Excerpts

Fayda Sits in the Corner
Therapeutic Paws: A Tail of Success

Chapter One

Fayda Sits in the Corner

Patricia Petersen, MA, OTR

It was an ordinary day in our household. Fayda sat in her highchair dabbing at Cheerios with her palm. After several dabs, she would bring her hands to her mouth and lick the Cheerios off her wet palm. At 6 months old, Fayda was enjoying her new-found ability to feed herself. Fayda was in many ways an ordinary child. She enjoyed exploring her environment with her hands, feet, arms, and legs, but mostly with her mouth. She would spend many happy minutes sitting in her highchair playing with her food.

Every so often, however, Fayda would let out a loud and pitiful cry. I would turn to investigate and try to ascertain what was the source of her distress. Sometimes a toy had fallen over the side of the tray attached to the highchair. A quick retrieval would set things right, and Fayda would resume her play. But there were other times that she would cry differently. Not so much a cry as a plaintive wail. She didn’t sound frustrated or mad, but hurt. Several times when this happened, I was not immediately sure what had caused her sorrow. Her toys would all be on the tray. Her food would be within easy reach. Nothing seemed amiss. I would search the floor again to see if I could find anything that she had dropped. Nothing was on the floor. Everything was on the tray. Then I noticed her arms were at her sides.

Of course, having her arms at her sides does not seem to be an obvious cause for distress, but Fayda with her arms at her sides was Fayda left without the ability to touch. Fayda had been born without the usual formation of muscles in her shoulders and upper arms. As a result, she did not have the ability to lift her arms from her side, and place them on the tray of her highchair. When properly seated, with her arms placed in front of her on the tray, she would happily play with whatever was provided for her enjoyment. However, once her arms left the tray and returned to her sides, she could no longer grasp or play with any of the enticements lying before her eyes, just out of reach.

Realizing the difficulty that Fayda was having keeping her arms on the tray, I tried to devise some sort of propping system to allow her arms to remain at the level of the tray. The combination of pillows and blankets worked well enough until her torso began to slip down and tilt to the side. Once the delicate balance was lost, all the pillows and blankets were just so much stuffing around her limp body. Somehow, I thought, we needed to find a way to keep her upright so that this tilting-slipping process would not end again with her arms, useless, at her sides.

At our next visit with Fayda’s occupational therapist, I mentioned the trouble that we were having with the highchair and Fayda’s frustration with not being able to keep her arms on the tray. Terri had worked with Fayda on those muscle problems since she was 2 months old and was familiar with both her persistence and her lack of tolerance for frustration. Terri immediately agreed that we needed to find a solution to the problem of the tray.

Terri asked about the highchair: Did it have straps for the waist? The crotch? Did the tray wrap around the arms? Was it adjustable? Did the chair tilt? I described the highchair in as much detail as I could, and Terri listened attentively. When I was finished, Terri asked me to describe what I had done to try to help Fayda with keeping her arms on the tray. I explained about the pillows and blankets and mentioned that they seemed effective until Fayda began to tilt and eventually slip down in the seat.

Terri’s response was almost immediate. She asked if I had ever heard of a corner chair. I had not, but was interested in anything that might help the problem. Terri asked me to wait for a few minutes while she looked through the storage closet in which she kept that type of chair.

When Terri returned, she had in her arms a curious-looking chair and a low table. The chair was constructed of two perpendicular pieces of wood, attached to a third piece that formed the base. The three pieces together formed what amounted to a corner, thus the name—corner chair. Inserted into this corner arrangement were two cushions which formed the seat and back of the chair. Terri placed the chair on the ground and set the table directly in front of the chair. Terri then asked me to put Fayda into the chair.

I set Fayda down into the chair, and Terri assisted me with fastening a large Velcro strap around Fayda’s torso. The strap held her snugly against the seat back. Terri explained how the strap gave excellent support to Fayda’s body, which might prevent the slipping and sliding I had described. It would also help her conserve her strength, which she had been previously using merely to hold her body erect.

Terri then placed some toys on the table in front of the chair. Fayda almost immediately raised her arms and began to play with the toys on the table. I was astounded. Never before had she been able to raise her arms up to near shoulder level without full assistance. This time she just raised her arms and reached for the toys. The body support she was getting from the Velcro strap and the sides of the chair did the trick! It truly seemed like a miracle. Terri suggested that we borrow the chair and table and try it at home.

When we brought the chair home and set it up, Fayda’s older brother and sister were immediately interested in this new piece of equipment in the house. We put Fayda into the chair and placed some of her toys on the table. She began playing with the toys just as she had at the therapy clinic. Even more amazing than that, however, was the fact that Fayda’s brother and sister came and sat down on the floor near her and began playing with her. This was the first time in her life that Fayda had been able to play with her siblings without being held by an adult for support.

They played together for almost an hour, never seeming to tire of handing toys to Fayda, which she would touch, mouth, and throw off the table, only to have them retrieved by her brother or sister and placed again on the table. Each day this scene was repeated, and as Fayda played with her toys on the table, we began to notice that her arms were growing stronger. The support from the Velcro strap around her torso allowed her to conserve the strength that before she had needed to use to remain upright. Now, instead, she could use that strength for moving her arms. From that point on, we began referring to the chair and table that Terri had loaned us as the "miracle chair," for the change it had made in our family was really something of a miracle.

Fayda’s chair became the focal point of daily activities in our family, with Fayda sitting grandly in the middle of the living room where everyone would stop and play. As Fayda continued to grow and develop, she eventually outgrew her need for the miracle chair. We came to see that the real miracle was Fayda herself and the amazing progress that she has made with the help of her occupational therapist and others. Fayda is now an active 4-year-old girl who attends a neighborhood preschool and sits in any chair she chooses.

Chapter Eleven

Therapeutic Paws: A Tail of Success

Rhona Feldt-Stein, BSc OT, OT Reg (Ont)

One day, quite unexpectedly, the stray cat living in the store next to our clinic wandered in. Before long, it had adopted us. Our practice, York Pediatric Therapy Services, Inc, has been known to use all sorts of inducements to keep their young clients motivated during therapy. Because play is a child’s way of learning, fun and games are a part of all occupational therapy practices that treat children; stuffed animals routinely reside at clinics, but sometimes a live animal is even more effective at catching a child’s attention. So, we seized the opportunity for her to become our "clinic cat." The appearance of a soft four-legged creature was an immediate hit with the children who attended the clinic for occupational therapy. Suddenly, "therapy" was a fun place to come. But nights and weekends were lonely for our new feline therapist without any children around, and soon it was apparent that she needed a companion to fill the hours. Enter Max.

Max had good timing. That little brown tabby and white ball of fluff just seemed to know he was needed. As I made my way out of the barn where I had come to choose a kitten, his meowing trailed after me, begging me to stop, as if to say "hey, wait up for me." When I finally did, he trundled over and dutifully lay at my feet as an offering. I guess you can say, he chose me.

So Max eagerly joined our two- and four-legged staff at the clinic. As a 6-week-old kitten, Max accepted his role as entertainer and toy with complete resolution. The children would pick him up and carry him upside down, and he tolerated this with nary a cry or complaint.

But then an amazing transformation occurred. Max seemed to realize that our occupational therapy clinic wasn’t only for fun, we had business to accomplish. So he began to train himself to be a therapist like the rest of us! Max could easily motivate a stubborn child to use both hands to pull apart two ropes to send a float zooming from one end to the other by jumping up to get the float as it passed by. He tirelessly trotted after a piece of string attached to a tricycle to entice the child to peddle it.

As he grew, Max would jump up on the table where we do hand skill activities. At times, he would just lie close by, purring away, adding just enough distraction for a child with an attention deficit to allow us two-legged therapists to complete our evaluation and to test the child’s level of concentration. Finish the task and you get to play with Max! One time in particular, I was trying to get a little boy who had cerebral palsy to use his spastic arm to reach up and put a toy in the upper room of a toy house. After much fretting and my getting nowhere with him, Max jumped up onto the table and stuck his paw through the window of the room in the house. In no time flat, the little boy’s arm was extended to reach out and touch his new friend.

Max’s willingness to be part of the crowd is always apparent. He loves to greet people as they walk into the office and rolls his now 17-pound body onto his back, eagerly anticipating a belly rub. One thing that really bothers Max, however, is the sound of a crying child. That is how he came to meet Erin.

Erin is a 2½-year-old girl who is a petite bundle of charm and personality. Her adult-like speech and long brown curls make you laugh and want to cuddle her at the same time. Erin has been coming to our clinic since the age of 1 year for mild right-sided weakness as the result of a prebirth stroke.

At the beginning of therapy, Erin tended to hold her right arm close to her body. She could not put out her arms and hands to protect herself. She could go from sitting to a crawl position, then crawled using alternative arm and leg movements equally. Erin could begin the process of bringing herself up to tall-kneeling; however, she was not yet pulling herself up to stand or to crawl up or down stairs. Her balance was also very unstable; she, therefore, refused to get up and move. If she was placed in a standing position, Erin would hold onto another person for support, but she was not yet standing on her own to "cruise" and move around furniture.

Erin, despite her cunning ways, was very stubborn and had a temper to rival anyone. She often cried to avoid doing new or challenging activities. If she did engage in these, it was for very short periods of time. Therapy goals, therefore, were very hard to achieve.

Enter Max. During some of the trying times, Max would often wander into the therapy gym and distract Erin during therapy. This allowed the therapist to work with Erin for extended periods of time. Max seemed to sense when and where he was needed quite naturally. When we were trying to get Erin to crawl up the stairs, Max would independently place himself on the top step, meow, and wait for Erin to get to him. Once she patted him, he would then go down and wait for her near the bottom step. This would be repeated several times without Erin’s becoming disagreeable. Within a number of sessions, Erin would wait for Max to go to the top stair, crawl up and then crawl down to pat him, with very little assistance.

Max also therapeutically assisted Erin in getting her to walk. Upon request he would climb onto the seat of a wheeled secretary’s chair and allow Erin to push him through the clinic. When we were trying to teach Erin more independent walking, Max would position himself about 6 to 10 feet in front of her. Every time she would get closer, he would instinctively move a little farther away and lie down. Every now and then he would allow her to catch him, pet him, and give him a belly rub. Then it was back to therapy business as he moved enticingly out of her reach to encourage her to walk toward him once more.

Max also assisted in encouraging Erin to use her right hand. Once again, he would come and position himself on the therapy mat near Erin, but on her right, so she would need to use her right hand or both hands to pet him. At other times, he would play with a toy, again on her right, thus engaging her interest. This would allow me to get Erin to use her right hand to get the toy.

Erin is now walking and using the stairs independently. She uses both her hands for many activities, although she still needs encouragement at times to use her right hand. Erin can still be quite stubborn, but this has dissipated considerably.

Despite the progressive changing of therapy goals, Max is still an "active assistant" in Erin’s therapy. Whenever Erin arrives for therapy, she now comes in asking for the "Meow," and Max is always there to greet her, waiting for his next "therapy assignment."

Max, along with our other cat, and my dog Penny, who is a regular visitor to the clinic, are supplemental to our two-legged occupational therapy staff at the clinic, but they remain the most sought-after "therapists." Their needs are few—food, water, a cozy place to sleep, and lots of love and attention from us and the children—but their contributions are enormous. And best of all, their salaries are low and I pay no taxes on their wages.

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