Constraint Therapy

It's been a long couple of weeks in the Morgan household...Jake has spent his winter break from school doing constraint therapy to try and help increase the function in his left hand. He was fit for a cast in the middle of December that he wears on his right hand which forces him to use his left hand. It was removable to make things like showering easier, but in retrospect I wonder if we should have gone with a permanent cast...

We made the decision to do this back in November at one of his OT appointments. It's something that she had mentioned before, but I've been resistant because I knew how hard it would be for him (and me watching him go through it). Imagine having to use only your non-dominant hand to do everyday tasks like eating or getting dressed, then take away a lot of that hands function. Doesn't sound like too much fun. I hated the thought of putting him through that. When his OT and I talked in November, she mentioned how much progress kids can show in a fairly short amount of time because of the forced use. Jake has talked about wanting to improve his hand function so he can drum better, so it seemed like the right time. He wasn't thrilled about the idea but he was willing to try it.

As you can imagine, it was extremely frustrating for him. The first morning he had the cast on we had scrambled eggs, bacon, hash browns, and pineapple for breakfast. Not very stab-friendly foods, he was almost in tears after struggling to get eggs into his mouth three or four times. We actually got to the point where we told him to forget the fork and just try to eat with his hands. That didn't go well either, not much to grab when eggs are scrambled and pineapple is slippery. We were told that if he got too frustrated to take it off, it wasn't supposed to be viewed as punishment. We ended up taking the cast off so he could eat and realized we needed to plan our food options a little better. (He had much better success later in the week with yogurt and omelets.) Todd had decided he would get a cast made too so Jake wasn't doing it alone and we all ate with our non-dominate hand in support of Jake. Todd and I also put on an oven mitt while eating to try and hinder us a little further. While it was hard (especially drinking coffee), it was no where near what Jake was going through.

Another tough one I hadn't even thought about was hooking his seat belt. I would pull and hold the strap but wanted him to put the buckle into the clip, again not an easy one-handed task. There is alignment as well as pressure to make it work. He would finally get it but took awhile. We were supposed to encourage him to actually do things when he was wearing the cast, not just sit and watch TV and not use his hand. He and Luke played connect four and some other games or would eat popcorn while watching a movie, but if left alone his choice was to sit and "do nothing."

He ended up wearing it less than I had envisioned. We had planned on taking the cast off when he slept and showered, as well as Christmas Eve and Christmas Day. It was hard to deal with when he had his coat on because we couldn't get the sleeve over it or a glove on, so it came off a lot when we were out. Because of the directive to not make it a punishment and Jake's frustration level, we would take it off if a meal was especially difficult and when he wanted to play his drums. (On a positive note, he practiced A LOT over break.)

Wearing it for any length of time made him really tired, he's slept more during break than I've seen in a long time. It makes sense, he's having to work so hard to do the simplest of tasks, it's exhausting. He also had four OT appointments in two weeks where he worked on strength exercises to further rehab his hand. It was so tough to watch him struggle and get so discouraged, that didn't help my resolve too much either.

We took video's several times throughout the past few weeks of him eating so he could watch them and see the progress. I promised him I wouldn't share them because many times it wasn't too pretty and a lot of food ended up in his lap. He has a really hard time rotating his wrist as well as bending at the elbow, so even when he could get something on the fork, getting it into his mouth was a challenge.

We have seen progress, honestly not as much as I had hoped, but there are improvements. I think being realistic, we only had two weeks and he could have worn the cast more. We're going to continue having him wear it a couple times a week in the evenings and do something like play cards or a game where he can actively use his left hand so he doesn't lose the progress he's gained. All we can do now is continue trying to find ways to support him moving forward.