Hi All,
The below post is related to a topic which was part of the Conference / Workshop organized by Vasantham. Below are the details of the session:
Conference – Workshop cum conference on Best Practices in the rehabilitation of individuals with special needs
Date – 17th March 2023 16:00
Mode of Presentation – Offline Venue – Sengai Meenakshi Mahal, Mogappair, Chennai – 37
Topic – Facilitating active physiotherapy for children with multiple disabilities
Speaker – Mr.Jefferson Raj Leckler – Physiotherapist, Vidyasagar, Chennai
Below are the points shared in the presentation:
A) Demystifying Physiotherapy
Physiotherapy refers to movement in general, it could be exercises, gross motor skills, fine motor skills, etc. Physiotherapy is a process , it starts from the home to the physiotherapy clinic and back to home and it involves everything. It is not like an ICU in a hospital where you leave the patient behind for a specialized treatment or care, it is a continuous process that happens everywhere or wherever.
Physiotherapy treatments involve teamwork, it requires support of parents, psychologists, occupational therapists, right from the person who is wiping the physiotherapy mat to the senior most physiotherapist everyone is involved. Physiotherapy is a lifelong process, it is not just limited to a 45 minutes session that happens in the therapy clinic where parents sit outside scrolling their phones. Involvement of everyone is required.
B) Motor Learning
Learning to do a movement or a skill. To get a motor learning you need a) Person b) Task and c) Surrounding.
Only if you do purposeful repetitive activity, only then a child can learn it as a motor skill.
C) Active Physiotherapy Vs Passive Physiotherapy
The main difference between active and passive is the involvement of the child. Ownership of one’s body can be obtained in Passive mode. In passive mode, the kid is very submissive.
For example, a kid is lying on the mat, he is resting in a sleeping posture, the therapist now makes him stand, stretches his body, makes him sit, places him on an exercise ball, etc.. This is an example of passive therapy, where the therapist did all the work for the child.
But what is the purpose of the therapist making him do these postures or stretches or exercises, what is the child gaining out of it, will it result in him doing a purposeful functional activity ?
You might have seen many therapists do reaching activities for the children where they keep an object little far from the child and motivate the child to reach and grab it. Why are they doing this reaching activity ?
It would give strength, flexibility, etc .. but the functional activity where it would help him is when he sits on the study table or floor he should be able to reach for the books, pens, other stationary items that are around him. We should sit and see what functional activity is finally going to happen . Activating their own body is very very important
D) Respectiving Cues from the child
When we are making/performing an activity with the child, why are we waiting for their response ? Assume we are asking a child to pick a ball from the floor, some children may take it in 10 seconds, some may take a minute, some may take more time than that, only if you wait you will know when the child will respond. We should wait for cues/response from the child until it happens, this is a very important step in physiotherapy. Giving time to the child to perform a functional activity is very very important.
Promoting Physiotherapy Literacy
1) Functional Therapy and Motor Planning
Any activity which we are planning to do in a therapy for developing a motor skill can be done in many ways, it need not be performed in a single way all the time. It can be done in a way that correlates with the child’s interest, give a story narration for the activity to make it more likeable, etc. Finally it boils down to what the kid likes and how the therapist plans the motor activity according to the child.
2) Encouraging the use of Individualistic Aids and Adaptations
We use ankle weights for some children for specific requirements for that specific child. If you are a parent, you should know why a specific aid or tool that is used by another child is not being used for your child. You should ask questions and seek explanations.
If you are making a child to stand, who is unable to do it, so you give a specific adaptation for that child to perform that task. One size fits all approach does not work here, every child is different, their conditions are presented in a different manner. So we need to find specific aid and adaptation for each condition and for each child respectively.
3) Use of Assistive Technologies
Motorized wheelchair is used for Muscular Dystrophy kids. As a parent and special educator you should be knowing the struggles of the children and what kind of assistance would help the child navigate through those struggles. A kid spends more time in the classroom than in the physiotherapy session, as a special educator your observation and suggestions means a lot in providing the required assistance.
We should work together to achieve this, rather than Physiotherapists alone deciding on the solution/Fix. Which is why during assessments the presence of teachers, special educators, and parents is extremely important. We all have to sit together and drive this to reach the milestone or a goal.
4) Therapy in Leisure and Play
Assume a simple activity where we need to throw a ball from point A to Point B. How to make it interesting and playful for the child.
Randomly throwing it without a target does not interest the child, you provide a target so that child can throw at it.
5) Building an accessible Environment
Make the surrounding interesting for him instead of boring. Instead of throwing the ball at the wall, make him throw the ball to the person he likes: be it a friend, sibling, cousin etc. This will make the child maximize his motor function, his throw will be better.
Some activities in classroom
Please remember that every child is different, every classroom is different, hence what worked in one classroom for one child may not give the same result for another child in a different classroom. Hence i am sharing the basics that needs to be taken care:
1) Child’s position in the classroom
Muscle and body have to be in a proper alignment. Only when alignment is proper, the body will be able to function better. A child’s position in the classroom is very important. If a child is sitting in a wheelchair on the classroom, we need to see what type of wheelchair is it. We see many people are providing wheelchairs for free or at subsidized prices, but if you look at it, the wheelchair would be huge, the child would be sitting at the corner of the wheelchair due to its size. Hence in that case, he is not sitting in the right position. A child has to sit properly in that wheelchair, necessary strapping to be given for the back to be in the correct position, only then it will activate his back muscles. You should select the proper position for that child in that classroom. Improper positioning causes pain and it also impedes learning.
2) Childs mobility in the classroom
If a child needs to make use of the restroom, we need to provide the best mobility possible for that child. For the sake of convenience, a child who can walk with a walker or crutches will be forced to use a wheelchair for travelling to the restroom instead of the best mobility. Similarly when the teacher wants the child to participate by making the child write something on board or point an answer on the board, it is more wise to make provisions that allow the child to move to the board and come back to his position. Even as an adult we cannot be seated still for more than 10-15 minutes, we keep adjusting the posture , legs position etc… will the child not have the same requirement, should we not consider that. It becomes even more important for a non verbal child, who is unable to communicate. It is our responsibility to increase the movement and provide proper mobility in the classroom.
3) Child’s access to TLM i.e. Teaching and Learning Material
Are we handing over the books to him or is the book accessible for the child to reach and take it by himself. Are we keeping everything that he needs in a desk or cupboard that is not reachable or are we keeping all required things at a reachable place, height, etc. for the child. Access to TLM is very important
4) Peer responsibilities
Giving responsibility to the other child, like asking the other child to push the wheelchair and take him to the physiotherapy session and come back. Giving responsibilities to the classmates is very very important. If you are asking another child to ensure that a hyperactive child should not move or run, the other child will try to grab or hold the hyper active child tightly, it will make things worse. You should know when to give peer responsibility and how to give peer responsibility.
Q & A
Q – What are the activities that the child can engage in the Household.
A – You start with the ADLs (Activities of daily Living). Physiotherapy can be done at home as well, you can get a home program from the physiotherapist as well. It can be done by others as well.
Q – Difference between Occupational Therapy and Physiotherapy ?
A – We are all working together. The difference between OT and PT, we all work towards developing a life skill. There is not much of a difference. With respect to rehabilitation we all are the same.
Regards,
Saranya and Karthik
Autism Spectrum Disorder - Personal Experiences (Chennai Family) 