Chapter 7:Physical Management

in the ClassroomBy: Sarah Daniels

For a child with severe and multiple disabilities who have limited motor skills, classroom participation and learning will

depend on how the environment supports performance through a

daily physical management program that addresses the child’s unique motor needs.

Focus of chapterO Understanding the physical management

of children with cerebal palsy and other neuromotor involvement

O Practical information for teachers and classroom staff to help children participate in learning environment

O Addressing the child’s unique physical and motor needs need to be addressed so they are able to participate in classroom activities

Physical needs to addressO Muscle ToneO Muscle Co-activitationO Joint AlignmentO Postural ControlO Primitive ReflexesO Weight ShiftO Sensory InputO Volitional Control

Muscle ToneO The readiness of the muscles in the body to act, every movement

requires some degree of muscle tone.

O Example: To sit in a chair, the student muscles in their trunk must be high enough to align the trunk and spine in an upright position against gravity but low enough to adjust one’s posture to reach and use arms and hands

O A child may have muscle tone that is too high or too low which makes it difficult to stabilize joints and maintain position

O A student may require a classroom chair with supported back and pelvic seat belt or may require total assistance to use arms and hands depending on the needs.

O Hypotonia- muscles need to be activated

O Spasticity- diminished muscle tone

Muscle Co-activity

• Muscle Co-activity is movement and posture require a balance of muscle activation around a joint.

• Ex: Independent sitting requires a balance of muscle activation in the front, back, and sides of the trunk for the student to maintain a static sitting position.

• If the student has abnormal muscle tone they will require assistance from person or adaptive equipment to provide stability.

Joint Alignment• In order for muscles to

preform their typical action around a joint, the joint must be in proper proper alignment or have the ability to be moved into an aligned position by the actions of the muscles.

• Example: For a student to sit up, the vertebrae of the spine must be aligned over the pelvis.

• If a student has atypical muscle tone and poor postural alignment they may sit with a rounded spine.

Postural Control

• To maintain postural control a student makes slight adjustments such as movement in the trunk or shifts in body weight.

• Postural reactions are an integral component of dynamic movement in space, such as reaching, changing positions, crawling, walking or riding a bike

Primitive ReflexesO A primitive reflex is an involuntary

response of the body to a specific sensory stimulus that appears in early development (birth to 6 months) but disappears with maturation of the central nervous systems.

O In some children with severe and multiple disabilities, abnormal muscle tone and the presence of involuntary primitive reflexes interfere with the development of postural control.

Weight ShiftO The movement that involves change

in the center of the body to adjust for most activities

O A child with abnormal muscle tone and poor postural control has difficulty with weight shift

Sensory InputO A student must be able to process visual, tactile

proprioceptive (from muscles and joints), and vestibular (awareness of movement) information for postural control.

O Example of visual and auditory informationO Teacher calls on a studentO Teacher shows a picture

O Atypical muscle tone affects the quality of internal sensory feedback generated from movement

Volitional ControlO Volitional control is the ability to

initiate and carry out active and purposeful movement.

O Example: sitting in a chair using a manual sign to communicate a desire, taking a cookie from a platter, or reaching towards a communication board are all activates requiring volatile motor control.

O Examples on next page….page 259 in book

Things to do…O Encourage purposeful and meaningful

activities in the classroomO Position the student so they can engage in

classroom activitiesO Prepare a student to participate and provide

physical assistance as needed during motor activities

O Do motor activities designed to meet motor goals listed in IEP

O Plan a schedule with a variety of positions to meet and work towards the student’s goals and physical needs

5 Basic general principles to apply when guiding acquisition of motor skills

1. Motor learning is enhanced when participation is active

2. Motor learning is enhanced when actions are goal oriented

3. Motor learning is enhanced when sessions include both repetition and problem solving

4. Motor learning is enhanced by practice in meaningful contexts

5. Performance is enhanced when the performer assumes an optimal state of readiness for action

When developing a physical management plan ask the questions…

O What are the functions of the motor goals for the child that will maximize participation in the education environment?O Example: sitting for classroom activities, changing

positions, use of arms and hands, personal care, etc.O What areas need to be developed?O Are there health concerns that need to be

addressed?O What is the child’s positioning plan and schedule?O What roles do people play outlined in the IEP?O How are the goals achieved in inclusive environment

and daily routines?

Before handling (touching/assisting) a child know their needs

O Children with spasticity:O Make sure environment is calmO Tell the child who is going to help them and

what/how they will be movedO Firm touch that the child anticipates is best

O Children with hypotonia:O Benefit from an environment that generates

excitement or increase in muscle toneO Stimuli that is alerting or arousingO Quick, a-typical movements

Before starting an activity ask yourself…

O What movement does the student need to do to participate?

O Does the student need to prepare to participate?

O What assistance/handling does the child need during the activity? How should the child be handled?

Many students will need adaptive

seating, use the checklist for

seating positioning

(chart on page 274)

When choosing a seat consider the following…

OPositioning of the trunkOPositioning of the headOPositioning of the lower exterminates

OPositioning of the arms

The book has detailed movements for the

teacher here is one of them…

Forward weight shift

Daily activities for a child when forward weight shift

should be encouraged includes:

• Leaning forward to put on or take off a jacket

• Washing hands• Leaning forward on the

toilet to wipe• Pick up something from

the floor

The book provides detailed instruction on how to do this

movement on page 277

O Floor sitting is generally not appropriate for an inclusive environment

O It is suggested that children need floor time experience to achieve functional sitting and mobility goals that are documented in IEP

O Independent sitting requires..O Sufficient mobility and

stability in head and trunk

O Needs to have postural control to maintain position

O Joint mobility to be placed in sitting position

O Page 296 has floor sitting positions

Floor sitting

Positioning Schedule

• Positioning and meeting the physical needs of a classroom of children with severe and multiple disabilities can be challenging

• The teacher should develop a schedule that meetings each students needs and matches the classroom routines

• Things to think of …• What postures should be avoided

and/or what should be reinforced?• What positions should the child be in

to participate in the activity• Will the position allow the child to

participate?• Is the staff trained? Do they know

what they are doing• Example of positioning schedule

for pre-school age student that requires adaptive seating (page 299)

THE END!!!