Author: Darlene Sekerak, PT, PhD
Corey was a rising sixth grader. In the fall he was looking forward to attending his neighborhood middle school. Like most rising sixth graders he was a bit anxious about the transition from elementary to middle school. Would he be able to find and get to all of his classes on time? Would he like his teachers? Would there be a lot more work? Would there be a lot of cute girls? and Would they like him? Corey was a little more anxious than usual about getting to his classes on time and managing all the big books. He has spastic diplegia and walks with loftstrand crutches. This tends to slow him down and makes stairs more challenging.
Corey's physical and occupational therapists worked through some strategies with Corey about how to manage his backpack and how to balance with his crutches while getting books in and out of a locker. They also stressed the importance of building up his endurance over the summer, as more walking would be required in middle school than he had been use to in elementary school. The physical therapist talked with Corey and his mom about continuing physical therapy over the summer to be sure that he did not lose range of motion or function. His current therapist was employed by the school and would not be available over the summer but she hoped that Corey would begin seeing a private therapist. She suggested a summer camp that included physical and occupational therapies as a second option.
Corey was resistant to both ideas. Mom confided that Corey was bored with PT and wanted the summer off from all therapy. What he really wanted to do was go to hang out with his friends and lift weights. His dad had promised him a weight bench for his birthday. The therapist suggested that perhaps a private therapist could incorporate some weightlifting into his intervention plan but Corey balked at that too. He wanted no parts of therapy for the summer.
Recognizing that this was an important turning point in Corey's relationship with himself and with his therapy, the physical therapist offered a suggestion. She acknowledged that the decision about the weight bench and his summer activities were between Corey and his parents. If he chose to take up weightlifting, she would offer a few suggestions that might be helpful for Corey to gain the full benefit of a weightlifting program and precautions to prevent injury. They agreed to meet after school several days the following week for instruction about strength training protocols, where to start, how to progress, and how to structure a well-rounded program. The therapist included instruction about body mechanics, the importance of rest and how to monitor his responses to the activity. She tailored these suggestions to his particular needs. Although the more recent literature on spasticity supports strengthening of spastic muscles she still tended to be very conservative in her recommendations.
The first week of school in the fall, the physical therapist visited Corey at his new school. She was shocked at the progress he had made over the summer. She noted improvements in almost all area of function. He was still using his loftstrand crutches but was walking much faster, climbed stairs with ease, and his balance was noticeably improved. He was changing classes without difficulty and managing his huge book bag with ease. His level of self-confidence and social connectedness was markedly increased from last spring. He took great pride in showing off his "new" muscles.
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