Reflection

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Well its been pretty short and sweet and there is SO much more out there to explore in regards to children with cerebral palsy! Stepping in to this project I had fairly limited insight in to cerebral palsy and the effects it can have on a child's life. It has been such an insightful experience and so encouraging discovering such a wide range of resources that are available and how many support groups, blog's, websites, videos etc. that are being shared among parents, professionals, teachers and carers to improve and support children and families. The most beneficial information I have taken from this blog and research has been how important it is for treatment to be integrated in to a child's everyday functioning and ensuring that they still get to experience the fun and enjoyment that any other child would. Play is such a huge part of a child's life, I guess something that has challenged me the most from this project is ensuring that children still get to experience participation in activities that are of meaning to them, their desires are equally as important as they would be if we were working with adults. They want to participate in the world around them and develop physically, socially and cognitively and it is up to US to help facilitate them in doing this. 

Self Cares

Performance in self cares is strongly linked to feelings of self-worth and successful participation in social environments. Meeting the expectations of social and cultural norms affects how a child is accepted by their peers. Social acceptance has been identified as a crucial contributor to a persons over all self worth so it is important that we offer children the best opportunity to develop the necessary skills to meet their self care needs and perhaps the most important of these is feeding (Kramer, P., & Hinojosa, J. 1999).
I think it would be safe to say that we all understand the importance of eating! Food is something we revolve our entire lives around. Our routines and patterns are generally based on meal times and sources for food, it has been this way since the beginning of time. We use food as comfort, entertainment, nourishment, a whole range of things! For children eating is essential to providing them with nutrition to grow but also it is an experience for learning and interaction. Mealtimes occur several times a day and provide an opportunity to practice object manipulation, experience new sensations and communicate needs and desires.

Children with cerebral palsy and problems with motor control often exhibit oral motor delays due to abnormal muscle tone in proximal areas such as the face, neck and trunk. Early intervention can help reduce the risk of long term problems and improve child's functioning. (Merrill, S.C., Mulligan, S.E. 2003)


CP Feeding
This website has a few helpful tips that are worth checking out!


Help and information- Eating and meal times
Another great sight that may be of your liking that gives much more insight in to your child's eating and what to do to improve it.


Feeding the child
This is an easy to read article that has a few more helpful tips and things to remember or try out during meal times with your child.


Hopefully you find some helpful tips in there that ensure your child gets to experience the nourishment AND enjoyment of mealtime!!

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References
            Kramer, P., & Hinojosa, J. (1999). Frames of reference for paediatric occupational therapy (2nd ed). Philadelphia, USA: Lippincott, Williams & Wilkins

         Merrill, S.C., & Mulligan, S.E. (2003). Neurological dysfunction in children. In E.B. Crepeau, E.S.. Cohn, & B.A. Boyt-Schell (Eds.), Willard and spackman's occupational therapy (3rd ed., pp. 699-716). Philadelphia: Lippincott, Williams & Wilkins

Communication

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Communication is our expressive language, however we may do it and requires motor planning, sequencing and co-ordination. As infants our primary source of communication is crying or facial expressions, how ever language rapidly develops and it is said that by the age of 3-4 we use on average 2000-3000 words. As we mature being able to communicate effectively with others is essential to our independence and peer acceptance which become of increasing importance going in to our teenage years.
As a result of the inability to communicate effectively, problem areas may include coping skills, self regulatory behaviour, engagement in social interaction, development of healthy attachment with parents/caregiver/peers, self expression and development of self concept. these can influence a child's ability to play, establish routines, learn new skills and establish relationships. (Merrill, S.C., Mulligan, S.E. 2003) 
So you see why it is so important that a child is enabled with an ability to communicate and is an important focus for treatment. 

Here a clip that gives the run down on AAC, this seems to be a common tool used for communication so have a look. 

Perhaps a bit more appropriate in today's day and age however is the numerous iPod, iPad and iPhone apps, this clips gives a bit of a run down on a range that are around. 


References
         Merrill, S.C., Mulligan, S.E., (2003). Neurological dysfunction in children. In E.B. Crepeau, E.S. Cohn, & B.A. Boyt-Schell (Eds.), Willard and Spackman's occupational therapy (3rd ed., pp. 699-716). Philadelphia: Lippencott, Williams & Wilkins

Postural Control

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The development of postural control is the foundation for reaching motor milestones; these are rolling, crawling, creeping and walking. Until a baby can control their posture and balance, they struggle to focus on developing those more complex motor skills. (Case-Smith, J. 2001).

 I think of my own experiences of learning to snowboard, on my first day all my strength and energy was going in to maintaining an upright position and not falling over, I was not thinking about doing jumps or perfecting my turns. I was taking direction from the instructor on what was the correct standing position and practicing this while in a stable position then when I felt confident enough I threw myself down the slope. I have improved significantly since then and now when I go up the mountain I don’t need to focus on my balance as it is a skill I have already mastered, now I can focus on developing those more complex skills such as landing a jump or having the correct alignment to hit the box.

For a child with cerebral palsy, developing postural control is essential to developing those more complex skills and should be the focus for treatment, until they have achieved postural control it is much harder for them to learn other skills. So how can we make treatment enjoyable for the child? As with any new skills it is exhausting and can be frustrating learning something new, however it is proven that task-orientated exercises help improve basic motor abilities, functional muscle strength and walking abilities. For a child meaningful activities are of course play! How can we incorporate the necessary movements and exercise routines in to play to make it an enjoyable and meaningful experience for a child? And that can be carried out in your own lounge or in the class room? 
It has been found that children absorbed in play can be stimulated to use more appropriate movements to improve head, trunk and extremity control as they are not focussed on specific motor demands of the activity. (Merrill, S.C., Mulligan, S.E., 2003)

Here a couple of ideas that I came across. Feel free to share any helpful resources or ideas you know of that are related to improving postural control!

Postural Control Exercises

Activities to Improve Postural Control and Balance 

The above video is not specific to postural control but is a good example of how we can use a range of methods to encourage movement and strengthening of the muscles in children. 


9 best ways to help kid with cerebral palsy

This is a great clip on developing sitting balance and how you can encourage your child to do it


References
         Case-Smith, J. 2001. Occupational therapy for children (4^th ed). St. Louis, Missouri: Mosby.

          Merrill, S.C., Mulligan, S.E., (2003). Neurological dysfunction in children. In E.B. Crepeau, E.S. Cohn, & B.A. Boyt-Schell (Eds.), Willard and Spackman's occupational therapy (3rd ed., pp. 699-716). Philadelphia: Lippencott, Williams & Wilkins.

Child Development

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Development can be defined as the sequential changes in the functioning of the individual. The general parameters of development encompass biological, psychological and social aspects. The interaction between human biological capacities and maturation, and the impact of the environment on an individuals behavioural experiences is what influences development (Pratt, P., & Allen, A. 1989).

As children, we are part of an ever changing dynamic process in which our internal and external environments are continuously changing. Motor, psychological and social areas of development are all interrelated and interdependent. Family life and educational programmes are proven to be the most influential areas of a child’s development, hence why it is so important that a huge emphasis needs to be put on educating and enabling those who play a role in these areas with the means to ensure that the child is able to function within their environment to the best of their ability. (Kramer, P., & Hinojosa, J. 1999).

 Typically development is orderly, predictable and sequential however for a child with cerebral palsy this is not the case. As an infant and in early childhood sensorimotor exploration, repetition and imitation are the critical variables which can have occupational behaviour limitations on self-care areas of feeding, toileting and play. This has a knock on effect on academic preparation in sensorimotor, cognitive and psychosocial areas. At the middle to late childhood stage, fundamental skills, role models, tools, symbols and peer groups are important aspects that have occupational behaviour limitations in regards to self-care areas of feeding, toileting, hygiene, communication, geographic orientation, mobility and will impact on a child’s academic performance, environmental manipulation and relationships. Taking this in to account the aim of therapy should be in relation to being able to identify the nature of adaptations required in order to maintain, support and improve the child’s daily living performance in their current life roles, based on the understanding and appreciation of normal development (Pratt, P., & Allen, A. 1989).
Typical developing patterns of movement require experience of a previously acquired pattern, building upon skills through practice and interactions with the environment. (Barthel, K.A. 2010)

So when you think in terms of a child learning to crawl, even at those early stages before they can physically crawl along the ground there are patterns of movement that they exhibit that they then are able to build skills on until they can master the crawl. At first they will start off on their tummy's then they will begin to bring there legs up and position themselves on their knees then they usually do some sort of rocking action etc etc. For babies with cerebral palsy they require assistance in learning these functions and patterns, getting the feel of these movements is crucial. It is suggested by Bobath that by experiencing what normal movement feels like, normal movement can be learned (Barthel, K.A. 2010).
However some theories suggest that treatment for a child with cerebral palsy should not attempt to follow typical developmental sequence and regardless of age or physical disability, the priority for treatment should be around functioning that the child most urgently requires. If that is the case though, how will this effect the child socially? If they are moving through treatment at their own pace and its all based on their personal functioning abilities will this impact on their relations to other children? With the added supports in place is it possible to keep them up with the development of a 'normal' developing child and how unrealistic is this? Obviously it all depends on the individual but what is the best way to ensure that a child receives the best treatment to ensure that they too can engage in meaningful activities just as any other child would. 


References
         Barthel, K.A. (2010).A Frame of reference for  Neuro-developmental treatment. In P. Kramer.& J. Hinojosa (Eds.),   Frames of reference for pediatric occupational therapy (3rd ed.)  (pp.187-233). Philadelphia : Lippencott,Williams & Wilkins


         Kramer, P., & Hinojosa, J. (1999). Frames of reference for paediatric occupational therapy (2nd ed). Philadelphia, USA: Lippincott, Williams & Wilkins.


         Pratt, P., & Allen, A. (1989). Occupational therapy for children (2^nd ed.) St Louis, USA: The CV Mosby Company. 

Family Centred Approach

"Occupation is a collection of activities that individuals use to fill their time and give life meaning, organized around roles or in terms of activities of daily living, work and productive activities, or play and leisure" (Kramer, P., Hinojosa, J. 1999).

For young child play is their number one occupation, it is through play that they learn and develop those crucial skills that they require to carry out normal functioning. For a child with cerebral palsy, play is not quite that easy. Imagine the frustration of wanting to so badly reach out and grab that toy car on the floor next to you or being able to hear the rustling of people around you but physically being unable to control your body movements and having the strength to reach out and grab that toy or hold your head in an upright position. 

Cerebral Palsy is the most common disability among children, it is a permanent impairment that affects automatic postural control and movement as a result of non-progressive brain disorder.

(Home escapade.Cerebral palsy: A comprehensive medical guide about cerebral palsy syndrome. Retrieved http://www.homeescapade.com)

 While on one of my placements at a special needs school I had an opportunity to briefly work with children who had cerebral palsy, from kindergarten age to teenagers with a wide range of needs. I acted as my supervisors shadow who was a full time occupational therapist at this special needs school and had a case load of about 70 children whom she managed to see at least once every two weeks. Given that this was the case it was evident how important it was for the child’s family, care giver and teacher to be well educated in order to implement long lasting rehab that had a clear focus on the child’s individual needs. Often the child only got to spend half an hour or less one on one time with the OT due to time and resource limitations. I couldn’t help but wonder how much of a difference it would make if the therapist could offer that child their full attention and have all those one on one sessions two or three times a week, just how much would they improve then?! And why aren’t they receiving this type of therapy when it is so crucial to helping them improve and maintain functioning. It was then that I realised that those who aren’t necessarily health professionals are equally as important to the child’s health and functioning.

Rather than being guided by a health professional, children’s health is guided by the parent and a family centred approach is often more appropriate. Many service providers have now adopted this approach as they recognise the importance in respecting the parent as the expert in regards to the child and their needs (Jeglinsky, I., Autti-Ramo, I., & Brogren Carlberg, E. 2011).

 From an occupational therapy perspective, our concern is the performance context and enabling the child to function effectively within a range of environments. Clinicians teach parents/teachers/carers the skills and patterns that promote pro-social behaviour and decrease maladaptive behaviours. By embedding child interventions in to daily family life they remain consistent in order to optimize child outcomes (Whittingham, K., Wee, D., & Boyd, R. 2010).

Is the family centred approach the most appropriate and effective approach to therapy for children with cerebral palsy or are there other alternatives? And how can we ensure that it is effectively implemented in order to keep up treatment for the child?


References


         Jeglinsky, I., Autti-Ramo, I., & Brogren Carlberg, E. (2011). Professional background and the comprehension of family-centredness of rehabilitation for children with cerebral palsy. Child: Care, Health and Development. 38(1) 70-78. DOI: 10.1111/j.1365-2214.2011.01211x.


        Kramer, P., & Hinojosa, J. (1999). Frames of reference for paediatric occupational therapy (2nd ed). Philadelphia, USA: Lippincott, Williams & Wilkins. 

       Whittingham, K., Wee, D., & Boyd, R. (2010)  Systematic review of the efficacy of parenting interventions for children with cerebral palsy. Child: care, health and development 37(4) 475-483 doi:10.1111/j.1365-2214.2011.01212.x. 

CP for You and Me

Welcome to my Blog, my name is Elisabeth and I am a third year Occupational Therapists studying at Otago Polytechnic. Through this Blog I will focus on Cerebral palsy among children and exploring a range of interventions that can be implemented in to their everyday activities in order to improve their level of functioning and prevent future damage. I hope to provide a resource that is useful not just for professionals but for all of those who are involved with children with Cerebral palsy in offering helpful tips and guidance that will enable them to help their child to engage in occupations that are meaningful to them. I am no professional in this area so it is a learning experience for me also. I would love to receive any feedback or advice you have, feel free to share peoples. Enjoy!