B-Independent Therapy & B-Independent Babies Groups

✨ Why Early Monitoring and Upper limb Splinting and Range Of Movement Review Matters for Children with Cerebral Palsy ✨

Did you know that about 1 in 3 children with cerebral palsy develop some “contracture” or loss passive range of movement in their arms or hands as they grow? (Graff et al., 2018)

That might sound worrying but monitoring through a OT upper limb CPIPS pathway assessment can make a difference when we spot it early allowing for body structure and function interventions such as medical management, botulinum toxin or upper limb splinting. Ideally upper limb range review every six monthly in the under sixes and then yearly from there on in.

Researchers found that passive range of movement changes often start before school age. Children who find hand use more challenging are more likely to show early tightness (those with a higher MACS manual ability score)

But remember monitoring of range is only part of the support; it is also important to engage in early activity and participation interventions. Depending upon your child’s needs this may be early modified constraint induced movement therapy, bimanual intensive therapy or goal oriented intervention.

What can you do:
• Seek support on how to support your child to use both hands in play and everyday tasks.
• Notice if your child’s arm or hand seems harder to move and mention it to your therapy or medical team.
• Ask about regular range-of-movement checks or ‘OT CPIPS Assessment’

Remember range is one part of your child’s journey and activity and participation interventions are more powerful at leading to your child using their skills in daily activities!

📖 Based on research by Graff et al. (2018): Upper-limb contracture development in children with cerebral palsy a population-based study
📖 https://cpup.se/in-english/publications-in-english/

⭐️ Toy of the week ⭐️
Stickle Bricks

✨ Why we love them…..
• They encourage bimanual coordination – little hands need to work together to push pieces together and pull them apart against gentle resistance.
• The textured surfaces offer great feedback, helping children understand how much force to use with visual feedback if more push is needed by checking the teeth!
• Many children find them easier to orientate than toys like Duplo, while still providing opportunities to grade their precision and control.
• Because the pieces connect from multiple angles, they offer an ideal way to challenge spatial awareness and bimanual orientation and problem-solving at just the right level for each child with option to increase the challenge.

💡 Try building models with alternating colours or shapes to add a sequencing and planning element, too!

We have a few morning slots left on our 21st November ‘pop-up’ email to book and reserve.

🌟Toy of the Week 🌟
A bowling set is a brilliant way to encourage unimanual upper limb initiation movements. Grade it to hold and release to ball or simply knock the ball down a homemade ramp 🎳

Pick a light soft set for ease.

🖐 movement initiation
🎯 Developing accuracy and control
💡 easy cause and effect

It’s also a playful way to weave in number recognition, turn-taking also great for all ages!

⭐️ Toy of the week ⭐️
⭐️ Bounce Off ⭐️

I was introduced to this game by one of my clients (we have a deal where he brings along an activity to show me each session.

In essence it is competitive four in a row with more strategy and unpredictability.

Each draw a card and create your pattern promoting visual memory, visual spatial and visual motor integration.

⭐️ This is a great easy grasp and release toy
⭐️great for young people with partaking unilateral Cimt programmes or upper limb activity programs

Go off game playing:
⭐️ on their own making the card patterns
⭐️ create patterns
⭐️ turn taking game

https://www.b-independent.org/babymassagegroups

At B-Independent therapy, we believe in accessing informed early advice which is inclusive and offers access to a supportive and inclusive community. That's why we've adopted a pay-what-you-want pricing model for our workshops. We understand that everyone's financial situation is different, and we want to make our workshops accessible to as many people as possible. By offering this flexibility, we aim to build a community that values trust and collaboration. Your contributions, no matter the amount, support our aim to connect families and provide the best advice at the right age and stage of your child's development. We are keen to create an inclusive play environment for families with children with additional needs, for those who have had a difficult start to life, and those families looking for a safe non-judgemental play space.

Groups;
What is coming up….

22nd March 13.00 - Massage for managing pain and discomfort for infants with possible or confirmed additional needs. As part of the workshop we will explore your infant's regulation, sensory states and cues. This workshop is ideal for infants and children not crawling.

19th April 13.00 - Positions for play for pre-crawlers. Workshop designed for pre-crawlers of all ages no matter their stage of development.

17th May 13.00 - Adaptive play, switch skills and sensory play ideas for infants who play differently. Workshop designed for pre-crawlers of all ages no matter their stage of development.

14th June 13.00 - Play ideas to promote the development of your child's 8 senses and ideas to aid sensory and emotional regulation for your child. Workshop for pre-crawlers no matter their stage of development. We will discuss the senses, sensory overload and co-and self-regulation to help you make informed choices about nurturing your child's growth and development.

⭐️ Toy of the week ⭐️
⭐️ colour sort bears & pots ⭐️

This is an absolute with a little person I know! So many bears, so much fun!

Bimanual
⭐️assisting hand stabilisation of a large shape or weight of support or body stabilisation
⭐️ grade the force of the stabilisation to lift the lid off.
⭐️ stack and pull apart the bears on-top of their ears - great for promoting variety grasp and grasp small items
⭐️ stack the bears and plan how to orientate the bears in each hand to push them together and to pull them apart remove.

Unimanual:
⭐️ in CIMT programmes get a young person to work on grasp, release and transport and sort the bears
⭐️ grasp and release and roll the chunky dice
⭐️ explore using the large chunky tweezers with a whole hand grasp to pick the bears

Cognition:
⭐️ colour sorting
⭐️ promote counting
⭐️ work on making bf and replicating patterns
⭐️ work o. Shape matching using the shape dice and shapes on the pots

⭐️ Toy of the week ⭐️
⭐️ Mr Potato Head ⭐️

It is a classic use it in a bimanual way to encourage two handed interplays such as:
⭐️assisting hand stabilisation of a large shape by open hand grasp, weight of support or body stabilisation
⭐️ promotes planning and objective orientation to work out how to turn and stabilise the item for the next piece
⭐️ grade the force of the stabilisation to stop it slipping to offer you a stable potato head base.
⭐️ mix it up and use real smaller potatoes or fruits and veg to increase variety of assisting hand holds 🍅 🥔 🥒

Unimanual:
⭐️ in CIMT programmes get a young person to work on grasp, release and transport and reach skills of the part they want you you put into the face
⭐️ get them to grasp and pull to remove parts
⭐️ a significant cimt challenge is aligning with the small holes to fit the parts you may have helped them orient in their hands.

Multiple parts and 12 fascial features and pieces = repetitions and grading and variety!

Ban the Pen Licence!

I’m using the end of OT week to get on my soap box to celebrate and promote that there are many ways for children to participate in life and in the childhood occupation of recording work!

With pen licences the theory is we encourage children to improve their handwriting by giving the reward of a certificate at being able to write with a pen if they reach the desired level of skill.

In reality the practice highlights to peers those children that are ‘not good enough’ or those that will ‘never achieve this neuro-typical skill!’

We don’t stop or prevent children accessing other educational resources such as scissors or cutlery until they reach our social-defined expectations of what the majority of people perceive as a ‘normal participation.’

15.5% of children and young people in England have a special educational need and disability.

We should be empowering young people to celebrate differences, problem solve there are many ways to do the same task.

The the over arching aim, in an emerging digital society, is that children can do the life long skills and participate in their specific daily occupations such as a home manager, a worker or partake in their chosen leisure activities to:
-Fill out a form via electronic means or written means.
-Have a way of recording our thoughts and capabilities, or personal thoughts and creative thoughts even if it is using ICT, eye gaze or voice dictation software.
- Be able to text or send emails.
- Be able to send birthday card or postcard to a loved one (yep you can now do this all through a website without picking up a pen!)

- Type a letter of thanks or complaint.
- Be able to make notes or lists that are interpreted by you alone; we can use an app or pen!
- Write appointments in a dairy- Siri can add into your diary and Alexa can do the same and make your shopping list!

There are other ways of celebrating progress such as;
‘Independent learners awards’
‘Special achievement awards’
‘Personal achievement awards’

Let’s promote inclusivity in society by stopping archaic in direct child shaming practices. This 2014 education idea is outdated. So consider signing the Change.org petition.

Most families have heard of constraint induced movement therapy but have you heard of
Bimanual Intensive Therapy?

BMIT is focused on improving the use of two hands in daily activities.

All daily activities require us to use two hands from the moment we wake up and get dressed, open the lid on the toothpaste, open the cereal and pour the milk to simply open the door whilst holding a bag! For individuals with hemiplegia, these activities are extremely challenging.

Bimanual intensive therapy is different from constraint-induced therapy as both hands are used in the sessions. Activities and toys are carefully chosen to provoke and promote specific active two-handed actions, interplay’s and movements.

Bimanual intensive therapy differs from 'general two-handed occupational therapy advice’ as there is a prescribed daily practice amount and bespoke specific actions which are worked on specifically based on your child's upper limb function.

Evidence and clinical research has proven that the correct dosage and practice lead to motor learning and long term neuroplastic change. This means more transference and improvement in hand use during daily activities.
​
CIMT & BMIT are both interventions identified as effective for children with cerebral palsy and hemiplegia in research if they follow key therapeutic principles.

Connective Tissue and Fascia – A Forgotten Interface. A therapeutic adjunct to use in your day-to-day practice.
A one-day practical, introductory workshop for those working in neurological and general rehabilitation (adult or paediatrics).

Date: Saturday 18th November 2023 8.45am-5pm

Venue: Therapy Fusion Ltd, Stratford Upon Avon Warwickshire.

Cost: £130 per person

Led by Michelle Watson, Michelle will develop participants knowledge into into the role fascia plays in muscle stiffness and contracture.

Course overview:
www.b-independent.org/_files/ugd/ff50cc_fd7fdf74a23044a4afc9ee99f9da6849.pdf

Book at: scroll down the home page to at www.b-independent.org to book. Only online booking available.

⭐️ Toy of the week ⭐️
⭐️ Sorting Surprise Pirate Treasure ⭐️

Recommended to me by a wonderful OT friend! A great toy that can be used in so many bimanual and unimanual ways!

I love getting my hands on new toys to try out and explore the goal variety that can be achieved in one toy. didn’t fail to deliver yet again!

⭐️The 4 different toy elements prompt a range of grips and grasp in unimanual programs and bimanual grasp variety from pincer patterns to key grips to cylindrical grasps and tripod grasps.
⭐️Repetition through the 5 different boxes!
⭐️Variety and variability: the different treasure and key ends mean grasp adjustment is needed!
⭐️ Orientation - planning is needed to correctly place the treasure boxes to use the key to open them. Incorrect hand placement will prevent the lid popping open!
⭐️ Can be used to teach weight of support strategies
⭐️ Security of hold can easily be graded up and down up and down by using a table or holding on the air!
⭐️ cognitive counting
⭐️ visual sorting and colour matching

Do you have any more ideas?

Remember to model how or what toy interaction you want with this toy depending on the child or young persons goals!