I have a questions to the adults with CP here. My son is almost 8 years old and have virtually no self-help skills. I am having a hard time figuring out the problem. He has fairly significant physical impairment, but he is not completely helpless, however, he seems to have absolutely no drive to do things for himself. He is not toliet trained, and I understand he has a lack of control. What I do not understand is how he can sit in a messy diaper without complaint until someone sniffs him out. He cannot bathe himself, but he could certainly help if he so chose. Same with teeth brushing. Dressing is another area that he just doesn't even try. He could put on a t-shirt or take one off, but when I hand him a shirt to put on, he just crys. Does he truely believe he cannot do these things, or is it just easier to have mom do it for him? In areas other than self-help he is a very determined little boy, always wanting to try things himself or with minimal help. Is there a way I can help teach him to dress one handed? I want to help him achieve some degree of independance, but I am lost on how to achieve that. Any input would be helpful and appreciated!

Like for any other kid, it is the job of the parent to teach their child all this skills. I could not do lots of things at your son's age but just like how she taught my other siblings; my mother also taught me how to use the toilet, bath and much other stuff. If i had difficulty she would teach it to me in a different way which was more convenient for me. she even installed handles in my bathroom so that I can hold on to something while i bath and she keep all the shampoos and soaps within my reach. At the age of 8 I might have depended on my mother to make things easy but as I grew up and went to school with other AB kids i wanted to be independent just like them and I found that i could easily adapt myself to different situation because the need for independence was very strong in me and maybe because my mother had already had already taught me to be independent and that if i can't do something I should try it in a different way.Somethings it might be a little hard but if you know your child can do something on his own let him do it.Make it easy for him but don't do it for him.

If you have trouble finding ways to adapt activity it might be worth trying to find an Occupational Therapist - they can also help with working ways around behaviour/problem-solving how much is can't do, and how much is wont do/doesn't think he can/prefers help. They should also be able to work on adapting dressing/self care tasks.

HTH
Swift

I agree swift about the occupational Therapist. If they work with him for a while they may be able to determine how much of the issue is "can't do" and how much is "won't do".

If you learn that he can do things like put on clothes and use the bathroom by himself, just ask the O.T. for some techniques on the best way the help him along.

I can give you two things the really helped me.

Getting Dressed:

When I was about 6 or 7 my theapist would turn my clothes inside out, then make me turn them right side in and put them on again. I can tell you that the first few times I did this I did not like my theapist very much. But once I learned how to get dressed I was very proud.

Thing is I don't know how much time you have in your day to put up with the tantrum which will happen at first.

Tying my Shoes:

For the longest time I just had so much trouble with this one. No matter how many times someone showed me as the tied my shoes it woundn't sink in. Then one day I saw a toy with bottons and snaps and shoe laces. The kind of toy that it meant to show toddles how to do things like that. If memory serves it was a Snoopy toy. Anyway I asked my brother to show me again how to tie, and he did.

Now I don't know if it was looking at it in a different way or what it was but something clicked. I knew if I just did a few times by myself I would be able to do it. Well I practiced the rest of the day but I got it!

I have to say that was one of my happiest days when I was a kid because it was so hard for me when I was in school and I had to ask other kids for help tying my shoes.

I Hope this Helps
Write Back To Let Us Know How It Goes.

Have a Wonderful Day

StixForLife :wave:

I think these skills build upon themselves. The first two or three things he learns may be a trial for both of you. But once he starts feeling a sense of accomplishment, I don't think other skills will be as much of a struggle.

You're probably already doing this, but I'd focus on easy clothing items first: sweatpants, tube socks, velcro shoes, etc.

When I was little, putting on a coat was my biggest hurdle. I only have negligable upper body involvement, but balancing myself to put on a coat was really hard. My OT would sit me on the floor and place my coat in front of me. She's spread the coat on the floor so that the collar was facing me (closest to me), upside down. I'd place my arms in the coat and then flip it over my head. It was fun! And much easier than reaching around my back to put my other arm in my coat. On a bad day, I still put my coat on like that if no one's watching.

That sort of "out of the box" thinking is crucial.

LOL - what a cool way to put a coat on. :D It sounds really fun. :D I remember velcro shoes - it took me forever to learn to put my shoes on the right feet and tie them! My parents supported me, but they pushed me to do things on my own and for me to become independent. But if I really needed help and asked for it, they helped me. Heck, my writting is pretty yucky, so if I need something written quickly or whatever, I still have them or someone else help me out. I think that is very important - be supportive, but don't do everything for him. Litttle by little, start to push him to do things on his own. Like NJenn said, the skills will build upon themselves. And out of the box thinking is VERY crucial to the process of adaption. That's one thing I love about my CP, is how much it and my parents and other people have taught me about thinking outside of the box. That is a skill I will have with me forever...and it's uses reach far beyond adapting stuff because of "disability". My parents taught me I could do anything I set my mind, too. It just took me a while to figure that out. Now that I have grown and matured, I realize that...and I do anyhting I set my mind too. Sometimes it may take me a while, or I may go about things in a manner that makes peopel wonder what I'm doing :D...but oh well. :D Anyway - I kind of lost my train of thought...but if you found anything in there helpful to your situation, GREAT! Hope this helps! ;-)

I understand the need for him to have some degree of independance. That is why I push him to try to do things. However, I guess what I am looking for the technical application to teaching these skills to him. He has spastic quad. His balance is so poor that he cannot do anything standing and his right arm/hand is little more than a "helper" hand because he is contracted at the elbow (despite lengthing surgery last summer) and he cannot articulate his fingers or wrist. I really like the velcro show idea, however, I have been unable to find any velcro shoes that will work with his AFO's. I know when I had wrist surgery and was in a cast for 8 weeks, I found it almost impossible to dress myself, and I had the use of my fingers and full range of motion in my elbow!!

You can't find velcro shoes that work with the AFOs? I could have swore I wore my velcro shoes with my AFOs...did you try finding a wide shoe? I know with dress shoes, I have to go wide!

For my 5 year old nephew, my sister buys the cheapest velcro sneakers she can find, one size bigger than his actual size. Canvas didn't hold up to everyday wear and tear, so look for leather, real or fake, and the lower cut the better. Also, leather will stretch somewhat to fit the AFO without tearing. If your son's AFO are anything like Nick's, they have support the length of the foot, so it won't matter if the shoes are too long. The AFO should be providing the primary support, the shoes are mainly for traction.

Buy inexpensive shoes because the AFOs will cause the shoes to wear out - the metal hinges will cut into the sides at the ankle. You will have to put the shoes on for him - it will take some force to get the shoe over the AFO - but he can try to do and undo the velcro. With Nick, when its time to take his shoes off we free the shoe from his heel so that he can finish pulling the shoe off (its basically just hanging on his toe). We also have him do and undo the velcro on his AFOs.

Even if you are assisting him with forceful movements like pulling, you can try to encourage your son to grasp with 'thumb and pointer' with his more mobile hand. It can take Nick several tries before he can grasp the velcro this way, and he needs added pressure to actually pull, but he really needs all the practice he can get with fine motor skills, so its worth the effort.

Also, as a general tip, pretending is a great tool. It funny, but Nick needs lots of help with feeding, but lately he likes to 'pretend' to eat and he'll mimic our movements - holding a pretend cup and taking a sip, cutting with a pretend knife and fork. He can imitate with more fluidity and control than he can with actual utensils, so it may be that the tension of grasping interferes with the movements. Encourage him to pretend as much as possible. Nick pretends to play golf, cook and serve food for his family, play musical instruments, ride a motorcycle. Something about pretending and mimicing make him slow down and produce more controlled movements. And its FUN! I often mime several holes of golf with Nick seated in a chair - driving the gold cart, placing the tee, choosing his clubs, taking swings (to cries of "Whack!" and "Fore!"), even filling out his score card. Whatever your son shows interest in will do.

Best of luck.

One more thing about teeth brushing: how does he feel about electric toothbrushes? Some kids can't stand the feeling of the vibrating brush, but if your son can handle it, it might help with brushing. Since the toothbrush is doing most of the work, he doesn't need to move it back in forth in his mouth so much as hold it and move it over his teeth. The movements aren't so fine and quick.

Nick HATES electric toothbrushes so we're doing the brushing for him, and we let him 'finish' but hopefully he'll get over it because I'm not sure he'll have the control necessary to get his teeth clean on his own with a standard toothbrush.

Ditto - Any shoe that is too high/stiff, he won't be able to get his foot into.

The only shoes I have found that works for Brayden is Starter hightops or the M-3000 orthopedic high top, and I can't find those in velcro. His ankles are so weak, that even with his AFO's, he cannot get enough support.In fact, he can actually pronate out of his AFO's. The hightops can be tied tight around the ankle (granted is takes a LOT of work getting his feet and AFO's in there) so that his ankles are more or less stabilized between the AFO and top of the shoe. Other shoes I have tried have to be so much larger than his actual show size that he cannot walk in them. He has very tiny feet, and is still in toddler sizes....which may be the reason I cannot really find shoes that work with the AFO's

His ankles are so weak, that even with his AFO's, he cannot get enough support.In fact, he can actually pronate out of his AFO's.

That's too bad. I didn't start learning about CP until my nephew was born in 2000, and I was on a pre-PT track in college, with lots of volunteer hours in a variety of PT settings including Peds, but I didn't run across any children with such bad lateral stability in their ankles. My nephew can push out of his AFOs due to his tight calf muscles (plantar flexion), which is open at the top of his foot and secured with velcro, and that's somewhat common from what I've seen.

I'm sure you've already done so, but sounds like his PT/OTs need to get involved to find the right shoes/AFO system. Nick's AFOs have a small metal plate on both sides of the ankle supporting the hinge; it's embedded in the molded plastic part that fits his foot so it's VERY rigid and prevents all side to side movement or ankle rolling.

Let us know how things are going.

Other shoes I have tried have to be so much larger than his actual show size that he cannot walk in them. He has very tiny feet, and is still in toddler sizes....which may be the reason I cannot really find shoes that work with the AFO's

Try Zappos. I buy my EE tennis shoes for my AFOs there. If you click on the wide shoes link, you can search for wide toddler shoes (E and EE). They have wide child sized high top velcro tennis shoes (stride rite), I checked! They also have wide high tops in toddler size, but with no velcro. They also have free shipping and returns! I have no affiliation with them-- they are just a great resource for hard to fit feet-- especially braced feet! They have literally saved my sanity when it comes to shoes. Hope this helps!

Nicki

Try Zappos. I buy my EE tennis shoes for my AFOs there. If you click on the wide shoes link, you can search for wide toddler shoes (E and EE). They have wide child sized high top velcro tennis shoes (stride rite), I checked! They also have wide high tops in toddler size, but with no velcro. They also have free shipping and returns! I have no affiliation with them-- they are just a great resource for hard to fit feet-- especially braced feet! They have literally saved my sanity when it comes to shoes. Hope this helps!

Nicki


Thank you!! I will check those resources!!

Back to self help. I struggled through the daily ritual of self dressing with my son this morning so I know the frustration. My son would rather not help but of course that isn't an option in our home. :) He is 3 so we just recently expected him to start helping. Whenever I set out to teach him a new skill I approach it from educators perspective. I have a lesson plan persay. So the first week my only goal might be for him to open the bottom of the shirt up and get his arm somewhere in the shirt. the next week we add a step. A lot of times he doesn't need to go that slow but I prepare myself to break it down into minute little steps. Before I figure out the process I try to put myself in his shoes so if he can't use one arm I would sit their and try to do the task with just one arm and see what the most efficient process would entail. The next thing is engraining the movements in their brain. Motor planning is very hard for most kids with cp and instead of a few times to master it they need to do it maybe a hundred times more than the typical kid. When our son was trying to learn to use a spoon at 20 month we litteraly ate applesauce, cottage cheese,ice cream and pudding all day long. every hour we had a 'snack' and he do the movements over and over.He was happy because he got to pig out. The key is make sure there will be success and then celebrate the heck out of that success :jester: in the beginning I supported his wrist to help with the scooping then evenutally my hand was just a support of stabilization in his elbow and all the sudden he didn't need me at all. :) Best of luck but hang in their and insist he learn these skill if he is capable.