Hand Therapy| Homework with a Bang
Life Long Learning| like it or not.
Six weeks ago I fell and broke my wrist. Bad news is that it hurt like #$@! The good news is it’s healing well and gave me the opportunity to learn more about therapy. Hey, I’m a glass-half-full kind of person, right?
Aaron, my son with the label of autism, started physical, occupational and speech therapy when he was a baby. In fact, therapy was one of the things we won in our due process case with the school district. So, I’ve had years of observing therapists in action. We saw Aaron go through paradigm shifts in philosophies and approaches from sensory integration, NDT (neurodevelopmental), isolated medical model therapy, multidisciplinary, transdisciplinary, interdisciplinary…and others I can’t even remember.
My broken wrist was my first hand *laugh* opportunity to actually be the patient. I am now officially “disabled” I have crossed into the “yet”.
Of course there are many differences between Aaron and my experience:
*Mine is for a short time.
*I can tell the therapist when it hurts.
*I can ask questions.
*I can understand what the therapist is trying to do.
*I can look for ways to practice the exercises.
Because of my injury, I am going to a physical therapist who specializes in Hand Therapy. Hey, this is the day of specialization. I wonder if there is a physical therapist who specializes in “thumb” therapy? Probably is.
My therapist is great. What is really interesting is for the first time I finally understand how all those stairs-to-nowhere and giant pegboards ended up in special education.
In the 70s, when children like Aaron were granted the right to education (PL. 94-142) no one knew what curriculum to use for people with severe disabilities. It made perfect sense to start with the medical model and the exercises used in the therapy rooms. In fact, in the early days, many people thought education would be the cure.
Functional Activities
As many of you know, Lou Brown from the University of Madison, WI is one of my heroes. Not only is he an amazing person and teacher, but his innovative ideas helped win Aaron’s lawsuit, and introduce a “functional curriculum” which impacted all Greater Cincinnati.
Functional Curriculum:
If the person doesn’t do it, will someone else have to do it?”
What seems like a straightforward definition is often confusing to people. For instance. When I went home and substituted a hammer was that functional learning?
If you answered “NO” you are correct.
When a hammer is just a substitute for a one pound weight, it is not a “functional skill.” (BTW I felt ridiculous watching TV and pumping the hammer with claw.)
In a medical model or scientific method experiement, you always isolate and reduce the activity to one element. Exercises are specific to one area, so they can be more easily measured.
Did this exercise strengthen the wrist?
Can the patient lift one pound?
How many degrees can the patient turn their wrist?
After a week of practicing lifting one pound weights, could the patient now lift a two pound weight?
The answer would be clean, it would be easy to chart.
Now, if I used the exercise of lifting the hammer (one pound) to hit a nail, or build a cabinet then it would be a functional exercise. But it no longer requires just one skill. It would be more difficult to chart.
Make sense?
The hammer is a tool. The one pound weight is a good therapeutic exercise for my wrist, but until I give the hammer a purpose, there is no “functional skill.”
The idea of “functional skills” is that a person would practice the exercise many times, as opposed to just a couple times a week in therapy.
For years Aaron and others climbed the stairs-to-nowhere and were swung in nets to build therapy skills.
With a “functional curriculum” Aaron learned to climb the steps in the hallway to go to lunch. He used a swing on the playground at recess. He would practice these skills several times a day. They were real, not artifical exercises done in isolation.
Here is the test:
Goal is to strengthen wrist by turning an object.
Which picture shows a “functional” task?
Does that help explain it?
Keep Climbing: Onward and Upward
All my best,
Mary
Comment:
Of course, the peppermill is the correct answer. Can you think of other “functional” activities? Did this help explain this concept.
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Dr. Lou Brown: Busy vs. Bored, Life Space Analysis for People with Disabilities
This is great! I practiced my sign language all weekend! I’m trying to improve my skills so I can better communicate with the hearing impaired. I didn’t talk much but somehow I ended up losing my voice!
That’s great Taylor. We have so much to learn about communication and giving dignity to people with disabilities. For instance, there are some people who would be upset you used the phrase “hearing impaired.” Some would be telling you about “People First” language, that they are people first, and then they have a problem. Others would tell you that they are not “hearing impaired”–they are perfect just the way they are and you are the one with the communication problem. It is a complex world. If you are interested check out the comments by Bob Williams in the post, “What if?”
The other thing about keeping it as fuctional as possible is that if we start out using the skill in n everyday activity it makes it more likely that a person will continue using it . Also with clients who are disabled it makes it more likely that it will be used at all. Let’s face most parents and caregivers ar. As for the eye it was doing swell after the cornea transplant. With inflamation in the back it is starting to come down as the eye preasure starts to get back to the normal range. I have been informed that it can take up to 18 month for the orocess to work itself out.en’t good at therapy or thr like.
Practice, practice…use it or lose it. You’re right that therapy must be part of life.
Best wishes Gary. I’m sure your eye surgery and recovery is a long journey.
Hi all. I’m not sure we are more lucky than folks like Aaron. I have now experienced inflamation in the back of my right eye due to the removal of a special stitch from a glacoma inplant that corrected the overinflation caused by the cornea transplant. While I can think of ways to work vision as it comes back I can also over analyse my own progress. Oh thanks for sharing those examples of functional curricula is. I guess the walking on a narrow set of board on the ground would not be. That I did as a child was functional?
Hey Gary, glad to hear from you.
Hope your eye surgery helps. Are you getting some sight back? You have been through so much–that’s great news.
You’re right, unless the balance beam was to prepare for gymnastics or to cross into a boat, it was not “functional.”
However, as Annie pointed out. Not everything HAS to be functional. It’s just a way of looking at activities and evaluating whether it is worthy of our time.
You broke your wrist? I wondered where you’d been but I assumed you’d been to Florida for a break! How wrong I was! And there was me oblivious to a major disruption to your life and all the while you were dealing with pain and hammers. Oh dear.
We could have shared funny broken arm stories while you got better.
I didn’t do physical therapy when I broke my arm. I thought it was a waste of time. All that sitting around, putting my arm in hot and cold baths and massages might have got my arm better but my bum got numb instead. Plus it cost a lot. I preferred to do the things I normally do – exercise, cook, type, do laundry. Peg boards? No. Hammers, maybe. If I was hammering something. I can totally see the relevance here to autism treatment. Pointless and boring.
That’s right. I forgot about your roller skating accident.
I’m really not knocking therapy or therapists. This experience is making me get a different perspective and put things in place. There is so much we need to learn. I’m thankful for all the advice I can get.
I think the big problem with those peg boards is that they didn’t lead to anything. If someone had said, yeay! now you have a pincer grasp? So lets move to handwriting! It would have made sense. But the reason for peg boards was lost – it was just something to keep students busy, mostly because no one knew what else to do. Just like now people trace their names for years. We just have to keep them moving!
Those endless name exercises. I remember some people had whole notebooks of them.
I remember going to conferences and listening to hours of talk about “pincer grips” –it is amazing isn’t it?
We eventually got Aaron a name stamp, and he still uses it for his checks. I hope other people were as lucky.
Now, I keep thinking of songs, “If I had a hammer…” and “I’d rather be a hammer than a nail…”
Maybe I need a brain therapist too????
I guess as I get older and too tired to fight with schools any longer, I would have a very different argument for lifting the hammer (or a one pound weight). If you look at the future environment, you do need a stronger wrist after breaking it. So the practice may not be part of a functional task, but how many functional tasks would require the repetition for the amount of exercise you need for your future environment? Also, hitting a nail with the hammer may in itself be harmful – the shock/aftershock of hitting a nail would probably not only hurt but do more damage. I just don’t know about anything anymore.
Great points Annie. I don’t know anything either. Funny how age does that to you. I remember the song from King and I, “When I was a lad. World was simplier spot. What was so, was so. What was not, was not…”
Wonder if the schools have a closet full of giant pegboards somewhere? If they do, I’m sure the pegs are missing. 🙂