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

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..