World of prosthetics and rehabilitation for the youngest of kids. Part 2

We know from experience that children often have different relationships with their prostheses. Some people find the prosthesis heavy at first, while others barely notice the new weight. Some kids wear their prostheses every day and always wear them to kindergarten, while others use them once a week and only for 15 minutes.

There are many factors influencing the frequency of using a prosthesis, and one of them is preparation for prosthetics. Let's formulate global training goals.

We try to make our prostheses as light as possible; nevertheless, a prosthesis for a kid’s arm is an additional and unusual weight. In order for the arm to get tired less, move better with the prosthesis, and for the kid to be less capricious, the muscles need to be prepared for the future load, and their strength needs to be trained. In some cases, it is also necessary to work on increasing range (scope) of motion in joints. However, we warn about such cases individually and always select a set of special exercises.

We hope that the kid is already used to dealing with their special health conditions and is practically on par with its peers in terms of self-care. Certainly, their movements are not perfect, and sometimes it is difficult for you to resist doing something for them. But this is quite natural for this age. The situations that really worry us are when the kid is completely unable to cope with normal tasks of their age without your help, in other words, the kid is completely dependent on you in all aspects of life. This situation is dangerous because the child internally feels some kind of inferiority and becomes completely accustomed to your role in life. It would be very difficult to encourage them to start doing something with the prosthesis, because the kid is simply not used to doing anything independently. Now is the time to amend it, even if it concerns very simple things, from your point of view.

There are many examples showing that children and adults who have been involved in sports requiring good coordination (for example, gymnastics) and then lost a limb, learn to use a prosthesis much faster. They feel much more confident than their peers without sports experience. What does this mean for us? The better a kid feels the body as a whole and the better they can control it, the easier the kid would be able to adapt to the new device.

For good arm movements, the kid's body must be very stable. A strong body is the foundation underlying all our movements.

Perhaps, this paragraph should have been written first. It is this attitude, which largely determines whether the prosthesis remains a toy undeservedly forgotten on the shelf, or becomes an integral part of the kid’s life, significantly increasing their capabilities. At this stage, psychological preparation is especially important, when and how to tell the child about the prosthesis.

Certainly we have created separate detailed materials with specific recommendations before receiving the first prosthesis. We also have a step-by-step algorithm for getting a prosthesis, methodological manuals for getting used to the device, webinars with psychologists and prosthetists, our bloggers’ releases about life with a prosthesis, and even a chat for parents of children with special hands as a source of support and exchange of experience. We will be happy to share all the information with you as soon as it is necessary.

Dear parents, now it probably seems to you that there is so much information that you can’t remember everything, you are so afraid of missing something and not doing something for your child. But we have tried to fit two years of life into just 30 pages. It’s not easy, of course!

There will be more time in life for adaptation, there will be people ready to help, there will be a team of experienced specialists around the child, there will be experience of other mothers and adults with a special hand. There will be a lot of things. But that will come later. And now there is this little person, and for them you are the whole world, the whole universe. And this is the most important thing that could happen in life - the boundless love of the family. So love and grow together, and we will be there and will definitely help.

During the first two years of life, children completely change and acquire an incredible number of skills. Conscious movements, crawling, walking, speech appear, and attachment is formed. At no other time in our lives do we learn as much as we do in the first few years.

As we have already written above, in daily activities, games and everyday actions our children are not much different from other children. However, there are simple recommendations that can be taken into account in order to stimulate the child’s “special” hand and brain within the framework of normal child development during the first two years. It is especially important to form the habit of involving both limbs in the action.

Since in juniority almost all activities fall within the bounds of play and learning, we will talk about games and toys with an emphasis on the development of a special hand, but not the whole body. There are quite a lot of general development activities on the Internet, and their description is not the purpose of our material.

Useful toys are light, easy to grasp, brightly colored rattles. The child should feel the toy and try to touch it. Currently there are rattles that attach directly to the hand, which is a great idea to encourage interest in the movements of a special hand.

Toys should be of different sizes. The kid will most likely take small toys with the second hand, so it is important not to forget to give larger toys so that the child learns to push, move, and pull objects of different shapes and sizes with the help of a special handle. Then, every time playing with them, the baby will practice different types of grip - both with one and two hands.

Additional variety will be provided by different materials from which the toys are made, as well as the surface texture. Such games will become an additional type of massage and will develop both motor skills and tactile sensitivity. The hand that cannot grasp the object must touch it; stimulate it with different touches, objects, etc.

The child will find his own, often unexpected for you, ways of completing game tasks, for example, many of our children hold a rattle in the elbow of a special hand. Show this technique to the kid.

At this age, in the absence of medical contraindications, you can do gentle exercises to maintain good mobility in the wrist joint (bend/unbend the arm, tilt and rotate to the sides). If a kid has fingers, it is important to use them during games and exercises.

Useful toys are toys with a large number of all kinds of rings or very large beads that can be sorted through (rings connected together, rods with rings, etc.). The most desirable for the child will be a whole play center, where there will be many useful educational toys. So, the kid can feel the parts of toys, move rings, beads, grab the protruding handles. Don't be surprised that the child will most often hold objects with his special hand, while the other hand will string, take, and so on - this is natural.

You can give your child an unnecessary bag or a large pen-case with a zipper. You can put toys inside. This game will help your child master the skill of holding a large object with a special hand, while the other hand will perform an action – opening a zipper. The same skill can be practiced by turning pages of cardboard, and then books with thin pages.

While the child is small, instead of wooden cubes, you can offer sponges for stacking pyramids; this is a good example of objects with different stiffnesses. You can wet the sponges with water and teach the child how to “get” water by pressing on the sponge.

Playing with the ball will also be interesting – hold the ball over the baby lying on his back. They will not only kick it with its legs, but also grab it with its hands, try to hug it. And by the end of the sixth month or a little later, the child will be able to roll the ball from hands to feet and back. When the baby has learned to sit confidently, the ball can be rolled or pushed with both hands.

Musical toys are also very useful: you can play the piano or the drums even with a fingerless hand. The triangles can be put on a special hand, and the children's drum can be hit without sticks with both hands in turn. You can also use special toys with buttons that light up and make sounds when pressed. In addition to developing a sense of rhythm and fine motor skills, these toys are a great exercise for parents' nerves.

Teach your baby to clap their hands. Take the child's palms and clap them together, singing any counting nursery rhyme. It is very important to practice with both hands in turn. If the nursery rhyme involves interaction with fingers, interact with skin of the hand, where the fingers would be.

At about this age, supplemental feeding begins. When a child grabs food with their hands, licks fingers, “bathes in puree,” let the thought serve as consolation to you that in doing so he receives an invaluable stimulus to the nervous system and experience of interaction with objects of different texture, temperature, and so on. If such “non-food” interaction with food is unacceptable for your family, you need to provide your child with a worthy alternative at your discretion.

Talk to your child using simple phrases and an expressive voice. When you dress, bathe or feed your baby, always verbalize your actions. For example, when you dress your kid, say, "Give me your hands. Where are your hands?” This is important to include both limbs in the body pattern.

A useful toy for developing a child’s thinking, motor skills and coordination of movements is a stacking toy. The toy should be large, with a thick rod and large, easy-to-put-on rings. A baby will be able to manage with such a toy, and, therefore, he will not get bored with it after half a minute of play. Toys and play centers where a child needs to grab, move, turn, press, and sort through something are still relevant.

Also at this age, you can offer your baby large framework-liners and all kinds of sorters, where a child needs to push different parts into the corresponding holes.

Playing in a sandbox will be useful – at home with kinetic sand or outside with common sand. Pour, pick, tamp, look for objects – all this is a great stimulus to work with the hand.

Another good variant is playing with grains. You can move the child's hands over grains, pour them from one box to another, “bathe” the hands in them – whatever your imagination can come up with. Use different grains; and when your kid gets tired of grains, you can replace them with fancy spaghetti or beans.

The absolute favorites of children at this age are the games “patty-cake”, “forty-white-sided” and others. The baby can consciously repeat movements, which promotes development of motor skills and coordination of movements. Learn more different nursery rhymes, because your child will love these games both at 11 months and at one year.

We are approaching a wonderful age for creating first artistic masterpieces – a kid can paint with finger paints both on large sheets and on tiles in the bathroom. We dip the fingers into paints and use both hands, either one at a time or at the same time.

A training ring is a loose ring, such that the baby can squeeze it with both hands. How to play: sit your child in front of you, show them the training ring, let them play with it a little. Show how strong you are and how you can squeeze the ring. Help your baby squeeze the ring with both hands too. Constantly encourage and praise your child. Let the child try to press on the ring with each hand in turn, resting the ring itself on the table/floor/squeezing it between the knees.

Exercises to develop endurance and tactility - pressing with the hand on special pads of varying stiffness (cotton wool, felt, sandbags).

Playing with plasticine. When a child squeezes the plasticine, it leaves imprints on it, which helps the child understand the force of pressure.

You can also devote a small amount of time to exercises to develop core strength. It is the core muscles that provide correct posture and enable the arms to move correctly.

“Balloon” – a bright balloon will do for this exercise. The baby lies on its back and stretches their arms along its body. The child’s task is to raise his legs at a right angle and knock the ball out of hand (they should hold it above legs at a height of 20-25 cm). There is just one condition — the kid has to push both legs up at once. Another variation of the exercise: let the kid bend their legs at the knees and press them to their chest, then straighten them and lift them up. Playing air football will teach your child to maintain balance and strengthen the abdominal muscles.

"Hedgehog" - we will strengthen abdominal muscles by repeating after the hedgehog how he curls up into a ball. Starting position: lie on back (the hedgehog turns around). the child should get up and group himself (hedgehog curled up).

Exercises in water. Let the child slap their hand in water, make waves, put the hand under the stream of the faucet and shower. Of course, this will cause a lot of splashes, but it will give the child's hands a good massage. Throw small toys and objects (spoons, Kinder Surprise toys, shells, large stones, etc.) onto the bottom of the bathtub. Toys that float on the surface are also suitable. The child will be able to practice new movements. Show your baby that caught objects can be placed in a plastic bowl floating on the water.

Playing cook is always very joyful for both mother and child and useful for the whole family. Knead the dough and roll it out. Invite your child to decorate the dough with cherries or strawberries. Then bake the resulting pie and eat it with the whole family!

Games with a medical bulb. Show your child how to fill a syringe with water and pour it into a container. This game develops quite a few skills in a child: firstly, the child needs to learn how to fill a syringe with water; secondly, the child needs to learn how to dose the water and pour out exactly as much as needed so that the molds do not overflow. Both skills will help the child understand the strength of grip.

Collecting toys. For this exercise you will need toys of different sizes and a medium-sized box. The baby needs to sit up straight and rest his hands on the floor behind the back. If this is not possible, sit behind the child and let them lightly lean their back against you. IMPORTANT!!! Don't let your child fall on you!

On one side, you need to put a box at their feet, and on the other, lay out the toys. Let the child grasp the object with the feet, lift it up and transfer it to the box. Make sure the kid doesn't bend knees (legs should be straight). This exercise will strengthen lower abdominal muscles and leg muscles. At first, it is enough to move five toys. Gradually increase their number to 10.

Circus-circus-circus. Starting position: the child stands on the ball, mother holds the baby by hands. Invite the child to imagine that the kid is standing on the captain's bridge. It is very difficult to maintain balance on it. It takes a miracle of coordination to stay on.

Roly-poly. Have the child get on knees, put their hands down or, conversely, raise them up. Now the child needs to sit first on the left side (arms to the right), then on the right (arms to the left). This strengthens abdominal muscles and legs.

Games with household items. Household items and things from the "adult world" are great as training tools for developing fine motor skills. Show how to turn a handle and open a door, press a doorbell or elevator button, dial a number on a phone, etc. Such activities will strengthen the muscle strength of hands and develop coordination of movements.

Jumping. The child can move from room to room not with a normal step, but in different ways: lifting knees high, squatting, skipping, taking very long steps, like a cat, like a bunny, like a bear, etc. You can negotiate: we go to the bathroom this way, and to the kitchen that way.

We hope that these simple ideas will inspire you to come up with your own games to play with your child!

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.

We do not offer special training of hand muscle strength at this age yet, as it is very difficult to teach a small kid to perform them correctly through printed text.

A good option is infant swimming. For the little ones, a bath is suitable, for older children – in a pool with a trainer or with mother under the guidance of a specialist. Water is an excellent stimulus for the child’s nervous system, and properly selected exercises allow for a good “pumping” of necessary muscles.

It is important that the child is warm and calm. The human body, neither adult nor small, cannot benefit from anything, even the most useful, in a state of stress. Therefore, if a child does not go into the water or is categorically afraid of the trainer, it is worth looking for alternative options. All children are different, and their preferences also are different. The general recommendation is that the earlier you start exercises, the easier and faster the child will adapt to water. After all, a kid was in an aquatic environment before its birth, which means that “swimming” is completely natural for kids.

We leave the developmental activities – musical, dance, group and individual – to the discretion of parents. Developing a child, playing, drawing, learning new objects and shapes can be done equally effectively both at home and in special classes. Therefore, decide for yourself what is more comfortable and convenient for you, to come up with different activities at home or to take your child to a place where everything has already been thought out and purchased.

If you have time and opportunity, during direct preparation for prosthesis (closer to two years) you can call on resources of a rehabilitation center, both public and private. To be able to use resources of public centers, please ensure that not only the prosthesis, but also rehabilitation are included in the individual rehabilitation and habilitation program (IRHP). Your child's right to receive rehabilitation is legal. Before prosthetics, rehabilitation centers will be able to conduct a comprehensive health assessment of the kid and select exercises to develop those aspects that your baby will need. After prosthesis, it is important to teach the child how to use the prosthesis and help them to get used to it.

At your first meeting with a rehabilitation therapist or exercise therapy doctor tell them that your kid is 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. In addition to an exercise therapy doctor, a modern rehabilitation team necessarily includes a psychologist and an ergotherapist.

At this age, a psychologist most often works through parents, and this is a very necessary specialist. Dear mothers, if you feel that you are having a hard time coping with a new role, with the baby’s peculiarity or the reaction of family members, if you have questions, anxiety, worries, turning to a psychologist would be a very good idea. The child needs a happy and confident mother in the future. So helping yourself is the most important thing you can do for your son or daughter.

Moreover, long before prosthetics, it is necessary to understand how to present the child with his peculiarity, what to tell, in what form and when. If you don’t know how to do this yet, or it causes unpleasant emotions, psychological counseling can also be useful. Also a psychologist can better 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. If you cannot find a psychologist in your location, you can consider the possibility of remote sessions. Nowadays, they are quite accessible and effective. Moreover, given the kid’s age, the specialist will work primarily with you.

Another important member of the rehabilitation team is the ergotherapist. 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 in Russia; 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.

Our children are also recommended to have regular (every 6-9 months) examinations by an orthopedic traumatologist. It is good if the child is observed by the same specialist. This way, even the smallest changes in muscle tone and posture can be noticed, and therefore, the development of undesirable processes can be stopped in a timely manner.

Motorica has its own team of doctors who are always ready to provide assistance, develop an individual programme for getting used to the prosthesis, select a rehabilitation center and discuss all aspects that concern you. We are as open as possible to communicate with you and specialists who immediately work with your kid, and are ready to answer all questions and consider possible wishes. Please contact Alina Kuzyakina, our rehabilitation therapist, without hesitation. Alina studied rehabilitation in Canada and can suggest modern and effective methods of rehabilitation for upper limb prosthetics.

Remember that you are the most important member of your child's support team. Without participation, involvement and support of parents, the work of any specialist, even the most experienced, will be ineffective. Above we have given the criteria for a child’s readiness for prosthetics, but the parent’s readiness is no less important. Now that you are armed with information, let's review what is important to understand before getting an active prosthesis.

О You are sure that your baby tries to use both hands in everyday activities.
О You told the child how it happened that the kid doesn’t have a hand.
О You know how to massage the hand and you do it every day.
О You have the right expectations — you understand that a prosthesis is important for health, but it cannot replace a hand yet.
О You are prepared to work with your kid at home, because without home training it is very difficult to get used 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.