• Boy of 10 years old

  • Insufficient endurance, decrease in motivation

  • Born with right hemiplegia

Casus: Hemiplegie right

Mourrad’s story

Mourrad is a 10-year-old boy who was born with spastic hemiplegia on the right and who has been receiving therapy within our center for several years. He moves completely independently over short distances, can take stairs by using the handrail and has sufficient sitting balance to sit independently for a long time. For traveling long distances, Mourrad still uses his wheelchair as his stamina is still insufficient to sustain heavy movement activities for a long time. At the level of the upper limbs, the spasticity of Mourrad can be better regulated. He has sufficient control over the right arm himself to perform the majority of his ADL tasks independently. However, the spasticity and increased tone of the lower limbs remain more difficult to reduce.

However, the past few months have seen a sharp decline in Mourrad’s motivation and cooperation. During most motor exercises, he responds displeased and reluctant, or performs the tasks so quickly that the quality of the performance is severely affected. Mourrad does achieve very good results on cognitive tasks, and he clearly prefers these exercises. Mourrad himself also indicates that he experiences a lot of frustration about his physical difficulties. He is very bothered that he cannot play with his peers and he feels excluded and “weird”.

Mourrad’s main request for help is to learn how to play football and basketball so that he can join his friends in the neighborhood in the evening. For this he wants to be able to walk well and for a long time, to jump high and to work on his ball skills. The main concern of Mourrad’s parents is his safety, independence and psychological well-being.

They think that Mourrad can sometimes overestimate himself and endanger himself, while at other times he seems to give up and expect everything to be done for him. Mourrad’s framework offers him all the help and care he seems to need. There are few difficulties at school level.

Goals

  • Continue to affect tone regulation from the right side

  • Upper and lower limb stretching and mobilization

  • Applying relaxation therapy and techniques

  • Practice Range of Motion of the hip and shoulder

  • Improve endurance

  • Stimulating the balance skills (static and dynamic balance)

  • Stimulation of body coordination

  • Practice jumping skills

Integration of Matti inside therapy

How can Matti support Mourrad?

In general, we can say that the integration of Matti within Mourrad’s therapy can offer a certain added value in terms of motivation and work attitude. By offering the exercises in a playful way, we can somewhat reduce the frustrations. The visualizations of Mourrad’s progress make the therapy more concrete and can also encourage him to achieve his goals.

Mourrad has a hard time with slow and controlled movements. So it will be important to set up the games to reward slow and controlled actions. During such performances, the Heatmap can be used for every exercise to visualize the pressure distribution over the support points and Mourrad’s statics.

Whack-a-light

See how the game is played and where the settings are adjusted to suit your patient.

  • Performance: Bipodal jumping and Dropouts (Step Out Mode)

  • To help improve endurance, the overall Time Limit can be increased progressively. Mourrad has to move longer in this way, and in this way trains his condition.

  • By increasing the Button Hold Time, the exercise requires Mourrad to be slow and controlled. This attitude is essential in this case because a volatile version can be counterproductive here. Combining this setting with variations of the Mole Distance can further help to practice both the Range of Motion and the static balance (for a version with dropouts).

  • By lowering the Mole Timeout Time, the movement speed can be practiced. Refusal behavior can also be negated in this way.

Balance Orchestra

See how the game is played and where the settings are adjusted to suit your patient.

  • Execution: Hands (practice four-point posture and palm rest) or feet on the buttons.

  • Again the Time Limit can be increased to stimulate endurance. A longer practice time results in a longer standing phase and a longer focus on static balance and movements of the balance.

  • The Requires Threshold can avoid unnecessary frustration. If it is necessary that full support is applied to both feet, this setting can be checked. This makes the exercise less easy.

  • By increasing the Weight Range, control of the weight over both supports can be better practiced. This further stimulates static balancing skills and targeted movement control. A higher weight range will expect the center of gravity to move further to either side. This setting can be gradually adjusted to allow Mourrad to step further out of his “comfort zone”. By adjusting the Target Range, any increase in the weight range can be practiced gradually. Raising this slider will make the game easier.

  • Via the Bias setting you can gradually work towards the midpoint balance. By bringing this setting closer to zero you can practice step by step.

  • The Heatmap can always be consulted here to evaluate the pressure distribution over the feet.

Twister

See how the game is played and where the settings are adjusted to suit your patient.

  • Execution: two buttons: Hands (Upper Limb Exercise) and Feet (Static Balance). With four buttons you practice the four-point position.

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  • The main way to increase the difficulty is to increase the Maximum Button Distance. This value should provide a good challenge without making the game impossible.

  • During this exercise, the Heatmap can certainly come in handy to see if Mourrad puts enough pressure on the buttons or not.

Simon says

See how the game is played and where the settings are adjusted to suit your patient.

  • Execution: Bipodal jumping and Dropouts

  • Increasing the Time Limit will lead to longer exercise, which will improve overall endurance.

  • By adjusting the Sequence settings, the game can challenge Mourrad cognitively, while progressively performing longer movement tasks. For example, the Start Length can be increased to obtain a minimum of actions from the start. The other Sequence settings can be used to allow for variety and keep the game interesting.

Balance beam

See how the game is played and where the settings are adjusted to suit your patient.

  • Execution: These exercises can be performed both forward and backward

  • With Generalized Steps checked you can choose between Level 1 and 2 to determine the difficulty.

  • The Width can be progressively reduced to practice dynamic balance and coordination

  • With a slow and controlled execution of this exercise, the Heatmap can also be used here to evaluate the position and foot rolling.