to Program Personnel.

Physical Therapy Goal: In individual and group settings, Tanner will demonstrate improvement in functional mobility by 1) moving sit to stand without support, 2) independently walk 20 feet using a forward facing rolling walker following a straight path, 3) independently cruise along furniture in his preschool classroom, 4) independently move floor to sit on a chair, 5) independently move floor to stand at a walker by moving through a ½ kneel.

The following descriptions with pictures and videos depict activities Tanner is working on in his Physical Therapy sessions:

Mid-range knee flexion motion:
  • Therapy ball sit and bounce with therapist providing minimal joint compression through knees to maintain foot contact to floor and use of feet to stabilize body while sitting on the ball. Tanner bounce on the ball working for motivator of a small ball to throw.
  • Attempted bouncing on the trampoline and it was difficult for Tanner to grade small amplitude movements at the knee, he used large movements with a delay in switching direction to create a bounce. He was unable to do this motion while standing on the floor

Transfers and Transition Movements:
  • Sit to stand from Turt-L-shell with assist ½ way through the motion. Tanner is spontaneously using a forward lean then transfer to weight bearing push to stand with improved balance.
  • Scooting backward up a step, then lower back to the floor
  • Tall kneeling: Tanner is able to achieve a tall kneel when using a wide base (knees apart). With the therapist facilitating a narrow base, Tanner is able to maintain for a couple of seconds, but is unable to maintain while throwing a ball.
  • 1/2 kneel to stand at walker
  • Bear stance: hands and feet flat on floor, short distance with intermittent prompts and cues to look

Standing balance:
  • Standing at support for play without trunk in contact with support surface (maintaining his trunk a few inches from the support surface)
  • Stand and throw a bean bag to a target with one hand holding a support surface without trunk contact: able with the left arm throwing.

Gait Activities:
  • Side stepping along a support surface to the left and the right, prompts to keep trunk a few inches away from the support surface
  • Transition from one surface to another 12” away by side stepping.

Wheelchair mobility: Tanner tends to use both arms simultaneously. With prompts, Tanner can use 1 arm independently, but this takes a slight delay in processing.
Suggestions for working on wheelchair mobility at home:
  • Open space self exploration of wheelchair movement. Just letting him have the opportunity of exploring the movement of the wheelchair without adult direction.
  • Giving him large targets that motivate him (i.e. ball, basketball hoop), let him problem solve trying to move to the object, then provide prompts/assistance as needed so he can learn and be successful.
  • Prompts to reach further forward on the wheel to give him more range for a larger movement and better efficiency when going backward. A positive note: he has nice strength moving from the mid-wheel to behind the seat with his arms.
  • Turning: prompts to keep one arm holding the wheel still while the other one turns by pushing forward.
  • Exploration of turning wheelchair with only one hand, using an object held in his other hand to decrease his tendency to use both hands together.
  • I wouldn’t worry about backward turns yet, just try to get the idea of how to use his arms each doing a different motion to achieve a forward turn.

Ideas for activities at home:
  • Limiting trunk contact with a support surface while standing and playing, and cruising.
  • Working on cruising to each side without trunk contact and reaching for another surface positioned approximately 12 inches away.
  • Standing with 1 arm holding a support surface and body facing perpendicular to the support surface, throwing a bean bag to a target.
  • Sit to stand movements: lots of repetition to build mid-range knee strength and control
  • Bouncing on a therapy ball with assist to keep feet stabilized on the ground (usually provided through the knee): to build mid-range knee strength and control)
  • Bear stance and beginning to walk: builds trunk control, hip and leg strength, and arm strength, as well as coordination.
  • Play in deep squat for a length of time to work on balance and strength in this position.