Marie Tygesen Dalsgärd Hansen 18 October 2009 General Observations Head/Neck Connections Joint stability Functional improvements include

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1 Name Marie Tygesen Dalsgärd Hansen ABR Denmark ApS ABR Denmark ApS Starting Date: February 2008 Report Date: 18 October 2009 General Observations Since Marie started with the ABR Program in February 2008, she has achieved a reduction of compressional weakness of the thorax. This has given her increasing stability in the prone position and in sitting positions She is a child that can be characterized as having extremely weak and hyper-mobile joints. Joint stability is being achieved gradually allowing for improved weight bearing on the arms and legs. Her improvements are categorized as follows: - Reduction of compressional weakness within the thorax - A general increase in strength volume of the chest - Increased stability of the thorax as the basis for maintaining head positioning and vertical or horizontal weight bearing. Head/Neck Connections - Lengthening, strengthening and improved mobility at the level of the neck resulting in improved head control - Improved counterbalancing of head - Varied head positioning Joint stability She has achieved general joint stability improvement visible in: Neck Shoulders Hips Knees Functional improvements include: - Improved sitting 1. in tailor position 2. in edge sitting on the bench 3. independent sitting for short periods 4. improved sitting with suspended arm support - Improved mobility of the spine - Improved waist level mobility - Improved counter balancing in sitting - Improved prone position 1

2 General Observations Reported by the Parents in the period between February 2008 and August 2009 Marie har haft store forbedringer på synet. Ser flere detaljer og skeler mindre end tidligere. Marie er nu i stand til kortvarigt at stå i kravlestilling. Marie kan sætte sig op og hendes balance er blevet væsentligt forbedret. Hun sidder ikke længere på halebenet som tidligere og hun sidder med ret ryg i længere tid end før. I skrædderstilling kan hun sidde i op til 10 min ad gangen. Hun kan nu tage fra med armene ved forlæns fald. Hun kan sidde på en stolekant uden støtte i op til 2 min ad gangen. Marie har flere lyde der minder om ord, såsom far og hej. Marie er mere smilende og har bedre fokus på det der sker omkring hende. Marie er blevet stærkere fysisk og har fået styrke i hænderne til at gribe og holde et objekt, såsom moderens tommelfinger etc. Marie får ikke længere epilepsimedicin og har færre anfald end tidligere. 2

3 General supported sitting (Stabilization of head, neck and upper thorax) February 2008 Any attempt to place the child in sitting positions resulted in the child falling. Supported Tailor Sitting The child falls. Supported Sitting on the Bench The child falls, the legs go upwards. Some counter balancing with head when falling to the right. No counter balancing with head falling to the left. The child falls as a block. Below. August 2009 Attainment of Independent Sitting Independent sitting has been attained for short periods. She is able to change head and arm positions without losing her position. 3

4 Sitting with one and two arm support August 2008 Sitting with one arm support. The child falls. She attempts to support with the arm. The shoulder gives way. August One arm suspended support. The shoulder blade slips the thorax is weak. The child falls. She falls when the other arm is used for support. No counter balancing with head. Next page page 5 4

5 August 2009 Sitting with one arm support. Improved trunk stability and head control. She is stable with a one arm support. 5

6 August 2008 Sitting with two arm support. No control, the child drops backwards. Backwards drop is the same as attempts to sit. The child falls. The head is frozen in one position. August 2009 Sitting with two arm support. Improved trunk stability and head control. Sitting with two arm support Backwards drops initiated by the tester. Here one sees much improved counter balancing with the head and head control. She brings the head back up. This was not possible in August

7 February 2008 Prone Position In prone position the child was consistently in the frog position displaying the weakness and hypermobility of the hip joints. Attmepts to lift her head failed. She let it drop again. August 2008 The child still lies in frog position. The head has two positions. Either tilted extremely backwards for stability or falling forwards August 2009 Prone Position - The child is much more stabile on her front. She can raise the head for longer periods and hold it in varied positions. Back and trunk strength is visible through the various arching positions with legs held in the air. The change in leg positioning is visible frog position has disappeared. 7

8 August - Prone Position Elbow Support The child lies in frog position. The head has two positions. Either tilted extremely backwards for stability or She collapses. Frog position. August Prone Position Elbow Support Acquired independent Movements The child can support herself on her elbows in prone position, free the arms one at a time. This is the preparation for creeping forwards on the stomach. August 2009 Testing weight bearing on elbows. She is stable on the elbows and can move head more freely. Taking one arm up, does not cause her to fall or to flip over. 8

9 August Testing arm weight bearing capacity and strength of the vertebral column. Wheel Barrow Test The arms do not hold and the head falls. The back sags and arches forwards. August 2009 Wheel Barrow Test The imropvements in this test are obvious. One can see the improved strength of the arms and back. The back does not sag and the abdomen does not hang through as much as a year before. 9

10 Improvements of Compressionable Weakness of Thorax: February 2008 The weakness of the shoulders is evident. August 2008 The child collapses in this position. The head drops forwards. August 2009 Obvious stability. The shoulders do not slip upwards. Even this flying test shows increased stability. 10

11 Goals for the following year: 1. Further strengthening of the thorax and the vertebral column 2. Further improvements in neck strengthening and mobility 3. Improvements in head positioning and head control 4. Improved weight bearing: - on the elbows in prone position - weight transitions from one arm to the other in prone position elbow stand - longer stability and better balancing in this position - achievement of longer periods of independent sitting on the edge of the table and on the floor - improved weight bearing in quadruped position 5. Improved counter balancing when: - sitting on the edge of the table with one arm support - sitting on the edge of the table with support at the level of the abdomen - tailor sitting with one arm support 6. Improved hand functioning. 7. Further improvements of sitting platform improvements in the tilt of the pelvis 8. Improved independent transitions from prone position to sitting position 9. Improved independent sitting ABR Denmark ApS This report is completed by: Diane Vincentz on October 18, 2009 in Skanderborg Diane Vincentz Director ABR Danmark ApS Horndrupvej Skanderborg 11

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