mother-child plays strengthens the bonding

Play is a primary occupation of childhood which is characterized by fun and spontaneity and involves exploration, experimentation, imitation and repetition. Play is also considered as our brain’s favorite way of learning new things.

Play deprivation is common  in children with developmental disabilities because of different forms of barrier which include limitation imposed by care givers,physical limitation of child due to spasticity, environmental barrier in home or schools and  social barriers due to limited interaction with other children.

Play is very essential n integral part for every child’s normal growth and development and as it also helps to improve coordination, communication and interpersonal skills; so it is very important to include therapeutic play as a part of rehabilitation program.

By integrating play within therapy sessions a child’s interaction with environment can be encouraged.It also helps n acquisition and mastery of new skills. It also develops risk taking problem solving and decision making abilities.

Some points to be taken into consideration while incorporation play are as follows:

1. The kind of play chosen for the child should be interesting and age appropriate.

child plays with balloon

2. It should gain the attention of the child

3. Able to attract  him

4. The objects used in play are used in different ways

5. These should have a variety value associated with them

6. Activities chosen should be such which arouses curiosity and simultaneously provide new information

7. It should also be stimulating fun based medium for developing  and enhancing social interaction

8. Most importantly, play activities should be designed keeping in mind that all the family members will take active part in it

family playing together

Incorporating play into therapeutic approaches such as NDT (NeuroDevelopmental Therapy)can be particularly effective because normal pattern of movement can be promoted and abnormal postural reaction can be prevented while the child is engaged in functional purposeful activities.
NDT aims to produce automatic movement patterns without placing conscious attention on the process eliciting excessive effort.
Child absorbed in play is not focused on the specific motor demands of the activity and can be stimulated to use appropriate moment to improve control of trunk arms during manipulation of toys.

Play is an active form of learning and beginning of knowledge that unites the mind, body and spirit.

Visual impairments can result from problems with any part of the visual system including the eyes,eye muscles, optic nerve and the areas of cerebral cortex that process visual information. Optic nerve damage, visual field losses , and cataracts are common in premature infant with retinopathy of prematurity. Children with cerebral palsy exhibit a variety of problems with acuity and focusing, oculomotor performance and visual perception.

Almost 75 % children have refractive errors including near sightedness or farsightedness + astigmatism.Cortical visual impairment is defined as partial or total blindness due to injury in the visual pathway or visual cortex of the brain rather than in the eye itself.

Visual perception the process of obtaining information from the environment which includes discrimination, memory, spatial relationship, form constancy, sequential memory, figure ground and closure.Children with cerebral palsy have been found to score significantly lower then normal children on motor-free tests of visual perceptual skills.

NDT approach

NDT is a form of therapy used with persons who have central nervous system disorders resulting in abnormal posture & movement. Th treatment approach attempts to initiate or refine the normal stages & processes in the development of movement.Specific handling techniques as well as adaptive equipment are used to achieve inhibition of abnormal patterns, normalization of muscle tone & facilitation of more normal movement.
The main principle of NDT are :

1. The damaged central nervous system blocks normal movement.
2. Abnormal muscle tone results in abnormal patterns of posture & movement.
3. These abnormal patterns affect all function i.e. respiration, speech, feeding, perception, self-care & walking.
4. Because the basis of movement is sensation so the change requires the person to feel more normal movements.
5. Optimal Gains are achieved only with combined efforts of patient, family, physician & therapists.

The concept that movements range from least automatic to most automatic has been useful in explaining the NDT approach to therapeutic handling attempting to obtain active & automatic movements from the child which leads to voluntary purposeful movements. The child gains normal sensory motor feedback from active movements achieved without excessive efforts.

proper positioning facilitates greater trunk control

The role of NDT in Cerebral Palsy emphasizes upper body control with acquisition of hand skills for self care, academics, leisure & other community activities leading to as much independence as possible. Handling techniques are designed to normalize muscle tone & obtain postural alignment throughout the entire body & to prepare upper & lower extremities for weight bearing, weight shifting & function.

NDT has also combined with sensory integration treatment as both approaches addresses the adaptive responses of the person and use sensory input to produce the motor response. NDT focuses on motor-output & motor-control whereas sensory integration focuses on sensory processing issues

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Swavalamban Children Rehabilitation Centre

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#reflexes #newborn #cerebralpalsy #primitive #infant

reflexes

A reflex is a muscle reaction that happens automatically in response to stimulation. Certain sensations or movements produces specific muscle response. Many infant reflexes will disappear as the child grows older, although some remain intact throughout adulthood. A reflex that is present after a certain age will when it is supposed to disappear will be considered as a sign of damage to brain or nervous system.

Reflexes are the most objective part of neurological examination as these are extremely helpful in determining the level of damage to the nervous system.All reflexes when reduced to their simplest level are sensorimotor arcs. Simple reflex involves direct synapse between sensory fiber and motor neuron i.e. monosynaptic, many reflexes have several neurons interposed i.e. polysynaptic reflexes.

Primitive reflexes also known as infant or newborn reflexes are exhibited by normal infants in response to particular stimuli, as the child grows older, these will gradually disappear.Infants with cerebral palsy have persistent or delay in the disappearance of primitive reflexes and pathological or absent postural reactions.Lesions that damage the sensory or motor limb of a reflex arc will diminish that reflex. This can occur at any level of sensory or motor pathway.

Primitive Reflexes are :

1. Tonic Neck Reflex
Head of the lying child is moved to one side, the arm on the side where the head is facing will reaches away from the body with the hands partly open. the arm on the side away from the face is flexed with tightly clenched fist. turning the baby’s head in opposite direction will reverse the position. TNR is a precursor to hand eye coordination of infant.

2. Moro response
present at birth and began to disappear by 2 months of age. It is also known as startle reaction , appears when infant suddenly changes his head position, head and legs extend whie the arms jerk up and out with the palm up n thumb flexed, followed by arms brought together, clenched fist and infant cries loudly.

3. Rooting
occurs when the baby’s cheeks are stroked,as infant will tun towards the side of stroking and make sucking motion.

4. Sucking
presents at birth,child began to suck when area around the mouth is touched.

5 Palmar grasp
present at birth and persist until 5-6 months of age.when an object is placed in infant’s hand, the fingers will close and baby will grasp it.Causing to remove the object will make the grip tighten.New born infants have strong grasp and can be lifted up if both hands are grasping your fingers.

6. Galant/ Truncal incurvation
occurs when the side of spine of infant is stroked or tapped while the infant lies on stomach. the infant will twitch his hips towards the touch in a dancing pattern. If reflex persist beyond 6 months then it is a sign of pathology.

7. Parachute
occurs in slightly older infants, child is held upright and his body is rotated quickly to face forward as in falling then baby will extend his arms forward as if to break a fall. this reflexes appears long before the baby walks.

8. Walking/ stepping
present at birth, when sole of infant’s feet is touched on ground or a flat surface, they will attempt to walk by placing one foot in front of other.It disappears at 6 weeks and reappears at 8 to 12 months as a voluntary behavior.

9. Planter reflex/ Babinski
normal planter reflex involves planter flexion of foot which moves toe away from shin and curls them down. Babinski results in dorsiflexion of foot and in adults its presence is considered as a sign of upper motor neuron lesion.

effects of persistent reflexes

10. Some reflexes that lasts into adulthood are:

– Blinking reflex: blinking the eyes when they are touched or when sudden bright light appears

– Cough reflex: coughing when airway is stimulated

– Gag reflex: gagging when throat or back of the mouth is stimulated

– Sneezing reflex: sneeze when nasal passage is irritated

– Yawn reflex: yawing when body needs more oxygen

Cerebral palsy can affect the muscles which controls opening and closing of mouth,moves lips and tongue and jaw movement. The muscle coordination and movements in face and neck allows a person to breath,swallow and talk. Some children may face difficulties in chewing and swallowing food and liquid items, the condition is known as Dysphagia. Dysphagia occurs because the esophagus cannot move food and liquids from back of child’s mouth to the stomach.

Due to feeding and swallowing problems the child may be prone to poor nutritional status,growth failure, chronic aspiration, oesophagitis,and respiratory infections.

Dysphagia can be classified into 2 types:

1. Oropharyngeal Dysphagia : occurs due to nerve and muscle malfunction leading to weaken the throat muscles, thereby making it difficult to move the food from mouth to the throat

2. Esophageal Dysphagia: occurs due to malformation or malfunction of the lower esophageal sphincter, as if the food gets stuck in the esophagus

Signs and Symptoms of feeding and speech related Dysphagia

– apnea during feeding
– aspiration
– delayed swallowing reflex
– esophageal spasm
– difficulty in feeding
– oral apraxia
– pain during feeding
– lack of vocal articulation
– inability to speak
– spastic dysarthria
– verbal apraxia

Indications of Dysphagia

-back pain,chest pain
– choking,constant cough,sore throat
– dry mouth
– drooling
– nasal regurgitation
– taking a long time to eat
– unexplained weight loss

The ill effects of malnutrition can affect physiology, motor functions, neurological and psychological functions affecting the child’s early growth and development. Diminished muscle strength leads to impairment in motor function as well as weakness of respiratory muscles, with resultant cough and predisposition to pneumonia. Malnutrition results in increased circulation times and diminished cardiac capacity.It also causes diminished cerebral growth,delayed cognitive growth and abnormal behavior. Undernourished children shows lower level of exploratory activity and affected socio-emotional development.

Remedies

A number of feeding and oral motor intervention strategies has been developed to address the difficulties with sucking,chewing,swallowing. These include oral sensorimotor stimulation,positioning,food appliances,and neuromuscular stimulation.

#cerebralpalsy #balance #coordination #therapy #spasticity

Thera suit is a bio-mechanical suit used to increase feedback to the brain and enhance purposeful movement. The thera suit is comprised of hat,vest,knee pads along with custom made shoes worn by the child or adult having cerebral palsy.

The suit comprises of multiple adjustable rings and elastic band on the garment that can be adjusted to provide pressure and support the affected muscles and joints.The bungee cords are are placed at specific points and the whole suit will act as an exoskeleton for the child by keeping the body in proper anatomical alignment thereby helping in normalizing the muscle tone and preventing the risk for developing limb deformities.

Wearing the suit during exercise program will help in reducing the effects of spasticity,athetosis,hypertonia,hypotonia and ataxia. The suit provides proprioceptive input thereby helping a child to build strength for performing various activities.

Other benefits of therasuit are as followed:

1. retrains central nervous system
2. Restores ontogenic development
3. provides external stabilization
4. normalize muscle tone
5. provide dynamic correction
6. normalizes gait pattern
7. provides tactile stimulation
8. improves balance
9. improves coordination
10. support weak muscles
11. decreased uncontrolled movement in ataxia and athetosis

Cerebral Palsy is a group of disorders that affect a persons’ ability to move and maintain balance and posture.”Cerebral” refers to the brain and “palsy” refers to the muscle weakness and poor control.Cerebral Palsy or CP is an umbrella like term which describes a group of chronic disorders impairing control of movement in first few years of life which generally do no worsen over the time.
These disorders are caused by faulty development or damage to motor areas of brain disrupting the brain’s ability to control posture and movement.
CP occurs in about 1 in 500 live births with only 60% of them having an identifiable cause.

Causes of CP:
The causes are braodly divided into 3 categories namely
1) Pre-natal
2) Peri-natal
3) Post-natal
along with other associated maternal risk factors like maternal toxemia,hypothyroidism, etc.

Classification of CP
CP is a disorder which can be classified according to the site, lesion and extent of the damaged it caused to the brain for example based on topographical distribution i.e. the parts of body affected it is divided into monoplegia,diplegia,hemiplegia,paraplegia,quadriplegia,and double hemiparesis.

Diagnosing CP
Based on the history taking,examination for growth and developmental milestones appropriate to child’s age, the results are interpreted.

Differential Diagnosis
It is also important to look out for other disorders which also coincides with presenting signs and symptoms similar to CP.

Clinical Manifestation
Child shows abnormal muscle tone,imbalance of agonist and antagonist, deficit in righting and equilibrium reactions,difficulty in sequencing,timing,and controlling muscle response.
Disorders associated with CP includes seizure disorder,visual and auditory problems, feeding difficulties,poor jaw control, speech disorders,and issues related with intelligence
Child also presents with limb and spinal deformities,torsions,subluxation of joints, scissoring gait pattern.