How to prepare a kid aged 6 to 11 for prosthetics. Part 2
Special activities to prepare the arm for prosthetics
Here, two blocks can be outlined. Let's start with the simpler first block — massage.
We are often asked whether kids with upper limb disabilities need to be massaged? There is no clear-cut answer to this question, since certain medical procedures can be recommended only after an in-person examination of the kid and a detailed study of the health specifics. A proper body massage cannot cause any harm; however, you must remember that it is not suitable for effective muscle training. This requires active movements.
Nevertheless, we still recommend doing an unassisted arm massage “at home”. Such a massage helps prepare for wearing a prosthesis, decrease the size of the arm by reducing swelling, improve blood supply, and therefore, the growth and “frost resistance” of the limb.
The massage should be done several times a day:
Stroking: lightly stroke with your palms the entire surface of the arm from its lower part to the upper part, twice for 7-10 seconds.
Rubbing: rub the arm gently with your palm until the tissues become slightly warm; this procedure should be not longer than 10 seconds. Repeat the stroking procedure.
Kneading: gently knead the arm with your fingers. The procedure lasts on average 30 seconds; after kneading, be sure to repeat the stroking procedure. The total duration of the kneading is 2-5 minutes. Then, repeat the rubbing procedure.
Vibration: relaxing light patting for 5 to 10 seconds. After that, repeat stroking.
The second block consists of specialised training of the limb muscle strength. This can be combined with physical exercises or perfromed separately — the choice is yours.
Before doing the exercises, you need to warm up. Warm-up exercises may include active rotations of the limbs in all planes, tilting the torso and head forward and backward, right and left, flexing of all joints, etc.
The equipment required is forearm weights and resistance bands (also called rubber bands).
It is important to buy weights in the presence of the kid, since the weight is selected depending on the current state of muscle tissue. The weight have to be tried on — put it on below the elbow bend and make sure that it does not slip off when actively swinging the arm. The kid should feel the weight, which cannot be too heavy, though. It is important that the kid is able to perform 15 active elbow flexions and extensions, feeling mild to moderate fatigue after all repetitions.
Resistance bands are usually sold in sets. Within one set, they vary in the degree of resistance. That is, one rubber band is more difficult to stretch than another. We recommend purchasing the set, since during the training you will be able to determine which band is more comfortable now, and later, in course of the training, you can make the task more difficult by using a tighter band.
Block 1 — physical exercises with weights:
Elbow flexion and extension with a weight — 15 repetitions (with shoulder along the body).
Elbow flexion and extension with a weight — 15 repetitions (with shoulder abducted from the torso at 90 degrees).
Elbow flexion and extension with a weight — 15 repetitions (with shoulder raised vertically upward).
The pace is medium; flexion should be done during inpiration, and extension — during expiration.
Block 2 – exercises with resistance bands (do not require wearing of weights):
Flexion and extension of the most proximal joint with resistance — 15 repetitions.
What does proximal mean? For example, if the kid has a hand, the rubber band is thrown over the palm, and the other end is fixed on any stationary object / held by the mother. The kid needs to bend the hand against the rubber band resistance.
Then, the rubber band is thrown over the back of the hand — the kid needs to bend the hand against the rubber band resistance. After that, we train the elbow joint in the same way.
If the kid does not have a wrist joint, train the elbow joint. The principle is the same: flex and extend the elbow joint against the rubber band resistance.
The pace is medium; flexion should be done during inpiration, and extension — during expiration.
Psychological preparation for prosthetics
For primary and secondary school ages, prosthetics are possible ONLY if the kid so desires. Then, there may be two options. Option 1: the kid, with or without your help, saw the Motorica prostheses and fell in love with them instantly. The kid is imbued with the idea of prosthetics and is eagerly awaiting the day X.
However, this is not always the case. A kid often does not really understand why they need a prosthesis. For example, the kid has lived without it for most of their life, and is completely independent. The kid may also have certain fears associated with the prosthetics procedure. For example, “Mom will make me wear a prosthesis at school, and everyone will stare at me there.” Or, “the prosthesis might squeeze my arm painfully, and I won’t be able to remove it myself.” There are quite a few options. One thing is clear: the unknown frightens the most.
Therefore, the kid must understand what, how, when and why will happen.
How to discuss the potential prosthetics with your kid?
It is important to tell your kid about the prosthesis when the kid is in a good mood. In a world of modern technology and a huge amount of visual information, this is best done by showing the kid photos and videos of other prosthetic users of their age or elder. Motivation schemes are discussed in more details below.
It is important to understand that their attitude towards the upcoming event will be determined by how you and the people who are important to the kid feel about it. So, before talking about a kid's motivation, let's discuss a few other important points.
What is important to understand before the prosthetics
All parents have their own ideas about the prosthesis, their own motivation for using it, and perhaps their own concerns. We would like to highlight some key points that are of great importance, but which, in our experience, are rarely communicated in prosthetic companies.
Today, a prosthesis cannot completely replace a normal hand, but our task is to give the kid the opportunity to get used to it, learn how to use it and choose those activities in which, over time (not immediately), the prosthesis would be comfortable (this is what we described at the beginning of the manual as “regular use for selected activities”).
You might have a question: "If a prosthesis doesn't replace a hand, what is it for?” This situation arises especially often in families with fairly independent kids — “The kid can do everything without a prosthesis. Do we really need prosthetics?” The question is natural and logical. Let's address this aspect in detail.
The prosthesis helps the back muscles to develop correctly. Back posture does matter. Firstly, a straight back is beautiful; secondly, when posture is changed, sooner or later painful sensations arise. It will be difficult for a kid to sit at a school desk or carry a school bag, and there will be limitations in active movement or playing sports. Once a change in posture has already occurred, it is extremely difficult to “unbend” the spine and correct everything. This is why it is important to avoid this situation or to prevent its further development if disorder already exists.
Let's not forget about the arm muscles — the prosthesis can train the muscles, then in the shoulder area one arm will not look thinner than the other.
Surprisingly, the peculiarity of one arm causes changes in the other limb over time. When you refuse to use a prosthesis, all the load falls on the second arm. Because of this, its joints, ligaments and fascia become overloaded. In foreign literature, this is called overuse syndrome — a conditionally “healthy” arm begins to hurt and requires close monitoring, and, most likely, treatment.
A prosthesis is uncommon and stylish. Perhaps, this is not the strongest motivation for you and your kid right now, but over time it may come to the fore.
Prosthetics is currently developing at a tremendous pace — new technologies and solutions are constantly emerging, bank cards and fitbits are already being built into adult and teenage prosthetics, and who knows what lies ahead for us. However, to be able to use the coolest developments of the future, it is important to wear and be able to use the prosthetics of the present. Otherwise, the muscles may not be ready for installation of another type of prosthesis (bionic), and the prosthesis cannot be used.
Simple putting a prosthesis on the arm is not sufficient — it is important to help the kid understand how it works, perform daily exercises, and motivate them in difficult moments. The success of prosthetics depends 50% on the parents, only 25% on the kid and 25% on the prosthetic company. This is especially acute at an early age.
Summary:
A prosthesis is not a full-fledged “ordinary” arm; a prosthesis is about health and access to modern and future technologies.
We hope that the motivation for using a prosthesis has become a little clearer for you, but for a kid, most of these theses would be unimpressive. Few people think about their health at 6 or even 11 years old. However, all kids are different, and no one knows your son or daughter better than you. Therefore, the choice of how best to present the prosthesis to the kid is up to you. For our part, we can offer several possible options.
For those who value opportunities and new skills.
Tell your kid what they will be able to do with a prosthesis — for example, to ride a bike or scooter much faster. Tell about the prosthesis attachments (you can find out more about them from the Motorica managers). You know what your kid dreams about, what they would like to do better — use this knowledge! Explain that all the activities the kid chooses to do with the prosthesis will definitely work, but training is essential. You will be there and will definitely help.
For those who are especially concerned about appearance and visual components.
Focus on the product appearance: "The prosthesis can be whatever you imagine." Suggest thinking about how the prosthesis will look — what color is it, is a drawing needed, or maybe some kind of inscription should be printed on the prosthesis?
For especially thoughtful children.
Be sure to tell us how the prosthesis affects the posture and muscles. Explain that the doctor has advised wearing such a device so that the muscles are strong, the back is straight, and the arms at the shoulders look the same. For older children, explain in more detail how exactly these processes occur.
For dreamers and “people of the future”.
Dream together about what the prosthesis will look like in 10 or 20 years. What will they be made of, what can they be used for, what “super-powers” will they give? It is important for us to reach the point where all these developments would be available to those who learn to use prosthetics now, since prostheses of the future will definitely be more complex and will require strong muscles and strong skills.
For "young stars".
If your kid loves being the center of attention, explain that the prosthesis is a point of attraction for other people. Nowadays, it is becoming more and more fashionable to be different. Users of our prostheses are invited to fashion shows, to film music videos, and to pre-premiere screenings of cartoons and films. Further, many of our users have established themselves as YouTube, TikTok and Instagram bloggers (Motorica managers can tell you the contact details of our stars). The prosthesis is their highlight. Perhaps, your kid will also be interested in this “star” life.
What to do if your kid refuses a prosthesis?
First of all, you need to try to understand why this is happening. What confuses or scares the kid? Perhaps, we chose the wrong arguments and they simply didn't impress the kid? Ask them straight out. Frequently children themselves tell why they don’t want a prosthesis. This is the easiest thing to work with.
In our experience, one of the most common reasons is the fear of how peers would perceive the prosthesis. Explain that it is not necessary to wear a prosthesis at school or outside from the very first day. Let’s start with getting to know it at home, learning how to use it, and only then will we decide whether to wear it at school or not. There will be no compulsion.
Another possible reason is “I don’t need a prosthesis, and I’m fine without it.” In this situation, go back to the previous paragraph and use the arguments that you did not use before. You may resort to doctors, our full-time rehabilitation specialist Alina Kuzyakina, or adults who are valuable for the kid.
If the kid or despite your straight questions does not pronounce the reasons for the refusal, do not insist too much, take a break, observe and think about what the problem might be. We are here for you and ready to help — together to find the reason for such behavior and figure out how to properly motivate the kid.
What else would be good to consider?
Try not to mention the prosthesis when your kid is having trouble with something or is upset. It is not necessarily right that information about the prosthesis could lift their mood, and we don’t want associations with bad emotions.
Do not overdo it! Be proactive in responsiveness to your kid's desire to discuss the prosthesis, but don't push the topic too often. It is not our goal to tear the kid away from their usual way of life and usual games or activities.
Immediately 1-2 weeks before the prosthetics, it is necessary to “become active” again and remind where you are going and why. The best thing to do is to make a holiday out of your trip to get a prosthesis — on the way back or on the next day to stop by the zoo/amusement park/cinema or cafe. It is better to discuss the plan for the “festive” day immediately before the trip, so that the kid does not have time to “burn out” on the idea.
Be sure to tell your kid in advance how exactly the prosthesis will be installed. You can use phrases like: “The prosthesis consists of two parts — external and internal. It was the outer part that you and I came up with, and it is what was visible in all the photos and videos. It is created on a computer according to our design and printed on a 3D printer. By the time we arrive for prosthetics, it will be ready. The inner part of the prosthesis is called the sleeve. The sleeve fits tightly on the arm, like a glove. It will be molded on site from warm plastic to the shape of your arm. It is very important that you tell how your arm feels in the sleeve – is it comfortable or is it pinching somewhere. Because no one can feel it for you. Please, tell me about even the slightest inconvenience. The sleeve will then be inserted into the prosthesis and you will be able to try to grab something. At first it won’t be easy; you’ll need to get used to the prosthesis. However, everything will definitely work out with time."
Who can help prepare for prosthetics?
If you have the time and opportunity, during preparation for prosthetics you can call on resources of a rehabilitation center, both public and private. These centers can provide a comprehensive health assessment of the kid and select exercises to develop those aspects, which are required for prosthetics specifically for your kid.
At your first meeting with a rehabilitation specialist, tell them that you are preparing for prosthetics and that therefore you would like to focus on creation of sufficient strength in the arm muscles and sufficient range of motion, expansion and improvement of the kid’s existing abilities for self-care and use of the arm in everyday life, development of coordination skills and improvement of the posture.
A modern rehabilitation team necessarily includes a psychologist and an ergotherapist. A psychologist is able to more thoroughly prepare a family for prosthetics, understand hidden fears, teach how to respond correctly to uncomfortable questions, and to tell you how to properly motivate a kid to use a prosthesis. When a limb is lost as a result of injury or surgery, working with a psychologist often comes to the forefront. Keep in mind that if you cannot find a suitable specialist in your location, you can consider the possibility of remote sessions. Nowadays, they are quite accessible and effective. A psychologist can work immediately with your kid or with you to find the right communication strategy.
An ergotherapist is a specialist whose work is aimed at maximizing a person’s adaptation to the environment, taking into account preserved functions, and at developing hand motor skills. The kid is able to prepare the hand for prosthetics, and later teach how to use the prosthesis, and select special devices to enhance the kid’s abilities. The term “ergotherapist” is new for our country; these specialists are few in number. If you cannot find an ergotherapist, you can try to resort to a speech therapist or an occupational therapist/social adaptation specialist.
In addition, the Motorica company has its own team of doctors who are always ready to provide assistance, develop an individual programme for getting used to the prosthesis, and discuss all aspects that concern you. We are as open as possible to communication with specialists who work with your kid in person, and are ready to answer all questions and consider possible wishes. Please contact Alina Kuzyakina, the doctor of rehabilitation medicine, without hesitation. Alina studied rehabilitation in Canada and can suggest modern and effective methods of rehabilitation for upper limb prosthetics.
Checklist of readiness for prosthetics
О Your kid's daily routine includes regular home gymnastics/exercises, massage and upper limb training.
О The kid tries to use both hands in everyday activities.
О The kid wants to get a prosthesis or at least agrees to prosthetics.
О You have the right expectations — you understand that a prosthesis is important for health, but it cannot replace a hand yet.
О The kid understands how the prosthesis is installed.
О You are prepared to work with your kid at home, because without home training it is very difficult to get used to and adapt to a prosthesis.
О You have written down the contacts of Motorica, and you remember that for any questions related to the prosthesis and getting used to it, our medical team is ready to help.
Yay! The prosthesis is installed!
Let's discuss how to help your kid get used to it.
How long should your kid wear a prosthesis?
It is important to make using your prosthesis a habit, just like washing your hands before eating or brushing your teeth before going to bed; so, wear the prosthesis regularly. At first, the optimal regime is 20–30 minutes daily. Gradually, the usage time of the prosthesis should be increased, for example, by 5–10 minutes a day.
When to wear a prosthesis?
If the kid does not show initiative, suggest it yourself — it is best when the kid is not tired, is in a good, even mood and is ready to learn new things.
What can a prosthesis do?
There is no universal recommendation on what to do while using a prosthesis. The main principle for the first time is to do what the kid loves. It is important that they look forward to putting on the prosthesis. In the first weeks after prosthetics, this may not necessarily be related to the prosthesis function — if the kid now likes to ride a scooter the most, let the kid ride it. At this time, the prosthesis is still on the arm, and the kid psychologically adapts and physically gets used to the new weight. In our experience, magnetic meccano toys work well. The general rule is that it is easier to pick up large objects at first, and only then learn to pick up small ones. When explaining to your kid how to pick up small objects, tell them to “aim” so that the object is between the thumb and index finger. Larger objects are placed inside the palm.
For creative and goal-oriented parents, we have prepared a whole set of games and activities with the prosthesis. It consists of science lab games. For older kids, our bloggers made a more complicated programme. Motorica managers can help you find both options.
When should I suggest putting the prosthesis off?
It is better to put off the prosthesis before the kid gets tired, because when attention decreases, it becomes more difficult to pick up and hold objects, and failures cause irritation. Therefore, it is optimal to finish at the moment of success and switch the kid to another activity, having put off the prosthesis. It is important for us that the kid anticipates the moment when the kid put on the prosthesis rather than when the kid puts it off.
In addition, the arm in the prosthesis may swell slightly for 2-3 weeks after prosthetics. This situation is normal, as the body needs to get used to the new load. Pay your attention (on the contrary, do not focus the kid’s attention on this) to whether there is any redness on the arm. Light marks from the prosthesis do not require special attention. However, in no case the kid should feel pain, and there should be no abrasions or blisters. If such a problem occurs, please contact Motorica and we will decide together what is the best course of action.
Are there any special periods in getting used to the prosthesis?
As a rule, children are enthusiastic about prosthetics. In the first days or 1-2 weeks after receiving the prosthesis, parents often ask themselves: “Why did we read so many recommendations,if it's all so simple?” The fact is that in childhood, a kid perceives the prosthesis as a new, interesting and bright toy, and this is exactly what we were striving for when creating it. However, there is one downside: a kid may get bored with any toy. Here we come to the crisis of the first weeks. After one, two or sometimes three weeks, the kid is already satiated with new impressions with the prosthesis, but the habit of using it has not been formed yet. It is often during this period that the prosthesis is laid on the shelf.
Now, everything is in our hands — it is important to support the kid’s motivation. For example, the kid may be awarded with points for each time a prosthesis is put on or a task is successfully completed. They can spend their points on a purchase or a nice bonus — the kid can eat ice cream instead of porridge for breakfast, go to bed 30 minutes later, or go to the cinema on the weekend. You can make a huge table for your kid with “prices” for each option, and let them look at it and choose how to spend the points the kid has been awarded with.
What other crises exist in the use of prosthesis?
In addition to the crisis of the first weeks described above, seasonal difficulties can be distinguished as well. They are especially acute in winter, since in the cold period the use of a prosthesis is often associated with certain specifics. Let's look at the most common ones.
The prosthesis does not fit through the sleeves of outerwear. Indeed, most manufacturers strive to make the sleeves of their jackets as narrow as possible so that the wind does not blow inside the clothing. This makes wearing the prosthesis much more difficult.
Our first recommendation is to try putting an ordinary plastic bag over the prosthesis when putting on outerwear. Later, when the hand has already passed through the sleeve, the bag can be pulled out and removed. This simple life hack will improve sliding and facilitate the movement of the prosthesis in the sleeve. An alternative option is suitable for needlewomen — you may sew a zipper or clasp into the sleeve. Regular folks who do not have a sewing machine or special skills can turn to a tailor shop. Although, the easiest way for the future is to try on new clothes with the prosthesis immediately when buying them, and choose depending on how easy it is to put on the prosthesis.
The arm with the prosthesis gets colder. It is important to understand that the blood flow and innervation (location of nerves) in an arm requiring prosthetics are usually different from those in a conditionally healthy hand. This is why one hand often gets colder than the other. In our experience, the prosthesis does not make this situation worse. However, if your kid feels discomfort in cold weather, remember that you can also put a mitten or glove on the prosthesis.
Concerns that snow will get on the prosthesis. This is not critical — the superhero's hand can withstand even worse things!
What to do during the crisis of the first weeks, seasonal or any other crisis?
The answer is simple — call Motorica and we will help.
Is it worth wearing a prosthesis at school?
Definitely wear it!
This question is often difficult for parents. We often hear: "We love our prosthesis so much and don't want it to get broken at school."
Let's compare — what is more important for you as parents — the health and comfort of the kid or the integrity of the product? Seemingly, the answer is obvious.
Prostheses are breakable — a kid can fall on them, other kids can step on them, some internal parts can fail, but this is normal. Kids fall on their own limbs, sometimes breaking something, but this is not a reason to forbid them from going outside or playing with other children. We are ready to repair the prosthesis, and in most cases it is absolutely free. The only thing you lose in this situation is the time that the kid does not wear the prosthesis while it is being repaired.
Please tell your kid that the kid needs to treat their prosthesis with care — “If you put it off, place it in your backpack/give it to your class teacher. However, if something breaks, we won’t be upset or scold you — the prosthesis can be repaired.”
Another difficulty is that “At school, they are already used to the kid without a prosthesis, and we don’t want to attract unnecessary attention.”
Due to the peculiarity of their hands, our kids inevitably attract increased attention, and our task is to develop the correct attitude towards this in them and in ourselves. Let's start doing this now.
Here are some simple steps to help your kid get used to wearing a prosthesis at school.
The kid may wear the prosthesis at school after the kid has finally gotten used to it at home and has expressed a desire to take the device to school. Once the kid has gotten comfortable with the prosthesis at home, before wearing the prosthesis at school you have to check how the kid copes with all the activities that await them there, and only then send the kid on a “big voyage”. Think about the course of actions for the kid — for example, you take the kid to school. The first thing the kid does is taking their jacket off and changing their shoes. Decide how it is more convenient to do this — with or without the prosthesis, and rehearse all the activities at home in a playful way. For example, if your kid has to carry a tray of food for lunch at school, set up an obstacle course at home and have your kid go through it with a tray of marbles, trying not to lose them. Often children are immediately “eager to get into action” and on the very first day they want to take the prosthesis to school and show it to their friends. We suggest assent to the kid’s request and let them bring the prosthesis to school. However, warn the kid that it is better to just show it to friends for now, but not to wear the prosthesis for the whole day. It is important to give the arm a rest, otherwise swelling may occur “out of habit”, and the prosthesis would be difficult to put off. Teachers should be advised that if a kid removes a prosthesis, the kid should not be forced to put it back on; it is their own choice when to use it.
If your kid likes to be the center of attention, suggest that they have a small celebration at school during a homeroom in honor of the appearance of the prosthesis — treat the children to something tasty, tell them how the prosthesis has been made, let the kid demonstrate what the kid can do with the prosthesis (certainly, you need to prepare for this at home in advance). If the kid does not like to be the center of attention, it is worth coming to school with them and trying to tell the children about the prosthesis in as much detail as possible, and answer all their questions. Then your kid will get fewer questions, but you need to understand that they will be asked anyway.
Attention! You should come with your kids to school only if they desire so. Many older kids strive for independence, and the arrival of their parents may humiliate them.
In case of difficult relationships at school, we have prepared special tolerance lessons for classmates or the entire school — you can get them from Motorica managers.
You can also prepare your kid for a temporary increase in attention. For younger children, you can prepare for questions in the following way. Request your kid to imagine that their friend has brought to school a remote-controlled helicopter/new tablet (or any other desirable and rare item at school). Tell them what you would like to ask about the helicopter. Then, invite your kid to ask questions. After that, play the same game with the prosthesis: “We all know that you have something unusual and bright. Do you remember how many questions we had when we saw it? The kids at school will be very interested too, and will ask questions — just like we did with the helicopter. Let's imagine what they might ask — you ask, I answer, and then we can switch.” In this way, you may not only prepare your kid for the attention of the peers, but also find out what worries them and what the kid may be embarrassed to ask about. The kid should understand that the kid is not required to answer all the questions. If there are too many questions or one of them is somewhat embarrassing, the kid may say plainly: “I don't want to answer this question, I don't like talking about it.” All people have their own boundaries and if someone enters their private space, the kid has the full right to shove out — first in a polite manner. So, if you like it, then answer or make it known if otherwise.
With older children, you can talk about personal boundaries, how to set them, and what to do if they are breached. We will not go into further details on this topic, as it is quite multifaceted, and is not the subject of our tutorial. A lot of materials about boundaries can be found now on the Internet. You can watch a film or TV series on this topic together to strengthen this knowledge. You can also call on a psychologist to help you in controversial situations.
When to call Motorica?
All kids are so different, and it is simply impossible to foresee everything — that is why we always try to work individually and be close to the family throughout the entire period of using the prosthesis.
Please contact us if:
The kid does not want to receive or wear a prosthesis;
You don't know how to learn anything with a prosthesis or what to do when your kid wears a prosthesis;
The prosthesis causes discomfort (squeezes, rubs) or pain to the kid;
The prosthesis is broken;
You don’t know how and when to wear a prosthesis at school; and
You have any questions or suggestions.
Instead of a conclusion
Dear parents, in this tutorial we have tried to include the knowledge you need to get acquainted with the prosthesis. We hope this information was useful. Certainly, we can talk endlessly about prostheses, our wonderful strong and smart kids, developmental psychology and adaptation to a prosthesis — this topic is incredibly interesting. However, we understand that parents' time is a very valuable resource and finding time to study even more extensive material can be difficult. So, with this we say goodbye. Please remember that we are close by and ready to help in word or deed.
Good luck, dear parents! We look forward to meeting you and your kid!