I had stepped out of the house during the last few minutes of physical therapy earlier this week to take out the trash. When I came back in, I noticed Tony was limping as he walked over to his speech device and asked me to help him. Apparently he had used his foot to move one of the kitchen benches out of the way while putting away some toys, and he unfortunately injured his foot in the process.

In asking for help, that didn’t mean he liked the help I had to offer.

Ice?

Didn’t want to keep it on, with or without a cloth underneath it.

Ace bandage? Couldn’t even get it wrapped before he was ripping it off and saying “uh-uh.”

Because there was swelling involved and he didn’t want to walk on it anyway, the first thing we worked on was icing. I started out with just a count of 10 seconds, giving him an MnM for each period. Since the intervals were brief, I didn’t bother putting a cloth underneath it. He was eventually able to work up to several minutes while scrolling through pictures on my phone, a preferred activity.

For the bandage, I just started with having him tolerate it draped across the foot without being wrapped…so, just contacting his skin. I was able to get him to tolerate a few minutes with it loosely wrapped around his foot- again while scrolling through pictures- but this remains an item that will need more targeted practice going forward so that he can tolerate the use for the amount of time required for an injury. Because he’s still not going to keep it on for more than a few minutes regardless of the reinforcer used. We’ve not really done any work towards tolerating this type of bandage before because he’s not needed one, and we had more pressing matters to address first, but from here on out this is going to be added to his hab therapy schedule.

For the most part we’ve needed to rely on Ibuprofen and reducing his physical activities and therapy schedule as it heals. His swelling is mostly gone, his limp is improving, and he’s trying to do some running and jumping despite my attempts to discourage him in that.

So many times I find something comes up when we’re not in or expecting to be in a regular therapy session, but it still requires a therapeutic approach to work through. The most important thing is to follow his cues in terms of how long he’s comfortable tolerating something and what he considers to be a desirable item to receive in exchange for doing so.