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 of generalized 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 of Sensory 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 of Flexon 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 of Cerebral 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.
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