Stretching
Below are photos and descriptions on how to help your child stretch their hemiparetic upper extremity.
General Tips for Stretching
Think of how it feels when you stretch a tight muscle. It's uncomfortable, but not causing harm to you.
When done properly, stretching is not harmful to your child even though they may react negatively. Many children will cry, whine, or squirm away when they realize stretching is being attempted.
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Some ways to "disguise" stretching or make it seem less scary for the child are:
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Singing while stretching
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Hold their hands in yours to go through the motions of a song (stretching that isn't "formal" like those listed below is still stretching!)
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Making silly noises while you stretch
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Taking breaks to play between sets of a stretch
Don't pull the arm, wrist, or fingers into a position by pulling at the fingers themselves.
For example:
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Wrist extension is achieved by stretching the child's wrist from their forearm and the palm of their hand
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Finger extension is achieved by stretching the child's fingers open from the palm of their hand
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Thumb abduction is achieved by stretching the child's thumb outward from the palm of their hand
(more thorough descriptions of where to support for stretching of the joints are below)
Overall Directions
Push into each stretch until you feel some resistance. Hold it here for 30 seconds. Then, push a little further into resistance for about 5-30 seconds dependent on what the child can tolerate.
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Do this 3-5x a day!
Shoulder
Shoulder Rotation
Option 1:
Hold the child's upper arm still flush against their side with one hand while using your other hand to hold the forearm. Slowly swing the child's forearm from across their stomach and out to the side.
Option 2:
Hold the child's upper arm still out to the side as if they are making a T, but with their elbows bent. Slowly move the child's forearm into a field goal position and then back down.
Elbow
Elbow Extension
Hold the child's upper arm with one hand and place your other hand at their wrist. Gradually bring the wrist down to straighten the elbow.
Wrist
Wrist Extension
Hold the child's forearm with one hand and the palm of their hand (not their fingers!) with your other hand. Move the hand back and forth.
Fingers
Finger Flexion & Extension
Use one of your hands to hold the child's wrist while using the other to hold at the base of the fingers (inside their palm). Be sure to not pull at the top of the fingers. Gradually straighten the fingers.
Thumb Abduction
Use one of your hands to hold the child's hand while using the other to hold at the base of the thumb (inside their palm). Be sure to not pull at the top of the thumb. Gradually stretch the thumb towards a "thumbs up" position.
Stretching directions adapted from Nationwide Children's, Exercises: Upper Extremities Infant (Passive).
Photos from Nationwide Children's Exercises: Upper Extremities Infant (Passive). https://www.nationwidechildrens.org/family-resources-education/health-wellness-and-safety-resources/helping-hands/exercises-upper-extremities-infant