PowerPoint Presentation

CP Umbrella. Spastic Quad. Ataxic CP. Choreo-Athetotic CP.

Managing the child with Cerebral Palsy Analysis of Function Activity & Participation Handling & Function Future Planning Problem Solving Team Approach Goal Setting with parents Elements of Typical Development Carry Over.

Classification of CP. SCPE GMFCS MACS Mini MACS EDACS CFCS.

CFCS Level Identification Chart Does the person consistently and effectively communicate with unfamiliar partners? Does the consistently and effectively alternate sender and receiver roles with familiar partners? Level III CFCS Is the an effective sender AND/OR a receiver at least some of YES the skrson usually maintain a comfortable conversational pace with partners? Level I Effective Sender and Receiver with unfamiliar familiar the time? Level IV Effective Sender AND Effective Receiver with familiar partners Level II Effective, but slower- paced Sender and/or Receiver with unfamiliar and familiar Inconsistent Sender and/or Receiver with familiar partners Level V Seldom Effective Sender and Receiver with familiar partners.

Ill.

Eating and Drinking Ability Classification System Is the individual able to swallow food and drink without risk of Is the individual able to bite and chew on hard lumps of food without choking? Yes Is the individual able to eat a meal in the same time Yes aspiration? No Level Ill Eats and drinks with some limitations to safety; there may be limitations to efficiency. No Level IV Eats and drinks with significant limitations to safety. Can risks of aspiration be managed to eliminate harm to the individual? Level V Unable to eat or drink safely — tube feeding may be considered to provide nutrition. as peers? Level I Eats and drinks safely and efficiently. Level II Eats and drinks safely but with some limitations to efficiency..

Effects of Typical vs Atypical movement patterns of development.

Facebook page: Pathways.org. Typical Reeoqni*inq Eqrly Motor Pelqys A EXAWNATU)N OF TWO-MONTH-OLD INFANTS Needs more suppoct to sustain Sitting posture • Inability to achieve Atypical o N • • • Head is aligned With ear directty over the shoulder Holds and sustains posture With assistance Head turning may or may not be present at 2 months, but should be seen by 3 months Able to activate adequate neck and trunk extension to sustain posture Can majntajn bnef penods of head control, but may not be able to hold the head in midline • and sustain head lifting in upright position Little to no antigravity arm activity Difficulty or inability to activate neck or upper thoracjc extensors to lift head May try to use arm and leg movements to sustain posture.

What does child development teach us with regard to the management of the child with CP?.

What does child development teach us with regard to the management of the child with CP?.

What does child development teach us with regard to the management of the child with CP?.

5 month roll Dissociated legs from each other and from trunk rm free to move an ot trapped beneath runk- scapula- umeral dissociation Weight bearing side elongated Eccentric trunk extensor activity Head off surface.

Assessment:. Assessment observation sheet Name: Age: Classification: • • • • GMFC5 MACS CFCS EADACS Relevant background Information General Impression/ snapshot Associated Impairments collaborative Goal area-Main participation restriction- 1. Activities and Pärticipation What can the child do independently and paint a verbal picture of how they do it- Related to goal area What can't they do? Limitations- What components of the task are they missing? Related to goal area Body Structure and Function Why not? Whät is interfering with the skill acquisition? Impairments What are the main problems. prioritise impairments that are influencing the child's ability to complete the activity 1. 2. 3. 4. SHORT TERM FUNCTIONAL GOAL: (meaningful, attainable and task criented activity leading towards he p&tcipaicn you deeded upon. It cculd even be part or specific components of an actj',W) SMART goal Treatment Planning.

Transverse Frontal Sagittal. Rotation Abduction / Adduction Flexion / Extension.

Treatment Principals Spastic Quadriplegic Spastic Diplegic Work asymmetrically to achieve symmetry Don’t forget the trunk Working in the frontal plane is essential Include weight bearing and weight shifting Include variety and selectivity Practice repetition without repetition Be forward looking –prevent C&D Use big movements and mobilise Dissociation : trunk pelvis/ pelvis femur Mobilise the pelvis in frontal and transverse plane Get off the floor – floor time just feeds into their patterns Crawling will not be your goal Work on cruising for a long time, then work on walking forward Work to get hip flexion and knee extension Work in closed chain Attend to the child’s hand function.

Treatment Principals Preterm CP Hypotonia Encourage self initiation/correction of movement with facilitation for success Consider the sensory system at all times Use the child’s own activity to facilitate stability Work for sustained co-activation proximally active flexion and active extension against gravity They have no physiological flexion, find their middle and give a starting point Spend more time activating Closed chain activities Work up against gravity Alignment, Alignment, Alignment Child must be engaged and then wait for a response Work proximally and in weight bearing Change position as often as possible Mobilize area of tightness.

Treatment Principals Spastic Hemiplegia Ataxic Work asymmetrically to achieve symmetry Weight bearing is essential for development of the bones Do not only focus on the hemi side Aim for dynamic stability Work up against gravity Postural alignment is NB Challenge their BOS Go where the child does not want to go, but give support Aim to get movement in the transverse plane.

Treatment Principals Dystonic Choreoathetosis Work/ treat slow- but move through large range of movement, allowing child to adjust Work in frontal and transverse planes using diagonal Try to prevent predictability Use techniques to reduce spasms, anti-gravity weight bearing positions can be helpful Build head and trunk control and stability in a wide variety of positions Grade stimulation 24 hour positioning Address communication issues: AAC Work for sustained activity up against gravity Use closed-chain purposeful activities to work for co-contraction and control and grading in mid-range of movement Work of mid-line Work slowly for control but not statically Connect the shoulder and pelvis, work in transverse plane Grade stimulation Work for greater variety and variability of movement patterns with control They have mobility, work for stability.

Acknowledgements. SANDTA Basic Paediatric NDT course notes SANDTA Basic Paediatric NDT Tutors PLEASE DO NOT COPY OR REPRODUCE ANY OF THE INFORMATION SHARED IN THIS TRAINING. PLEASE DO NOT TAKE PHOTOS OR VIDEOS OF THE DEMO SESSIONS. A special Thank You to Pathways School and Tamsamqwa Centre.