Physical therapy and occupational therapy.

Physiotherapy And Occupational Therapy

Physical Therapy For Cerebral Palsy

Physical therapy should usually begin within the first few months of life once the diagnosis of cerebral palsy is suspected. A physical therapist improves the development of the large muscles of the body, such as those in the legs, arms and abdomen. They use specific sets of exercises to help the child learn to stand, walk, use a wheelchair. Neurodevelopmental therapy is fast becoming popular and forms the mainstay of therapy. It is used to decrease spasticity, strengthen underlying muscles, and teach proper or functional motor patterns. These exercises help in preventing musculoskeletal problems. Also, physical therapy will help avoid contractures, in which muscles become fixed in a rigid, abnormal position.

Occupational Therapy For Cerebral Palsy

An occupational therapist helps in development of fine motor skills and activities of daily living. They specialize in improving the development of the small muscles of the body, such as the hands, feet, face, fingers and toes. These therapists also teach daily living skills such as dressing and eating, as well as making sure children are properly positioned in wheelchairs. They may teach your child better or easier ways to write, draw, brush their teeth, dress, and feed themselves.

Early Detection Of Developmental Delay In Infants

By Dr. Poonam C Bhalchandra. Paediatric Physiotherapist, NDT Trained

Early detection and intervention is the key to maximal recovery of child from aspects

If they are treated as early as few months of their age these kids can be near to normal! For this the most important role is played by their parents/care takers who need to be aware of the possible risks their child can face Read More…..

Early Physiotherapy Interventions In Paediatric Practise

Supriya A. Joshi.BPth, MIAP. Paediatric Physiotherapist

Physiotherapy plays an important role in the treatment and rehabilitation of all paediatric cases like cerebral palsy, Down’s syndrome, spinal cord injuries etc.

Physiotherapy treatment gives optimum results with early intervention. In all the paediatric cases there is delay in developmental milestones like head holding, sitting, crawling and walking. With early physiotherapy intervention the child will be highly benefited as proper physiotherapy techniques help them achieve these milestones quicker which otherwise can take longer or does not develop at all.Read More…..

Neurodevelopmental Treatment Approach In Cerebral Palsy

Dr Madahvi Kelapure.B.Pt.H. C/NDT (ped). Paediatric Physiotherapist

Parents of children with special needs are always faced by multitude of questions. Why is my child not able to move like other children? Why did this problem occur? Will this problem increase further? Will he be cured? When will my child start walking? What can I do as a parent to aid his development? Once the diagnosis of Cerebral Palsy is made, first and foremost recommendation to the parents is Physical therapy. Cerebral Palsy is a condition which occurs due to insult to an immature brain, where the child has difficulty to coordinate the movements of body and control his/her posture. It is important to notice that, although the lesion in brain is permanent and will not change, the consequences of the lesion do change over a period of time as the child grows. Physical therapy program is directed to make the child as independent as possible. Over years, there have been advances in the field of physical therapy for children with Cerebral Palsy. At present, Neurodevelopmental Treatment Approach is the most commonly Read More…..

used model of treatment for children with Cerebral Palsy. The approach is unique by the virtue that it looks at the child as a ‘whole’. That means the treatment is directed not only towards physical independence, but it also targets child’s emotional, social, sensory, perceptual aspects so that he or she becomes an active member of the society and can fulfil his duties like any other individual. Treatment by the approach does not stop at achieving physical improvement; but assures that the child is able to use the same to accomplish his age- appropriate roles e.g. a 4 years old child is expected to eat by self, play with toys indoors and outdoors, attend school so on and so forth… All these deeds are called as ‘functional activities’ and the ultimate goal of NDT is to optimize these functional activities. For convenience, this treatment is divided into three specialities. Physical therapists, Occupational therapists and Speech & Language therapists, all provide a NDT based treatment intervention. Physical therapists (PT) target the child’s ‘gross motor’ abilities. i.e. to be able to sit, stand, walk; to be able to transfer self from floor to chair/car and vice versa so on and so forth. A program of Occupational therapy (OT) based on NDT helps to improve ‘fine motor’ function, i.e. the ability to use hand to hold and manipulate different objects, toys, crayon etc. OT also helps to improve quality of eye function, sensation and perception. OT also trains the child for Activities of Daily Living (ADLs) like bathing, dressing, feeding etc. Speech and Language therapists work towards quality of breathing, phonation, eating, drinking which are important for development of speech. Therapists have to undergo intensive training to become NDTA certified. How exactly these therapists work? It commences by evaluation of child’s functional abilities and impairments. Interview with the parents yields a whole lot of important information about the child. Evaluation also specifies the way child is able to move, noting the wrong posture and movement patterns. NDT approach relates these posture and movement patterns to specific system impairments. E.g. if the child is walking on his toes with knees touching each other and he trips and falls often, then evaluation analyses its probable causes like, increased stiffness in leg muscles, difficulty to generate force in the muscles, difficulty to relax one muscle group while the other is active, not able to use his eyes well; so on and so forth. All these jobs are assigned to different systems in our bodies like musculoskeletal system, neuromuscular system and sensory systems. In treatment, strategies are targeted towards these systems in order to improve the postural control and movement coordination so that, at the end of treatment session, the child is able to walk in a near normal pattern without falling off frequently. The goal of treatment is often decided jointly by the parents and therapists and the child whenever he is able to take part in decision making. Goal is often the ‘just right’ challenge for the child. Evaluation and treatment goes hand in hand. Therapists often use manual handling during treatment to guide active movement from the child. They make use of adaptive equipments like balls, bolsters, benches etc to make the movement easy for the child. Therapist always creates a situation where the activity is made meaningful, safe and enjoyable to the child so that he feels an urge to move. Thus, treatment is a close interplay between the child and therapist.

Repetition is important for learning a new movement and the therapist gradually decreases her control so that the child is required the ‘take over’. Thus the child ‘owns’ newly learnt movement. To achieve the set goals, it is very essential that there is a ‘carry over’ of the change made during treatment to the home environment. For this, guiding and training parents/ caregivers during treatment, is very important. This happens when there is a mutual communication and rapport between the therapist and mother. Also, therapist always takes into account the personal factors of the child, what are the facilitators and barriers, the cultural and family background and respects the situation and capabilities of the family. Treatment session generally lasts for an hour and the frequency is decided according to the problems of the child. A severely involved child will benefit from 5 days a week treatment sessions where as for a mildly involved child, twice a week could be sufficient. A home management program is always given to the parents, so that whatever the child does throughout the day happens in a therapeutic way. To conclude, although NDT approach cannot ‘cure’ your child with Cerebral Palsy, but it assures improved quality of life by optimizing function.

Vision Therapy

By Dr.Rashmi Bala Keshri, Occupational Therapist, Dr Poonam C Bhalchandra, BPth. Paediatric Physiotherapist. NDT Trained

Common visual problems associated with cerebral palsy

Impaired acuity of vision [low vision]
visual fields limitations[less side vision] in one or both eyes
strabismus [squint/ wall eyes] may be associated with retinal or structural anomalies

rare anomalies like cataract, glaucoma,& maldevelopment of eyes are not uncommon in a C.P. child.
Visual-perceptual problems

Hand Functions

By Rashmi Bala Keshri, Occupational Therapist

Cerebral palsy kids usually have problems in fine hand functions and in-hand manipulations. Fine hand functions like use of pointing finger for any activity and activity with more wrist movements, Proper training of the hand muscles without reinforcing abnormal movement and teaching correct muscle actions from the very beginning helps the kids. Once the kids learn abnormal movement pattern it becomes very difficult to change them.

Parents and therapists usually concentrate on milestone development so that the child should walk first but hand functions should not be neglected and should be looked after side by side. Example:manipulating small objects, using both hands effectively for any activity, shoe lace tying.

Oral Motor Function

By Rashmi Bala Keshri, Occupational Therapist

Children with cerebral palsy show oral motor problems like drooling, not chewing food effectively, have swallowing and sucking problems; they keep their mouth open and have expressionless face. In cerebral palsy some children have over sensitive and some less sensitive oral motor area. So, we either need to de-sensitize or stimulate the oral motor area depending on the case. In case the child is not able to swallow, stimulation of tongue is given to facilitate swallowing. Similarly, other aspects are dealt with depending on the problem. Children with expressionless face are taught to use facial muscles.

Speech And Language Therapy For Cerebral Palsy

A speech and language therapist helps develop better control of the jaw and mouth muscles, which can improve speech and language skills and eating abilities of children with cerebral palsy. They will teach both parents and child talking, using sign language, or using a communication aid. Children who are able to talk may work with a speech therapist on making their speech clearer, or on building their language skills by learning new words, learning to speak in sentences, or improving their listening skills. Children who cannot talk may learn sign language, or how to use special equipment such as a computer that actually talks for them.

Need of Orthosis for Cerebral Palsy Children.

Dr.Neha Rai,PT,C/NDT-USA

Orthotics is an additional help to physiotherapy pre-surgery and post surgery to provide stability to cp kids when standing and walking. It’s a Kinesthetic reminder(orthosis provides sensory/visual feedback that reminds the patient to adapt a more corrective or appropriate position to avoid some unusual compensatory movements).Read More…..

1)Orthotic treatment following surgery
The correct orthosis for the correct period of time with physiotherapy yield best results.

2)Aims of orthotic Treatment.
a:Improves and assists joint biomechanics.
b:Protect surgical correction soft tissue or bony.
c:Prevent recurrent deformity.
d:Maintain muscle length.
e:Encourage motor learning of the muscles.
f:Facilitate function and independence.
g:Helps in proper balancing of the child in weight bearing functional positions.
h:To maintain proper alignment.
i:To give proper correction of bones and muscles around ankle and foot.
j:Limit ROM(restriction of motion).

3)Different types of orthosis.

A)Ground Reaction AFO.(GRAFO)
1.:commonly used in cerebral palsy post surgery.
2:Diplegia-crouch or Flexed Knee Gait.
3:Hemiplegia-post single event multi level surgery.
4:Acquirede brain injury.
5:Spina bifida.

B)Solid Ankle Foot Orthosis(SAFO).
1)Night splinting which is required if the child’s foot is in foot drop/plantarflexion.
2)Need to maintain the ankle in neutral in post surgical cases.
3)To prevent tightness around ankle and maintain the muscle length.

C)Dynamic Ankle Foot Orthosis(DAFO)
1:Allows motion at the ankle for producing correct amount of plantarflexion/dorsiflexion.
2:Duration-to be worn throughout the day in weight bearing functional positions.

D)Supra Malleolar Orthosis(SMO)
1:Provides control in moving the foot sideways(frontal plane) but allows motion at the ankle up and down.(dorsiflexion/plantarflexion).

E)Posterior Leaf Spring AFO(PLS)
Indications:1:Flaccid foot drop.
2:Mild spasticity.
F)Knee Ankle Foot Orthosis(KAFO).
1:Stabilizes and allows motion at knee, ankle,foot in more than one plane.
2:Used in patients where AFO is covered and for whom additional knee
stability is required.
3:Condition necessitating the orthosis is expected to be permanent or of longstanding
duration(more than 6mnths).
4:The patient has a neurological,circulatory or orthopaedic status that requires custom fabricating over a model to prevent tissue
injury.
5:Patients with Knee hyperextension(genurecurvatum).

G)Hip Knee Ankle Foot Orthosis(HKAFO).
1:Stabilizes and allows motion at hip,knee,ankle,foot in more than one plane.
2:Hip Flexion/Extension instability.
3:Hip Adduction/Abduction weakness.
4:Hip Internal/External Rotation instability.

Summary:
1:Orthotic management using AFO is a critical part of rehabilitation pre and post surgery.
2:Controlling ankle joint motion produces an effect on the knee joint as well during walking.
3:By using an AFO to manipulate the ankle joint we can increase or decrease the plantarflexion
knee extension couple there by giving correct alignment and balance to the child in weight
bearing functional positions like standing and walking thus improving functional independence
of the child.