In the title is a very frequently asked question that I just received again twice last week.
The short answer is absolutely! The benefits of dynamic elbow bracing go way beyond the skills learned down on the floor and in mid-level positions such as sitting and 4-point crawling.
When doing PT with smaller, developing children one pillar of treatment is that most of the time the arm patterns that are challenging in one position (e.g. rolling, crawling) continue to be challenging in other positions. (e.g. standing, walking) Therefore if we really want to help kids integrate the “new” arm control we’ve introduced at the elbow, shoulder and core, then we continue to work diligently up in standing, walking, running, and climbing with dynamic elbow bracing. Using the Bamboo Brace to assist us in breaking the nonproductive tie between the shoulder elbow and trunk is much easier then trying to verbally tells the kids to straighten out their elbow or use their affected arm more.
As the kids get up on their feet more and closer to walking its a great time to continue using the brace for at least a few hours/day as it frees ups the trunk and shoulder to participate in the rotation necessary for learning how to keep their balance and protecting themselves when falling as well as participate in climbing activities at the park and playground.
After crawling some helpful activities:
Continue trying to encourage cruising (sideways walking along objects) toward the weaker-side arm.
Encourage bridging between objects.
If the kids can climb stairs then I would do a lot of that and if they can’t I would teach them with the help of your therapist.
Finding a nice little park with stairs access to a platform is ideal, doing climbing repetitions while using the slide as a reward.
Activities like slide climbs and hill crawls really build arm, shoulder, leg and core strength in preparation for walking. I’m Talking about little grass hills (5-8′ in distance with gentle to moderate slopes, crawling to get toys or things they want, then repeat.
Beck is great little guy with a very rare form of myelopathy which has affected his ability to move, talk and walk. He is now about 16 months old and had a pretty rocky start to his life. For his first 8-10 months he had many challenges with his health, eating and general motor development. Because of his diagnosis his muscle tone is very low and I expected that it would take us quite a while longer to get him going on his feet and walking.
No one could have predicted the speed at which Beck has progressed over the past 5-6 months. In December 2011 he was just barley able to roll on the floor and sit with assistance and now he is beginning to walk! In the PT business this is an outstanding rate of progress in a very short amount of time.
I always joke that, “Years ago I used to make predictions, until I realized that I’m usually wrong.” The kids I thought would blaze through with ease had issues, and the kids that I thought would have difficulty progressing, did so in spite of their bodies not cooperating most of the time.
Kids like Beck always remind me that no matter what physical challenges are present you cannot predict the will, motivation and fire inside that propels children to progress. Set your expectations high and you just might achieve them.
I got an email question from a therapist on the east coast today and thought I would share my answer with you all.
Has anyone tried the Bamboo Brace with a child with Prader-Willi syndrome? I am working with a child whose corrected age is 5 months old. Shoulder girdle, upper back and neck are severely hypotonic. Do you think the brace could give her enough stability at the elbow to weight bear in prone? The weight bearing would help develop the shoulder girdle and neck muscles.
Cole who has PWS working hard in 4-point
Thank you for the question. I have personally used The Bamboo Brace with several children having Prader-Willi Syndrome (PWS) as have several other clinicians around the country with great success.
Dynamic elbow bracing works extremely well for children with PWS of all ages but especially those children under about 18 months who are just learning foundational floor skills such as rolling, army crawling, hands/knees crawling and sitting.
Typically when using The Bamboo Brace bilaterally for learning floor skills, we keep the brace as flexible as possible. For your patient (5 months) we would be using at most a #2 stay but hopefully even the #1 stay or possibly no stay at all.
Many people might ask, “Why would we use the brace at all if we are merely working on rolling and not 4-point crawling isn’t it just for extended arm weight bearing?” The reason is because the children are so weak and unstable around the shoulder girdle, and trunk that by keeping the elbows just a bit more extended it allows us to focus more strengthening on the proximal areas around the shoulder girdle and trunk. This process frees up the suprascapular and neck musculature and through repetition, the children gain more strength, stability and function.
Additionally, in prone as well as supine I find that the flexible braces help the children with significant hypotonia to continue in developing more balanced flexion-extension control in the sagittal plane. Of course more sagittal control then allows more controlled and effective abduction and adduction in the frontal plane.
I find as strength and stability continue to improve in the sagittal and frontal planes that I enjoy working with the children both in and out of the brace. One of the most remarkable aspects of using a flexible and dynamic elbow brace is that as you move upward against gravity into the 4-point position, the brace places the triceps, pectorals and latissimus groups at a great mechanical in which to actively fire. This in turn leads to more quality repetitions in 4-point which usually means increased strength and stability, and with some treatment time, we can wean the kids from the The Bamboo Brace entirely.
Lastly the fact that The Bamboo Brace frees up your hands during treatment so that you might be able to concentrate on other keys points around the core, pelvis or ribcage cannot be overlooked. This allows the children to work for longer periods in more challenging postures which generally equates to a faster rate of functional progress during treatment.
Thank you again and please keep us posted on her progress.
Climbing Slides is an easy and fun way for kids to gain the necessary strength in some key muscle groups that help us to stand, walk, run and more.
I’m not sure exactly what it is about climbing slides, but most kids love it! In my experience they will repeat it over and over which is great fun for everybody and an excellent strengthening exercise to assist us in getting our kids to achieve some important motor skills.
The gluteals, quadriceps, calves and muscles of the core are very necessary when kids are learning how pull themselves to standing, cruising (sideways walking along objects), walking, running and jumping and it just so happens that slide climbs strengthen all of them.
Here are a couple of tips:
Make it fun and they will repeat it. When they get to the top have a toy ready such as a ball, matchbox car or action figure they can send down the slide, or let them slide down on their belly.
Remember it is the propulsion of their body upward that gives them the strengthening repetition, its not absolutely necessary that they climb the entire slide by themselves without help to get the benefits.
As you can see in the video, I’m supporting Braxton from behind his feet. This is key as it prevents him from slipping backward which is very frustrating for kids and they will give up fast if they’re not progressing upward on the slide.
If the kids aren’t quite strong enough to propels themselves you can assist by guiding their body upward with your hand that is on the swing leg (leg that is not in contact with the slide). Try to direct your guiding (force) diagonally upward through the knee that is contact with the slide and then repeat on the opposite side as they progress upward.
For larger, longer, steeper and tube slides you will likely have to be on the slide behind your child. Sounds silly but your footwear is key to you not slipping backward as you assist your child in climbing. Good rubber sneakers or Teva type sandals work well for me.
Good luck, get your kids out and look here for more tips. Have a fun Spring and Summer!
Starting March 19th we are starting our “Fan it Forward” campaign and once we reach 2012 “Likes” we will donate $5,000 worth of Bamboo Braces to therapy clinics across the country to share with their patients.
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What is The Bamboo Brace and What Does It Do?
The Bamboo Brace is a pediatric elbow brace for children with cerebral palsy, Down syndrome, brachial plexus injury, global developmental delays, Rett syndrome and various other diagnoses. The Bamboo Brace assists children in maintaining a more extended position at the elbow so that both gross and fine motor skills are easier to perform, learn and repeat. It is a flexible brace providing five adjustable levels of support, allowing children to build strength and independence as they learn to roll, sit, crawl, stand and walk on their own. The Bamboo Brace comes in three different sizes accommodating babies to early grade school children. Who Can Benefit From The Bamboo Brace?
*Any child who has a predominant flexion (bending) pattern at the elbow that is slowing development.
*Any child needing more stability at the elbow to bear weight for crawling and other developmental activities.
Thought I’d write a quick blog about a question we received through our Bamboo Brace FB page, about, “Why The Bamboo Brace is different from other braces that we are using to assist with weight bearing.”
In terms of Rett Syndrome what separates The Bamboo Brace from the competition is the snug, non-slip fit in combination with the flexibility that you can adjust to your daughter’s specific needs. While working on weight bearing you are able to adjust the flexibility to offer just enough support so that she is still required to work a bit and this allows her to gain the necessary strength in the triceps muscles so that she can eventually bear weight without being braced.
For many years I treated children with more rigid products and they looked pretty good while they were braced in weight bearing positions, however there was little if any carryover when they were unbraced. This is one of the main reasons I developed a more flexible brace, to allow strengthening to become possible while still allowing the children to function in many positions during the process.
Another added benefit in terms of Rett Syndrome is that we can make The Bamboo Brace just stiff enough so that the girls cannot quite get their hands to mouth, which can be a common behavioral pattern. Again the flexibility is key in that it still allows the girls to functionally use their hands and arms while just not allowing them to get to their mouth. I am told by many that using The Bamboo Brace for the purpose of preventing mouthing has made the girls find other things to do with their hands and as a byproduct families have experienced some nice cognitive and fine motor gains.
Much of our information and promotional material for The Bamboo Brace lists that it works well for children with Down Syndrome. Although this is very true and I have used it personally with great success, I thought I should clarify, so that families and therapists will have a better idea which ages and skill levels of children with Down Syndrome respond best to its use.
I am mostly talking about infants, toddlers and smaller children under two years of age who we are trying to help learn how to walk. Most of these kids will of course have lower muscle tone as is typical for Down Syndrome, however they might also have a sensitivity to weight bearing through their hands and do not tolerate the loading of the joints of their arms as is necessary to learn how to crawl, sit themselves up, kneel and pull to standing.
Many of the children also have arm weakness that does not allow them to sustain positions like 4-point (hands & knees) without collapsing. These children have a difficult time pushing themselves up from the floor and transitioning into 4-point, sitting, kneeling and pulling to standing. The weakness in my experience is usually no more complicated than not having done enough repetitions in each of the positions to build strength, this is where The Bamboo Brace is extremely helpful.
Using most likely the infant/toddler size or the Preschool size if the children are more near two years, I select one of the more flexible stays (1,2,3) that give just enough resistance so that the child’s elbow won’t collapse in weight bearing positions and place one Bamboo Braces on each elbow.
The flexibility of the brace is very important for a few of reasons. First, we want it flexible enough so that the children can build themselves up from the floor to 4-point, sitting and kneeling without having the brace too stiff and rigid to do so. Secondly, the flexible nature of the brace is what allows the children to gain strength by allowing the elbow to bend 20-30 degrees repeatedly in weight bearing positions and with each repetition the child continues to gain strength, until they no longer need to wear the brace. Lastly, the flexible and supportive nature of The Bamboo Brace gives both parents and therapists an extra set of hands so that you can assist the children around their core or legs without always having to support the elbows to keep them from collapsing.
In years past I would have spent many months with the children trying to gain the necessary strength in weight bearing positions so that they can build themselves up from the floor to standing. Once I began using the early Bamboo Brace prototypes to supplement my treatments, I began to realize strength gains much more rapidly in children with Down Syndrome. I credit this to nothing more fancy than just helping the children to perform more repetitions against gravity within each treatment session than before I dynamically braced the elbow.
Many younger children with Down Syndrome described above might only need to use The Bamboo Brace for a few weeks or a few months depending on individual differences to gain the necessary independence to get up onto their feet.
Occasionally we have used The Bamboo Brace in older children with Down Syndrome who are “mouthing” incessantly with their hands, but this is not as common it seems as with some other diagnoses such as Rett Syndrome and Autism. Nonetheless when using it for this purpose I recommend keeping The Bamboo Brace as flexible as possible so the children can continue to use their hands and arms as much as possible without quite being able to get them to mouth.
I am frequently asked this question, so I thought a quick post might help others.
The short answer is “Yes” The Bamboo Brace works well for most daily and weekly constraint therapy programs and as a good transitional program after casting for children with hemiplegia.
Here’s more information.
Constraint Induced Movement Therapy or CIMT is the therapy technique of wrapping, casting or immobilizing a child’s non-affected arm who has hemiplegia so that they will use their affected arm with improved function.
The research is promising but the candidates, frequency, duration and activities are up for debate so make sure you seek advice from your occupational therapist before beginning any home CIMT program.
Typically for constraint induced therapy and The Bamboo Brace you’d use one of (or a combination of) the more rigid stays (#4 or #5 ) and then wrap the child’s good hand gently into a fist for some time each day or week.
For the hand wrap, I have had the most success using a disposable material that they can’t pull, rub or bite off as easily and that wraps with good contour like Coban or CoFlex. I recommend starting from the back of the wrist and wrapping over the back of the fingers bringing them gently into a fist and then continuing around a couple of times.
You need to be careful that you don’t wrap the hand too tight and decrease circulation in the fingers (This is one of the reasons that I don’t recommend Ace or elastic type wraps.) Sometimes we’ll place a soft object in the hand before wrapping like a kids sock so that the nails are not marking into the the palm of the hand.
Most kids will let you do anything once, however if you want a lasting program, get some ideas and parameters from your OT that include lightweight, easy to grab and successful activities that decrease the potential of frustration.
I would recommend setting up some sort of reward system where you and your child have an “understanding” that if your child wears The Bamboo Brace/hand wrap combination for the agreed upon time they receive a positive based reward.
Smaller kids might need to be rewarded immediately, older kids could be rewarded weekly and work toward a toy and still older kids might receive an activity or a trip for working on it for a month or 3 months. All I know about rewards is that they have to be organized, consistent and easy to follow like poster boards with stickers, goals and so forth.
Just responding to a frequent question that I am asked, “Should I keep my child’s Bamboo Brace more rigid or more flexible?”
The fast answer is, “It depends on what you’re trying to achieve” To assist with gross and fine motor development then more flexible bracing is better than rigid, no question. If you are using The Bamboo Brace to keep your child’s hands from their mouth, then a bit more rigid is helpful but still as flexible as possible to give them good use of their hands even though they can’t quite bring them to mouth.
For motor development:
In early days of brace development (10-12 years ago) I kept many of the prototypes more rigid by using stay materials such as aluminum. The children performed well, but only in a couple of developmental positions such as hands/knees and standing.
The real challenge was to be able to use an effective dynamic elbow brace in other positions that are in-between the floor to hands/knees and hands/knees to standing. The solution as I discovered during many hours of treatment is to keep the brace much more flexible than you might think. When the elbow is flexed about 20-30 degrees the tricep muscles are at an excellent angle to gain strength and many times will lead to wearing the brace less as motor control, coordination and strength improve at the individual joints of the upper extremity.
Having the brace too rigid does not allow the children to strengthen the muscles of the arm that they need in order to push their bodies upward against gravity. The constant bending and straightening of the elbow during developmental movement and play with the assistance of The Bamboo Brace allows the exact strengthening and motor control to develop that I have found most beneficial in helping children learn to move themselves from the floor to from middle positions such as sitting/kneeling and then upward to standing and walking.
During treatment yesterday a very cool thing happened to a cute little kid named Hannah, she learned how to crawl!
You might think this is a pretty routine thing and many times you would be right, however Hannah has spastic hemiplegia (one-sided cerebral palsy) and learning to crawl is a very challenging thing.
Kids with hemiplegia often cannot easily control the elbow on their affected side and instinctively flex (bend) it the majority of the time. This makes movements like pushing up to sit, onto hands and knees and pulling to standing very difficult. With Hannah I attribute much of her success to us using dynamic bracing at her elbow over the past 10 months.
Dynamic elbow bracing consists of using a flexible yet stiff brace that helps Hannah keep her elbow more extended for a greater amount of time throughout the day. It simply gives her more balance between elbow flexion and extension which is what typical kids do when they are learning how to move.
In my experience with many children over the past 15 years the bracing not only assists the elbow in functioning in a more balanced position but it also allows the shoulder joint and the trunk muscles on the affected side to operate independent of one another which also assists greatly in making the kids more symmetrical between their affected and unaffected sides.
Hannah and I have much work left to do but today we celebrate because crawling is such a pivotal and functional skill to learn that will pay huge functional dividends moving forward. Great work kid!!