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U-Turn Approach to Independent Sitting (El enfoque “Giro de 180º” respecto al sentado independiente)

A mother has asked us to elaborate on what ABR calls the “U-Turn Approach to Independent Sitting”.

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ABR is a technique that addresses weaknesses within the connective tissue skeleton and brings structural improvements to children with muscular skeletal and movement disorders. The following explanation is given in order to create the basis for understanding how these structural improvements translate to improved function.
The child cannot sit independently. What stages does she have to go through to attain independent sitting? How will we be able to mark and to notice the improvements when they start to appear? The speed of transitions from one step to another will depend upon the severity of the child. A mildly affected child will progress through these stages in such a way that the parent may not even notice it. The parents will notice the appearance of more dynamic functions like rolling and crawling and creeping, as well as transitions from one position to another. In the case of a more severe child, these stages will show up more gradually.

In the description given below, sitting is used as an example, but this example could equally be applied to many other movements and functional complexes as well.
What ABR demonstrates repeatedly is that, when the direct road to the achievement of independent sitting is closed for the child, one can take the U-Turn approach and still come to independent sitting.

On the other hand, if the child does not show any spine movement, if the thorax is excessively weak, and the entire body responds as one block in respect to changes in positioning – the child will never learn to sit, regardless of how much training and brain stimulation the child receives.

The U-turn approach describes the functional steps that will show up along the way that lead the child to the attainment of the function of independent sitting.

Normally the problem is analyzed as follows:
If we were to put the child into a sitting position on a stool and go away the child would fall. One could say: “Well her brain is damaged and the brain is sending poor signals to the body. Therefore she cannot sit.” We can try to train her to sit anyways, and this is the basis of most training programs.

But this will not help us to come further. We need to look deeper to find the elements of independent sitting that the child is missing, and then make a strategy as to how to attain them. We can see that she seems to initiate the fall. But, if she initiates a fall she is not able to stop or to brake the fall. Movement in the healthy person is not only constituted of the ability to initiate a movement, but a controlled movement is also made up of the ability to stop or brake the movements in any and every position and at any and (almost) every acceleration.

At the minute, if she starts to fall, she will do this with the accelerated fall. She does not have a simple fall following the gravitational pull, but will fall with increasing velocity. This is due to the fact that when we put her into a sitting position we do this against inherent bodily resistance. This resistance is a result of a combination of factors such as backline spasticity and fascial shortening which are brought into an elongated tension when she is put in sitting position. As soon as the external support is taken away, the tightness along her back re-contracts and returns to the neutral position, making the velocity of her fall accelerate. We can observe the “snap back” reactions.

She is simply unable to brake the fall.

  1. If we want her to improve we need help her to go through several phases.
    The first thing that needs to happen is that she can begin to fall with a simple, floppy and loose fall. This will appear when spasticity and fascial tightness begin to release and is – never the less – a result of connective tissue strengthening and remodeling. This is an improvement, but not yet a functional improvement.
  2. The next step is that she will be able to begin to slow down the fall. She will not yet have achieved the strength needed to brake the fall entirely, but if we – for example – initiate a change of position, the child will begin to show us that she is trying to slow down the fall.
  3. Thereafter the child will move on to having control of the fall in some positions, but not yet in all of them. The child still cannot really sit alone, but if we change the sitting position, the child will not helplessly go into the falling mode, but will be able to stop the fall at some of the positions between being upright and being completely horizontal.
  4. After arriving at this stage, the next really big step is when the child begins to perform the counter balancing movements. A counter balancing movement is a movement that balances out another bodily movement in order to avoid distortion of the body or the loss of balance. We make the stages of counter balancing development visible by initiating a movement through the utilization of one segment – for example the head or the upper trunk or pelvis for this. If the child can start to return part of the body towards the initial position whilst another bodily segment stays or still moves in the counter direction, then the counter balancing movements are starting to appear. In effect all of our changes of positioning and especially walking involve a highly developed complex of counter balancing movements. With respect to a child who has not yet attained free and independent sitting, the achievement of some counter balancing movements show us that the child is getting close to being able to sit without support.

On the way to achieving the counter balancing movements, the child will of course have improved significantly in respect to trunk strength and stability, pelvis positioning, the strength and mobility of the vertebral column as well as to increasing bodily segmentation. The child will begin to show mobility in the upper body that is independent of the movements of the extremities, i.e. arms and legs. The head will have to become independently mobile with respect to the trunk, and the thorax needs to be independently mobile in respect to the abdomen, etc.

In this respect one can understand how the ability to perform segmented movements of bodily parts in respect to each other is essential for the attainment of independent sitting. As long as the different segments – be it head, neck, chest, abdomen, arms or legs – are all fused together as one movement unit, then the possibility for both “braking” a movement and also for the counter balancing movement are not available to the child.

In order to summarize one can say that the child will go through the stages of:
1. A simple and loose fall
2. Slowing down the initiated fall
3. Stopping an initiated fall
4. Counter balancing movements
5. Returning herself to the original position on the way to the attainment of independent sitting.
This describes the “U-Turn” approach that is possible when the progress is otherwise impossible.

 

Diane Vincentz
Director
ABR Denmark Aps

 

(En castellano)

Una madre nos pidió que le expliquemos lo que ABR llama “el enfoque U-Turn para el sentado independiente”.

ABR es una técnica que se ocupa de las debilidades del tejido conectivo en el esqueleto y aporta mejoras estructurales a los niños con trastornos musculoesqueléticos y del movimiento. La explicación siguiente intenta sentar las bases para un correcto entendimiento de cómo las mejoras estructurales se traducen en mejoras de la función.

El niño no puede sentarse de forma independiente. ¿Cuáles son las fases que tiene que pasar para poder sentarse de forma independiente? ¿Cómo vamos a ser capaces darnos cuenta de las mejoras cuando comiencen a aparecer? La velocidad de las transiciones de una etapa a otra dependerá de la gravedad de la situación del niño. Un niño levemente afectado va progresar de tal manera que los padres a lo mejor ni siquiera lo noten. Los padres se darán cuenta de la aparición de funciones más dinámicas como son: rodar, gatear y arrastrarse, así como las transiciones de una posición a otra. En el caso de un niño más grave, estas etapas se mostrarán de forma más gradual.

En la descripción que sigue a continuación, utilizamos el sentarse como un ejemplo, pero este ejemplo podría aplicarse a muchos otros movimientos y funciones complejas.

Lo que ABR demuestra repetidamente es que cuando el camino directo a un sentado independiente está cerrado para el niño, puede usarse el enfoque “U-Turn” (Giro de 180º) y lograrse el sentado de forma independiente.

Por otro lado, si el niño no muestra ningún movimiento en la columna, si el tórax es demasiado débil, y todo el cuerpo responde como un solo bloque con respecto a los cambios de posición – el niño nunca va a aprender a sentarse, independientemente de la cantidad de estimulación cerebral y del entrenamiento que reciba el niño.

El enfoque del “Giro de 180º” describe los pasos funcionales que van a aparecer en el proceso que va a llevar al niño hacia la función de sentado independiente.

Normalmente el problema se analiza como:

Si pusiéramos al niño en posición sentada en un taburete y nos alejáramos, el niño se caería. Podríamos decir: “Bueno, su cerebro está dañado y el cerebro envía señales pobres al cuerpo. Por eso no puede sentarse. ” Podríamos de todas formas intentar entrenarle a sentarse, y esta es la base de la mayoría de los programas de rehabilitación.

Pero esto no nos ayudará a avanzar. Tenemos que mirar más hacia dentro para encontrar los elementos que faltan para que pueda sentarse de forma independiente, y luego planear una estrategia para conseguirlos. Podemos ver que el niño inicia la caída, pero que no es capaz de detenerla o frenarla. El movimiento en una persona sana no se basa solamente en la posibilidad de iniciar un movimiento sino también en la habilidad de detener o frenar los movimientos en cualquier posición y en cualquier aceleración.

Pero, en este momento, si empieza a caer, lo va a hacer con una caída acelerada. No tiene una simple caída siguiendo la fuerza de la gravedad, sino que cae con velocidad creciente. Esto se debe al hecho de que cuando lo ponemos en posición sentada, lo hacemos contra la resistencia inherente de su cuerpo. Esta resistencia es el resultado de una combinación de factores tales como la espasticidad en la espalda y el acortamiento fascial que generan una tensión elongada en posición de sentado. Tan pronto como se elimine el apoyo externo, la tensión a lo largo de la espalda vuelve a la posición neutral causando que la velocidad de su caída acelere. Podemos notar reacciones como de “chasquido”.

El niño es simplemente incapaz de frenar la caída.

Si queremos que se mejore, tenemos que ayudarlo a pasar por varias fases.

  1. Lo primero que tiene que ocurrir es caer con una caída simple, flexible y suelta. Esto aparecerá cuando la espasticidad y la rigidez fascial comienzan a liberarse, y es el resultado del fortalecimiento y de la remodelación del tejido conectivo. Esta ya es una mejora, pero todavía no es una mejora de la función.
  2. El siguiente paso es hacerlo capaz de frenar su caída. Aún ha logrado la fuerza necesaria para frenar la caída del todo, pero si – por ejemplo – iniciamos un cambio en su posición, el niño nos mostrará que está tratando de frenar la caída.
  3. A partir de entonces el niño tendrá control de la caída en algunas posiciones pero todavía no en todas. El niño todavía no puede sentarse independientemente, pero si cambiamos su posición de sentado, el niño no se caerá irremediablemente, sino que será capaz de detener la caída en algunas posiciones entre la vertical y la totalmente horizontal.
  4. Después de llegar a esta etapa, el siguiente paso es muy grande y es cuando el niño comienza a realizar los movimientos de contrabalanceo. Un movimiento de contrabalanceo es un movimiento que equilibra a otro movimiento corporal con el fin de evitar la distorsión del cuerpo o la pérdida del equilibrio. Mostramos las etapas del desarrollo de contrapeso iniciando un movimiento utilizando un segmento – por ejemplo, la cabeza o parte superior del tronco o la pelvis. Si el niño comienza a mover parte del cuerpo hacia la posición inicial mientras que otro segmento del cuerpo permanece quieto o se mueve en sentido contrario, entonces los movimientos de contrabalanceo están comenzando a aparecer. De hecho, todos nuestros cambios de posición, y sobre todo caminar, implican un estado muy desarrollado de los movimientos de contrapeso. Con respecto a un niño que todavía no ha alcanzado un sentado libre e independiente, la realización de algunos movimientos de contrapeso nos muestran que el niño se está acercando a ser capaz de sentarse sin ayuda.

En el camino hacia la consecución de los movimientos de contrapeso, el niño por supuesto mejorará significativamente en la fuerza del tronco y su estabilidad, en la posición pélvica, en la fuerza y la movilidad de la columna vertebral, así como va aumentar la segmentación corporal. El niño empezará a mostrar movilidad en la parte superior del cuerpo independiente de los movimientos de las extremidades, es decir, brazos y piernas. La cabeza tendrá que lograr una movilidad independiente del tronco y el tórax tiene que tener una movilidad independiente con respecto al abdomen, etc.

En este sentido, se puede notar como la capacidad de realizar movimientos segmentados de unas partes del cuerpo con respecto a los demás es esencial para conseguir un sentado independiente. Mientras que los distintos segmentos – la cabeza, cuello, pecho, abdomen, brazos o piernas – estén fusionados y se muevan como una unidad, la posibilidad tanto de “frenado” del movimiento como de un movimiento de contrabalanceo no estárn disponibles para el niño.

Para resumir, se puede decir que el niño tiene que pasar por las etapas de:

  1. Una caída simple y suave
  2. Disminuir la velocidad de la caída iniciada
  3. Conseguir parar la caída comenzada
  4. Movimientos de contrabalanceo
  5. Volver a sí mismo a la posición original

en su camino hacia el logro de sentarse de forma independiente.

Esto describe el enfoque “U-Turn” (Giro 180º), con las que el progreso es posible cuando de otras formas es imposible.

El agua y la hidratación.

water 1

Estamos en verano y disfrutamos con el buen tiempo. Al igual que es fantástico para un niño con una lesión cerebral experimentar los rayos del sol en su piel y estar en la calle sin llevar ropa extra, esta época del año nos trae retos adicionales si los padres no estamos atentos.

El post que sigue no solo es importante en el verano, pero quizás es una de las piezas de información más importantes para cuidar adecuadamente de vuestro hijo con PC. ¡Y puede implementarse inmediatamente!

Los padres de miles de niños con lesión cerebral nos dicen constantemente: “al niño no le gusta beber, y sobre todo no le gusta beber agua”.

Para un evaluador ABR que hace las evaluaciones de los niños, esto no es en absoluto una sorpresa. Incluso nos entretiene escuchar las historias de cómo los padres se las ingenian para que sus hijos beban algo en el día, pero pocos padres han conseguido desarrollar unas rutinas de hidratación exitosas. Desafortunadamente, la mayoría de padres se adaptan al nivel de sed de su hijo.

Pero el tema principal que los padres de un niño con PC tienen que tener en mente s que una vez que el cuerpo de su hijo está deshidratado, ya no siente la sed. Así que es increíblemente importante para la toma de agua y la hidratación, que los padres no sientan la tentación de “seguir al niño”. La mayoría de padres simplemente lo hacen y es por supuesto algo normal. Estos niños tienen tantos problemas que la negativa a beber parece algo sin importancia. Pero, especialmente por la hidratación, ¡los padres tienen que saber que ellos saben más, mucho más, que su hijo! Solo los padres pueden regular la toma de agua de su hijo y especialmente para uno que ciertamente ya está deshidratado.

water 2El agua es el origen de toda la vida y posee cualidades dinámicas

Los padres tienen que saber y recordar que el agua y los flujos de líquido son la base de todos los procesos vitales que ocurren en su hijo. Al mismo tiempo, una pequeña deshidratación tiene un efecto cascada enorme sobre la totalidad del sistema corporal de su hijo.

  • Cuando ocurre la deshidratación y se reduce el volumen global de agua en el cuerpo, esto produce una reducción del volumen sanguíneo central y por lo tanto también en el fluido de sangre a nivel de la piel.
  • La disminución del volumen sanguíneo causa entonces un incremento compensatorio en el ritmo cardíaco, que provoca a su vez una disminución en el volumen sistólico (la cantidad de sangre que expulsa el corazón). Esto se debe al incremento de ritmo cardiaco y al menor tiempo de rellenado que tiene el corazón.
  • ¡Recuerda el incremento en el ritmo cardiaco! Muchos niños con PC tienen taquicardias. Antes de darle medicación para esta situación, ¡intenta incrementar el nivel de hidratación!

El agua es esencial para todos los procesos vitales. Es importante darse cuenta  de que el flujo de los fluidos entre los tejidos y el flujo capilar es la estimulación de los tejidos esencial para la regeneración y renovación de los tejidos. Este movimiento de intercambio de fluidos tiene un efecto remodelador sobre los tejidos. Cuando los tejidos se secan y se reducen los conductos para el flujo de sangre capilar, entonces los tejidos van a verse empujados a un lento y continuo proceso de degeneración. Para un niño con desórdenes en el movimiento, la reducción sistemática del fluido en los tejidos es uno de los factores principales que reducen su desempeño general. ¡También es responsable del incremento de la tensión en las articulaciones y de la espasticidad!

Ya hemos escrito suficiente sobre la importancia de tomar agua. Podríamos continuar con muchos más aspectos, pero los padres y cuidadores deben ser capaces de ver la conexión entre la toma suficiente de agua y el desarrollo y la salud de su propio hijo.

Algunos signos de deshidratación son fáciles de reconocer:

  • El color de la orina es el más significativo. En vez de ser de un amarillo verdoso, se vuelve de un brillante amarillo anaranjado, o incluso peor de un marron amarillento. Cuando el color de la orina está en este rango, es un signo claro de que el niño ha bebido muy poco. Si es niño está usando pañales desechables, puede ser complicado discernir el color. Aquí los padres tienen que ser creativos y quizás utilizar un pañal de tela para ver el color.
  • El olor de la orina – si huele es un signo de deshidratación.
  • Si el niño huele mal (y muchos niños con PC tienen mal olor) – esto tampoco es una buena señal. Los niños sanos correctamente hidratados no huelen.
  • Mareos y dolores de cabeza. Muchos niños no pueden expresarnos estos temas, pero seguro que tienen estos síntomas
  • Confusión
  • Piel seca, brillante o fina como una hoja de papel en la que pueden verse claramente el color azulado de las venas.

 Por otro lado, si uno consigue un poco de diligencia en que el niño beba, el resultado de lo que puede verse como una batalla puede ilustrarse con uno de nuestros niños de Hungría.

Los padres trajeron su hija a una de nuestras largas pre-evaluaciones y encontramos que la niña no bebía prácticamente nada. Además, la niña tenía otros problemas como:

  • Somnolencia
  • Masticado y tragado – les llevaba medio día hacer que terminara sus comidas.
  • Beber
  • Estreñimiento
  • Reflujo
  • Crisis
  • Cambios repentinos de humor
  • Cansancio
  • Problemas de atención, etc

Seis semanas después, nos volvimos a encontrar para una evaluación ABR completa antes de que iniciaran la formación en ABR. En esta reunión, descubirmos que la madre se había tomado muy en serio nuestras recomendaciones respecto a beber y había intentado incrementar la toma de agua al menos a un litro por día para una niña pequeña. Lo más sorprendente de todo fue la larga lista de mejoras que los padres nos dijeron aparecieron espontáneamente durante esas cortas semanas simplemente incrementando la toma de agua.

  • La niña empezó a dormir por las noches.
  • El estreñimiento desapareció.
  • Se redujo significativamente el reflujo
  • La niña empezó a poder tragar y masticar casi normalmente. El tiempo necesario para las comidas se redujo a un tiempo “normal” en el que la niña terminaba a la vez que los padres.
  • Se redujeron el nivel de las crisis y casi desaparecieron.
  • Mejoró su función motora
  • Mejoró la producción de sonidos
  • Empezó a intentar comunicarse.

Esta historia ilustra la importancia extrema de una buena hidratación para un niño con parálisis cerebral.

¡Los padres tienen que prestar atención a la hidratación en todo momento! No debe haber ni un solo día en que su hijo no tenga lo suficiente para beber.

Si el niño está deshidratado por mucho tiempo – y este es el caso de la mayoría de los niños con lesión cerebral – no podemos esperar que la sed aparezca. Las células en el cuerpo se han acostumbrado a un intercambio de líquidos mínimo. Va a llevar su tiempo el que el agua introducida empiece a moverse consistentemente por todo el sistema – ¡pero no abandonéis!

Tenéis que ser consistentes y desarrollar una estrategia.

Algunos métodos que funcionan son:

  1. Ofrecer los líquidos al menos cada media hora. De esta forma, el niño se acostumbra a tener líquido en su cuerpo.
  2. Si hay problemas en conseguir que el niño tome líquidos por la boca, probad usando variaciones de botellas, tazas, jeringuillas o incluso sprays al principio.
  3. Si el niño se niega a beber, pobad a usar una jeringuilla y descubrid dónde poner el agua en la boca para que el niño no se atragante y pueda beberlo. O usad un bote de sprays y simplemente echad el spray con agua en su boca.
  4. Tened un objetivo realista de cuanto incrementar la toma de líquidos semana tras semana. Incrementad en aproximadamente 100ml cada semana hasta llegar a la toma de agua diaria deseada.
  5. El sabor puede ser importante. Si el agua tiene algo de sabor, el estómago reaccionará inmediatamente facilitando la ingesta. Si el niño simplemente rehusa beber agua, añadid un poco de zumo no azucarado o caldo. El sabor puede ser importante para ayudar el tragado del agua y puede ser necesario al principio añadir algo de sabor.
  6. Hay muchos alimentos saludables que pueden usarse como espesantes si todo lo demás no sirve. Esto ayuda a que el niño que tenga muchos problemas para tragar agua pueda tomar los líquidos cuando entran en la boca. Agar agar, Psyllium, semillas de chía… pueden usarse como agentes espesantes del agua. También el arrurruz. No recomendamos la goma xantana, ya que es un aditivo industrializado (podéis leer aquí – en inglés: https://draxe.com/what-is-xanthan-gum/)

Diane Vincentz
ABR Denmark
Director

Water and Hydration

water 1.jpg

It is Summer time now and we enjoy basking in the warmth!  As lovely as it is for the brain injured child to experience the warmth of the Sun on his or her skin and to be outside without extra clothing – this time of year can present even extra challenges if the parents are not attentive!

The post below is not only important in the Summer but it may be one of the most important piece of information that you need for the optimal care of your CP child.  It can be immediately implemented as well.

The parents of thousands of children with brain damage have told us:  The child does not like to drink – and especially not water.

For the ABR Accessors who do the children’s evaluations – this is not a surprise.  Moreover the “song and dance” routines that some mothers and fathers have thought out in order to try to get their children to drink anything at all can be very amusing to hear – but it is not the main proportion of the parents who have developed these hydration routines with success. Unfortunately most parents will tend settle at the thirst level of the child.

The main thing that parents of a brain injured child need to keep in mind, is that once the child’s body is dehydrated, he or she does not feel thirst. So it is incredibly important that in respect to water intake and hydration, the parents do not feel inclined to “follow the child”!  Most parents will simply do this – and this is of course natural.  These children have so many problems and the refusal to drink seems to be rather small one in respect to the other difficulties on hand.  But especially in the case of hydration, the parent has to know that he or she knows best – and much better than the child!  Only the parent can regulate the intake of water for a child and especially for one who is certainly already dehydrated.

water 2.jpg

Water is the foundation for all life and it possesses dynamic qualities!

The parent needs to know and remember that water and liquid flow is the basis for all of the life processes taking part in the child.  At the same time, even a slight dehydration has an enormous cascade effect upon the entire bodily system!

  • When dehydration occurs and the overall water volume in the body is reduced: this then results in a reduction in the central blood volume and, therefore also in skin blood flow!
  • The decrease in the blood volume then causes a compensatory increase in the heart rate, which is then again followed by a decrease in stroke volume. This is due to the increased heart rate and decreased filling time for the heart!
  • Remember that the heart beat rate increases! Many children with CP have tachycardia. Before giving the child pharmaceutical drugs for this condition – try to bring up the hydration level!

Water is essential for all of the life processes.  It is important to realize that the flow of the fluids within the tissues together with the capillary flow is the essential tissue stimulation required for all tissue regeneration and tissue renewal.  This fluid exchange movement known as “liquid shear” has a positive remodelling effect upon the tissues.  When the tissues dry out and the pathways for the more capillary located blood flow decrease, then the tissues will of necessity be locked into a process of slow and steady degeneration.  For a children with movement disorders the systemic reduction of tissue fluids is one of the leading factors which reduces the child’s general performance.  It is also responsible for an increase in joint stiffness and spasticity!

Enough written about the importance of water intake!   We could continue with many more aspects but the parents and caretakers should be able to see the connections between sufficient water intake and their own child’s health and development.

Some of the signs of dehydration that are easy to recognize are as follows:

  • The colour of the urine is the most significant sign. Instead of being a light greenish yellow, it becomes bright orange yellow or worse yet dark yellowish amber brown.  When the colour of the urine is in this range it is a sign that the child has much too little to drink.  If the child is using disposable nappies, it may be difficult to discern the colour.  Here also the parent needs to be creative and perhaps use a cloth nappy in order to see the colour.
  • Odour of the urine – if it smells this is a sign of dehydration
  • If the child smells badly (and many children with CP have a bad smell) – this is also not a good sign! Healthy hydrated children do not smell.
  • Dizziness and headaches. Most children will not be able to express anything about this, but they may certainly being having these symptoms.
  • Confusion
  • Dry skin, brittle skin or paper thin skin where one can easily see the bluish colour of veins

On the other hand, if one can achieve some diligence in getting the child to drink, the success of what may seem like a bagatelle can be shown in an interesting example of a child from Hungary.  The parents came with the child to a long pre-assessment where we found out that the child drank almost nothing at all.  In addition the girl had problems with:

  • sleeplessness
  • chewing and swallowing – it took half the day to give the child her meals
  • drinking
  • seizures
  • mood swings
  • restlessness
  • attentiveness problems

Six weeks later we met for a further assessment before the family started with the ABR training.  At this meeting we found out that the mother had taken the recommendations we had given her to take the drinking seriously and had tried to increase the water intake up to at least one liter per day for a child of her small size.  The mother was fortunately able to get the girl to drink consistently.  Most amazing however was the long list of improvements that the parents told us about that had came about spontaneously during these short weeks simply through increasing the water intake!

  • The child started sleeping through the nights.
  • Constipation was relieved.
  • She was much less restless during the day as well.
  • The child began to be able to swallow and to chew almost normally!. The time taken for the meals was down to a normal time for a meal so that the child is now finished eating together with the parents.
  • The seizure level decreased significantly and seizures almost disappeared.
  • Motor function improvements
  • Sound production
  • Communication efforts

This story illustrates the extreme importance of good hydration for children with cerebral palsy.

The parents need to be encouraged to pay attention to hydration at all times!  Not one day should go by when the child has too little to drink.

If the child has been dehydrated for a long time – and this is the case of most children with brain injury – then it cannot be expected that thirst will simply be present.  The cells within the body have been used to a minimal liquid exchange.  It will take time for the introduced water to begin to move consistently through the system – but do not give up!

You need to be consistent and will also need to develop a strategy.

Some of the methods that work are:

  1. Offer the liquids at least once each half an hour.  In this way the child will become used to having liquids in his body.
  2. If there are issues with getting the fluids into the child’s mouth, try using a variety of cups, bottles, syringes or even spray bottles at first.
  3. If the child refuses to drink, try using a syringe and find out where to bring the water into the mouth so that the child does not choke but can swallow it. Or use even a spray bottle and simply spray the water into the child’s mouth.
  4. Make a realistic goal for increasing the liquid intake on a week-to-week basis. Increase by ca. 100 ml each week until one achieves the wished for daily water intake.
  5. Taste can be important. If the water has some taste then the stomach will automatically react in such a way as to facilitate swallowing.  If the child simply refuses the water, then add a bit of non-sweetened juice or some soup broth.  Taste can be important assistant in swallowing and it may be necessary in the beginning to add something that has some taste.
  6. There are several healthy foods that can be used as thickeners if all else fails to work. This helps the child who has much difficulty with the swallowing of water to be able to manage the liquids when they enter the mouth.  Agar, psyllium fiber or chia seeds can all be used as a thickener agent for water. Arrowroot can also be tried.  Xanthan gum is not to be recommended, as it is a more or less engineered food additive. ( read here:  https://draxe.com/what-is-xanthan-gum/)

 

Diane Vincentz
Director
ABR Denmark Aps

Toe Curling Crutches – Insight Gleaned From Clients

We were exceedingly pleased when earlier this month several new ABR enthusiasts joined our group in Austria.  Special to this group is however that they are all talkative young men – both walking and in wheel chair.

From these adult individuals we could glean direct from the affected individuals themselves confirmations about many aspects of our basic ABR understanding and principles.

Those of you who have been following my blog for some months will have read the post called Hands and Feet:

https://abrdenmark.wordpress.com/2016/07/15/the-hands-and-feet/

This post is an illustration of the internal necessity for stiff arms/hands and legs/feet in children with cerebral palsy.

In that post, we expounded upon the idea that if any individual has a weak spine, the person will then search for the next best solution available in order to add more stability to his or her body.  If the neck is weak, then one can stabilize the neck by stiffening the arms.  The arms are of course not meant to be used as spine stabilizers.  When they are stiffened continuously in order to add stability to the spine, then they will of course soon “remodel” in a stiffer fashion.  This “stiffening” of the arms is then popularly termed “spasticity”.  One does not need to apply the typical neurological reasoning in order to find the direct cause of spasticity.

This month in Austria when holding the first assessment for a young man with cerebral palsy I asked him:

“Can you try to stand on one foot?”  His answer was nothing less that a direct confirmation of what is written above:

“Yes I can, but I need to curl my toes.”

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Toe curling is a creative way to clench and to stiffen the body in order to add stability!  If I clench my toes, I feel it all the way up to my buttocks and the pelvis but also the lumbar area gets tense!  What geniuses these individuals are!
Their body tells them automatically that they do not have the spine stability needed to be able to stand on one foot, but that if they clench or curl the toes, then they will be able to mobilize more stability to make the standing on one foot possible.  They can
compensate for the lack of the central stability that the vertebral column needs to provide for by stiffening other areas.

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So, Dear Parents:  The ABR message to you is to please stop worrying about the spastic legs and feet and the spastic arms and hands!  Stop fighting with them by stretching them, cutting the tendons and lengthening the muscles, and by injecting them with toxins!  You need to understand that your child needs these spastic feet, legs, arms and hands.  Your child is an amazing genius who has been able to sense and to navigate within his own weaknesses and has been able to find an alternative for what he does not have intrinsically.

That which he or she is missing intrinsically is sufficient stability of the Connective Tissue Based Architecture!  This is the internal support system that we use all the time at a very low cost.  The healthy persons are so used to this internal architecture that we take it 100% for granted, day in and day out.

It is only when we do not have it that we notice:  “I need to curl my toes to stand on one foot.”

And now Dear Parents:  You can all re-assess your child’s movements and manners.  You can begin to see and to understand what is going on.

When your child opens his or her mouth wide each time he/she wants to lift or to move his head:  Now you understand why!  The wide-open mouth brings tension into the neck and the base of the skull and makes it easier for your child to control the head movement.

This is of course not the best way to do things, but this is what your child has figured out how to use.  Your child is not “brain deficient” but exceedingly smart.  If he or she has figured this out, then it is only a matter of diligence of application of ABR Techniques designed to strengthen the central core of the body, of the spine and of the internal connective tissue base that will in turn allow for him to find new strategies for lifting the head.  As soon as the central structures are strengthened internally, your child will not need to use his wide open mouth, or his arm stiffening to support the neck.

Before this internal strengthening is achieved, then any attempts to “loosen up” the arms or legs are not going to lead to positive results.  It is comparable to taking away someone’s crutches when he needs crutches for walking.  No one would do this!  But yet we as parents of Special Needs Children are lead to believe that we need to cut, to inject, to stretch the very structures that our children need as crutches for their own central and internal weaknesses.

As all families, parents and clients soon find out, at ABR we take time to listen.  We listen to your stories, your struggles, your successes, your difficult and intense problems, and your journeys.

Not only do we use the information you give us to shape your ABR Program, to guide you on a day to day basis with respect to general health based insights and suggestions, but we can then let the information flow from parent to parent.  What works for one family, will often work for another family, so there is no reason to keep anything to ourselves?  Each small bit of information can be given further.

This kind of information coming from young adults with cerebral palsy is precious.  It confirms our understanding that we are on the correct path in the promotion of the ABR Techniques and Methods which are all designed to provide for internal intrinsic architectural connective tissue based strength and stability.

Diane Vincentz

ABR Denmark

ABR Grassroots

During the past months we have held many lectures about ABR for new and interested parents around Europe and in Africa.  I begin each of these lectures with the comment and observation that ABR has developed together with children or adults with special needs and their families.

Without these individuals who have been willing and enthusiastic about working with ABR during the last 17 years, ABR would not have entered into existence and would not have developed to the most effective means of addressing brain injury in the world today.  There is no laboratory where ABR is tested – far away from any patients.  There are no biopsies, MRI’s, or Ultra Sound tests fuelling ABR development.

ABR development has happened 100% in the field and this makes it specifically viable as a grass roots movement.

Especially in a world that is so dominated by the modern scientific methods, and the “evidence based” industrial medicine, it is important to remember how necessary the “Hands On” and “Real Life” evaluation of any phenomena is in order to attain the essential information for creating and developing anything new for addressing real life problems.

A cell culture or biopsy, an MRI or CT scanning can never give any information about how a child or an adult with severe muscular skeletal problems can improve, evolve or develop.  For this it is important to go directly to the individuals themselves and do an in-depth and as thorough an evaluation as possible.

We as human beings have amazing sensory abilities:  sight, touch, hearing, smell, taste – but more that the famous five we learned about in school – we have the sense of movement, we have proprioception, interoception, exteroception, nocioception – we can sense a thought, we understand speech, we feel warmth – our senses are amazingly rich and manifold!  How is it possible that mankind has gone so far astray, as to think that any invented apparatus for measuring some of the electrical activity in the brain or some device that is dependant upon magnetic resonance or an ultra sound light spectrum can tell us information that is more important that all we can gather ourselves through our own observation and thinking?  We can of course glean additional information through the use of such devices, but technical devices and laboratories cannot take the place of what the information can gain through our own sensory based facilities for observation.

It is here that ABR developed it’s own foundation.  Where parents and other affected individuals are willing to take the time, observe together with the ABR Assessors and Trainers – seek and find the limitations of the bodies of affected children and adults – and then to go further and to implement the techniques that have emerged based upon the observations of these weaknesses.  ABR Techniques have all developed as means of addressing “real life” and “hands on” tangible weaknesses and disorders.

Long years of application, trial and on the other hand the applied understanding of the emerging Fascia Based Research that has intensified globally during the last 20 years are then the practical results of the ABR Based Observational Methods.

The entire ABR Team is thankful for the hundreds of families around the world who are taking part in this new emerging science and understanding for addressing brain injury, cerebral palsy and other related disorders – based entirely upon observation and thinking and the application of the real-life ABR techniques evolving thereout.

 

A Peek into the World of Advanced Biomechanical Rehabilitation – Building a Bridge Between ABR and Physiotherapy of Children with Cerebral Palsy

Here is a bachelors thesis about ABR written by two physical therapists in Finland. We say thank you to Pipsa and Sini for the permission to post and share their ABR Thesis!  Enjoy the reading and share it further.

A Peek into the World of ABR

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Diane Vincentz
Director
ABR Denmark Aps