Ot Presentation 2 In Cp

Role of Occupational Therapy in management of Cerebral Palsy

Mrs Sadhana P. Joshi Head, O.T. Dept, C.O.H.

What is cerebral palsy 

Cerebral palsy is a disorder of posture and locomotion due to the lesion in the immature brain (It is non-progressive and non unchanging disorder).It is a disorder of sensory motor functions in which child is having difficulty in controlling and carrying out voluntary movements.

What is cerebral palsy cont…  This

central motor handicap is frequently associated with impaired speech, vision, hearing and various types of perceptual disturbances and some degree of mental retardation and/ or epilepsy.

Aim of treatment  Aim

of treatment will be to improve the individuals possibility by re-educating the movements and pattern through various therapies. It is long term training programme. Results of treatment are more promising if begun at early stage.

Types of Cerebral palsy  The

nature extent and area of lesion gives rise to many disorders affecting one or several limbs.  Spastic – Increased muscle tone.

• Quadriplegia – whole body affected • Diplegia – legs affected > hands • Hemiplegia – one hand and one leg affected • Double hemiplegia – hands affected>legs

Types of Cerebral palsy cont… 

Athetoid

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Movements are uncoordinated, involuntary and are carried by sudden unpredictable variation in muscle tone.

Ataxic

• •

Movements lack assurance and are awkward and imbalanced. Mostly muscular tension is free. Child may be floppy (Low muscle tone) or mixed type

Therapies 

There are different non-surgical therapies like

• • • • • • • • •

Phelp, Fay, Knott, Vojta, Petto, Kabat Bobath S.I. N.D.T.

Neuro Developmental Therapy 

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• • • • • •

Neuro Developmental Therapy is a form of therapy utilized with individuals who have C.N.S. disorders resulting in abnormal movements. This treatment approach attempts to facilitate the normal stages and process in the development of movements. CNS Controls movements not muscles The sensory systems affects motor functions Functional movements requires complex CNS process Abnormal tone resulting from CNS dysfunction affects movements performance Acquisition of a functional skill in normal infants and children provides a system of analysis of abnormal movements Dynamic postural controls is necessary for normal movements

Philosophy of N.D.T.  

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To get optimum function To treat a child as a whole person who functions within family and society Treatment is active movements, can be automatic or voluntary but not cognitively controlled Treat in a frame work of normal development as well as abnormal Team approach necessary to treat the CNS dysfunction Teach movements (not huge) constantly assess response Input to be constant Future – short term and long term goals Different treatment in different settings

Philosophy of N.D.T.     

Problem solving Helps restore functions Gets mobility through positioning Facilitate and inhibit You can develop your own style

Therapy cont…  Fundamentals

of various systems of

treatment is-

• To improve postural mechanism ( Parachute, • •

Righting, Equilibrium) To improve voluntary movements To improve perceptual motor activities

Therapy cont… 

Occupational Therapists work with a goal to provide services that enable patients to restore and improve their functional capacity.



To attend the above goal, the programme of occupational therapy addresses the problems concerned with :

7.

Posture and balance Muscle tone and strength Gross motor skills Fine motor skills Motor planning Manipulation and constructive play Eye hand coordination Visual motor perception Sensory integration .

8. 9. 10. 11. 12. 13. 14. 15. 

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Intervention of above problems result in enhancement of performances of skills like

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Activities of daily living Pre academics

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Pre vocational and vocational skills

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In C.O.H. patient is evaluated and assessed for the motor development of the upper extremities

Upper Extremity function  Functional

development of the upper extremity depends upon

• Postural adjustability – Child should have a

good head, neck and trunk control , good righting and equilibrium reactions, good girdle stability and scatpula humeral dissociation. Dynamic postural control is necessary for normal movement

Upper Extremity function cont…

• Neuro muscular status – Abnormal tone

•

resulting from C.N.S. dysfunction affects movements performance. Spastic child is having poverty of movements and athetoid child is having a problem in stability and mid range control. Perceptual motor ability and sensory integration function – Organisation of sensation is defective. Motor adaptive response is not proper. cont….

Upper Extremity function cont… cont… Children are having lot of perceptual problem like right, left , up down etc. Children are having problem in visual perception and visiomotor coordination. • Sensory integration deficits that are most likely to influence hand use are tactile defensiveness, poor bilateral integration and dyspraxia.

Upper Extremity function cont… 

Development of the motor pattern involved in hand function as described by Jean Ayres –

• • • • • • • • •

Control of neck and eye movements Trunk stability and balance Shoulder stability and movements Elbow movements Gross grasp Wrist positioning and movements Release of grasp Forearm supination and pronation Individual finger manipulation

Points for planning treatment 

Points to consider while planning programme –

• • • •

C.N.S.controls movements not just muscles Abnormal tone resulting from C.N.S. dysfunction affects movement performance. Functional movements require complex C.N.S. process. Sensory input plays an important role in motor behaviour. Exteroceptor initiate the movements and proprioceptors guide the movements.

Points for planning treatment cont..

• Pattern of motor output which are inherent and • •

have maturation sequence to each other have an important role in motor behaviour. Muscles that function together facilitate each other. Action of muscles of one side of the body is greatly influenced by the muscles of the other side of the body. It is called as cross education. Dynamic postural control is necessary for normal movements

Sensory Integration 

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Sensory integration is defined as a neurological process that organizes sensation from ones own body and the environment in the brain to make adaptive response and makes it possible to use the body efficiently within the environment. Sensory integration functions will include the awareness, discrimination & recognition of sensory stimuli from the environment & from C.N.S. to direct motor behaviour.

Sensory Integration cont… Sensory Stimuli

Feedback/ Previous Experience

Adaptive Response

Input

CNS Integration

Output

Sensory Integration cont… Sensory Input  Tactile

CNS Integration  Organisation

Adaptive

Response

Visual

Association

Motor

Concept

Auditory

Past Experience

Response

Of Form

Olfactory

Interpretation

Kinesthetic Vestibular

Space Time

Perceptual problems 



Perception is defined as a process of organizing and interpreting sensations that individual receives from internal and external stimuli. Children suffering from perceptual problems may having difficulty in identifying and discriminating shapes, colours, very poor concept of body in space, slightly distracted, hyperactive, poor concentration, lack of directionality, clumsy, poor bilateral integration, unable to copy designs & figures.

Perceptual problems cont…  Visual

perceptual problems include

• Figure ground • Position in shape • Spatial relationship • Perceptual constancy • Eye hand coordination

Treatment  “O.T.

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for Independence” is the prime motto of

Occupational Therapy. So training in self care activities (ADLs) like feeding, dressing, undressing, grooming, ambulation etc. is of utmost importance. Different tailor made adaptive devices and equipments are made as per child’s requirements to make him independent as far as possible.

 The

concept of the above said role of Occupational Therapy lies in the Chinese proverb – ‘Give a man a fish and you feed him for a day, teach a man to fish and you feed him for a lifetime’

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