Rhythmic movements and primitive reflex integration help teen with cerebral palsy accomplish ADLs
Over the course of 6 months, this young teen girl gained confidence and a great sense of accomplishment after completing tasks she hadn't been able to do before. Life-changing!
Submitted by Kerbe Shephard, OTR/L
| Before | After |
|---|---|
| Often felt defeated with things she “can’t” do | Feeling independent and confident |
| Lacked many fine motor skills that directly impacted her ability to complete self-care tasks independently | Can hang her laundry on a hanger, fold a towel after washing her hands, and pour herself juice from the fridge with only verbal cues |
| Difficulty with finger isolation | Can complete finger opposition and isolation on both hands |
Karla is a 13.5-year-old girl diagnosed with Cerebral Palsy. She spends most of her day in her wheelchair and is unable to walk. Her left side is stronger than her right side on both upper and lower extremities. Karla received occupational therapy as a child, but terminated sessions with the exception of at school until about 1.5 years ago. She has always received physical therapy, but was lacking many fine motor skills that directly impact her ability to complete self-care tasks independently. Karla was unable to complete zippers, turn on the water to wash her hands, pour herself a drink, write legibly, or brush her hair.
Upon beginning treatment with Karla, we focused on the skills necessary to complete ADLs and fine-motor tasks in general with fair progress; but there was a lot of frustration and assistance required over a few months of treatment. Grasping was difficult, and she was unable to complete skills such as opposition, forearm supination, finger isolation, gripping, and dexterity. After taking your [Brain and Sensory Foundations] course.
I immediately realized her palmar reflex was retained and began the hand and finger exercises along with a modified 5-step balance process, with the overall intention to integrate her reflex and be able to complete putting her hair in a pony tail (one of her most desired tasks to learn). We were not able to complete the repatterning sequence movements due to her limitations in physical abilities, but her progress with her intention and mental well-being was noticeable to both herself and others close to her.
We began with one hand at a time with moderate assistance to maintain positioning and complete the exercises. She needed hand-over-hand assistance to complete many of the exercises due to difficulty with motor planning and overall endurance in her hands. She often feels defeated with things she “can’t” do, but appreciated the simplicity of the exercises, and was willing to practice them at home when she was watching television or relaxing.
Her progress over 6 months was incredible! Karla worked up to being able to complete the finger exercises with independence and felt a sense of accomplishment when she was able to FINALLY complete them! In a matter of 6 months (and over telehealth to boot!), she was able to successfully complete finger opposition and isolation on EACH hand, hanging her laundry on a hanger, folding a towel after washing her hands, and pouring herself juice from the fridge with only verbal cues. We still have a long way to go with her self-care skills, but she is doing more independently than she has ever been able to do before.
Although this is not a case study on whole body RMT or reflex integration, I felt it was important to highlight the way this simple, so many times forgotten, reflex can change someone’s life so drastically. Karla often hears or thinks she “can’t” and is dependent in almost all aspects of her life. At such a vulnerable age, this integration has allowed her to feel independent in various ways and has given her the confidence she needs to continue working hard at her therapy sessions and in everyday life.
Update from therapist: Nov 2, 2021: Karla was able to make a complete pony tail for the first time last week independently.
[Edited for length and clarity; emphasis added]