SUGGESTIONS FOR GRADUALLY INCREASED
TREATMENT PROGRAMS USING THE
MARIBELLE EXERCISE ASSIST SYSTEM (MEAS)
The inside cover page of the MEAS Manual lists 15 areas in which children
or adults have
shown progress, in eight weeks or longer, when following a planned treatment
program. If
you do not have a MEAS Manual, it is available at a cost of $8.00.
The following Progressive Treatment Plans for different levels of client
ability are
suggestions ONLY. Please show them to the therapists working with you OR
contact Mary
Elizabeth Lacerte, O.T. (Ret.) for more guidance IF you are involved with
another therapist.
Start off with short periods (10-15 minutes) and build up the time gradually
to an hour IF the
child/adult is enjoying exercising.
In cases of:
1. Generalized low muscle tone
2. Poor head and trunk balance
3. Epileptic Seizure
4. Spastic Cerebral Palsy
5. Impaired Vision OR Total Blindness
6. Fearfulness and Insecurity
We feel that it is best to begin with using the Upper Body Support and Bucket
Seat ONLY
until the customer and the caregivers are ready to progress to a standing
posture.
Pages 8 and 9 of the MEAS Manual explain how to use the Bucket Seat.
Treatment Program progressions:
a) Gentle movements with the caregiver keeping voice and eye contact with
the customer
and holding onto the client's legs or onto the sling straps at the front
sides of the
Bucket Seat's padded board.
b) Tilting from side-to-side or back-to-front (like using a large balance
ball).
c) Spinning. The caregiver holds the bottom pulley with one hand and turns
the
Trapezoid frame with their other hand.
d) Swinging very gently at first with the customer tilted back for as
much support as needed. Postural position, speed, and distance can be adjusted
to the limits of their tolerance and enjoyment. Swing me/catch me is a lot
of fun, when two caregivers are available. This is the most advanced form
of swinging exercise and very effective in stimulating the spinal cord reflexes
to improve the neck and trunk muscle tone.
e) Bouncing the customer takes very little effort. At first keep eye
contact with them as suggested in a) above. The next stage would be to have
the customer's postural position changed to normal sitting position but
at a comfortable distance from the floor so that the caregiver can reach
the front of the frame and push down on it as softly or as vigorously as
the customer enjoys. This ''fun'' activity can become an opportunity for
caregivers to do hamstring muscle stretching by holding the customer's legs
below their knees while doing bouncing movements.
f ) As soon as the customer has developed head and trunk balance, move the
adjustable balance joint on the Trapezoid frame, adjust the straps on the
Bucket Seat to a normal sitting angle, lower the pulley lines to enable
the customer's feet to reach the floor, then encourage the customer to use
their feet and move the MEAS themselves.
Two female students at Emily Follensbee Center, Calgary, really enjoy
this activity but they require one of our optional chest braces so that
they do not lean too far forward while they exercise on their own.
Some clients can learn to ''pump and swing'' just like using a swing at
the park but they are more comfortable and much safer than being on a normal
park swing.
In cases where a Standing Posture is desirable, the child/adult has
near normal range-of- motion at their hips and knee joints, and tolerates
movement without emotional stress, the Pelvic Support can be used as described
on pages 12 and 13 of the MEAS Manual.
The first time that the child/adult is placed in Pelvic Support and raised
to a normal standing position, it is best to have two caregivers, one to
work the pulley and one to hold the child/ adult's hands while keeping eye
contact and reassuring them. When the child's/adult's feet are in contact
with the floor but their body is leaning backward, gently pull the child's/adult's
hands forward to lift the child/adult to normal standing with floor contact
and weight bearing. Gentle rocking back and forth provides ''intermittent
weight bearing'' and stimulates the neuro-pathways in the brain as the first
stage of learning to walk. Gentle rocking is a way to desensitize the child's/adult's
feet, tone down extensor thrusts, check for seizure activity, and to reassure
the child/adult before letting go of their hands.
The second stage is to let the child/adult move freely, lift their feet
to swing, turn in small circles, do deep knee bends, dance with a caregiver
and do some gentle bouncing.
When the child/adult has reached this second stage of activity, one caregiver
is all that is
needed to raise them to the correct position.
IF the child/adult really wants to bounce hard, we recommend that they be
placed on a small
rebounder. Sundance Trampoline in Vancouver makes an excellent model.
We feel that
some other makes are not as safe as they should be.
The Pelvic Support section is the one used for standing, knee walking (bilateral
amputees,
great discrepancy in leg length OR very distorted feet) AND for gait training
with the child/
adult connected to an overhead track. Round, sliding-door track like Combo
is inexpensive
and works very well. It can be easily installed on the side of an exposed
beam OR flush to a
ceiling and comes in lengths from 8 to 16 feet which can be joined together.
In cases ofgeneralized restricted Range-of-Motion, MEAS can
be used with either the
Bucket Seat or the Pelvic Support attached; the pulley lines adjusted to
allow the child/adult
to sit on a gym mat, plinth or bed, with their legs stretched out in front
of them.
Caregivers can make a game out of holding the child's/adult's hands pushing
backwards,
pulling forwards or turning the child/adult side to side. The pulley lines
need to be taut
enough to prevent the child/adult from falling backwards but slack enough
so the above
movements are easy for the caregiver and enjoyable for them both.
The second stage of the program can include shoulder, elbow, wrist and ankle
joint
stretching, as tolerated.
The third stage might be for the caregiver to work on all the muscle groups
of the child's/
adult's legs and feet. Music in the background or constant verbal contact
are helpful when
the caregiver has let go of the child's/adult's hands.
The fourth stage is to raise the child/adult to normal sitting in the Bucket
Seat or standing in
the Pelvic Support.
In extreme cases of hip and knee contractures, a Scoop Seat might be needed
before progressing to a Pelvic Support. IF so, the measuring Instructions
are available. In most
incidences, using the Pelvic Support in concert with a mini trampoline is
the best way to
overcome hip/knee/ankle contractures before progressing to gait training
with an overhead
track.
In cases ofSensory Deprivation, where sight and/or hearing
are affected, children or adults
are much less likely to be self-abusive when they use a MEAS. This
is especially true when
they learn, usually quickly, how to control themselves.
In cases ofFlexon Spasticity as sometimes seen in Hemiplegla
or Cerebral Palsy, we
suggest that the Bucket Seat be used and the pulley adjusted to a comfortable
height for the caregiver's back. Three to five minutes of gentle bouncing,
followed by swinging as fast as
the child/adult enjoys, invariably will relax tight elbow joints and clenched
hands will open
up. The Neuro/physiological reasons for this change have been well documented
in research
studies about using rebounders.
In cases ofCerebral Palsy with startle reflexes and/or extensor
thrusts, it has been our
experience that under-the-knee wedges inside the Bucket Seat, such as those
inside some
wheelchair seats, do more harm than good. Whereas over a relatively short
time (two months
or less) starting again with the Bucket Seat raised to protect the caregiver's
back, as des-
cribed in the flexor spasticity paragraph above, children/adults who have
spent years in a
''MOHOLAND'' or similar wheelchair with multiple clamps and restraints not
only ENJOY
the freedom of swinging and bouncing but develop head and trunk control,
eye-hand co-
ordination, fewer Extensor spasms and the ability to return themselves to
normal setting IF an
extension spasm does strike them. We have a photographic record of a female
from the age
of 5 to 13 years and full permission from her parents to use the photos
in any way.
