dystonic cp

[spandanphysio]

thanx humera for u r detailed rply.the child is as i said more dynamic dystonic and i want to control that.his right side is better than left one.hw to improve transition as no stable base in suppine..kindly add more ndt points if u can...

[humera]

Hi, I am sorry but I am bit confused with the term you are using Dystonic. If I am not mistaken, dystonia goes more with getting stucked with one posture as children with athetoid. however your child as he looks, goes more with dynamic spasticity. he seems to have moderate spasticity at rest as sitting with support, which increases to severe with movement. I would lebell this child moderate spastic diplegic, lowerlimb involved> upper limb, left side involved > right side. I would describe therapy plan of one session how we can progress during the session.

take him in supine on wedge. start from shld take one L in TIP i.e depression, abd, ext rot at shoulder, elbow straight and wrist and fingers open, taking shld as key point of controll. try to get this position gradually as child allows you. after moments when you feel arm is relaxed, mobilize the shld more in ext rotation. now keep that arm at side and do the same with R shld. now bring the two legs apart and in ext rotation with knees straight as much as possible. mobilize hips in external rot. now fix the legs at knees by sitting over the knees, make the child to do trunk rot at pelvis by picking any big object with L hand from same side and dropping on R side of body. do the same on R side. after this u will feel decreased spasticity in legs.

progress from here to long sitting, by pulling child to sit. make the child to to side lying on L side using R shld as KPC and help him to come up to sitting taking wt on L arm. come behind the child supporting his back from your body and keep his legs straight using your legs coming over his knees. now bring one arm in abd at 90 degrees keeping elbow straight and palms open. sup him from shld and wrist and make the child to hit small balls with open hands in different directions to get big and rapid movts at shoulder. this will also help to dev weight shifting at pelvis thus reducing spasticity in legs. repeat the same with other arm. now bring tilting/ balance board on L side. make child to transfer on balance board and take him in supine. come behind the child at his head side. bring both arms in abd at 90 degrees keeping elbows straight as much as possible. now move balance board side to side slowly to shift body weight to one side and wait till child comes in middle to keep his body straight. from here bring him again in long sitting as you did before in lying on floor. adapt the same long sitting position by sitting behind the child on balance board and engage him in play with both hands. keep moving board side to side with your body weight to make the child to adjust with weight shifting and balancing himself. from here you can take child in cross sitting on board and come in front to play with him keeping the board moving side to side.

[estherderu]

Dear Colleague,
I would suggest to everyone treating children that you need to learn the GMFM. You can order the test manual /book including 3 DVD's on CanChild Centre for Childhood Disability Research
Reading and learning it ( proferably with others) it not only gives you the possibility to learn the test, it also gives you the possibility to think up new treatment goals.
We now realize that one of the biggest problem many children with neurological problems face is muscle weakness.

One of the new ways of treating children in a functional way is to give them the oppertunity to find their own solution to a problem. You only help make this easier. So if a child cannot sit alone, try teaching them to lower themselves from sit to supine or prone slowly (excentric), use 4point gate to slowly lower to sit. But most importantly, give the child the time to allow the movement, don't help. The suggestions made before are not bad but I personally miss the action. You cannot only passively move children. The child has to experience the weight change by doing it themselves.

Hope this helps a bit.

kind regards

esther

[humera]

Dear Estherderu,
I totally agree with you to learn and use GMFM in our pediatric practice as it really help to set treatment goals in more realistic way. also it gives the idea that which part of gross motor needs to get more work done.

the suggestions I made regarding dystonic child, I neverth meant to move child passively rather I wanted to say to facilitate the child. as we say facilitation in NDT/ Bobath approach, it is a proecess in which we try to give the child more active control gradually throughout the activity through our handling till the child can take over completely. I never meant to move child passively. It would be the problem with my writing abilities that I couldnt express the things properly. I am sorry for that.

the suggestions you made regarding eccentric work, I agree with you that it is vey helpful. we always try to facilitate activities not only in forward chaining but in the backward chaining at the same time and it gives child more active control to reach to the final activity in the single session.

Thnx once again for taking the time out to read my reply to the thread. your suggestions are always very helpful.

thnx.