Academy Eng

How to prepare a kid aged 6 to 11 for prosthetics. Part 1

Opening remarks

Hello, dear parents! We look forward to meeting you and your kid to create a prosthesis, which we hope would make their life more interesting, brighter, and open up new opportunities and horizons.

It is important to understand that accepting any changes, even positive ones, requires efforts from both the kid and the whole family. For the prosthetic procedure to go smoothly and for the kid to get used to the kid`s new hand faster, we need to make preparations — both physically and psychologically.

We have assembled a team of experts — physicians and prosthetists, who have helped us to prepare this book for you.

The task was not easy: to cover a wide group of children aged 6 to 11 in one tutorial. Psychologists call this age a primary school age; in fact, it is a kind of “peak of childhood”. This is no longer a baby, but an almost fully formed personality. In some ways, the kid is still frivolous and naive, but at the same time striving to find the kid among their peers, with new knowledge, and with the bundle of the kid`s own values and beliefs. The kid already remembers well the successes and failures, words, actions and views of other people, relates them to each other, deeply experiences and understands events. Interestingly, this age period begins with the crisis of 6-7 years and ends on the eve of the difficult teenage period. That is why it is especially important now to strengthen trusting and close relationships with your kid.

Regardless of whether you are receiving a prosthesis for the first time or this is a repeat prosthetics, together we should try to approach the issue of getting used to the prosthesis as sensitively as possible. We will try to answer the main question — how to properly help your kid and motivate them in the process of preparation for prosthetics and getting used to the device. However, if something remains unclear, we are always in touch with you, ready to provide additional information and answer your questions.

Why can’t one put on a prosthesis right away or why is preparation necessary?

The Motorica team has already provided prostheses to 238 children. We know from our own experience that children often have different relationships with their prostheses. Some kids wear their prostheses every day and always wear them at school, while others use them once a week for 15 minutes. Preemptively, we may say that extreme scenarios — for example, when a kid is embarrassed to leave the home without a prosthesis or, on the contrary, does not wear a prosthesis at all — are considered a failure. The most correct scenario from the viewpoint of the international medical community is that the kid is adapted to everyday life both with and without a prosthesis. In this scenario, the prosthesis is used regularly (daily) for selected activities. In the final chapters we will return to this thesis and examine it in more details.

What influences the kid’s ability to use a prosthesis regularly and correctly? There are many factors, and one of them is preparation for prosthetics. Before we find out how exactly we can help our kid come to prosthetics in the right physical and psychological condition, let's formulate the global goals of preparation.
Building up sufficient arm muscle strength
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, that is, their strength needs to be trained. In some cases, it is also necessary to work on increasing the range of motion in the joints. However, we warn about such cases individually and always select a set of special exercises.

Expansion and improvement of the kid’s existing abilities for self-care and use of the hand in everyday life.
Generally, most of our primary school-age patients with a unilaterally specific limb are fully adapted to everyday life. They cope with all the tasks typical for their age on par with their peers, sometimes even surpassing them in some ways. Zippers and laces are common difficulties, but these are minor problems. The situations that really worry us are when the kid is completely unable to cope with normal tasks of the kid's age without your help, i.e. the kid is completely dependent on you in all or many aspects of life. This situation is dangerous because the kid internally feels some kind of inferiority and gets used to your role in their 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.

Development of coordination skills, which help quickly master the control of a prosthesis.
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 kid`s body as a whole and the better they can control it, the easier the kid would be able to get used to a new device.

Improvement of the posture and correction of its changes.
For good arm movements, the kid's body must be very stable. A strong body is the foundation underlying all our movements.

Development of a positive attitude towards the prosthesis in the kid.
Perhaps, this paragraph should have been written first. It is this attitude, which largely determines whether the prosthesis remains a toy or a mother’s “whim” undeservedly forgotten on the shelf, or becomes an integral part of the kid’s life, increasing the kid`s capabilities.

When should you start preparations?

Preparations need to start today. The more time we have to prepare, the better we can work on all the aspects mentioned above.

In addition, it is known that it takes at least 3 weeks to develop a lasting habit. Other scientists put the figure at 66 days. One way or another, if we start early, by the time the prosthesis is installed the kid will already have developed a useful habit, and adding the use of a prosthesis to this habit will be easier.

If our prosthetists and doctors have informed you that it will take some time to collect the documents, this gives you a head start in terms of preparation. Please do not delay starting the work. A small kid will be able to get used to a change in the daily schedule more easily, and you will be able to achieve excellent results and optimally approach the moment of prosthetics.

How to prepare for prosthetics?

The entire preparation block is divided into 3 conditional parts:

  • Physical training
  • Special activities to prepare the arm for prosthetics
  • Psychological training

Before we proceed immediately to the exercises and recommendations, let's note the following: an individual approach to a kid’s rehabilitation is the most correct one. Through this tutorial, we try to convey all our great experiences; however, unfortunately, we cannot see the kid. The work of a rehabilitation therapist occurs not only within the framework of thought processes, but also involves an in-person examination and manual procedures.

Therefore, to develop an optimal plan for trainings with your kid, it is best to contact a specialist in your location. Even if the kid has no experience with upper limb prostheses, you can discuss the general goals of the trainings or give them this material to read. If necessary, our rehabilitation therapist will contact the doctor working with your kid, and together we will be able to develop the correct preparation plan.

We will tell you below, which specialists you can contact for help.

Physical training for prosthetics is aimed at:

  • Strengthening the muscles of the back, abdomen and upper limbs;
  • Prevention of posture disorders;
  • Enhancement of stamina; and
  • Development of a habit of training.

No matter how much you tell your kid about the benefits of exercises, they will not show any interest in it if the kid does not see a clear example in front of them. Tell the kid that you would like to feel better and wake up easier in the morning. That's why you're thinking of starting to do gymnastics. However, you really don’t want to do this alone. Ask for help — say that it would be much easier for you to train together. Get the rest of your family on board and join you at least a few times a week.

To benefit from your exercises, you need to follow 5 simple rules.

  1. The exercise should be fun! Play some music your kid likes and encourage them to create the kid`s own playlist. Come up with your own funny exercise names. The exercise may end with some kind of dance or other tradition — for example, a joint meditation to slow music or a discussion of the day’s plan.
  2. The exercises should be regular! Choose a convenient schedule to exercise 4-5 times a week, but be sure to maintain the frequency. Set a convenient time — if your family has trouble getting up in the morning, waking up 30 minutes earlier can be a real challenge. In this case, do your exercises, for example, after school or before dinner. It's a good idea to include a physical training break into homework.
  3. The duration of exercises may vary from 15 minutes to an hour, depending on age and mood.
  4. Ensure safety during your training — it is important to remove all unnecessary objects from the floor so as not to slip on them, choose comfortable clothes and non-slip shoes. Be sure to start with a warm-up and end with a cool-down.
  5. Complicate the exercises following the pyramid principle, from the simplest things to the most difficult ones. Start with easy exercises and gradually add more complex ones. Take your time and do not overload your kid. If it did not work today, try again in a week or a month.

Below we provide some exercise and activity options. You can always expand or reduce the set, and add something else, which may be already familiar or especially favourite to your kid. Remember, it is better to do less but regularly than more but once a week. If you get bored with our set, don’t hesitate to expand it. You can find quite a lot of exercises and workout options on the Internet. Your main task is to train your abdominal and back muscles. These phrases can be used for further independent search.

Warm-up

Warm-up is required to prepare muscles and joints. If you skip this part and go straight to the main training, there is a risk of injury. Below are some exercises that are good for warming up.

Head tilt (10 repetitions): slowly tilt the head left and right.

Circular head movements (10 repetitions): in clockwise and counterclockwise directions. To avoid dizziness in the kid, movements should be slow.

Heel raise (10 repetitions): inhale — raise hands up and stretch up on your toes as high as possible, hold this position for a short time and lower down while exhaling.

Squats (10 repetitions): heels should always touch the floor. Hold your hands on the waist or extend arms forward when reaching the lowest point.

Shoulder lift and arm swing (10 repetitions): lift and lower shoulders alternately and then together, after which perform arm swings alternately.

Marching on the spot with gradual speed increase and transition to jogging.

Main part

It is better to combine basic exercises into blocks for specific muscle groups (below we provide examples of exercises). Repeat every exercise 10-12 times. Then, make a 30-second break and start the next series.

Exercises for the torso, lower extremities and overall endurance

“Feet off the ground” (jumping rope or just a rope is needed) — quickly pass the rope under the kid’s feet, the kid must jump so that it does not touch the kid`s feet. You set the conditions — jump on one or two legs, forward or backward. Then swap roles.

“Frog” (jumps from a squat) — the starting position is squatting, knees together, then jump high up, while straightening your back and raising your straight arms up, then immediately squat down to the starting position, and make the next jump.

“Ball Master” — hold the ball between knees, straighten shoulders, don’t slouch, keep hands on the waist. Squat down, trying not to drop the ball. If the ball falls out, but the kid manages to catch it before you, the exercise is still considered completed.

“Jelly” — a smooth wall is required; you can use a closed door to the room. Stand with your back to the wall and lean against it. Squat down, sliding over the wall and rise up. Keep your hands close to your kid: if they suddenly can't get up, gently push them under the hips from the bottom point.

“Alley-oop” — stand up straight, don't slouch, straighten your shoulders, hands on your waist. Move one leg half a step forward, and the other — half a step back. Switch legs with a jump. Over time, tell your kid to place the kid`s feet wider — this is more difficult.

“The horse bows” — stand up as for the previous exercise, move one leg forward and the other back. The distance between the legs should be greater than in the previous case. Squat down, bending your front leg at the knee, lifting your back heel off the floor, and directing your back knee toward the floor. The kid can even touch the floor with the kid`s back knee, if this does not hurt them.

Exercises for the abdominal muscles

“Catch it quickly” — sitting opposite each other, throwing a small ball to each other. While the ball is flying, the kid should lie on the kid`s back on the floor and touch the floor with their lower back, then rise up and catch the ball, stretching the top of the kid's head upward.

“Air football” — the kid lies on their back and stretches the kid`s arms along the body. The goal is to raise the kid`s legs at a right angle and knock the ball out of your hands. 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 the kid`s chest, then straighten them and lift them up.

“Bike” — in a sitting position, rest your hands on the floor behind your back. Lift your legs off the floor and begin to move them to simulate spinning the bike pedals. Hold the legs suspended all the time. The duration of the exercise is 5 to 15 seconds.

“Scissors” — in a supine position, lift straight legs and cross them in a horizontal plane, simulating the work of scissors. The duration of the exercise is 5 to 15 seconds.

Exercises for the back musscles

“Sea bear” — starting position is lying on the stomach on the floor; legs should be secured under the sofa or you should hold them, palms crossed at the back of head. Raise the torso from the floor to the highest possible level, then slowly lower to the starting position and immediately repeat the exercise.

“Flapping wings” — stand up straight, do not slouch, feet shoulder width apart. Spread arms, bend forward (approximately to horizontal, no need to go lower), raise arms up as far as possible. Wave arms up and down, simulating the movements of a bird's wings.

“Let’s swim — let’s go” — in a prone position, simultaneously lift arms and legs off the floor in different combinations (3-9 repetitions). If possible, hold each position for 5 to 20 seconds:

Airplane — straight arms are directed to the sides, moving back and forth, imitating the flight of an airplane, legs are raised straight up;

Boat — straight arms are directed forward, legs are raised straight up. Rock a little on stomach, imitating the movements of a boat;

Froglet — simulate swimming movements with your hands. Bend arms at the elbows (elbows pointing to the side) and your legs at the knees (heels pointing to the ceiling), then straighten your arms and legs. Repeat from the beginning without lowering the limbs to the floor.

Another interesting training variation is to exercise with a bag or sock filled with cereal or granulated sugar.

“Circus training” — take up correct posture in a standing position, placing the bag on your head. Squat down, trying not to drop the bag, then stand up to the starting position;

Walk with a bag on your head, the back should be straight. The position of the hands can be changed (on the waist, to the sides, up);

Walking with a bag on the head and stepping over obstacles (toys, pillows, etc. can be used as obstacles). Stop to check if your back is straight;

Walking with a bag on the head while performing different movements at the same time: walking in a semi-squat “goose-step”, with raising knee high; on tiptoes, heels, etc.

“Sea bear” — take up the correct posture with a bag on your head, throw the ball up and catch it. Make sure your posture is straight.

“Tricks” — lying on the stomach, the kid takes a bag in right hand and passes it behind their back to left hand. Then the kid returns the bag to the right hand, this time in front of them. The kid's head, shoulders and arms should be in the air. Then do it in the opposite direction. Attention: when the kid tries to pass the bag behind their back, do not let them roll onto their side. The torso and legs should remain straight. You can add variety to this exercise by turning away and then guessing, which hand the kid hides the bag in.

Cool-down is the final part of our training. Its purpose is to let the body smoothly transit from training to a calm state.

Slow steps in place.

“Stretching” — in a sitting position, stretch your arms towards your straight legs. The legs can be spread. How wide is up to you — it should be comfortable, not painful and only a little difficult. Try to hold each tilt for 5 to 15 seconds without swinging.

“Lazy hedgehogs” — sit on your knees so that your big toes touch each other and your knees are slightly apart. Slowly bend over and touch the floor with your forehead. Hands are extended in front of the head with palms facing the floor. Inhale and exhale slowly and deeply, holding the position for 3 to 5 breaths.

“To the sun and higher” — stretch your arms above your head. Make sure that your legs, arms and back are straight. You can do a slight backward bend.

“Swan geese wake up” — stand with your arms wide apart, outstretched, thumbs pointing down. Gently extend your arms back as if squeezing a ball between your shoulder blades. Alternatively, slowly rotate your hands so that your thumbs point upward. Hold for a few seconds, then return to the first position.

“Lunges” — keeping your back straight, place your left leg forward and bend it to 90 degrees (the knee is directly above the ankle). Place your hands on your left knee, holding the position for 5 to 15 seconds without bouncing. Switch legs and repeat.

“Side lunge” — stand straight, legs wide apart. Bend your left leg to 90 degrees, keeping your right leg straight for 5 to 15 seconds without bouncing. Switch legs and repeat.

“Butterfly” — in a sitting position, place the soles of your feet together and hold them with your hands. The legs are now the “wings” of a butterfly. Elbows can rest on knees. Gently flap your “butterfly wings”. To add a stretch to your spine, lean forward and touch your forehead to your feet.

“Heron” — stand up, leaning one hand on the back of a chair. A wall or tree will work too, you just need some support to keep you from falling. Bend your left leg and take it with your right hand. Gently pull your leg towards your body. Hold for 5 to 15 seconds, then switch legs.

“Pendulum” — in a standing position, arms hanging freely at the sides, knees slightly bent. Slowly bend over and reach your hands towards your toes.

“Kitty in the crib” — lying on your back, stretching well, stretching your arms and legs to the sides as much as possible, tensing your abdominal muscles.

Real-world examples

Vanya, 8 years old, lives in the city of Kemerovo and is literally crazy about football. Football is everywhere for him — in games on his phone, on a poster on the wall, and with friends on the ground. Vanya didn’t want to find time to exercise in such a busy schedule. However, Vanya’s mother didn’t lose her heart — she completely reshaped our set, having added exercises with a ball almost everywhere. At the end of the training, she gave a new dribbling exercise (maneuvers with the ball). Now for Vanya this is not an exercise, but a real football training session, and he is absolutely delighted with the new component of his day.

For children who are interested in sports and attend sports clubs, the exercise routine can include more complex elements,
such as the plank position, squats, balance stand, etc.

Constantly add variety — change the music, do exercises outside in good weather, invite your kid to do exercises and you will repeat all the movements after them.

An interesting example of motivation was offered by Taya's mother. Taya is in the 4th grade and loves to come first in everything. For motivation, they hung a large sheet of paper at home and every day after exercise they put check marks on the number of exercises they completed: whoever completes more exercises during the day gets an evening prize — a Kinder Surprise for Taya or washing the dishes for her mother.

The main thing is not to be a harsh, tough coach — play with your kid and remember to praise them and yourself for successfully completing the exercises.

If the interest in training has faded, do not compel or persuade. We all have days when we do not feel like doing our usual and favourite things. Kids are no different. They may get tired. If the day comes when your daughter or son refuses to do exercises under any circumstances, do not push them.

Take a break. Have a talk. Find out the reasons for the refusal and try to reconsider your approach.

Make the set easier or more difficult, add variety, offer new exercises or involve another family member. Let this be not an exercise, but training. Now, instead of exercises there will be attempts. Once you feel a change of heart, return to your daily practice.

Let exercises become a new and interesting family tradition for your kid.
FOR USERS PREPARATION FOR PROSTHETICS