All ABR children do significantly improve motor functions… but ABR goal is to make them emerge at the same time as healthier, stronger, happier kids…which reflects on the entire family’s happiness.
Let me ask you a question:
What would bring happiness and joy to your child… and yourself?
Most parents spontaneously answer: ‘If he/she could only walk!’, ‘If he/she could only talk!’
But, are you sure that this is what would really make your child happier?
As human beings, we have the tendency of seeing things through our own lens, through our reality… which is not necessarily our child’s reality.
Walking and talking is an essential part of our happiness and many parents are ready to do anything (and very often even overdo it…) in order to bring their child to THEIR reality… instead of respecting HIS/HERS!
Too often, this immense desire to bring their child to what they consider ‘paradise’, turns out to be ‘hell’ for the child, as over-stimulation and constant insatisfaction with results, soon takes over all reason.
It is for this reason that it is so imperative to reconsider the whole rehabilitation approach and focus on the human aspect… more precisely towards the human ‘being’.
This implies that you stop looking at ‘how many meters’, ‘how many seconds’ your child is managing, but rather look at the fundamentals: What is your child’s repertoire? What is your child’s ability to express themselves? Develop their own personality? Explore the world?
You need to bring the whole situation closer to the human perspective rather than focusing ONLY on ‘what is wrong with the machine’, constantly and avidly measuring how many meters, seconds, more…
Happiness and thriving intersect and connect with one another.
And this happens at 3 levels:
Human contact, translating into unconditional love … independently of what he/she can or cannot do.
Real thriving… if your child is heavily struggling, facing metabolic challenges on a daily basis, then it is very difficult for him/her and the family to genuinely experience happiness. That’s where the concept of Vitality and vigor vs vulnerability and fragility discussed in Part 1 of this series comes into place and should be a priority over any desire for motor development.
This is THE central element.
Systematically and cleverly building the blocks which must precede performance: robustness, segmentation, weight-bearing response, autopilot positioning, etc…
And this implies a dramatic change of expectations! It is not about ‘doing’ it at all cost… it is about developing the very fabric of ‘being’…which is also the very fabric of happiness.
Too many parents look at their child as the ‘broken machine that has to be repaired’. ABR looks at them as unique individuals with their own character, sensitivity, awareness, thoughts, love of life, dignity and works at making them ‘thrive and flourish’ as human beings through structural metamorphosis.
We have the tendency to think that our child’s presence and alertness is innately linked to the signals coming from the brain.
If brain’s signals definitely play a role, shouldn’t we perhaps attribute all the responsibility of the child’s poor interaction with his surroundings?
If we simply look at the mechanical and metabolic elements listed above, we get a hint of a totally different interpretation of the child with CP and their poor presence and alertness.
You just need to picture your child’s daily reality:
causes permanent or at least recurrent collapse of his/her head and trunk, depriving your child from important eye contact with his/her surroundings.
Guillaume Dulude, doctor in neuro-psychology explains that … ‘communication starts as soon as people enter into each other’s field of vision…’ For the child with CP, communication is then based more on hearing rather that sight, which completely changes his/her relation to the world.
bring daily challenges. Poor health, poor sleep, poor digestion all lead to constant fatigue and overexertion are factors that obviously do not favor social exchange with parents, siblings and friends.
make your child’s life extremely challenging throughout the day. The smallest change to his/her position converts to being off balance and therefore they may potentially fall.
The child with CP profoundly mistrusts his/her body. He/she is in a constant situation of fear and stress leaving a very narrow window for interaction with you.
forcing him/her to appeal to his/her skeletal muscles, connective tissues being too weak to help him/her fight against gravity. Any request for performance translates into immense effort, overdrive and fatigue… contributing very little to positive interaction.
The child with CP, just through their structural and metabolic challenges, has VERY little room for presence with their surroundings and very little chance to satisfy their parents in terms of alertness.
On the other hand, a child with a robust neck and torso, full of vitality and vigor, benefiting from an extended repertoire of movement, thanks to an adequate segmentation, experiencing spontaneous and easy weight-bearing response, will unfailingly be more present, more aware and will interact better with their surroundings.
Presence and alertness necessitates first and foremost feeling well in one’s body! Upper body robustness, vitality and vigor, balance and weight-bearing spontaneous response are improvements at your reach through the ABR trans-fascial techniques … just imagine how these structural improvements could change your child’s relationship with you!!!!
We have covered in the previous articles the necessity of strengthen fascia in order to ‘spontaneously and without effort‘
Let’s talk today about balance.
Normal sitting is the position where the child is capable of maintaining equilibrium throughout an entire range of positions. In such a situation, if pushed off balance, he/she is able to counterbalance, regaining their original position, rather than falling as a unified block.
I invite you to try a few tests with your own child to understand what hinders him/her from developing balance.
While lying down on his/her back,
You will see that any attempt to move their head to the side causes the involvement of the shoulders in the movement. This means that head does not move independently from the thorax.
In the sitting position,
you will see their legs will lift off the bench or the table. This means that legs do not move independently from the pelvis.
In the same position,
you will see that their legs will move in the opposite direction. This means that lumbar spine, pelvis and legs are all attached to one another.
While still seated and facing you,
you will see that he/she will rapidly ‘spring’ back into the initial position…showing poor division between the vertebrae translating into overall rigidity in the spine.
These are only a few restrictions depicting your child’s incapacity of adjusting to any external challenges to his/her initial position and are the manifestations of the weakness of the deep core tissues, also called fascia, and the necessity to proceed to their remodeling and strengthening before contemplating body control and equilibrium.
Training balance in these conditions is a utopian initiative.
Only fascia strengthening can free your child from the mono-block condition in which he/she is imprisoned and allow the development of true balance.
How many times do we see children with CP encouraged to lift their head off the ground when put on all fours, with the hopes of making a few attempts at crawling?
We see the child desperately pushing on his/her arms to try to lift off the ground, holding the position is a COLOSSAL effort for a few short seconds… to PITIFULLY collapse from absolute exhaustion.
Why is it so difficult?
Healthy individuals don’t even think about weight-bearing, they simply weight-bear… it is an involuntary act that does not require any muscular effort.
Because with weight-bearing, we unconsciously appeal to our compressional strength (inner hydraulic force) which is intimately linked to adequate fascial tone. There is no effort involved in lifting our head or torso…while the child with CP, suffering from weakened fascial tone, does not have sufficient hydraulic force and has no other recourse than appealing to his skeletal muscles to accomplish the same task.
The problem is that the skeletal muscles are 1) not designed to weight-bear and 2) are extremely expensive in terms of energy expenditure.
Biceps/triceps, for example, were not designed to weight-bear our body. They were designed to provide our arms with the mechanical structure needed to allow for the movement of the arms (lift, lower, push, pull, etc.)
Appealing to skeletal muscles (like a child with CP does) demands a lot in terms of energy consumption. You just have to remember how quickly you get tired when lifting weights at the gym…
It is the same Olympic workout that is expected from your child with CP when you ask him/her to lift their body off the ground by pushing on his/her arms or when you ask him/her to lift their head (as he/she has no other way than appealing to their neck muscles).
This explains the basic shortcomings of training at this level.
This leads us to an essential question:
What kind of training are you imposing on your child with CP? Is it leading towards a ‘gain’ or a ‘drain’? Is it leading towards ‘efficiency’ or ‘overdrive’? Once you start understanding the human structure, you quickly realize how illusive training is, if you don’t improve the structure first!
Building a strong deep core structure by strengthening fascial tone is a essential prerequisite for developing effortless weight-bearing capacity.
‘I would like my child be able to grab objects’ or ‘I would like to see my child able to crawl’, etc.
This over-simplification shows that they usually oversee the uniqueness of each piece of the big puzzle they are trying to put together. We will see here that any movement necessitates preliminary mechanical characteristics that must absolutely be present.
Let’s do a few simple tests with your child:
Lay him/her down on a table.
Observe what happens. The shoulders leave the ground? Lifting the head coincides with lifting part of the thorax itself? Fascia is weak and your child lost proper segmentation between the head and the thorax.
In the same position,
The head (and in many cases, the rest of the torso) are involved in the movement as well? This means that fascia is weak and your child lost proper segmentation (division) between the arms and the thorax.
Still laying down on the back,
The other leg and even the pelvis leaves the ground? This means, in turn, that fascias is weak and your child lost proper segmentation between the legs, the pelvis and the lumber spine.
In other words, your child is moving as one block.
Training him/her to move without first creating proper segmentation between the head and the shoulder girdle (1); between the arms and the torso (2) and between the legs and pelvis (3) is, at the very least, very limited and leads to what is called, ‘robotic mono-dimensional movements’.
In healthy individuals, yourself for example, you will observe that your head is segmented from your torso (which allows you to turn the head selectively), your thoracic cavity is segmented from your abdominal cavity (which allows you to turn to the side without moving the pelvis), your legs move independently from each other and from your pelvis(which allows you to walk with balance).
You benefit of what is called multi-dimensional repertoire of gestures.
With time, the child shows movements which are more selective, fluid and controlled. Training then makes more sense as the child with CP is not imprisoned in a mono-block structure anymore.
Next time, I will speak about Spontaneous Weight-bearing vs excessive voluntary effort.
See you soon!
Two dayss ago we discussed the concepts of Robustness (vs Neck and Trunk weakness),
Today, I would like to discuss another essential concept in which the development of your child’s motor skills depend: Vitality and Vigor
Does your child have the energy and vigor to accomplish all the demands that are placed on him/her throughout the day?
‘Hold your head up!’ ‘Straighten up!’ ‘Put one leg in front of the other!’ ‘Watch this video!’ ‘Crawl!’ ‘Go to school!’ ‘Do this… and do that…’ ‘Common, you can do it!’
Let’s have a closer look…
Where do healthy children get their energy resources from?
Good food absorption, digestion, hydration, respiration and sleep… these are the main fuel sources that allow them to respond to physical, intellectual and metabolic energy demands day after day. Once they have used up their energy throughout the day, when they go to bed, there is always a ‘surplus’ of energy left that allows them to grow and remodel throughout the night. Their battery is never totally dead.
What about a child with cerebral palsy?
Food absorption is poorer, hydration is not ideal, respiration is far from optimal and sleep is rarely restorative.
As a result, the child with CP cannot benefit from the same energy resources as his/her peers or siblings. Actually, these deficiencies take a heavy toll on your child’s overall energy and as a result, your child uses at least three times more energy as their peers, to carry out any activity, be it metabolic, intellectual or physical.
3 times more energy!!! Can you appreciate how significant this is?
This means they use 3 times as much energy to breathe, digest, move around and even just to stay seated in their wheelchair!
If commuting to school is a one-hour journey, this corresponds to 3 hours of fatigue for your child with cerebral palsy… just on the way to school!!! The round-trip to school and back creates 6 hours of fatigue every day, just to go to school and stimulation is not even accounted for yet. Would you personally be willing to face the fatigue that comes with commuting 6 hours a day to go to work? Five days a week?
As a result, a child with CP is usually exhausted, out of any ‘surplus’ that would allow him/her the ability to thrive and flourish as any other child.
Stimulation at all cost is not the answer!
It has to be intelligently and strategically planned and applied. Otherwise, you override your child that already has to deal with
metabolic, physical and sensory challenges.
Reinforcing fascia(connective tissues which surround and inter-penetrate all internal organs) improves metabolic functions automatically and spontaneously.
Your child starts breathing better, digesting better and sleeping better. Consequently, their energy level is tripled and interactions with their surroundings therefore improve.
This should be your first objective, regardless of the rehabilitation approach you choose to follow.
Just experiment 2 small changes in your child’s life:
1. Increase relaxation time. Encourage moments of rest, away from noise and confusion; introduce soft music sessions.
2. Double their water intake
With just these two small changes, your child will already feel a difference, be more relaxed and open to his/her environment and to you!
Next time, I will talk about another essential developmental virtue you can develop with your child:
Multi-dimensional repertoire of movement vs robotic mono-dimensional movement
or more simply, the importance of creating independent movement of the head, arms and legs from the torso to expand their repertoire of movement.
Don’t miss it!
It is the ‘spontaneous’ capacity to hold one’s head up and trunk straight in a vertical position.
When I say ‘spontaneous’, I mean that this ability cannot be attained through training, it has to be embedded into your child’s structure. You have certainly observed your child’s strenuous efforts to attain these achievements, which look more like an Olympic accomplishment rather than normal motor functions.
Why is it so difficult for your child to lift the head or sit ‘up’?
Simply because the very canvas embedded in each of us, ensuring proper and spontaneous support, is dramatically weakened in a child with cerebral palsy. Asking your child to ‘hold’ a position, while his/her canvas is not reinforced, goes back to attempting to get a rag doll to stand upright.
Your child bravely appeals to their skeletal muscles to attempt to ‘lift off’, but these muscles aren’t designed to accomplish that function and require lots of energy to activate (just think how tired your muscles get when you lift weights at the gym!)
Weight-bearing should not require any effort!
When our fascias have proper tone, they insure a hydraulic capacity within our bodies that allows us to hold spontaneously hold a specific position.
The problem, in children with cerebral palsy, is that these tissues are weakened and hydraulic capacity is consequently lessened. However, the good news is that fascias can be strengthened through specific and easy to learn techniques.
No more strenuous effort, no more unattainable goals, no more disappointments.
Strengthened fascia creates an improved hydraulic capacity inside your child’s neck and torso, improving the spontaneous and real support of their structure.
Next time, I will be covering the second set of developmental conditions that are realistically attainable:
Vitality and vigor vs vulnerability and fragility
You won’t want to miss it!
Last November, at the Acquired Brain Injury Provincial Conference, organized by the Ontario Brain Injury Association, we had the opportunity to meet Joanne Smith, certified nutritional practitioner and co-author of the book Eat Well, Live Well with Spinal Cord Injury & Other Neurological Conditions. She runs a successful nutrition business, specializing in providing optimal nutritional health for people with disabilities, with special interest in spinal cord injury. Joanne has presented at conferences across Canada.
Her expertise in the disability community comes from her personal experience of living with a spinal cord injury for twenty-five years, as well as her years as host and producer of two national television programs focusing on in-depth stories about Canadians with disabilities, the Gemini award-winning CBC show Moving On and Accessibility in Action.
Joanne’s dedication to raising awareness and improving the lives of Canadians with disabilities led to her receiving the King Clancy Award in 2006, being inducted into the Terry Fox Hall of Fame in 2007 and being honored with the Gabriel Award in 2008.
ABR’s approach piqued her curiosity and she decided to attend our last Thrive and Flourish session in Toronto. She was absolutely thrilled by the experience: ‘Just wanted to let you know that I attended the introductory session yesterday with Marianna and the new parents. It was absolutely fascinating and Marianna is such a wonderful speaker/therapist! …’
We concluded that her nutritional knowledge in the domain would be a fantastic complement to ABR’s trans-fascial approach.
Joanne will be writing a monthly nutritional blog for ABR Americas. Here is what she has to say…
Any parent living with a child with Cerebral Palsy, or any other neurological condition, knows that nutrition has not traditionally played a significant role in their child’s rehabilitation or long term health care. Trying to find accessible facilities or even information that caters to the unique nutritional needs of children with disabilities (the people who in many cases need this form of complimentary and preventative health care the most) is extremely difficult.