I am concerned that the therapist in my son's rehab hospital is concentrating on his upper body but is doing nothing with his feet.
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Answer transcribed from Brightway's interview with physical therapist Susan Little:
That's a tough one. I certainly don't like to second-guess another therapist, especially with little information. I would say that certainly, core strengthening, or the work on as you say his upper body and his torso is important. It’s a precursor to work on standing and walking and what I would think of as more aggressive activities for his lower extremities. With that said, I do believe that progression to supported standing as soon as it is safely possible is very important to promote functional recovery. When you say plantar fixation, it makes me think that perhaps there are contractures or loss of flexibility at your son's ankles that might be preventing safe standing. In most instances, it's a situation where their foot is pointed downward and when they stand, either their ankles twist or they are simply not able to get their foot on the ground in a safe manner.
From a physical therapy point of view, the most aggressive technique that we can utilize to correct that situation is something called serial casting, which is a gradual application of casts where we stretch the joint, apply a cast, leave it on for three or four days, take that cast off, stretch the joint a little bit further, cast it again, and gradually stretch that out. We all know that when we stretch our muscles before we go for a run, we can lengthen those muscles. But after that run a couple of hours later, they kind of go back to where they were unless we continue with that stretching. That's the idea with serial casts. We provide a 24-hour/72-hour stretch on that muscle and we can regain the flexibility at that joint. It’s not always successful, but certainly worth it if that is the concern of the therapist regarding standing. I would certainly ask whether they have the capability to try this type of casting. If not, even an addition of consultation with an orthopedic doctor to address the difficulties with the joints that are limiting your son's progression to standing and war activities with their legs would be good.