Wednesday, June 24, 2009

The dreaded W sit

Until Drake started seeing his physical therapists, I hadn't spent much time thinking about sitting. I surely didn't know the names of all the different ways to sit: the prop sit, the ring sit, the side sit, the (dreaded) W sit, the short sit, the long sit. I didn't know that sitting was such an important indicator of future mobility. I didn't know getting in and out of sitting is one of the most difficult transitions for people with CP.

Drake has been sitting for a few months. But he's been mostly prop sitting (using his arms to support himself) in ring, side or W sitting. He can get out of any kind of sitting, but he can only get into propped W sitting. When he wants to sit, he rolls to his stomach, pushes up to all fours, and then sits back on his haunches. This works well with his crawling, too, as when he wants to crawl, he just shifts his weight forward and takes off. When he wants to rest, he sits back on his haunches again.

We have loved all this progress with sitting, but it's not that fun for Drake, as he can't use his hands to play in this position. He can shift his weight to one arm or the other, so he can use one hand to grab a toy or open and close a drawer (new favorite pastime). But things that need two hands to hold, like a book or a bottle or something he wants to manipulate, just doesn't work in propped sitting. He tends to roll onto his back to play with things that require two hands.

All his therapists keep telling us to not let him W sit. When we see him do it, we are supposed to swipe a leg underneath for side sit. Or even better, transition him to ring sitting.

But recently, he is starting to lift up both arms in W sitting and sit there without any arm support. And even more recently, bring a toy up with him and play with it... with two hands...sitting straight up! But it's the dreaded W sit! And when I take him out of it, he loses his balance and can't play with his two-handed toy anymore.

I feel like such a bummer parent. He is so excited to have his new skill and is trying to do it a lot. And here I come, and knock him down. I keep thinking that getting the balance and trunk strength to sit unsupported in W sitting must help sitting unsupported in other positions down the road. Is it true that once they learn to W sit they won't sit in any other positions? That is how his therapists have painted it to me. But I could see letting him get really solid in this position, then helping him learn to sit unsupported in other positions, too.


Hopeful Mother said...

You know, looking from the photo, that looks more like a "heel sit" to me. His legs are not totally bent outward, (his butt is resting on his heels) so I don't think it's quite as bad as a "pure" W sit.

Alex W sits too - but he mainly uses it as a transitional position. (He has been sitting unassisted since about 11.5 mos but just in the last 3-4 months has mastered getting in and out of all kinds of sitting without falling over.) We ask him to "fix his legs" if he sits in W too long, and he usually complies. That said, it's harder for him to sit with his legs outward (lots more work!) so I can see why he prefers it. I'd prefer the most stable position possible too, and we don't have to work nearly as hard as they do to do simple tasks.

The big "problem" with W sitting, as I understand it, is that it can cause major problems with the hips if done repeatedly for long periods of time. Not sure what to do if they won't sit any other way, but encouraging him to sit other ways will keep him from possibly having hip problems down the road.

I've been reading a book called "Teaching Motor Skills to Children With Cerebral Palsy" and it gives some good strategies for positioning. You might want to see if your local library system has it.

Just wanted you to know that I know where you're coming from on this one! :-)

Katy said...

Hmmm. . . wish that I could say I feel your pain, but I don't. . . Charlie is still a prop sitter. When he does attempt to push up to a sit from crawling, he's in the side sit position--please don't ask me how he manages these things--I don't know.

Our PT feel that some sitting is better than no sitting and warned me that many CP kids start out with the W sit. Some neuro-typical kids do soo. If it were me (and it isn't, so feel free to ignore my blather), I'd "practice" the other sits and then just make sure he's not spending all day in the W sit.

Drake seem pretty strong and I'd bet that before you know it, he's moved on too bigger and better things.

Anonymous said...

I'm in agreement with the other two comments - for what its worth.

Consider broaching this topic with your PT again. It is tried-and-true to give absolutes (all or nothing) to parents to at least get some leaning in the desired direction.