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DISABILITY REHABILITATION KISHORE JEBASINGH.T MPT, MSW, PGDHM, DAcu PHYSIOTHERAPIST KHORFAKKAN HOSPITAL T. KISHORE JEBASINGH, MPT, MSW, PGDHM PHYSIOTHERAPIST KHORFAKKAN HOSPITAL

disability rehabilitation

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Page 1: disability rehabilitation

DISABILITY REHABILITATION

KISHORE JEBASINGH.TMPT, MSW, PGDHM, DAcu

PHYSIOTHERAPISTKHORFAKKAN HOSPITAL

T. KISHORE JEBASINGH, MPT, MSW, PGDHM

PHYSIOTHERAPIST KHORFAKKAN HOSPITAL

Page 2: disability rehabilitation

• Disability• According to the World Health Organization, a

disability is…“any restriction or lack (resulting from any

impairment) of ability to perform an activity in the manner or within the range considered normal for a human being”

T. KISHORE JEBASINGH, MPT, MSW, PGDHM PHYSIOTHERAPIST

KHORFAKKAN HOSPITAL

Page 3: disability rehabilitation

When most people think of the word “disability” they immediately picture someone in a wheelchair.

T. KISHORE JEBASINGH, MPT, MSW, PGDHM PHYSIOTHERAPIST

KHORFAKKAN HOSPITAL

Page 4: disability rehabilitation

Disease or Disorder

T. KISHORE JEBASINGH, MPT, MSW, PGDHM PHYSIOTHERAPIST

KHORFAKKAN HOSPITAL

Page 5: disability rehabilitation

• Impairmentis any loss or abnormality of psychological, physiological, or

anatomical structure or function.

• Disabilitiesis any restriction or lack (resulting from an impairment) of ability

to perform an activity in the manner or within the range considered normal for a human being.

• Handicapsis a disadvantage for a given individual, resulting from an

impairment or a disability, that limits or prevents the fulfillment of a "survival" role that is normal (depending on age, sex, and social and cultural factors) for that individual.

T. KISHORE JEBASINGH, MPT, MSW, PGDHM PHYSIOTHERAPIST

KHORFAKKAN HOSPITAL

Page 6: disability rehabilitation

REHABILITATION

• Rehabilitation is process to restore or helping an individual achieve the highest level of independence and quality of life possible physically, emotionally, socially and spiritually

T. KISHORE JEBASINGH, MPT, MSW, PGDHM

PHYSIOTHERAPIST KHORFAKKAN HOSPITAL

Page 7: disability rehabilitation

REHABILITATION TEAM

“COMING TOGETHER IS THE BEGINNING, STAYING TOGETHER IS PROGRESS, WORK TOGETHER IS

SUCESS,.” – HENRY FORD

T. KISHORE JEBASINGH, MPT, MSW, PGDHM

PHYSIOTHERAPIST KHORFAKKAN HOSPITAL

Page 8: disability rehabilitation

MULTIDISCIPLINARY TEAM

1. Family2. Rehabilitation physician3. Specialized physician4. Behavioral psychologist5. Nurse6. Nutritionist7. Physical therapist8. Occupational therapist9. Speech therapist10. Dental hygienist11. Social worker12. Orthotic and prosthetics13. Rehabilitation engineers

T. KISHORE JEBASINGH, MPT, MSW, PGDHM

PHYSIOTHERAPIST KHORFAKKAN HOSPITAL

Page 9: disability rehabilitation

How does the team work

• Assessment• Planning, Referral and Follow-up• The family centered approach

T. KISHORE JEBASINGH, MPT, MSW, PGDHM

PHYSIOTHERAPIST KHORFAKKAN HOSPITAL

Page 10: disability rehabilitation

Assessment

The interdisciplinary team provides comprehensive assessment of motor, nutritional, functional and eating habits

1.Direct or videotaped observation2.Individual assessments by team members

T. KISHORE JEBASINGH, MPT, MSW, PGDHM

PHYSIOTHERAPIST KHORFAKKAN HOSPITAL

Page 11: disability rehabilitation

Planning, Referral and Follow-up

• The team works with the family to make a written plan for intervention

• The team communicates closely with community professionals already involved

• Appropriate referrals are made at the family’s request• Periodic follow-up is provided to address changing needs

T. KISHORE JEBASINGH, MPT, MSW, PGDHM

PHYSIOTHERAPIST KHORFAKKAN HOSPITAL

Page 12: disability rehabilitation

The family centered approach

• The team works with the family to prioritize goals for the child

• The team works together to make consistent recommendations

• The team helps consolidate appointment to the family• Team evaluations and planning are sensitive to the cultural

background of the family

T. KISHORE JEBASINGH, MPT, MSW, PGDHM

PHYSIOTHERAPIST KHORFAKKAN HOSPITAL

Page 13: disability rehabilitation

Working together, the family and team produce positive outcomes…….

A recent study of community teams showed the following positive outcomes

1. Appropriate growth2. Improved dietary intake decreased illness and hospitalization3. Improved feeding skills4. Improved health status

T. KISHORE JEBASINGH, MPT, MSW, PGDHM

PHYSIOTHERAPIST KHORFAKKAN HOSPITAL

Page 14: disability rehabilitation

Occupational therapy service

• Working directly in partnership with person to maintain or develop their occupational performance skills that are meaningful to them to lead productive adult lives

• Provide specialist assessments appropriate to learning disabilities

• Provide specialist intervention carried out in most appropriate disabilities

T. KISHORE JEBASINGH, MPT, MSW, PGDHM

PHYSIOTHERAPIST KHORFAKKAN HOSPITAL

Page 15: disability rehabilitation

Physiotherapy services

Physiotherapy outcomes• Which treatment and intervention strategies have

been most successful• Evaluate the long-term outcomes of early

interventions including exercise, electro therapy splint and brace etc..

T. KISHORE JEBASINGH, MPT, MSW, PGDHM

PHYSIOTHERAPIST KHORFAKKAN HOSPITAL

Page 16: disability rehabilitation

Physiotherapy Treatments• Electrical stimulation• Strength training• Motor control approaches

– Rood – The Bobaths- NDT– Brunnstrom– PNF– Carr & Shepherd

T. KISHORE JEBASINGH, MPT, MSW, PGDHM

PHYSIOTHERAPIST KHORFAKKAN HOSPITAL

Page 17: disability rehabilitation

Need of oromotor rehabilitation

A poor Oromotor activity leads to poor nutrition. Poor oral hygiene may leads to frequent (upper)

respiratory tract infection Poor coordination between swallowing and

breathing leads to excessive chocking Inadequate tongue movement biomechanically

affects neck control Oral tonicity also influence facilitation techniques

by other approaches Oromotor problem leads high social stigma

T. KISHORE JEBASINGH, MPT, MSW, PGDHM PHYSIOTHERAPIST

KHORFAKKAN HOSPITAL

Page 18: disability rehabilitation

Oromotor problem in CP ? / !

• One hundred children (76 boys and 24 girls) with cerebral palsy of mean age 2.5 years (range 1 to 9 years) and mean developmental age of 7.6 months (range 1 to 36 months) were included for the Indian study on Oromotor problem on 2001. The oral motor dysfunction was found in all cases and in each category. Spastic quadriplegic cerebral palsy and hypotonic patients had significantly poor feeding skill score (p < 0.001)

- Gangil A. Indian Pediatr. 2001 Aug;38(8):839-46

T. KISHORE JEBASINGH, MPT, MSW, PGDHM PHYSIOTHERAPIST

KHORFAKKAN HOSPITAL

Page 19: disability rehabilitation

Common symptoms of poor Oromotor control

• Poor strength and coordination of the lips, tongue, and jaw.

• Poor speech clarity ("muddled" speech)• Drooling• Poor muscle tone in the face (muscles appear to

be "sagging")• Difficulty with chewing and swallowing• Voice changes - speech sounding hoarse, nasal,

or soft• Unable to perform coordinated oral movements

T. KISHORE JEBASINGH, MPT, MSW, PGDHM PHYSIOTHERAPIST

KHORFAKKAN HOSPITAL

Page 20: disability rehabilitation

• Developmental - Presence of malocclusions • Teething (Problems for effective lip sealing.)• Nausea• Foods• Emotional stimuli• Central nervous system and muscular disorders• Mental retardation• Oro-pharyngeal lesions• Esophageal lesions• Gastroesophageal reflux• Drugs and chemicals (Antecedents of seizures

and the use of antiseizure drugsT. KISHORE JEBASINGH, MPT, MSW,

PGDHM PHYSIOTHERAPIST KHORFAKKAN HOSPITAL

Common cause for Oromotor problem - Drooling

Page 21: disability rehabilitation

Common treatment techniques I

Bite Chew activities

Gauze methods

Page 22: disability rehabilitation

Common treatment tools I

Tongue Depressors

NUK Brush

Page 23: disability rehabilitation

Common treatment tools II

Textured Grabber XT

No name

Page 24: disability rehabilitation

Selection of food

• Thicken the liquid by adding fruits or sugar with juice/milk will help to increase the oral alertness.

 • Strong acid base juice like orange will increase

the saliva production.  • Milk and milk based products tends to increase

the mucos production, leads to difficult in swallowing respiration and swallowing.

T. KISHORE JEBASINGH, MPT, MSW, PGDHM PHYSIOTHERAPIST

KHORFAKKAN HOSPITAL

Page 25: disability rehabilitation

Management of too tight cheek• Facial moulding before meal time

• Shaking of face muscles

• Proper positioning (sitting -Head in neutral position and allow head extension)

• Applying the sustained compression on the top of the head towards the spine will facilitate the contraction of all musculature around neck and encourage the swallowing

T. KISHORE JEBASINGH, MPT, MSW, PGDHM PHYSIOTHERAPIST

KHORFAKKAN HOSPITAL

Page 26: disability rehabilitation

Management of too floppy cheek• Face rubbing before meal• Vibration of face muscles• Encourage quick stretch of face muscles • Cheek tapping before meal• Can also try/use

– NUK brushing– Infra dent finger tooth brush– Gum massager

T. KISHORE JEBASINGH, MPT, MSW, PGDHM PHYSIOTHERAPIST

KHORFAKKAN HOSPITAL

Page 27: disability rehabilitation

Management of too tight tongue• Positioning• Maroon spoon• Beckman spoon• NUK massager• Avoid tongue over activity

T. KISHORE JEBASINGH, MPT, MSW, PGDHM PHYSIOTHERAPIST

KHORFAKKAN HOSPITAL

Page 28: disability rehabilitation

Management of too floppy tongue

• Iced food and liquid• strong flavor• Infra dent finger brush• Gum massager• Pressure with NUK massager• Downward pressure on tongue by

spoon

T. KISHORE JEBASINGH, MPT, MSW, PGDHM PHYSIOTHERAPIST

KHORFAKKAN HOSPITAL

Page 29: disability rehabilitation

Working for tongue lateralization

• Bite chew activity• Gauze bite activity• Tooth brush• NUK massager • Hide food in cheek pouches

T. KISHORE JEBASINGH, MPT, MSW, PGDHM PHYSIOTHERAPIST

KHORFAKKAN HOSPITAL

Page 30: disability rehabilitation

Working for tongue tip elevation

• Tongue cheek education• Encourage jaw control• Biting and chewing activities• Tongue lateralization• NUK, infra dent brushing

T. KISHORE JEBASINGH, MPT, MSW, PGDHM PHYSIOTHERAPIST

KHORFAKKAN HOSPITAL

Page 31: disability rehabilitation

Working for spontaneous mouth opening

• Arousal techniques• Elicit rooting reflex• Assist mouth opening

– gentle downward pressure and traction to jaw

• Inhibit jaw clenching– vibration to the mouth– touch/pressure to gums

T. KISHORE JEBASINGH, MPT, MSW, PGDHM PHYSIOTHERAPIST

KHORFAKKAN HOSPITAL

Page 32: disability rehabilitation

Electrical stimulation• NMES activates a greater number of motor

units and produces higher firing rates of the active motor units than can be obtained volitionally

T. KISHORE JEBASINGH, MPT, MSW, PGDHM

PHYSIOTHERAPIST KHORFAKKAN HOSPITAL

Page 33: disability rehabilitation

Exercise• Muscles can adapt to training stimuli that

target specific muscle architectural parameters, such as fascicle length and cross-sectional area

T. KISHORE JEBASINGH, MPT, MSW, PGDHM

PHYSIOTHERAPIST KHORFAKKAN HOSPITAL

Page 34: disability rehabilitation

Exercise intervention• Engagement• Enjoyable• Targeted• Based on sound theories of motor learning• Include sensory-perceptual components• Require anticipatory planning• Develop cognitive aspects of motor planning for action

prediction• Computerized music games ‘Magic’ hand tricks

T. KISHORE JEBASINGH, MPT, MSW, PGDHM

PHYSIOTHERAPIST KHORFAKKAN HOSPITAL

Page 35: disability rehabilitation

T. KISHORE JEBASINGH, MPT, MSW, PGDHM

PHYSIOTHERAPIST KHORFAKKAN HOSPITAL

Page 36: disability rehabilitation

Motor control approaches

Focus• Treatment of paralysis, flaccidity & spasticity of muscles

resulting from damage or disease to the central nervous system

• Treatment of movement disorder

Each theorist has a somewhat different approach, assessment technique, and

intervention strategies

T. KISHORE JEBASINGH, MPT, MSW, PGDHM

PHYSIOTHERAPIST KHORFAKKAN HOSPITAL

Page 37: disability rehabilitation

Principles of rood Approach• Sensory input is required for normalization of tone and

evocation of desired muscular response• Sensory motor control is developmentally based• Movement is purposeful, engagement in activities is required

to produce a normal response• Repetition of movement is necessary for learning

T. KISHORE JEBASINGH, MPT, MSW, PGDHM

PHYSIOTHERAPIST KHORFAKKAN HOSPITAL

Page 38: disability rehabilitation

Facilitation techniques– Light stroking– Brushing– Icing– Joint compression

Inhibition technique– Joint approximation– Neutral warmth– Pressure on tendon insertion– Slow rhythmical movement are used to inhibit unwanted

movement

T. KISHORE JEBASINGH, MPT, MSW, PGDHM

PHYSIOTHERAPIST KHORFAKKAN HOSPITAL

Page 39: disability rehabilitation

The Bobaths approach• NDT focuses on the sensation of movement• Reflex inhibiting postures are used to inhibit primitive reflexes• Sensory stimulation is regulated with great care• Weight bearing, placing and holding, tapping and joint

compression are used• Compensation using the noninvolved side

T. KISHORE JEBASINGH, MPT, MSW, PGDHM

PHYSIOTHERAPIST KHORFAKKAN HOSPITAL

Page 40: disability rehabilitation

Brunnstrom approach• Focuses on reflexes which provide the components of normal

movement• Patients are encouraged to think about the movement and to

gain control• Brunstrom also uses associated reactions and synergies• Stages of recovery

T. KISHORE JEBASINGH, MPT, MSW, PGDHM

PHYSIOTHERAPIST KHORFAKKAN HOSPITAL

Page 41: disability rehabilitation

PNF• Uses diagonal & spiraling patterns movement• Guides thinking about the sequence of normal development• Uses two diagonal pattern patterns crossing the mid-line for

each major body part, often incorporating verbal commands

T. KISHORE JEBASINGH, MPT, MSW, PGDHM

PHYSIOTHERAPIST KHORFAKKAN HOSPITAL

Page 42: disability rehabilitation

Carr & Shepherd’s motor relearning program• Uses dynamical systems model or motor control• Emphasize interaction between performer and environment• Acknowledge critical role of cognition in motor learning• Movement pattern practiced in context of tasks, rather than

exercises

T. KISHORE JEBASINGH, MPT, MSW, PGDHM

PHYSIOTHERAPIST KHORFAKKAN HOSPITAL

Page 43: disability rehabilitation

Rehabilitation Engineering and Assistive Technology

Rehabilitation engineering• the application of science and technology to improving the

quality of life of people with disabilities

Assistive technology• products, devices or equipment … that are used to maintain,

increase or improve the functional capabilities of individuals with disabilities

T. KISHORE JEBASINGH, MPT, MSW, PGDHM

PHYSIOTHERAPIST KHORFAKKAN HOSPITAL

Page 44: disability rehabilitation

T. KISHORE JEBASINGH, MPT, MSW, PGDHM

PHYSIOTHERAPIST KHORFAKKAN HOSPITAL

Augmentative communication

Computer access

Page 45: disability rehabilitation

T. KISHORE JEBASINGH, MPT, MSW, PGDHM

PHYSIOTHERAPIST KHORFAKKAN HOSPITAL

Ergonomics Prosthetics and Orthotics

Page 46: disability rehabilitation

T. KISHORE JEBASINGH, MPT, MSW, PGDHM

PHYSIOTHERAPIST KHORFAKKAN HOSPITAL

Recreationtransportation

Page 47: disability rehabilitation

T. KISHORE JEBASINGH, MPT, MSW, PGDHM

PHYSIOTHERAPIST KHORFAKKAN HOSPITAL

Universal design

The design of products and environments to be usable by all people, to the greatest extent possible, without the need for adaptation or specialized design.

Page 48: disability rehabilitation

• Sensory stimulation pop beads

T. KISHORE JEBASINGH, MPT, MSW, PGDHM

PHYSIOTHERAPIST KHORFAKKAN HOSPITAL

• Beads light up, vibrate, and play a song for 5-10 seconds when connected or disconnected

• This makes the task more fun

Inside of bead Battery recharging stand

Page 49: disability rehabilitation

Sensory stimulation

T. KISHORE JEBASINGH, MPT, MSW, PGDHM

PHYSIOTHERAPIST KHORFAKKAN HOSPITAL

• If poor arm and trunk strength

• used sensory stimulation to encourage to reach forward and up

Page 50: disability rehabilitation

• Work chair

T. KISHORE JEBASINGH, MPT, MSW, PGDHM

PHYSIOTHERAPIST KHORFAKKAN HOSPITAL

Face forward,and steps retract

Turn to side, and steps extend

• Uses file drawer slides, springs, and pulleys

• When chair rotates, it changes the angle of the file drawer slides

• Simple, safe, inconspicuous

Page 51: disability rehabilitation

• Orientation device

T. KISHORE JEBASINGH, MPT, MSW, PGDHM

PHYSIOTHERAPIST KHORFAKKAN HOSPITAL

Young children do not have the cognitive ability to use ultrasonic cane that helps to navigate