Describe about the Paediatric Physical Therapy for Community Training Programme?
The children with cerebral palsy have certain movement disorders and muscle weakness that appear in their early childhood and become permanent. The symptoms include stiff muscles, poor coordination, weak muscles and tremors. Some special fitness programmes are there specially designed for the children with cerebral palsy. To implement such a fitness programme in the community will be helpful for the physical development for the children with cerebral palsy. For implementing such programme:
Firstly, the significance of such programmes should be understood by the people of community (Case-Smith & O’Brien, 2013).
The parents of the children with cerebral palsy must be involved in such programme and it is important to make them understand the significance of these activities and how these can improve the health of their children.
The parents should be trained properly about how to take care of the physical health of their children at home.
A paediatric physical therapist is to be assigned to check the physical health of the children such as, their muscle strength, ability to walk, co-ordination etc.
A trainer must be assigned to guide the children with the appropriate physical exercise.
Arranging and setting the necessary equipments for the training of the children.
The children are checked for the improvement of their physical health after a certain interval.
For setting such programme, fund should be raised. It can be done with the help of the people of the community or with the sponsorship of any organization (Verschuren et al., 2011).
There are some challenges that are faced while conducting such training programme in a community for the children having cerebral palsy.
The most common challenge of conducting any kind of training programme is to raise the fund or arranging the sponsorship.
Sometimes it may be difficult to convince the people of the society and the parents of the disabled children for co-operation.
Sometimes parents feel awkward to take their children to the society because of their disability (Campbell, Palisano & Vander Linden, 2006).
In many cases parents who have children with cerebral palsy stated that, their children refused to join as they are not comfortable to come for such training as they consider themselves inferior and that is why they feel shy to participate in the training programme. So, there is also a difficulty to make the children participate in such programme (Wiert et al., 2010).
Such problem can be avoided by convincing the community people to donate for this purpose. The problem of participation of children can be managed by the individual mental counselling of them and making them realize the importance of this training in their physical health and they can also be encouraged by involving certain fun activities in the training programme (Gordon et al., 2011) . The parents of the children must be co-operative. It is important for them to understand the physical improvement that can happen to their children and they must be aware of the positive impact of this improvement on the future life of the children (Verschuren et al., 2011).
As evidenced in many researches, there should be a positive change in the physical health of the children. The activities that are included in the training are specially designed to enhance the physical abilities of the children with cerebral palsy. The primary goals of these physical activities are to improve the physical functioning, impaired mobility, co-ordination and muscle strength of the children (Campbell, Palisano & Vander Linden, 2006). These activities not only bring about a change in the physical health but an improvement in mental health also occurs. The disabled children are more likely to restrict themselves to participate in the society. These training programmes allow the children to be more participative that is they become socialized and make friends. By involving some sports or dance in the training, the physical ability as well as creativity of the children can be encouraged (Reid et al., 2010).
The purpose of monitoring the outcomes is to determine the effectiveness of the intervention for meeting the desired goals. The physical therapist along with the trainer and the adolescent’s family can determine the effectiveness of the training. The methods of the strength measurement are:
Maximal and sub-maximal aerobic test: This process involves a six minute walk or ride and a modified shuttle run or ride test (Hubur et al., 2010).
Anaerobic and power test: In this method a 10×5 metre sprint test is done and then another two muscle power sprint test: 6×15 meter, 3×15 meter are done.
Strength tests: The process for determining strength involves hand held dynamometry, lower limb muscle strength test and 6-15 repetition maximum testing (Campbell, Palisano & Vander Linden, 2006).
Guidelines for the training of young athletes are classified according to their age and the activities are designed according to that.
7 years or younger: Basic and light exercise with no or a little weight along with a concept of the training session is introduced. The children are taught with the proper techniques of exercise. In this age the training volume is low.
8 to 10 years: Increment in the number of exercises and the volume of training is done. Gradual progression of the loading of exercise is occurred and exercise is practices in all lifts. The tolerance to the stress is monitored carefully.
11 to 13 years: Progressive loading of exercise is continued and more advanced techniques are involved into the curriculum. The techniques of different are emphasized.
14 to 15 years: More advanced exercises are designed for the athletes, techniques become tougher and the training volume is increased.
16 years or above: The athletes are introduced to the adult programmes and are moved to the entry level adult programmes (Armstrong & Barker, 2010).
The training also includes several programmes to develop certain skills of the athletes which are:
Energy training is given to the athletes to develop good aerobic base. It involves exercise with low intensity and long duration.
Resistant training is for the development of physical strength of the athletes.
Activities to fasten the movement of muscles and to increase the flexibility.
Training is given to the athletes to make them understand the nutritional and caloric requirements and to make their diet chart according to that (Faigenbaum & Myer, 2010).
A proper supervision of the coach is necessary to train the young athletes in a correct way. Supervision of the coach guides the athletes to perform the exercise in a right manner depending on the physical condition of them. It is very important to train the athletes in the correct way otherwise it can affect the health of them. So, supervising the young athletes and directing them to the right way is a major duty of the coach to build their future ( Mufulli et al., 2010).
Occurrence of injury is very common for athletes. There are some common ways to prevent or minimize the injuries.
It is mandatory to use proper equipments for the protection of participants.
Participants should appear in the ground in proper dress code along with appropriate footwear.
Protective headgear is necessary for some sports like baseball, cricket, hockey etc. to minimize the injuries of head and neck.
Eye protector is required to avoid eye injuries in racquet sports and it should not interfere with the vision of the athlete (Armstrong & Barker, 2010).
Mouth guard is essential for boxers and hockey players and it has effectively reduced oral injuries.
Facial protection is also needed in some sports especially in boxing and wrestling. These protections should not interfere with speech and breath.
A proper supervision during the training can minimize the chance of any injury.
In this case, the role of a physical therapist is to monitor that, whether the above stated instructions are being followed or not. He or she should make the trainee athletes realise the importance of following the guidelines and the safety measures to avoid any major injury. The physical therapist should also make the athletes aware of the consequences of not following the guidelines on their physical health (Jayanthi et al., 2012)
At the time of birth, Blair had a brachial plexus injury due to some problems at the time of delivery. Initially she faced much problem due to this but improved gradually. At the age of 2 years, Blair faces some mild sensory loss along with some residual impairment. A decrease in the activity of shoulder and elbow ROM has also been noticed. Due to these residual impairments she faces some restriction while doing certain activities (Murphy et al., 2012). Her parents must be involved in the procedure of her treatment. There are certain activities that they can do at home to help her to overcome the weaknesses.
First of all her parents should be provided with the home programme sheets and are suggested to follow that.
The exercises that are mentioned in the home programme guidelines should be performed in a regular basis.
Provide a tactile stimulation using a vibrator or a massage to the upper extremity in order to increase the sensation of shoulder and arms.
Providing a joint compression to the joints of arm and soldier in order to facilitate muscle co-ordination.
Insist her to use the upper extremity in various activities she likes to do.
Resistive exercise using a very light weight.
Providing electrical stimulation by a trained therapist (Mehlman et al., 2011).
As she has a tendency of soldier stiffening, a hot compress can be given to her soldier for 10 to 15 minutes followed by a massage.
It should be noticed that she is not lying on her back or in an inverted position. She must avoid side-lying.
She should not get picked up under armpit and her arm should not be lifted in the elbow flexion on the top of her chest. She should not be allowed to dangle her arm in space (Campbell, Palisano & Vander Linden, 2006).
For the protection of hand and deficits in the sensory nerves a hand splint can be applied. It will also maintain her hand in the proper position. Dynamic splints can be used for her elbow.
Monitoring the improvement of physical strength of Blair regularly.
Taking her to a doctor on a regular basis for health check up and for checking the strength of her muscle, improvement in co-ordination, impairments and sensory properties (Pham et al., 2011).
There are some activities of daily life that should be encouraged by Blair’s parents and Blair should try to perform regularly in order to improve her residual impairments. These activities are:
Brushing teeth and combing hair to improve the movement of elbow.
Climb on stair holding the railing with the support of her hand which will make the muscles of her arm and soldier work (Vaz et al., 2010).
She should be encouraged to draw on paper using crayons to increase the activity of her arm.
Her parents should play some game with her where the upper extremity is involved mostly (Campbell, Palisano & Vander Linden, 2006).
References:
Armstrong, N., & Barker, A. R. (2010). Endurance training and elite young athletes.
Campbell, S., Palisano, R., & Vander Linden, D. (2006). Physical therapy for children. St. Louis, MO: Elsevier Saunders.
Case-Smith, J., & O’Brien, J. C. (2013). Occupational therapy for children. Elsevier Health Sciences.
Faigenbaum, A. D., & Myer, G. D. (2010). Resistance training among young athletes: safety, efficacy and injury prevention effects. British journal of sports medicine, 44(1), 56-63.
Gordon, A. M., Hung, Y. C., Brandao, M., Ferre, C. L., Kuo, H. C., Friel, K., … & Charles, J. R. (2011). Bimanual Training and Constraint-Induced Movement Therapy in Children With Hemiplegic Cerebral Palsy A Randomized Trial. Neurorehabilitation and Neural Repair, 25(8), 692-702.
Hale, H. B., Bae, D. S., & Waters, P. M. (2010). Current concepts in the management of brachial plexus birth palsy. The Journal of hand surgery,35(2), 322-331.
Huber, M., Rabin, B., Docan, C., Burdea, G. C., AbdelBaky, M., & Golomb, M. R. (2010). Feasibility of modified remotely monitored in-home gaming technology for improving hand function in adolescents with cerebral palsy.Information Technology in Biomedicine, IEEE Transactions on, 14(2), 526-534.
Jayanthi, N., Pinkham, C., Dugas, L., Patrick, B., & LaBella, C. (2012). Sports specialization in young athletes evidence-based recommendations.Sports Health: A Multidisciplinary Approach, 1941738112464626.
Maffulli, N., Longo, U. G., Spiezia, F., & Denaro, V. (2010). Aetiology and prevention of injuries in elite young athletes.
Mehlman, C. T., DeVoe, W. B., Lippert, W. C., Michaud, L. J., Allgier, A. J., & Foad, S. L. (2011). Arthroscopically assisted Sever-L’Episcopo procedure improves clinical and radiographic outcomes in neonatal brachial plexus palsy patients. Journal of Pediatric Orthopaedics, 31(3), 341-351.
Murphy, K. M., Rasmussen, L., Hervey-Jumper, S. L., Justice, D., Nelson, V. S., & Yang, L. J. S. (2012). An assessment of the compliance and utility of a home exercise DVD for caregivers of children and adolescents with brachial plexus palsy: a pilot study. PM&R, 4(3), 190-197.
Pham, C. B., Kratz, J. R., Jelin, A. C., & Gelfand, A. A. (2011). Child Neurology: Brachial plexus birth injury What every neurologist needs to know. Neurology, 77(7), 695-697.
Reid, S., Hamer, P., Alderson, J., & Lloyd, D. (2010). Neuromuscular adaptations to eccentric strength training in children and adolescents with cerebral palsy. Developmental Medicine & Child Neurology, 52(4), 358-363.
Vaz, D. V., Mancini, M. C., do Amaral, M. F., de Brito Brandão, M., de França Drummond, A., & da Fonseca, S. T. (2010). Clinical changes during an intervention based on constraintâ€Âinduced movement therapy principles on use of the affected arm of a child with obstetric brachial plexus injury: a case report. Occupational therapy international, 17(4), 159-167.
Verschuren, O., Ada, L., Maltais, D. B., Gorter, J. W., Scianni, A., & Ketelaar, M. (2011). Muscle strengthening in children and adolescents with spastic cerebral palsy: considerations for future resistance training protocols.Physical Therapy, 91(7), 1130-1139.
Wiart, L., Ray, L., Darrah, J., & Magill-Evans, J. (2010). Parents’ perspectives on occupational therapy and physical therapy goals for children with cerebral palsy. Disability and rehabilitation, 32(3), 248-258.
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