When nature has its way

The human body is not designed to stay put. It is designed in a way so that it can move, change its position and change its place in a multitude of ways. The change of position and place are designed to happen more or less constantly at waking hours; in fact, we need to move quite a lot if we wish to stay healthy. If our body stays put for a long time for whatever reason, there will be consequences, and those can be quite severely bad.

A child’s body doesn’t automatically grow into a healthy adult’s body; our growth and development are shaped by our environment and our own activities.

If you ever had a ‘perpetum mobile’ toddler in your care who seemed to constantly run around and climb on everything that happened to be in the way, you have your picture about the amount and type of physical activity a little body needs to be able to develop and learn.

Children with injured central nervous systems have their bodies made from the same material as anybody else’s. Their bones and muscles, tendons, ligaments start up looking the same; but because the central part—that ultimately decides over muscle tone and every move—has its injuries, there will not be any or not as much moving around, running, jumping, riding bikes and so on as there would be without the injury.

The brain injury itself doesn’t get worse over time. However, it doesn’t go away either, and the inactivity persists and creates an array of secondary complications because no use or abnormal use of the locomotor system results in its abnormal growth.

(Inactivity causes secondary complications that affect all areas of learning and the development of the entire personality but I’m keeping this post within the topic of gross motor development with a purpose.)

Staying in the same position for hours on end will have a very unfortunate effect on development and learning. Staying in bad positions will have a devastating effect laden with deformity and pain. The former set of problems do not traditionally get as much coverage as teacher folks like me think would be necessary, but the latter set of problems are quite successfully taken care of in developed countries using braces, special seats, standers, exercises and a whole lot more, provided by PT and OT services.

While we can’t replace the damaged parts of the brain or grow new brain, not even a bit (regardless of what you may have heard elsewhere), following the recommendations of the professionals (PTs and OTs) can very well prevent our children from staying in bad positions that can cause their muscles to shorten, joints to loose their range of movements and deformities to further debilitate them.

There is also a way to avoid bad positions and staying in the same positions for extended periods: making sure that the children, however disabled, get to move around in all ways typical of children of similar age, with help if necessary, ideally both within their educational setting and at home. This isn’t provided via therapy services and these activities are not exercises. They are part of a daily routine of education and play that incorporates moving one’s own body in meaningful ways, replacing any kind of seats with wheels. This is provided in educational settings called Conductive Education schools, and any parent can provide it at home as a way of upbringing for their children. (I know of parents who provided such upbringing without ever having heard of Conductive Education, but this is rather rare.) Moving around is extremely effective for preventing problems that are caused by the lack of moving around.

What happens when there are insufficient services or no services to help prevent the preventable? In this case, nature, the cruel nature gets its way.

Here is an illustrated account of what happens:

This is India, who has cerebral palsy. Up until 3 years ago she regularly received intensive PT and also some (although only periodical) Conductive Education at various places.

Here are two pictures of India busy working with her PT. The PT did exercises with India which helped to keep her musculoskeletal system in a good shape. Whatever was too short and stiff was stretched, whatever didn’t move by itself was moved, and whatever was week was strengthened. Look at how wide India’s legs are opened while she’s sitting on the bench—opening the legs wide is a very good thing to do for someone whose legs are constantly pulled together by stiff muscles so close that they cross.

India is standing in her walker on the second picture, in the middle of walking up and down a corridor with her PT’s help. Being upright and bearing weight stretches stiff muscles out, increases bone density, contributes to the health of joints and so on.

India was also able to support her weight and stand (for hours) when a person held her hands; she has even learned to take steps by herself if the person held her shoulders and transferred her weight for her before each step. India loved standing and ‘dancing’, and once she figured out how to walk she didn’t want to stop—she wanted to walk around and open every door and look what’s behind!

Unfortunately, India also participated in many other therapies (20 different therapies plus Conductive Education altogether) over the years, because her parents wanted to do everything on earth to help her. Now she was getting older, and her parents were realizing that despite some lofty claims none of the therapies will cure India. They were burning out emotionally from all the false hope and financially from travelling to the moon and back and paying out hundreds of thousands of dollars. Finally, the credit crunch hit, in the meantime her family was falling apart, so all of India’s therapies (quacks and legitimate ones alike) were abruptly stopped. Conductive Education stopped too.

India ended up spending the next several months either sitting in her wheelchair or stroller (which is a necessity because of her inclusion in a mainstream school,—she has to get around somehow—or sitting on the couch at home while the world was happening around her, without her participation. She had been sitting on the couch in a bad, bad way with her legs crossed for many hours a day, for months and months on end. Shorty, abiding to the laws of nature and physics, her stiff muscles on the inside of her thighs pulled her legs closer and closer. Here is a picture of a child who seems to be comfortable and having fun on vacation, but this is just an extremely damaging way for India’s legs to be; a simple abduction device could have stopped this constant nightmare from happening.

While India’s legs always had the tendency to cross, they could easily be taken apart as the first picture shows—as long as it was regularly done. When it wasn’t done any more, her hip joints went through a permanent change so it couldn’t be done any more. As a result, India lost her ability to weight-bear and when after almost a year of doing nothing I attempted to get her to stand, this is how it looked like:

No more dancing, no more walking and looking behind doors. Her legs were crossing very badly and I couldn’t take them apart. When I managed to take them apart a little, she hissed in pain and immediately collapsed—she couldn’t bear her weight; she could stand a little on her left foot, but not even for a second on her right. She in fact was in such a bad shape that the slightest move was painful for her: she hissed when being lifted, carried, moved in any way. She woke up every night, crying and complaining that her knee hurts. Even the limited use of the stander at her school was discontinued.

Last summer when I moved in with India’s dad I declared that she was on the bottom of the slippery slope: I couldn’t get her body into any symmetrical position, her right knee was permanently bent, I couldn’t stretch it, there were hurting knees every night —but anyway, I started to teach her whatever I could every day after school.

I knew that the horrible suffering of this little girl would have been totally and entirely avoidable, have there been better services or at least better trained parents available.

This was 9 months ago. She’s come a long way, the little warrior.

Many people ask me if India is in pain or no when we’re doing Conductive Ed at home. She isn’t. Appropriate physical activity prevents pain, and doesn’t cause it.

Please note that there are no exercises in Conductive Ed and it is not a CE teacher’s job to make the children practice movements or any separate functions (there’s nothing wrong with those though, but they’re somebody else’s area of expertise).

The activities are very complex within Conductive Ed and every activity—playing with dolls, reading a book, spelling words, sorting and counting, etc—are carried out in conjunction with physical activities. A CE teacher always teaches to manage the entire body at any given time—that’s just the way it is. The complex activities are designed to be fun, engaging, and educational.

India loves predictable routines and although I make sure she always knows what’s next and I do give her appropriate choices, she does always get upset when there’s something new. She screamed for a week when I re-introduced standing, but later she demanded that I hold her and help her stand because she wanted to dance! Re-introducing the walker 2 months ago was ‘interesting’, too, but now anyone can see how much she loves it. Pain isn’t the only single reason why children cry. They also cry when they’re freaked out and they do absolutely

cry when they've been taught and have successfully learned that crying is an appropriate means of communication that ultimately results in getting whatever they want.

I know that India would be much, much ahead if there wasn't an unfortunate break in her development. I’m not thinking about that, though. I’m thinking about the incredible improvement she made in the past 9 months and I’m blown away by the ability of her little body to come back from where she was. Needless to say, we haven’t heard her complaining about hurting knees for a long, long time. Watching her pushing her walker downhill on the street and laughing so loud is a pure delight.