InversionStrengthening in Sitting with Manual Resistance/Assistance Email Week 29

I do a lot of this exercise with children who have weak inverters. I like the position I am in here in this picture. I can rest the child’s calf on my knees and discourage cheating. I use one hand to provide resistance/assistance to the foot and the thumb on the other hand is the target. I start the child in extreme eversion and cue him bring his foot into inversion. If a child can get any inversion, it is usually from the extreme everted position back toward midline. I tend to position the target hand by having my fingers on the shin and the child inverts to touch my thumb. This ensures that where ever the shin goes, my target hand moves along with it. It is not uncommon for children to try to move their leg medially to bring the foot over. This way of providing the target eliminates the effectiveness of that cheat. The target position is important. Usually I check a child’s range first to see what a reasonable target end position is.You don’t want an impossible end position of inversion…unless you plan to assist a whole lot at the end of the range of movement. Some children have no idea how to move their foot into inversion, so I may have to help them move the child's foot through the entire range. I find this very common in my children with cerebral palsy. I find plantarflexion control develops first, then dorsiflexion, then eversion/inversion. Sometimes I use electric stimulation to help a child get the feeling of this movement. Sometimes children will do this activity for a reward afterward but some times I have to hold a puzzle piece or a car for the child to come over and touch with inversion. I perform this activity concentrically but also eccentrically. This time, I have the child invert his foot, and I try to pull it toward eversion in the direction of my thumb I am holding out laterally (opposite as described above) as a target for me. If I pull his foot into eversion touching my thumb on the everted side before I get to the count of 10, I win. If he keeps his foot off of my thumb target for the entire count of 10, then he wins! He is basically resisting me trying to force his foot into end range eversion. Children are amazingly motivated to win a competition with their therapist. I try to provide just enough resistance to make the child work really hard to beat me. I make a big deal about losing...and the child is delighted. ...and so secretly am I.