1.21.2023
Guatemala. Simply put, it was not about me, it was about the children.
Their laughter.
Their smiles.
Their courage.
Their hope…
I certainly had selfish motives.
- How nice would it be to leave the frigid temperatures for 80-degree days and sunshine?
- How can I scratch my travel itch?
- How am I able to keep my Spanish and Pediatric therapy skills alive, or expand upon them on a team with others more proficient than myself? (Little did I know I would also help others learn too.)
I had two kiddos in intensivos, intensive 3-hour-a-day sessions for 1 week to produce as much change and as much carryover into everyday life as possible. “Carryover” meaning, if we taught something, that their local Guatemalan PTs, the caregivers (usually parents), and the kiddos themselves could continue the new skillset.
—
From a whopping 6-hours away, A., is an 8-year-old boy with cerebral palsy of right > left lower extremity with lower body weakness post-multiple tendon release and apprehension to stand and walk since late Nov. when his casts were removed.
 |
| The Futbol Champ is here! |
Day 1: A. needed help to get from his bed to his wheelchair, or to the toilet. He couldn’t stand on his own, and wouldn’t sit up for long on his own. He couldn’t kick from various positions.
Motivations: The joy of working with A. was finding what motivated him. Even our translator and PT tech and other teammates learned quickly what that was, as his first day after about 30 minutes he was constantly asking his mother for Coca-Cola or helado (ice cream). We also found he was a huge Lionel Messi fan, post-World Cup.
Treatment: Throughout the days, A. was able to maintain energy a little more each day, especially with the aforementioned motivations incorporated into games. (Ice cream became his graduation surprise.) We worked in every position, lying down, sitting, kneeling, on all fours, standing, transferring, walking. Just like my other kiddo, he had right > left-sided leg weakness and so I played games where he could only reach with his left arm while on all fours to force a weight shift onto his right hip. I facilitated his crawling patterns so he wouldn’t scoot or drag himself on his knees. His favorite games involved kicking or hitting things, so we used a boxing balloon (kudos to the PT students on my team) while in kneeling to maintain trunk and core activation. He was able to progress throughout the week to use both hands and maintain himself upright on two knees without upper extremity support for 30 seconds or more. The little miracles that took place were finding just-the-right ankle braces for him. With a little help from my friends, we flushed out one that would help support his ankle, which was very weak and keep his knee from hyperextending. It even had Spiderman on it! After playing orthotist for the day, I reworked it, again with some help, to fit him perfectly!
 |
| Futbol was always motivating! |
 |
| Coming up with games to get A to weight shift onto his right side. |
Outcomes: By the last day, he was sitting on his own and standing from his chair with one hand on the walker, counting in English to ten! His mom only needed to help guide his bum from seat to seat instead of dragging him around under his shoulders. He was then able to walk with a posterior aka reverse aka Nimbo walker, with only help to lift and steer it around cones, 35-40 feet to kick a futbol into the goal against his arch nemesis, France! Unfortunately it wasn’t captured on photo or video, but the other boys at the clinic huddled around him afterwards and clapped for him. It was precious!
 |
| A. and mother at graduation. |
 |
| A. finally got his helado! |
—
If I thought A. was fun, the little girl I got to work with totally stole my heart. ‘Your wife better watch out,’ everyone joked.
X. is a 6-year-old girl with Zika-related microcephaly and cerebral palsy of right > left trunk and lower extremity involvement with spasticity and extensor tone. She also has little function in her right hand due to flexion tone. She will likely benefit from multiple tendon releases. Mom wanted to know if she needed hip surgery, to which we found by x-ray that her hips were okay, but underdeveloped due to a lack of crawling/standing/walking/weight-bearing.
 |
| After a long day at the office-- ice cream! |
Day 1: X. needed help with all positions. If you were careful, she would involuntarily go into an extension pattern with her whole body and knock you off of your feet or whatever ball you were sitting on. ;) As mentioned, she rarely used her right hand. She bunny hopped around in a kneeling position on her ankles. She was not sitting, standing or walking independently, nor crawling at all.
Motivations: X. was motivated by squishy toys, toys that made messes, light toys (like a light board she drew on that was perfectly eye level for her), and by whatever else the other kids in the room were doing. (which we tried to use to our advantage instead of distraction)
Treatment: Because of her spasticity (a malfunction of the circuitry between the brain and the muscles which sends them into a state of being 'powered on' against your will), we began each session with progressive stretching to dial this down. (We used other techniques for this too beyond the scope of this blog, but PT nerds feel free to reach out.) I learned a lot during this time myself. We did a lot in sitting on peanut ball (peanut shaped yoga balls) to increase her core strength and help her maintain sitting positions. We worked on proper bracing for her right hand and either bearing weight through, or reaching with, her right arm as much as possible to allow her to better interact and help mom at home, play with friends (which we did across the table on day 4), and ultimately to crawl instead of hop/scoot.
 |
| Working to break up spasticity and increase sitting and standing independence. |
We incorporated all of these principles in a standing position and sitting-to-standing transitions and by day 4 and 5, I made sure her mother was performing as much as she could without my physical help. With both kids, a lot of photos and videos were taken and they will be able to follow up with the Hearts in Motion center in the future with all questions, concerns. X. did trial a brace that kept her from walking with as much crossing of her feet, but it was not perfect despite a lot of trouble shooting.
(Video note: X walking above is one of her best walks without her feet crossing, nor heavy bracing.)Outcome: Mom learned how to do all of the techniques we used to stretch, and otherwise, decrease her spastic muscles in her legs and right arm and right trunk. She was able to guide her to crawl and use her right hand more while on all fours, or when sitting independently. She learned where to place her hands, objects, toys, and how to cue X. to stand without falling backwards. She learned how to walk with her by herself, but ultimately she will do best with surgery to bring more independence to her walking.
 |
| Sitting and using her affected hand! <3 |
One day, when I thought she was too tired and distracted, we took a break and she was definitely NOT ignoring me. When I asked if I could have some helado, she stuck me right in the mouth with a phlegm-filled sponge “ice cream cone” and somehow I didn’t get sick. My teammate captured this moment, and it’s my favorite photo from the trip.
 |
| Ice cream, real and fake, is a great motivator! (PC: Anna) |
 |
| Graduation |
—
There are so many other things I don’t have time to touch upon… (i.e. delivering wheelchairs to kiddos in need; the divine setup of how our team came together–it almost didn’t for most of us! – and the tourism fun we had...). But, reflecting upon my checklist above, if there was any other “selfish” point of the trip that surprised me by being met, it was that I was reminded of the full-circle nature of my calling to physical therapy and to help people in great need in ways beyond just PT. From the Syrian kiddos with CP I met in 2014, to X and A in Guatemala in 2023, God affirmed for me the delight it is to work with the most precious of children. He also reminded me in the productive brevity of this trip, that nurturing my spirit, and the spirit and souls of those around me, is just as important as caring for the body. So, if there is one message I would pass along, besides the cute photos and inspiring stories, it’s this: carry God’s joy deep within you and pray that it overflows to those around you, in every interaction you have. And when you have the opportunity to spend time with God’s precious little ones, soak it in like a sponge, because they often resemble Him–freely giving joy. Let’s be more like them.
SWT - 2023-
[P.S. 1/27/2023 - I got an update from A's mom today telling me he has begun to walk without his walker. She said she would have sent a photo, but she's still cautiously right by his side. 💘 ]
—
 |
| Blessing a family with an upgraded wheelchair. |
 |
| The AM Crew |
 |
| The PM Crew |
More info:
HEARTS IN MOTION (H.I.M.) – 8 WAYS YOU CAN HELP:
Pray for H.I.M.
Host a fundraiser
Collect education toys for the preschool in Pueblo Modelo
Invite others to join on your next trip!
Sponsor a child for school ($35 monthly)
Sponsor a child in the weekly feed program ($15 monthly)
Sponsor a home for a family ($3750)
Collect and donate acoustic guitars, strings, and picks
