Using Moving and Handling Equipment to Support Therapeutic Interventions
Elliot is an 8-year-old boy with Wolf-Hirschhorn syndrome who presents with delayed motor development and hypotonia. Penny Townsend, a physiotherapist who works with children, has been working with Elliot and his family for the last 7 years. Elliot's parents conduct his therapy programme daily, along with his educational setting.
Wolf-Hirschhorn syndrome is a rare genetic condition caused by a deletion of genetic material near the end of the short arm of chromosome 4. The severity of the condition depends on the amount of genetic material that is missing. Children with this syndrome can have a characteristic facial appearance, delayed growth, and development, hypotonia (low muscle tone/floppiness) and seizures.
Therapy overview
When Penny first started working with Elliot, he had no head or trunk control, was unable to roll independently, and could not sit unaided. He also had large involuntary movements, which made it difficult for him to be in functional positions to improve his gross motor skills.
Over the years, Elliot's gross motor skills have improved, but he still faces challenges. He uses a wheelchair and specialist postural support seating for his mobility and to maintain his posture. He also uses a supine stander at school and has a Rifton Pacer walking frame. When he is in his walking frame, he will initiate reciprocal steps.
Elliot can now sit unaided on the floor without the support of an adult or equipment, and in this position, he enjoys playing with his musical toys. However, he is unable to get into a sitting position from lying independently and requires help from an adult. Elliot has always disliked working in the prone position, but he has recently been rolling himself onto his tummy and his mother, Kristy, has observed him trying to move towards his toys, although he is unable to organize his trunk and limbs to do this. Due to Elliot's increased size and weight, it has become more challenging to place him in functional positions such as 4-point kneeling.
Maximizing Elliot's independent drive for movement
Penny and Elliot's parents decided that it would be therapeutically beneficial to maximize Elliot's independent drive for movement. They had already been using a Guldmann Active Vest with a room-covering ceiling hoist system for standing and stepping practice, which encourages better balance reactions and postural tone control. This activity had a positive impact on his stamina in an upright position.
To further support Elliot's progress, they decided to try a Multi Support sling to help support him in a 4-point kneeling position with the ceiling hoist system. Achieving 4-point kneeling without the use of equipment can be a difficult activity for the therapist or parent but using the Multi Support sling allows for ease of handling and gives the ability to help Elliot transfer his weight to reach for a toy and move his arms and legs.
Since using the Multi Support sling with the ceiling hoist, Elliot has been able to push up into 4-point kneeling with improved control, and he is gaining improved ability to move himself on the floor to reach for his toys. The use of the Multi Support sling has made the therapeutic activity much easier for handlers, allowing for prolonged periods of activity.
Using the Multi Support sling has not only supported Elliot's progress towards his gross motor goals but has also opened a whole new exercise program for him, the therapist, and his family.
The long-term aim is to work toward crawling or belly crawling as an independent form of mobility.
Multi Support sling
– for lifting and support
The Guldmann Multi Support sling supports and lifts limbs in conjunction with the hoist, avoiding unnecessary strain to the care provider.
The sling is used to lift or support specific parts of the body, such as the torso, pelvis, legs, or arms.