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Theo, and his helping hands

In this case study I hope to illustrate how engaging the use of hands in space and in the environment can elicit the freedom of movement and perhaps even voice.

A six year boy I see, ‘Theo’ who has a severe form of cerebral palsy, is kept in a wheelchair for most of his waking time. When I met him he spent most of his time on an iPad with a touch screen on his lap, and was able to swipe with his index finger for screen interactivity. Theo was unable to raise his head, to interact visually with people when they were in his vicinity, and had no verbal skills.

The only vocalization I heard was him crying.

We may be familiar with the movements of the hand, but the link to expression and communication is profound. It is summed up beautifully in the book The Hand by neurologist Frank R. Wilson.

‘Somewhere between 18 months and two years... the eruption of mobility gesture and verbalism(are) an incomparable moment in human cognitive life and in the genesis of human consciousness.’

My priority was to find a way Theo could move from what seemed like permanent flexion and activate his extensors. Then when I came to visit he would lift his head and stare me in the eyes.

Once he was able to raise himself, we could play with the use of the hands. We spent a long time enabling his capacity to grasp objects, cross the midline, and contact between the left and right hand. We did this with Aboriginal clap sticks. We gurgled and laughed together. As we worked he would begin to verbalise, in his own way, his interpretations of his experience. I don’t know if it had anything to do with the rhythm of the sticks, his hands or whether he was going to get there anyway. Whether this was coincidental is not clear to me.

The confluence of gesture and speech is quite specific according to Dr Susan Goldin-Meadow. In her book Hearing Gesture: How our hands help us to thinkiii, she suggests that the movement and gesture of the hands and the rhythmic pattern is a key mechanism that launch the process for human language acquisition. This was certainly my interpretation of Theo’s increased ability to babble with me. His language may not have had specific meaning to me, but it certainly did to him.

The other day when I saw Theo at school his hands were in splints to differentiate the use of the thumb, which is chronically flexed. I removed them and placed him on his belly. He had forgotten how to raise himself and collapsed on the ground. Here's how we got him to do it himself: just by showing him he could weight bear. He was able then to use his hands push down and so to lift his head up high to see the world. If we were to think of an Awareness Through Movement lesson that fit the work we did it may be the Active Dominant Hand, exploring the opening and closing of the hand in various positions. We then put it into practice, in relation to the physical world of the school floor. With Theo those positions were all about engaging with the world. In this context the use of the hands were an essential part of this small boy being able to organize his own weight shift, but more importantly to organize his self-image as an individual with capacity in the world.

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Tags: hands, focal dystonia, frozen shoulder, cerebral palsy, musicians, computer problems, repetitive strain