This page includes email responses from Jennifer Majors
Hi, I am a pediatric PT at a children's hospital in KCMO. I work with quite a few families with children who have SMA. I work a lot in aquatic therapy. I am a little surprised at your therapists recommendation for trunk mobility. I hope she is doing more in the lines of spinal and rib mobility. The water is a wonderful modality to achieve this. You can contact me anytime for specific activities.
Scoliosis is inevitable however there is research that has demonstrated that with specific techniques you can delay the progression. Most children do end up undergoing spinal surgery.
There are various relaxation techniques in the water to work on range. One is the badragaz. You can use the water for resistance to movements. Position your child in a back float with her head on your shoulder, put your hands around her rib cage then glide her back and forth along the surface of the water. Her body will move at the points you are not holding. I always start with this. Same position-you can change her angle in the water to get rotation. Once she feels relaxed you can move into more specific movements to isolate each rib level. Your therapist should know this maneuver if he/she had been trained in basic aquatics.
On land I always start with the child in a comfortable position on her back (propped on wedge if cannot tolerate laying flat on back), then I have the child's knees bent and rotate both knees at the same time side to side (for relaxation and a gentle rotation stretch). Have her sit on your lap or lay on her side or whatever position she feels most relaxed. Run your fingers with minimal to moderate pressure through each space between her ribs, both sides. Then when you have completed this go to her side of her body, her outer side of her ribs that would be where your arms are when you stand comfortably and gently give a tug downward about three times. This will mobilize the rib and open up the intercostal space between each rib. As far as specific spinal mobilization you should try positioning techniques. Look at your child, which way is the curve. We call them c-curves where the round side of the c is convex and the opposite side is concave. You want to position your child on her side with the convex side down. Put a towel roll under her side and you will notice her 'opening up' on the concave side. Move the towel around to open up various intercostal space (the space between the ribs) and just notice what difference it makes.