THE ROLE OF PHYSIOTHERAPY IN THE DISABLED CHILD Red Cross War Memorial Children’s Hospital Physiotherapy Samantha van Deventer Janine Victor

INTRODUCTION The Disabled Child • WHO and The International Classification of Functioning,

Disability and Health (ICF) Health Condition (disorder or disease)

Body Function & Structure

Activity Limitation

Environmental Factors Contextual Factors

Participation Restriction

Personal Factors

THE DISABLED CHILD • Moderate to severe physical disability

• Spectrum of motor impairments • Congenital or acquired • Including but not limited to: Cerebral Palsy Traumatic Brain Injury Spina Bifida Spinal Cord Injury Neuromuscular Disease • The Global burden of Disease: ≈ 9.5 million children 0 -14 yrs with

disability of which 1.3 million are classified as severely disabled

ROLE OF PHYSIOTHERAPY • Physiotherapists focus on gross motor skills and

functional mobility, including positioning, transitional movements, use and issue of assistive devices

• Postural management programme • Positioning • Education, training and support • Multi-disciplinary team involvement • Physiotherapist’s role in palliation

PRINCIPLES OF MANAGEMENT • Practice specific, relevant and functional skills

• Facilitation of normal movement patterns • Work for better active participation • Improve/maintain range of movement

• Improve/maintain muscle strength and control • Improve/maintain postural alignment • Parent participation and education

Patients should be assessed individually and treated age appropriately.

APPROPRIATE MANAGEMENT • Importance of early referral and intervention

• Anticipate progression/effects of condition

Initial / Evolving stage

Plateau Stage

Palliative Stage

POSTURAL MANAGEMENT PROGRAMME • 24 hours

• Variation in environment, activity and intervention • Positively impacting on posture and function • Enhanced communication and participation

• Transitioning through stages of life

Positioner Wedge Standing frame Wheelchair (seating system)

POSTURAL MANAGEMENT PROGRAMME o Immature skeletal and neuromuscular system o Biomechanical alignment o Considerations should be given to: Assistive device for play, feeding,

relaxing and independence Stretching positions Sleeping positions

SIDE LYING

WEDGE

STANDING • Advantages

o Bone density Decreased incidence of fractures Decreased incidence of hip dysplasia Increased bone growth

o Improved passive range of movement (maintaining neutral alignment) o Influences tone o Activation of anti-gravity muscles o Improved lung function o Improved bladder and bowel function o Socialisation and interaction

STANDING

THE WHEELCHAIR

THE WHEELCHAIR • Extensive Research • Major role under Physio- and Occupational Therapy • Human Rights Framework – Ability rather than DISablility • Full assessment of child considering:  Diagnosis  Age  Functional abilities  Postural deviations  Deformities  Environment  Function

THE WHEELCHAIR

THE WHEELCHAIR Pressure Mapping

BEFORE

AFTER

BUGGY

POSTURE CHAIR

WHEELCHAIR Hybrid Dual Terrain Chair

WHEELCHAIR Active Urban chair

MOTORISED WHEELCHAIR Motorised Chair

EDUCATION AND TRAINING • Caregiver’s acceptance and understanding of child’s

disability • Child’s capabilities in optimum position • Focus on abilities rather than disabilities • Caregiver main role-player:  Therapy manager  Caregiver included in decisions re: therapy,

frequency and intensity  Goal setting  Therapy incorporated into daily routine

MULTIDISCIPLINARY COLLABORATION • Ideally collaboration between role players across

disciplines to meet common goals • Therapy and management of one role player directly influences that of another

PHYSIOTHERAPY AND PALLIATIVE CARE

 Symptom control: • • • •

Suctioning Supportive chest physio Importance of movement Pain relief

 Support for the patient & family • • • • •

Positions of rest/comfort Back care Independence Distraction Enhanced QOL

THANK YOU

REFERENCES • Armstrong, W., Borg, J., Krizack, M., Lindsley, A., Mines, K., Pearlman, J., Reisinger, K. &

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Sheldon, S. (2008). Guidelines on the provision of Manual Wheelchairs in less resourced settings. Publications of the World Health Organization. Geneva. Bax, M., Goldstein, M., Rosenbaum, P., Leviton, A. & Paneth. N. (2005). Proposed definition and classification of cerebral palsy. Developmental Medicine and Child Neurology. 47: 571576. Big Shoes., Hospice Palliative Care Association of South Africa. (2012). Management of Common Symptoms and Problems in Paediatric Palliative Care. Clinical Guidelines. Google Images Gough, M. (2009). Continuous postural management and the prevention of deformity in children with cerebral palsy. Developmental Medicine & Child Neurology. 51: 105-110. Gunel, M.K. (2011) Physiotherapy for Children with Cerebral Palsy, Epilepsy in Children – Clinical and Social Aspects, Dr. Zeljka Petelin Gadze (Ed.) http://www.who.int/mediacentre/factsheets/fs352/en/index.html http://www.who.int/topics/disabilities/en/ Laakso, L. (2006). The role of physiotherapy in palliative care. Australian Family Physician. 35(10): 781.

REFERENCES • Michaud, L.J. et al (2004). Prescribing Therapy Services for Children with Motor Disabilities. • • •

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American Academy of Pediatrics. 113 (6) 1836 – 1838. Pin, T.W. (2007). Effectiveness of Static Weight-Bearing Exercises in Children with Cerebral Palsy. Pediatric Physical Therapy. 19: 62-73. Pineda, V. S. (2008). It’s About Ability. An explanation of the Convention of the Rights of Persons with Disabilities. United National Children’s Fund (UNICEF) Quin, S., Clarke, J. & Murphy-Lawless, J.(2005). Report on a Research Study of the Palliative Care Needs of Children in Ireland. Department of Health and Children, The Irish Hospice Foundation and the Faculty of Paediatrics. Rosenbaum, P. (2009). Cerebral Palsy in the 21 st Century: Is There Anything Left to Say? Neuropediatrics. 40: 56-60. Saloojee, G.M., Rosenbaum, P.R. & Stewart, A.V. (2011). Using caregivers’ perception of rehabilitation services for children with Cerebral Palsy at public sector hospitals to identify the components of an appropriate service. South African Journal of Physiotherapy. 67(3). Scheffler, E. (2010). Basic wheelchair and seating training. Provincial Government of the Western Cape, Department of Health. Scheffler, E. (2012). Intermediate wheelchair and seating training. Disability and Rehabilitation Consultancy Services. Stewart, D. & Rosenbaum, P. (2003). The International Classification of Functioning, Disability, and Health (ICF) A Global Model to Guide Clinical thinking and Practice in Childhood Disability. CanChild Centre for Childhood Disability Research.