2) CENTRO DE PARALISIS CEREBRAL GP. & UATEWALA A757 en Home Program Instruction Sheets for Infants and Young Children by LaVonne Jaeger, M.A., PT. Ilustrations by Grace Ascher and Janis Atlee Kely> Vale fins Pin Ay sadn Rarenqne A Therapy Skill Builders A dision Communication Skill Builders UMBERTO MANROQUEZ BARRA (3830 E. Bellevue/P.O. Box 42050 —_- ‘Theson. arteons 687 5/{602) 2-7500 Ttee #5072About the Author ‘of Kentucky where her main teaching responsibilities are in the areas of pediat the neurophysical basis of movement. She is also engaged in a private practice in pediatrics. Previously she has taught at Washington University in St. Louis and practiced physical therapy in both pediatric and general hospital settings. She received her physical therapy degree at the University of Minnesota and her masters degree in physiology at Washington University. She has been the author of numerous articles in Physical Therapy and Clinical Management in Physical Therapy. In addition, she has conducted numerous continuing education courses throughout ‘the country. Duplicating ‘You may prefer to copy the designated reproducible materials by using stencils or spirit masters. Make a single photocopy of the desired page. Use that photocopy to make a stencil master on a thermal copier. © 1987 by Therapy Skill Builders A swsion of ‘Communication Skill Builders ‘3800 €. Bellewue/?O. Box 42050. ‘oeson, Anmona 89735/(802) 423-7800 Al rights reserved, Permission is granted for the user, to photocopy and to make duplicating masters of those pages So indicated in limited form for clinic or home use only. No other parts of this book may be teproduced or transmitted in any form or by.any * means, electronic or mechanical, including photo- copying and recording, or by any inlormation storage ‘and retrieval system, without written permission from the Publisher. ISBN 0-88450-224-4 Catalog No. 4138 10987654321 Printed in the United States of America-Hand Sweep .... Contents Prone, Supine, and Sidelying Spine Curl-Ups . Playing in Sidelying Prone, Weightbearing on Arm wi Head Approximation in Prone .. ‘Arm Approximation Prone Over Roli Forward Acceleration Over Roll Reaching While Prone Over Roll Bilateral Reaching While Prone Over Roll ‘Arm Position for Head Extension... Prone on a Ball .... Neck and Back Extension with Hips Flexed Playing Prone on Elbows . Tilting Sideways on Ball .. Tilting Sideways on Roll Shoulder Elevation ......... Play Over Legs 7 sociation of Legs and Heel Pressure . Dorsiflexion with Knee Extension (Sidelying) . Weightbearing on Extended Arms ...... ‘Approximation 22.0... Sitting ‘Trunk Relaxation in Sitting Reaching for Feet .... Hands to Midiine ©1111 Hand to Mouth ...... Hand to Foot . Passive Trunk Rotation - Head and Trunk Response to Diagonal Tilt. Sitting on Adult's Legs... Tilting on Lap ohkoOS Weight Shift and Protective Extension to Side Elongation with Weight Shift Tilting with Arm External Rotation Tilting Straddling Leg (for Trunk) Reaching on Stool . Backward Prop Sitting Side Sitting ........ “s Dorsiflexion with Knee Extension =" Heel Pressure with Lateral Weightbearing ... Partial Pull to Sit ors : Roll or Ball, Sitting Lateral Tilt Over Roll ............ isi Rotation to Hand Support Over Roll ........ Tilting on Roll Forward and Back (for Trunk) Tilting on Roll Sideways (for Trunk) . .. Playing Forward on Roll . Reaching Sideways on RollSide Sit Prone Over Roll Sitting ona Ball ..... . si Tilting on Ball Forward for Trunk (Control fram Behind) - Tilting on Ball Sideways and Back for Trunk (Control from Behind) Tilting on Ball for Trunk (Control from Front) Changing Positions Pull to Sit Prone to Sit Over Leg Prone to Sit Side Sit to Kneel ......2 2.02 Sit to Hands-Knees .. Sit to Stand .. Coming to Stand Stimulation of Rolling. Kneeling and Standing Approximation in Knee Stance Knee Stance ............ Weight Shifting in Knee Stance Balance in Kneeling .. Kneel to Half-Kneel .. Balance in Half-Kneel Step Standing ........c.sscsseee Standing Against the Wall Sideways. koes RRRARARR Miscellaneous Squatting ...... 2 Good Positioning for Carrying— Good Positioning for Carrying—2 | Pulling on Shirt—Prone on Lap Changing Diapers Stretching for Torticolius ‘Thumb Abduction Leg Control Wrap... Upper Extremity Range of Motion... ++ U4 10 U8 Lower Extremity Range of Motion .. LTO L6Acknowledgments I wish to acknowledge voan Hewitt-Gerw, M.S, P.T., and David Embrey, M.S., PT, for their assistance in photography and development of the instructions for activities in this collection. D. LaVonne JaegerPreface ‘The third edition of Home Program Instruction Sheets for Infants and Young Children is a culmination of eight years of effort to develop a collection of exercises for use with infants and young children who have motor dysfunctions such as cerebral palsy or motor delay. ‘Any home program should supplement but not supplant ongoing evaluation and ‘treatment by the physical therapist. These home instruction sheets are a reminder to the parents of what to do and how to do it, and are not meant to replace the physical therapist's demonstration and the supervised practice by the patient. ‘The home instruction sheets represent some of the more common exercises and activities used in home programs for infants and young children. Each sheet has an area for special structions so the physical therapist can modify the exercise or activity to meet the individual needs of the child. Since this is not a complete collection of exercises, the physical therapist must supplement these sheets with additional. exercises. When development of the home program instruction sheets began, the original intent was not to “publish” the resulting collection. Publication of the first edition in 1980 resulted from a need and a demand for a collection of exercises. A second edition—enlarged— {followed in 1981. The author and the publisher hope that the editing and format of this third edition will facilitate therapists’ use of this collection of exercises for infants and young children with motor dysfunction.Name Date HOME INSTRUCTIONS Spine Cur-Ups Purpose To relax muscle tone in trunk Instructions 1. Place child on back, holding legs with your hands. 2. Curl child up into a “ball” so seat is up in the air (see Figure 1) 3. Slowly roll hips and legs to side (see Figure 2). 4, Repeat in opposite direction (see Figure 3). Desired Response Trunk will relax Undesired Response Trunk will become stift. NOTE: Do not force. As child becomes more relaxed, you may be able to move further. Special Instructions Figure Figure 2 The exercises should be done only under the direction of @ physical therapist. Cae aName Date HOME INSTRUCTIONS Playing in Sidelying Purpose To encourage child to play with hands in midline and to bring hands to mouth Instructions Place child on side as pictured below. Arms should be forward, and hips and knees should be bent. Head should be bent and may be supported for comfort. If necessary, assist child in bringing hands to midline to play and/or to the mouth. Desired Response Child will be able to 1g hands to the midline and to the mouth. Undesired Response Neck, back, or legs will become stiff. Special Instructions The exercises should be done only under the direction of a physical therapist. atten comtantnes ah Sete ‘hovaege mayb epeaued ar mae P-2oy Name Date HOME INSTRUCTIONS Prone, Weight-Bearing on Arms with Approximation Purpose To enable child to bear weight on arms and strengthen neck and back muscles for better head contro! Instructions 1. Sit on the floor. 2. Place child on stomach, lying over your legs with child's hands on floor. 3, Place your hafds over the child's shoulders. 4, Firmly push downward on child's shoulders and release. Repeat several times. Desired Response Child will be able to support weight on hands with elbows straight, hands open, and head erect. Undesired Response Back, neck, or arms will become stiff, hands will ist, or elbows and head will bend. Special Instructions The exercises should be done only under the direction of # physical therapist. Se. P3Name Date HOME INSTRUCTIONS: Head Approximation in Prone Purpose To aid child in holding head up while tying on stomach Instructions 41, Sit on the floor. 2. Place child on stomach, lying across your legs. Place child's hands on floor to help support body weight, 3. Place your hand over child's head as pictured below. Child's neck and back should be straight. 4. Firmly push on head and release. Repeat several times, Undesired Response Back or neck will become stiff; head will come up too far. Special instructions The exercises should be done only under the direction of a physical therapist {or rr ne, ‘Tacmn moy be rode ar ate se Pay coe eee eee eee Cle eee ¢ \ Name Date 7 HOME INSTRUCTIONS Arm Approximation Prone Over Roll Purpose To enable child to bear weight on arms and to strengthen neck and back muscles for better head control Instructions 1. Place child on stomach, lying over a roll as pictured below. 2. Arms should be apart, not crossed. 3, Place your hand(s) over child’s shoulder(s). 4. Firmly press downward and release. Repeat several times. Desired Response Child will be able to support own weight on hands with elbows straight, hands open, head erect. Undesired Response Back, neck, or arms will become stiff, hands will fist, or elbows and head will flop. Special Instructions The exercises shoukd be done only unde of a physical therapist. ‘cog ney Taeaare orice oa PS‘ & \ Name Date HOME INSTRUCTIONS Forward Acceleration Over Roll Purpose To Increase child's ability to bear weight on arms for forward protective extension Instructions 1. Place child on stomach over a roll, with hands on floor. Hold child's legs apart with knees straight and rolled outward. 2. Roll child forward so that most of child's body weight is on arms. Desired Response Child will be able to support own body weight on hands with elbows straight, hands open, and head erect. Undesired Response Back, neck, or arms will become stiff; hands will fist, or elbows and head will bend. Special Instructions The ‘ercises should be dane only under the direction af # physical therapist iarnrees. ‘Tirowee oy oe rane Tosa e P-6§é 4 oR Name Date HOME INSTRUCTIONS Reaching While Prone Over Roll Purpose To aid child in increasing strength in neck and back muscles; to enable child to bear weight on one arm while reaching with the other Instructions 4. Place child on stomach, lying over @ roll. 2. Hold child's legs apart with knees rolled out and straight (see Figure 1). 3. Encourage child to reach out for toys with one hand while shifting weight to opposite side (see Figure 2). Desired Response Child will reach out while bearing weight on one arm. Undesired Response Back or legs will stiffen. Special InstructionsName Date HOME INSTRUCTIONS Bilateral Reaching While Prone Over Roll Purpose To encourage reaching with both hands to strengthen the back muscles Instructions 1. Place child on stomach, lying on a large roll or ball. The child's legs should be separated and knees rolled outward. Knees behind child and hold at hips (see Figure 1). You may want to place the legs on either side of your body. 2, Encourage the child to reach out with both hands for a toy. 3. When reaching becomes easier, you may move your support to the legs (see Figure 2) Desired Response Child will be able to reach for an object with both hands. Undesired Response Child will not be able to straighten arms completely or will lower head and rotate body in attempt to reach out. Special Instructions. ‘Seceoge my be aooaues or tone ae PBecececeocearecCeete & a¢ r \ Name Date HOME INSTRUCTIONS Arm Position for Head Extension Purpose To facilitate neck and back extension for better head control Instructions 1. Place child on stomach, lying over a roll. 2. Hold child's arms out to the side (see Figure 1). 3. Roll arms outward so that thumbs are pointed toward ceiling (see Figure 2) Desired Response Child will be able to hold head erect. Undesired Response Shoulder, back, neck, or arms will become stiff. Special Instructions Figure 1 Figure 2 The axercises should be done only under the direction of 2 physical therapist (ny Tey Si aor ne.oH Name Date HOME INSTRUCTIONS Prone on a Ball +i) Purpose To develop ability to bear weight on arms ‘ Instructions 1. Place child on stomach, lying on a ball as pictured. Be sure to hold legs apart with feet and knees Le turned out (see Figure 1). ‘ 2. Slowly roll the child forward (see Figure 2). , 3. You may place @ toy in front of the ball to encourage the child to reach down (see Figure 3). Desired Responses ia 4. Child will place both hands on floor. ® 2. Child will reach for toy with one hand, Undesired Response Child's arms will become rigid or child will not reach with arms. ‘ Special instructions j The exercises should be done only under the direction of @ physical therapist. ~ ‘esa tN er P40= Name Date v 7 we ws. HOME INSTRUCTIONS. Neck and Back Extension with Hips Flexed Purpose To encourage neck and back straightening while hips and knees are bent ‘ Instructions su 1. Place the child on stomach with hips and knees bent; arms should not be trapped under chest. my 2. Firmly press down on neck and back muscles as you slowly bring your hand from the neck < toward hips. ~ 3. Gentle tapping of the neck and back muscles may be beneficial prior to the firm pressure. ee Desired Response . The child will ift and hold head up and straighten back. v Undesired Response &, 1. Child may straighten legs as head is lifted. 2. Shoulders and arms may pull back as the head is lifted. s Special Instructions The exercises should be done only under the direction of a physica! therapist See Se PatName Date HOME INSTRUCTIONS Playing Prone on Elbows Purpose To develop head and upper trunk control and ability to bear weight on elbows Instructions 1. Place child on stomach with a roll under the chest, 2. Provide toys to play with and to look at Desired Response 1, The child will hold head up, but continue to look down at the toys (tuck the chin). 2. Child will support self on elbows. KSeSt0 Undesired Response 1. Child will lift head too far and be unable to look down. 2. Child will pull shoulders up or back. 3. Head or arms will pull down, ‘Special Instructions The exercises should be done only under the diraction of a physical iherapist Pectin€€CCeunet corte *Te “corner Name Date HOME INSTRUCTIONS. Tilting Sideways on Balt Purpose To encourage lateral trunk movement and elongation on weight-bearing side Instructions pel 4. Place child on stomach over ball. 2, Support at hips or lower trunk as needed (see Figure 1). 3. Slowly roll the ball sideways and wait for child to adjust (see Figures 2 and 3). Desired Response ‘The child will move head and trunk in an upward direction so that you will see a curve in the trunk. Undesired Response 1. The child will use hands for support instead of curving the trunk. 2. The head end trunk will arch back and the shoulder will retract. 3, The trunk will not adjust to the tilt. Special instructions sant Figure 2 Figure 3 ‘The exorcises should be done only under the direction of a physical therapist ‘Scag ay bps ornare PigName Date HOME INSTRUCTIONS Tilting Sideways on Roll Purpose \ To encourage protective reactions of arms } Instructions 1, Place child on stomach, lying parallel to the length of the roll. 2. Support the hips or lower trunk as needed (see Figure 1). 3. Slowly tilt the child and roll sideways (see Figure 2). Desired Response The child will support self with hand at the end of the movement. Undesired Response 4. Child will become stiff. 2. Arms will bend rather than straighten. Special instructions Figure 1 Figure 2 The exercises should be done only under the direction of a physical therapist. ieee. “Tha page mar be veoroauced for nachna var, Po14Name Purpose Date HOME INSTRUCTIONS Shoulder Elevation To encourage shoulder elevation and outward rotation instructions 4. Place child on stomach on your legs (see Figure 1) ‘slowly shift your leg out to the side, so that your leg moves from under 2. Asyou play with the child, the child's chest to under the arms. This will gradually allow more shoulder elevation (see Figure 2). 3. Support the child's shoulder forward and help child turn thumbs up (see Figure 3). Desired Response ‘Shoulder elevation will occur with outward rotation while head is up. Undesired Response 4. Shoulders will pull down and back. 2, Thumbs will turn down. 3, Elbows will bend. Special Instructions Figure 1 bythe child Figure 2 Figure 3 The exercises should be done only under the direction of a physical inerapist. PASName Date HOME INSTRUCTIONS Play Over Legs Purpose 1, To improve head and trunk control 2. To encourage child to bear weight on arms Instructions 1. Place child on stomach over your legs. 2. Provide a toy for the child to play with, Desired Response 4. Child will hold head up while looking at and playing with the toy. 2. Child will support body weight with hands. Undesired Response 1. Child will arch the head and trunk back. 2. Child will pull the arms up with elbows bent. 3, Legs will pull together. Special Instructions AS ® The exercises should be done only under the direction of & physical therapist, © 07 oy apy Sa Ouse anon of Camron aes ‘Ronee maybe bree noreCCELsS Name Date HOME INSTRUCTIONS Dissociation of Legs and Heel Pressure Purpose To prepare child for standing and walking Instructions 1. Place child on stomach over your leg. 2. Bend one leg between your legs and keep one leg straight (see Figure 1). 3, Provide gentle intermittent pressure to the bottom of the heel of the straight lag (see Figure 2). Desired Response ‘The child will hold the leg straight without pushing down with the foot. Undesired Response ssc 4. The child will bend the leg. 2. The child will push down with the foot. Special Instructions Figure 1 Figure 2 The exercises should be done only under the direction of a physical therapist. Sec er payName Date HOME INSTRUCTIONS Dorsiflexion with Knee Extension (Sidelying) Purpose To heip child learn to pull foot up while the knee is straight instructions 4. Place child on side, lying with upper knee straight. 2. With firm pressure, rub the ankle from the forefoot to the foreleg. (This should be done on the big toe side of the ankle.) 3. Place a small toy in front of the child and have child reach for that toy while keeping the knee straight. Desired Response The foot will pull up either when you are rubbing or when child reaches for the toy. Undesired Response The child will pull away from you or bend the knee. Special Instructions ‘The exercises should be done only under the direction of a ohysical therapist 2 3CEEEe & 9 Name Date HOME INSTRUCTIONS Weight-Bearing on Extended Arms Purpose To develop ability to stabilize with upper arm for weight-bearing and other activities Instructions 4. Place child on stomach in front of you. Spread child's legs apart on either side of your waist with the knees straight. Assist child at shoulders to lift self up onto arms. Ii child's trunk sags, gently rub child's stomach so muscles will straighten trunk. I arms do not remain straight, gently tap back of arm just above the elbows so muscles will straighten elbows. geen Desired Response Child will maintain weight on straight arms with a straight trunk. Undesired Response The trunk will sag or arms will bend and not maintain chila's weight. Special Instructions Ry The exercises should be done only under ihe direction of eoerer reer nanan ee ane Pag