How To Succeed At Patterning: Technical Points for Improved Patterning
If you haven’t already read my first blog on patterning, check that out here, and even if you are already patterning and have been for some time, I strongly recommend you read part one first!
How to Succeed with Patterning: My Very Best Advice - Part two: The Technical Points.
I’ll say Glenn’s insightful words once more...
“Patterning is closed brain surgery.”
This really outlines just how important and powerful this one program is for brain development and for healing injury in the brain, and this is why your patterning technique must be perfect!
By now you should have established Patterning as a daily routine, you have your rewards system and respectful practices in place and now it is time to perfect and improve your technique.
a) The Patterning Table
I have seen many variations on the patterning table. Some families use a massage table, some a dining table, others use the floor, or a gymnastics mat. These are all successful, but they adhere to the main requirements of a table:
The table needs to be firm and padded. Covered in a smooth and slippery surface that your child's limbs can be easily dragged over. Vinyl, pleather, or leather are ideal, they cause no friction while allowing the limbs to glide on them.
The table’s height should be so that you and the patterners are comfortable and not too bent over the table. You will be here moving around your child many times, you need to be at a good height to accommodate this. Some families do choose to do this on the floor, which is ok, but I suspect it is not the best for your back!
The table needs to be longer than your child is tall with at least an extra 15-30 cm more than their height. The width must be enough for their knees to remain on the table if they are bent.
B) The Guiding lines
You need to put lines on your table to help guide the movements to ensure that they are correct and effective. The midline is most important, right down the center of the table. This is to make sure you integrate the right and left sides of your child's brain by crossing over it with the hands. The hands need to cross over the midline both above the head and across the back. For the legs, when straightened, they should be parallel to the midline and not crossing over it. This can also help with any pronation of the feet; you can make sure that the foot is also straight and parallel and not turned in or out.
Next is the head-line, for your child to be underneath to make sure that you have enough room above the head for the hands to cross over the midline.
The last set of lines come out from the hips and control how far up you are moving each of the legs. This line’s angle depends on your child's mobility and is very important, especially for children who do not yet crawl for transportation.
For mobile children who do not need a bolster, the line should be at a 105-degree angle (C). When patterning, move the knee up to this line and no further.
The lines should be at a 50-degree angle (D) for children who need a bolster and lined up with the bolster’s bottom corners to ensure the knee does not move higher than the hip lines. This is important to make sure that the top of the femur goes into the hip socket fully and correctly.
C) BOLSTERS
For immobile children who do not yet crawl for transportation, a bolster is essential to protect the hips and make sure you are connecting the femur into the correct place in the hip socket. Immobile children are prone to partial or full dislocation of their hips while they are yet to develop the muscles around the hip to proctor it and keep it in place. A bolster will ensure you are moving the legs safely into the hip socket and strengthening the muscles around this.
Here, you can see how the bolster’s right corner is stopping the knee from moving too far up. The hip-line at a 50-degree angle is another safety measure to ensure this. The bolster should be made to fit your child’s measurements. The height is perfect for keeping the femur in the correct place and the leg moves smoothly.
For more specific instruction on creating a bolster to your child's measurements, you can talk to your staff coach for more information.
D) Holding your child
Correctly holding your child will greatly improve the effectiveness of the pattern and it can make the movement of the legs and arms easier and more smooth.
The head is always in charge of speed and rhythm. The patterner on the head leads the whole patterning sequence, this should always be a parent. The head movement is a simple left to right which initiates the movement of the arms and legs. Always hold your hand in an ‘L’ shape on your child's check and around the ear for the head’s best control and ensures your child can hear and is not bothered by any auditory or tactile irritation. You can see a perfect example of this in the picture above.
For the movement of the arms hold your child at the wrist, with your thumb underneath the wrist and your finger over theirs:
This is to make sure that you are pressing and brushing the palm of your child's hand into the table as you move it from above their head to across their back. Holding at the wrist also controls the whole arm allowing the elbow to bend naturally as you move the hand from above the head to across the back.
For those children who have rigidity in their hands or for those whose palms are sensitive, holding and pressing in this way will open the hand as you press and brush it down the table for extra tactile stimulation.
For smoother more controlled leg movements, hold your child just under the knee. If your child is older and larger you can hold onto the material of their shorts to pull the knee up and push it down. Holding at the ankle will not be as smooth and can be clunky.
Typically patterning is a three-person job; one person at the head and a person on each side to move the arms and legs together. For those children who are taller, or for young adults, you can do a four or five-person pattern for ease and coordination.
For a four-person pattern, you would have an extra person at the feet holding onto the ankles. This person can help to push the legs up, pull them down, and make sure that the foot and leg remain parallel to the midline. This person should hold the ankle underneath, on top of the foot and around the sides, to keep it straight and make sure the foot’s inside is being dragged down the table:
In this image, you can see how the patterners on the sides are still holding onto both the leg and the arm. They are still controlling the leg’s movement from the knee, but the fourth person helps to push the leg up and pull it back down and make sure it is still parallel to the midline.
A five-person pattern has one person on each limb a well as the head. For each of the legs, the patterner can hold on to the front of the knee and at the ankle. For the arm, you can hold at the elbow and the wrist as shown below:
If you think a four or five-person pattern would be easier for your child or young adult, you can contact your staff coach to ask the Mobility staff for the videos above.
E) Rhythm and Speed
The pattern’s rhythm is set and monitored by the head and is most important in an effective and synchronized patterning session.
Patterning should be slow and steady when you are learning to keep in time with each other. You can begin with a count to keep everyone in time. The patterner on the head will make sure that everyone is hitting their positions correctly and fully.
It is more important to get the movements correct and concise than it is to go fast. Once you all become more familiar with the movements, you can begin to pick up speed. You may find that slower is better for your child to cope with, or they may prefer faster.
Focus on your sequence of movements and stay in time with the count until this becomes muscle memory, and you no longer have to think very hard about it. Once you are familiar, you can start to do the patterning to music or a metronome.
If someone falls out of sync or out of time, keep your movements going and allow them to jump back in when they can. The person on the head can continue with the pace while they catch up or slow the movements down. If you get out of time with each other, you should not stop the patterning, just slow down to regain control and get back in time.
F) Scheduling
The ideal way to structure your day for patterning and for your whole program is to alternate input with output. Input is the sensory information to the brain that patterning provides. The output is the body using that information for crawling, creeping, walking, or running.
A session of patterning before an inclined floor, or before crawling or creeping is the perfect way to first give the brain input, and then allow it to use it in its output. This also gives plenty of time between each pattern session and program to break up the day and give a sense of variety. Instead of a whole 30 minutes struggling through 6 sessions of patterning, they are done throughout the day in small, easy sessions with many other things in between them.
For example, your daily schedule may look something like this:
This spreads the patterning throughout the day and between opportunities for output programs, and of course, you have many BEP breaks between everything for optimum oxygen saturation.
In an ideal world, this would be the best way to structure your Doman Program, but realistically this is not always possible. You may need to do all the patterning in one or two sessions when you have enough people in the house to do so, if this is what you need to do this is ok too, as long as you begin slowly and respectfully, there is no wrong or right way to schedule your patterning. You need to be mindful of your child's time and needs and allow them to gradually get used to the routine of patterning, and once they are used to this and it has become a seamless part of their daily routine, you can play around with the times and sessions.
To recap, here are my main points for improved patterning:
Have the best patterning table
Put lines on your table.
Use a bolster if necessary.
Hold your child correctly.
Brush the hands and legs firmly and effectively.
Follow the count and rhythm, and don’t stop.
Increase speed naturally as you improve.
Get a good and consistent schedule in place.
Finally… stay in good contact with your staff coach!