a) What is the basis for utilizing this type of intervention for children with cerebral palsy?
b) Why is this intervention being investigated? Is there a lack of supportive evidence or are there controversies surrounding this type of intervention?
c) Do the results of the study or summary of the study adequately support the efficacy of this intervention for children with cerebral palsy?
Neuro Developmental Treatment (NDT) has been considered as one of the most well-known approach that is associated to the children suffering from cerebral palsy. One of the most effective perspective associated to Neuro Developmental Treatment (NDT) highlights towards treatment of control groups. The results, which are found to be included with innovative treatment modalities, are compared to the results of NDT applications. The effectiveness of NDT continues to be in a factor of debate (Verschuren et al., 2013). It is definitely not the only approach associated to the pediatric therapy. Thus, it is often subjected to various pros and cons which are been estimated by the researchers associated to this domain. The strength training, mainly for the children suffering from cerebral palsy along with partial body weight supported ambulation training are considered as the two contemporary approaches which are found to be allied to the development of the children.
NDT is an effective and efficient approach which is mainly based on the theories of reflexes, maturation and hierarchic science. This approach is highly influenced by the factor of occupation, speech therapy and physical development of a child suffering from cerebral palsy. When a child suffers from the impairment of Central Nervous System, they tend to have an affected posture control against gravity (Figueroa & Yu, 2014). Thus, the goal of establishing a normal functioning of the nervous system and thereby the prevention of the deformities and contractures are carefully monitored by the concept of Neuro Developmental Treatment (NDT). The neurodevelopmental approach generally tend to focus towards the sensorimotor components such as the reflexes, abnormal movement patters, postural control, memory and the perception. Thus, handling these techniques in order to attain an effective sensory stimuli, in order to inhibit the spasticity, abnormal patterns, abnormal reflexes are carefully monitored for the patient in this protocol. Thus, the child would be facilitated with equilibrium responses, movement patterns and muscle tone under the supervision of Neuro Developmental Treatment (NDT).
The main reason for investigation was to provide the evidence about various intervention for management of developmental disabilities. The research which was conducted by American Academy for Cerebral Palsy and Developmental Medicine (AACPDM) which supported the intervention for medical condition, gauging the credibility of the evidence and thereby identifying the gaps of the scientific knowledge (Kaplan et al., 2013).
Fourteen of the 21 studies provided results regarding the efficiency of Neuro Developmental Treatment (NDT) tentatively, which directly ponders towards its validity. However, it can be clearly analyzed that one of the biggest threat which was associated to the context was the small sample size. The small sample size often may not be considered valid for generalizing the concept. Moreover, lack of information in order to detect a true difference between the heterogeneity of the population was also an alarming factor. Moreover, it can be analyzed that there were substantial gaps which need to be addressed in the future studies.
The nature of the results attained from the study is completely not adequate as it is supported by very low sample size. Low sample size along with the factor of diversified heterogeneity often results to the factor of lack of validity. Thus, further research based on this concept need to be accommodated in order to facilitate more accuracy and adaptability of Neuro Developmental Treatment (NDT).
Physical therapy is considered as one the early intervention services, which directly falls under Part C of IDEA. The Physical therapy so provided may be considered as the only early intervention service where a child need to be coordinated efficiently and effectively. It is considered as a multidisciplinary program, which mainly targets for a huge sector of children that can be directly involved to the program. The Physical therapy, which is generally associated by the services of Part C of the IDEA legislation is generally provided as a part of the child’s Individualized Family Service Plan (IFSP) through a family centered care philosophy. Moreover, the Physical therapy under Part C of the IDEA tend to utilize their knowledge along with their versatile skills to relate the motor and the self-care function. Apart from these perspectives, they also highlights towards the development of assistive technology, medical health care science and developing the self-care functioning of a child. All these parameters definitely target towards providing a unique contribution associated to the Individualized Family Service Plan (IFSP). Moreover, the Physical therapists provide a wide range of services to the clients, which includes collaborating others within a single team, integrating interventions into everyday routines, locations or activities, and efficiently exchanging information with the family members (Chen & Weaver, 2014). It can be clearly analyzed that all these facilities associated to this program of Part C in IDEA legislation targets in developing an effective platform for the improvising a child’s development in a systematic and a logical manner (Moody & McManus, 2014).
Parents are considered as an integral part of the IDEA protocol, which mainly includes the factor of development of Individualized Family Service Plan (IFSP), and the must notified of their rights. This also includes the right to due process. Secondly, IFSP is considered a process that is professionally associated to decision making along with the implementation of the early intervention of the services of families and children. Moreover, the team member tend to develop the objectives, outcomes and strategies, which would guide the provision of the early intervention service associated in the natural environment. It can be clearly analyzed that the team determines the amount along with location of the early intervention services, which includes the concept of physical therapy, supporting the family and child’s objective along with monitoring the income of the family members effectively (Levitt, 2013). Thus, the management would definitely monitor towards the economical consequences of a family and thereby would lay subsequent strategies to guide the child so that there is no constraint faced. Finally, the Service coordination is found to provide the families through the IFSP protocol.
Thoughts for Inclusion and its Effectiveness on the Educational Situation
It can be stated that there are few issues associated to the education, which generate more confusion, discussion or apprehension than the topic of inclusion. This is considered as an issue that has outspoken advocates on all the sides, whether loyally for, avowedly against or somewhere between the two parameters. Certainly, for the purpose of school of a district change, it can be analyzed that a more inclusive approach need to be provided which provides restructuring to the student associated to various disabilities. Special education program along with regular educational staff members (and the relationships) often changes the traditional rules under which most of the things happen with the premises of campus, district of classroom (Rackauskaite et al., 2015). Thus, the understanding of various ramifications and issues such as the restructuring protocols need to be amended significantly.
It can be clearly analyzed that the concept of inclusion is considered vague for most of the people. Its actual meaning, structure and its questioning regarding the mainstreaming factors. Thus, from my perspective, I can clearly define that Inclusion is not an innovative concept associated to education. However, it is in fact a related term, which is associated to a longer history including integration, normalization, mainstreaming, deinstitutionalization, least restrictive environment and the regular education initiative. It can be clearly stated that it is an inclusion stem from the lax usage of several of these related terms when important differences in meaning exists, especially among the common mainstreaming, full inclusion or integration inclusion (Schreiber et al., 2015).
From the perspectives of students associated to several disabilities, this concept have definitely targeted towards the development of opportunities to be around the non disabled peers which have been effectively limited to the lunch and recess. The other also may have been subsequently integrated into the fields of physical education, art, music and vocational training program. Typically, the students having mild disabilities are also been allowed with traditional core academic content areas, such as the subjects of mathematic, language, history, science, etc.
From all these perspectives, it can be clearly assumed that this program definitely targets towards the development of these affected children. These programs tend to limit the factor of discrimination to a huge extent from these children, which in turn helps to develop their internal strength. The factor of confidence is effectively boosted among these child members as they feel the sense of equality with the other children of the same age. Hence, this is one of the most effective parameter, which should be effectively monitored in order to peruse development among the mentally affected child members associated to a school or other organisation.
In context to the present case study that has been published on Derek, the annual goal is to enhance the activities of Derek. This would be followed in such a way that he gets to receive a consultative physical therapy at his school that will help in implementation of various kinds of educational program that will be able to address the issues that is related to his accessibility and fatigability during his school days. The annual goal is to make e Derek free from the mid gut deviation that becomes more prominent during his running (Berg et al., 2012). He shall be thus given the important physical therapies that will help him to come out of the problems that he has been presently suffering from. This includes supporting him in independent stair climbing using the suitable handrail that he has been associated in doing. He shall also need to be supported for his home program of heel cord stretching and night splint that will help the physical therapies to monitor the activities of Derek.
The short-term objectives in relation to Derek thus include:
Understanding of the outcomes that will help in relating Derek’s functional skills and activities
Understanding of the outcome that will help in enhancing Derek’s performance in school.
Understanding of the outcome that may be realistic and achievable within the frame of IEP fro motivating and improving the condition of Derek that he has been associated with
Derek needs to provide the suitable assistance for removing the mild gait deviations
To support Derek so that he can independently get associated in stair climbing by using a suitable handrail so that he can easily transfer himself from the floor to standing by using a Gowers’ maneuver.
Monitoring the activities of Derek at school through the use of MDA clinic that will help to focus on the home program of heel cord stretching and the implementation of night splint
The IFSP has laid down the guidelines that helps in providing a child’s “natural environment” whenever required. The term natural environment means settings and activities that are standardized for a child’s peers of the same age. It is the place or event the child is likely to get engaged if he or she did not have the disability. It includes care centers for children, church, libraries or grocery stores that help in the development of the child in a natural environment. However, what seems to be natural for one child is not necessarily natural for the other child.
The main question that arises here is the location for creating a natural environment. A location may not be treated as a natural environment if it is where the persons with disabilities go. For example, they should not be taken to hospitals, schools and classrooms (Bartonek, 2015). The stipulation of early interference services for any child may occur in a setting other than a natural environment only if early interference cannot be achieved satisfactorily. According to the Federal Idea Part C Regulations, the term natural environment means and includes, keeping in mind the needs of the child, natural environment community settings means home kind of environment in which children with disabilities are comfortable with. The state that is participating in Part C of Idea must ensure that early services should be provided for natural environments and ensuring that any child who cannot be a part of the natural environment easily shall be provided with an alternative in place of natural environment. Natural environment means settings that are real or normal for the child’s peer who otherwise have no disability.
According to Nebraska Title, natural environment means arrangement that is real or natural for the child similar age peers as compared to the child without any disability. In cases if the natural setting of environment is not achieved satisfactorily then, in such cases an alternative can be achieved. The Rule 51 of the Nebraska Title states that, the school district shall establish policies and procedures to the highest extent possible. Children with disabilities are to be educated with children who do not have any disabilities. In situations where there is a need of separating the educational system of those having disabilities, then they may get separated only in cases where by the aids and services provided do not allow to achieve proper education for those with disabilities.
The Individuals with Disabilities Educational Improvement Act of 2004 under Sub Part E lays down procedural safeguards. These safeguards serve to preserve the interests and rights of parents as well as children who bear a disability. The Act provides that at least once in a year, the parents of children bearing disability are entitled to Procedural Safeguard Notice from the schools in which their children are enrolled. This Act ensures that children who bear disability have proper access to education. It gives parents of children with disability a voice regarding the education of their children. The following are some of the remarkable rights laid down under the said Act;
The Act serves to protect the confidentiality of education of such children by way of allowing children the right to access the records of their children. In case they come across any information, which appears to be misleading or incorrect, or in violation of the privacy rights of their children they are entitled to request for amendment of such information.
The Act gives parents the right to take part in meetings concerning their children. This happens to be one of the most significant right available to the parents of children with disability (Oudenampsen et al., 2013). They are entitled to participate in meetings concerning;
Identification, evaluation and educational placement of their children
Application of the provisions of FAPE (free appropriate public education) to their children
Development or revision of the individualised education program for their children (IEP) for their children
The Act requires the school authorities to avail the consent of the parents of children with disability prior to taking certain specific actions regarding such children. There is no exhaustive list regarding such actions and would depend upon the policies of schools. These may include;
Prior to conducting evaluation of such children;
Prior to conducting re-evaluation of such children.
Parents have also been provided with the right of disagreeing with decisions which the schools take concerning children with disability.
In case parents of such children are not satisfied with the individualized evaluation of their children conducted by the school they have been accorded the right to obtain an Independent Educational Evaluation. Under this system, they have the right to get the evaluation done by an independent evaluator.
Parents of children with cognitive and physical special needs must be aware of the above stated rights as well as other rights available under the Act in connection with advocacy for their children.
Bartonek, Å. (2015). Commentary on “Foot Orthoses for Pediatric Flexible Flatfoot: Evidence and Current Practices Among Canadian Physical Therapists”. Pediatric Physical Therapy, 27(1), 60.
Berg, P., Becker, T., Martian, A., Danielle, P. K., & Wingen, J. (2012). Motor control outcomes following Nintendo Wii use by a child with Down syndrome.Pediatric Physical Therapy, 24(1), 78-84.
Chen, Y. P., & Weaver, L. (2014). Commentary on “Accommodating the Bayley-III for Motor and/or Visual Impairment: A Comparative Pilot Study”.Pediatric Physical Therapy, 26(1), 68.
Figueroa, A. M., & Yu, S. (2014). Commentary on “Functional Capacity, Strength, and Quality of Life in Children and Youth With Familial Mediterranean Fever”. Pediatric Physical Therapy, 26(3), 353.
Kaplan, S. L., Coulter, C., & Fetters, L. (2013). Physical therapy management of congenital muscular torticollis: an evidence-based clinical practice guideline: from the Section on Pediatrics of the American Physical Therapy Association. Pediatric Physical Therapy, 25(4), 348-394.
Levitt, S. (2013). Treatment of cerebral palsy and motor delay. John Wiley & Sons.
Lombard, K. A. (2016). Physical Therapy for a Child Poststroke With a Left Ventricular Assist Device. Pediatric Physical Therapy, 28(1), 126-132.
Moody, C., & McManus, B. M. (2014). Commentary on “The Effects of Massage Therapy to Induce Sleep in Infants Born Preterm”. Pediatric Physical Therapy, 26(4), 410.
Oudenampsen, C., Holty, L., Stuive, I., van der Hoek, F., Reinders-Messelink, H., Schoemaker, M., … & Buurke, J. (2013). Relationship between participation in leisure time physical activities and aerobic fitness in children with DCD. Pediatric Physical Therapy, 25(4), 422-429.
Rackauskaite, G., Uldall, P. W., Bech, B. H., & Østergaard, J. R. (2015). Impact of child and family characteristics on cerebral palsy treatment.Developmental Medicine & Child Neurology, 57(10), 948-954.
Schreiber, J., Moerchen, V. A., Rapport, M. J., Martin, K., Furze, J., Lundeen, H., & Pelletier, E. (2015). Experiential Learning With Children: An Essential Component of Professional Physical Therapy Education. Pediatric Physical Therapy, 27(4), 356-367.
Verschuren, O., Bongers, B. C., Obeid, J., Ruyten, T., & Takken, T. (2013). Validity of the muscle power sprint test in ambulatory youth with cerebral palsy. Pediatric Physical Therapy, 25(1), 25-28.
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