Cerebral palsy (CP), Traumatic brain injury (TBI) and Hypoxic Brain Injury due to any cause and affecting motor controlling parts of the brain and the nerve fibers connecting those parts to the body are a group of permanent disorders of the development of movement and posture, causing activity limitation, that are attributed to nonprogressive disturbances that
occurred in the developing fetal or infant brain or before the age of 2 years in case of CP. The motor disorders of may be accompanied by disturbances of sensation, perception, cognition, communication, and behavior, by epilepsy, and by secondary musculoskeletal problems.
Such children require intensive one-to-one physiotherapy on daily basis till bone growth stops ( 18 years for girls and 21 for boys) and further also if required.
Physiotherapy (PT) plays a central role in managing the condition; it focuses on function, movement, and optimal use of the child’s potential. PT uses physical approaches to promote, maintain and restore physical, psychological and social well-being. A physiotherapist will focus on helping children with strength, balance, flexibility and coordination required for motor skills and functional mobility including rolling, sitting, crawling, and walking. They also select, fabricate, modify, and train children and families in the use of adaptive equipment.
Physiotherapy approaches in rehabilitation applications aim to normalize sensorial and motor functions, provide normal posture and independent functional activity, regulate muscle tone, improve visual and auditory reactions,support normal motor development and motor control,improve ambulation and endurance, increase the quality of the existing movements, prevent soft tissue, joint and postural disorders, support orthopedic and surgical procedures,and finally to prepare the child for the adolescent and adult periods.
The physiotherapist focuses on gross motor skills and functional mobility in the management of motor deficits. Positioning, sitting, walking with or without assistive devices and orthoses, wheelchair use and transfers are areas that the physiotherapist works on. The physiotherapist performs and plans physiotherapy and home program and provides the interphase with the school and recommends equipment and orthosis. This approach also focuses on gross and fine motor activities, visual, and sensory processing skills needed for basic activities of daily living, training in school-related skills and also strategies to help children compensate for specific deficits in their daily lives.
Children with Autistic Spectrum Disorder (ASD) demonstrate a variety of behaviors which affect their ability to participate in their daily occupations. Occupational therapists use a number of approaches to enable children and young people with ASD to participate in everyday life and for families to better manage their children’s needs.
Many of the anxieties and resultant behaviors of individuals with ASD relate directly to their sensory differences and inability to process the world around them. They are unable to process and use the sensory input they receive. Frequently they have sensory defensiveness, in which children are unable to tolerate various kinds of sensory stimulus. These sensory integration issues fall within the frame of scope of OT. Some children with ASD also have additional diagnoses of dyspraxia, dyslexia and developmental coordination disorder and a large proportion experience problems with fine and gross motor skills and coordination.
Occupational / Sensory Integration Therapy is a method of helping people who are her oversensitive to the senses by overwhelming them with sensory experiences
The overall goal of occupational therapy is to help the children under autism spectrum disorder improve his or her quality of life at home and in school. The therapist helps introduce, maintain, and improve skills so that people with autism can be as independent as possible. They will use exercise, facilitated practice, alternative strategies and adaptive equipment to promote independence.
Occupational therapists focus on the development of fine motor skills and on optimizing upper body function and improving posture. Fine motor skills are required for holding objects while handwriting or cutting with scissors. Gross motor skills used for walking, climbing stairs, or riding a bike
The Occupational therapist works mainly on the following parameters of the child:
- Attention span and stamina
- Transition to new activities
- Play skills
- Need for personal space
- Responses to touch or other types of stimuli
- Motor skills such as posture, balance, or manipulation of small objects
- Aggression or other types of behaviors
- Interactions between the child and caregivers
- Behavioral Issues
By working on these skills during occupational therapy, a special child with autism may be able to:
- Develop peer and adult relationships
- Learn how to focus on tasks
- Learn how to delay gratification
- Express feelings in more appropriate ways
- Engage in play with peers
- Learn how to self-regulate
Speech and language therapists (also known as speech therapists or speech-language pathologists) observe, diagnose, and treat disorders of speech, language, voice, communication and auditory processing when the disorder results from cerebral palsy, hypoxic brain injury or autism spectrum disorders.
The services are part of a treatment plan with documented goals for functional improvement of the patient’s condition, e.g. speech, articulation, swallowing or communication with or without alternative methods.
They use a program of exercises to :
- Strengthen oral muscles,
- Improve feeding and swallowing disorders techniques including problems with gathering food and sucking, chewing, or swallowing food. For example, a child who cannot pick up food and get it to his/her mouth or cannot completely close his/her lips to keep food from falling out of his/her mouth may have a feeding disorder.
- Auditory (Aural) rehabilitation which includes speech – language therapy
- Typically includes the development and improvement of communication skills with concurrent correction of deficits; the development of alternative or augmentative communication strategies, when required; and efforts to enhance social adaptation of the individual in regard to communication.
A speech therapist works with your child on the receptive (understanding) part of speech and language as well as the expressive part (talking) to progress toward the documented treatment plan goals.
Speech therapist help improve your child’s ability to speak clearly or communicate using alternative means such as an augmentative communication devise or sign language. Speech interventions often use a child’s family members and friends to reinforce the lessons learned in a therapeutic setting. This kind of indirect therapy encourages people who are in close daily contact with a child to create opportunities for him or her to use their new skills in conversation, learning and play.
Special Education is that component of education which employs special instructional methodology (Remedial Instruction), instructional materials, learning-teaching aids and equipment to meet educational needs of children with specific learning disabilities. Remedial instruction or Remediation aims at improving a skill or ability in a student. Techniques for remedial instruction may include providing more practice or more explanation, repeating information, and devoting more time to working on the skill. Effective teaching strategies may include the use of ‘procedural facilitators’ like planning sheets, writing frames, story mapping and teacher modelling of cognitive strategies, although for quality and independence in learning it is crucial to extend these technical aids with elaborated ‘higher order’ questioning and dialogue between teachers and pupils.
Special education teachers use various techniques to promote learning such as :
- Approaches that encourage children to regulate their behaviour by teaching them selfmonitoring, self-instruction and self-reinforcement skills are effective in producing adaptive behaviour change (i.e. increased on-task behaviour, reductions in anti-social behaviour).
- Approaches using positive reinforcement (where appropriate behaviour is immediately rewarded), behaviour reduction strategies (such as reprimands and redirection), and response cost (a form of punishment in which something important is taken away) appear to be effective in increasing on-task behaviour.
- Combinations of approaches (e.g. cognitive-behavioural with family therapy) are more effective in facilitating positive social, emotional and behavioural outcomes than single approaches alone
Depending on the disability, teaching methods can include individualized instruction, problem-solving assignments, and small group work. Special education teachers help to develop an Individualized Education Program (IEP) for each special child. The IEP sets personalized goals for each student and is tailored to the student’s individual needs and ability. Teachers work closely with parents to inform them of their child’s progress and suggest techniques to promote learning at home. They are involved in the students’ behavioral, social, and academic development, helping the students develop emotionally, feel comfortable in social situations, and be aware of socially acceptable behavior. Special education teachers communicate and work together with parents, social workers, school psychologists, speech therapists, occupational and physical therapists, school administrators, and other teachers.
The knowledge and ability to carry out activities of daily living ( ADL) is the most fundamental request at the heart of every parent of a special need child. This entails teaching how to dress, undress, wash, toilet training, eating, hand function, etc that allow the special need child/person to be an independent member of the family as far as daily needs are concerned. A small special child may be a joy to behold and easy to carry, but when that same child grows up and does not have ADL abilities it becomes a tremendous burden on a mother because she is older and the child is heavier UDAAN is the only centre in Delhi to offer ADL training to the special children ADL Training involves self-care, self-management and home management. Activities of daily living (ADL) are the basic daily activities one does to be independent.
They include :
- Eating food independently.
- Dressing-ability to wear and remove shirt, pant shoes etc.
- Grooming-ability to brush teeth, comb hair , wash hands and face etc.
- Bathing and toileting-ability to take a bath independently
- Personal mobility
- The ability to be able to serve self or make simple snacks for oneself.
- Also being able to decide which books to take for school and to take them out when needed and to organize them.
- Organize the toys in their place etc.
- Understand the concept of money and handling money.
- Understanding the concept of going to a shop and remembering the way to go to a shop or home etc.
ADL also develops Fine motor (FM) skills. They are important to ensure proper development. It is an important component of development in infants and children to practice fine motor skills for functional use of hands. Examples of FM activities are: shoe tying, manipulating small objects such as buttons, zipping and unzipping, using scissors, pinching, opening and closing objects, handwriting, grasping items and being able to isolate finger movements to push buttons or type.
Fostering this kind of independence boosts self reliance and self-esteem, and also helps reduce demands on parents and caregivers.
Art Therapy is a psychological discipline that specializes in using visual art making and enhancing the inherent creative process to help children achieve their full potential and bring about therapeutic change. Art therapy is generally described as a highly illuminating, enjoyable, and unique experience.
There is a commonly held belief that art making is beneficial to people (particularly children) with Autism Spectrum Disorder due to their intense sensory needs (especially visual and tactile self-stimulation) and disregulation, often nonverbal nature, and need for more visual, concrete, hands-on therapies. ASD therapists of all kinds acknowledge this and, despite lack of appropriate training, many attempt to include therapeutic art making into their child’s activities on a regular basis. Art therapy literature on the subject is large enough to demonstrate that it is an effective, clinically-sound treatment option (especially when supplemented with studies from the fields of art, art education, psychology, and other creative arts therapies).
There are six major ASD treatment goal areas that art therapists are best qualified to treat:
- Imagination/abstract thinking deficits
- Sensory regulation and integration
- Developmental Growth
- Recreation/Leisure skills
- Visual-spatial deficits