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JM/AM FFS May 2009
THE ROLE OF THE OT/PT IN TREATING THE CHILD WITH
HEMIPLEGIA
Julia Maskery & Alison Mountstephen
JM/AM FFS May 2009
The Bobath Concept……..
……. A way of thinking; not a method but a concept.
What is normal movement?
What causes abnormal movement?
JM/AM FFS May 2009
Bobath Concept…
ABNORMAL MOVEMENT PATTERNS
ABNORMAL SENSORY FEEDBACK
ABNORMAL POSTURAL
TONE
LACK OF / EFFORTFUL TASK PERFORMANCE
INFLUENCING TONE
JM/AM FFS May 2009
Bobath Concept
No two children are the same!
Treatment is HandlingHandling is Treatment
24 hour approach is essential
Early treatment is important
Brain knows nothing about a movement only a sense of a movement
JM/AM FFS May 2009
Early Development
Working to improve head and trunk control
midline orientation alignment/symmetry equal weight bearing
Rotation and sequences of movement Therapy = child's routine Gradually withdraw hands-hand over control to the child
Body Awareness/ Spatial Awareness Begins hands to mouth.. hands together How child perceives self … self in relation to objects
JM/AM FFS May 2009
Early Development
Visual Abilities visual scanning / tracking important to have eyes assessed
Fine Motor Skills / manipulation hand eye coordination bilateral integration bilateral weight bearing Range of movement hand isolation finger isolation Pre-hension patterns
Tactile Awareness sensation /sensitivity / discrimination
JM/AM FFS May 2009
Early Development
Vocalisation/ Communication– increased tone may alter how a child vocalises
which can effect how they interact with the environment
Participation in Activities of daily living– lifting arm / placing limbs when dressing / messy
food play / bathing / toileting training
JM/AM FFS May 2009
Early Development
Socialisation– increase possibility to seek out and interact in their world
THE CONCEPT IS A WAY OF LIFE Parental involvement is essential for treatment
to have a carry over into everyday life
A team approach
Tapping into child's motivation, occupation- play
JM/AM FFS May 2009
School Life - Primary
Mobility /Gross Motor skills- gait, balance and coordination, ball skills, motor planning.
Sense of two sidedness/ reduce neglect of affected side.
Awareness of associated reactions, self inhibition
JM/AM FFS May 2009
School Life – Primary Cont:
Seating and posture.
Independence in activities of daily living.
Fine motor skills/ dexterity.
Pre writing skills.
JM/AM FFS May 2009
School Life – Primary Cont:
Perception /cognition– attention/concentration– visual perception, – spatial relations, – following instructions, – sequencing skills– memory/ recall
Emotional/ Behavioural
JM/AM FFS May 2009
School Life – Secondary
Puberty/adolescence- growth spurts
Independence
Self management awareness
Hobbies and interests – interacting with peers
Adjusting to social norms
WHAT NEXT?????
JM/AM FFS May 2009
Transition
“Young People face many changes in their lives but one of the most important and difficult is the move from school to adult life”
Transition planning is a partnership between the young person, parents, school, statutory authorities and voluntary organisations (cedar foundation, mencap, DEA etc..)
Transition planning involves the core team investigating work experience opportunities and post school placements
Aim To Provide: Advice, Support, Training for the:– Young Person– Family– Training providers in post school placements
JM/AM FFS May 2009
Occupational Therapy and Transitions
Based on individual need Home Assessments: family concerns, aspirations,
support Priority areas identified for intervention: ADL,
Outdoor Independence, Upper Limb function, Assistive Technology etc…
Independent living - advice re: care management Referral to other agencies: social services, cedar,
DEA Transfer to adult services etc..
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