Pediatric Hemiplegia: Affected Side Activity and Therapy Ideas

When starting out on this journey it is difficult sometimes to know what to DO. Taking action helps us to process our emotions, so we don’t feel so helpless.  We want our child to have the best care, the best recovery, the best resources.  To be honest, YOU are your child’s best therapist.  To have a therapist come in a few times a week (or less!) just doesn’t make much of a difference if there is no carry-over with caregiver/child…  YOU will make more of a difference in your child’s life and recovery than anyone else will.  This is not to say that consultation with therapists isn’t necessary or recommended, but implementing a home plan and minimizing therapist visits is a definite viable option.

The good part is you don’t have to feel guilty spending minimal $ on therapists when you can get similar or better results at home (especially if your child is like mine and gives you the “help!” look as soon as you arrive at the therapy building).  The cost is equal to your time and many things you already have around the house.

The bad part is that it puts pressure on you, the caregiver, to put in the time and effort for daily therapy; and guilt if you do not.  However, for your child to experience the best recovery possible, the onus is on you already unless you can afford daily therapy…

Recommendations I have read suggest 2 hours/day of therapy-type activities, 6 days a week.  This is great to shoot for…but life happens.  Therapy burnout happens.  The good thing is that not all of it has to be active on your part – i.e. iPad is a great activity for the affected hand where you don’t have to be hands-on.  Another way to get that therapy edge with minimal effort is to make use of braces, splints, and other alignment orthoses – see post HERE.  Dr. Karen Pape describes these devices as having a therapist’s hands following your child around all day long!

I have compiled some suggestions of possible activities to do around the house.  It’s a great idea to ask for a home plan as well from your child’s therapists.

Affected Hand Activities:

  • Playdough – squishing, rolling, stamping with handled stamps or palm stamps as your child’s affected hand is able – a good two handed activity is rolling it out with a rolling pin
  • Finger paint – or pudding – smearing on the bathtub, licking fingers if pudding, smearing on a mirror (great wrist exercise)
  • Transferring tasks – balls, rocks (whole hand), or beans, dried pasta (pinchers)
  • Throwing balls, or beanies into a bucket or through a hoop
  • Blowing bubbles with a wand – can make the wand handle thicker for easier grip using duct tape, foam tubing, etc.
  • Popping bubbles with affected hand – great for reaching and shoulder motions
  • Pull toys – like the classic puppy on a leash, or a real leash around a stuffed animal
  • LeapFrog Alphabet magnets, or other magnets to spread on the floor, pick up, and put on the fridge or in their holder
  • Puzzles with big pegs, can wrap coban (self-sticking stretchy material – can be purchased cheapest at farm supply stores as “vet wrap” for horses’ legs) around them to make them easier to grip – flip each piece over before placing (I put stickers on the bottoms – and need to assist with the supination)
  • Writing on mirrors or windows with Crayola Window markers or dry-erase crayons or markers – great wrist activity
  • Washing walls, mirrors, windows, tables with the affected hand – we used a wet sock over her hand that she could wipe with
  • Weight bearing – place your child in side-sitting, with their trunk weight supported by the affected arm.  Read to them, let them watch TV, etc, but only as long as they are weight bearing on the affected arm (you will have to watch!).  Start at around 1-2 min and work up to 10 minutes at a time.
  • 5 in a row type game where you pick up checker-type discs and drop down slots.  Thrift stores are a great place to pick up cheap games.
  • Trouble game where you have to push down the popper with the affected hand
  • iPad / tablet – place a sock or splint on the unaffected hand to restrain its’ use – have this be an affected hand ONLY task as it is HIGHLY motivating!
  • Eating popsicle with affected hand – use a tensor bandage to help wrap hand to the stick
  • Wash toys in a bubble-water bin with affected hand; can add little toys frozen in ice cubes for interest; can add food coloring for interest as well
  • Flip-sticks (where you flip them to get the sprinkles to fall from one side to the other) – goo tubes, etc, anything that needs to be flipped to watch the material flow down
  • Musical instruments – again, may need to use coban (vet) wrap or a tensor bandage to help strap wrist to the instrument
  • Memory game where the cards need to be flipped
  • Bean, Lentil, Dried Pasta etc. bins filled with hidden small toys to rifle through and discover
  • Many early childhood games can be adapted to be therapy for affected hands/arms, browse your local thrift shop or craigslist/kijiji 🙂

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Hint:  If your child is having difficulty with finger isolation, try wrapping the other fingers out of the way using vetwrap (try a livestock supply place) or a tensor bandage, being careful not to cut off circulation.

Bimanual Activities:

  • Plastic Eggs / Egg Hunts – hide treats, stickers, etc inside
  • Pop beads – get super easy ones at first
  • Catching balls
  • Coloring/writing – have your child lay down on their stomach, this will force your child to use the affected hand to hold themselves up & the other hand to color/write; aqua doodle mats (paint with water) are good for the younger pre-writers
  • Silly (Therapy) Putty – have a large enough chunk that both hands can grip it with assistance, then PULL-PULL-PULL it apart!  (Can be purchased as therapy putty with 5 different resistances – note that regular silly putty is close to the easiest resistance).

Balance and Gross Motor Activities:

  • Crawling – so excellent for hand/arm weight bearing as well as crossover between the 2 brain hemispheres!  Continue in older children, even if you have to bribe! – to help teach crawling, use a rolled towel like a sling around their belly to take the weight pressure off; discourage butt scooting as it is highly asymmetric
  • Crawl tunnels – even for bigger kids
  • Balance bridge made of 3-4 foam pool noodles duct-taped together
  • Balance transfer – climbing over and walking on couch cushions, dog beds, mattresses, air mattresses, pillows, piles of blankets – spread these all around a play room regularly
  • Standing Balance – have your child stand on a foam piece (dog beds work great) while standing to play at a coffee table or end table; even if it is iPad or while watching movies
  • Obstacle courses – climb over ottomans, climb on and jump off couch cushion, crawl through chair legs, jump from one hula hoop circle to another
  • Ball or foam pits, buy a cheap second hand toddler pool and load it up – you can get old foam cheap on used sites and cut it up into chunks
  • Walking on uneven surfaces – sand, gravel, dirt, mud
  • Walking up and down ramps and hills
  • Visit different playgrounds and utilize to your child’s ability
  • Standing on one foot, putting the other foot on their knee; switch legs (assist with balance as required)
  • Walking up and down steps
  • Treadmill, slow and steady, assisted in a harness or held (both sides) until gait is established
  • Gently massaging spastic and weak muscle groups with some massage oil, this encourages circulation and sensory awareness (my daughter hated massage from an infant up so we haven’t done much of it – maybe too much sensory overload)
  • Gymnastics – with one on one support
  • Exercise balls – balance sitting, on tummy, on back, etc.  These are great from baby + with assistance
  • Toys stationed at all different heights around the room to encourage up/down and side to side movements
  • Swimming
  • Water walking is GREAT for gait training; deep water even more so (with floatation device)
  • Balance / strider bike
  • Scooters (3-wheeeled, hint: Daisy Powerwing scooter has brake on Lt)
  • Tricycle
  • PlasmaCar

Therapy:

I strongly believe that in this life, nothing happens by accident or coincidence – things aren’t determined by fate or luck (good or bad).  I believe there is an overarching story – a beautiful picture of love, loss, and redemption – and that there is Someone who cares and is in control.  You are already a part of this story, whether you know or believe it or not.  While the end of the story has already been written, your own part lays open before you for you to choose your ultimate destiny.  Perhaps our coinciding struggles have been finely orchestrated to lead you to this one moment: The Bridge to God.

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“Praise be to the God and Father of our Lord Jesus Christ. The Father of compassion, the God of all comfort, who comforts us in all our troubles so that we can comfort those in any trouble with the comfort we ourselves have received from God. For just as the sufferings of Christ flow into our lives, so also should the comfort of Christ overflow.” (2 Corinthians 1:3-5)

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