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disability rehabilitation
 

disability rehabilitation

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this topic had been presented national level conference in UAE

this topic had been presented national level conference in UAE

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    disability rehabilitation disability rehabilitation Presentation Transcript

    • DISABILITY REHABILITATION KISHORE JEBASINGH.T MPT, MSW, PGDHM, DAcu PHYSIOTHERAPIST KHORFAKKAN HOSPITAL T. KISHORE JEBASINGH, MPT, MSW, PGDHM PHYSIOTHERAPIST KHORFAKKAN HOSPITAL
      • Disability
      • According to the World Health Organization, a disability is…
      • “ any restriction or lack (resulting from any impairment) of ability to perform an activity in the manner or within the range considered normal for a human being”
      T. KISHORE JEBASINGH, MPT, MSW, PGDHM PHYSIOTHERAPIST KHORFAKKAN HOSPITAL
      • When most people think of the word “disability” they immediately picture someone in a wheelchair.
      T. KISHORE JEBASINGH, MPT, MSW, PGDHM PHYSIOTHERAPIST KHORFAKKAN HOSPITAL
    • Disease or Disorder T. KISHORE JEBASINGH, MPT, MSW, PGDHM PHYSIOTHERAPIST KHORFAKKAN HOSPITAL
      • Impairment
      • is any loss or abnormality of psychological, physiological, or anatomical structure or function.
      • Disabilities
      • is any restriction or lack (resulting from an impairment) of ability to perform an activity in the manner or within the range considered normal for a human being.
      • Handicaps
      • is a disadvantage for a given individual, resulting from an impairment or a disability, that limits or prevents the fulfillment of a "survival" role that is normal (depending on age, sex, and social and cultural factors) for that individual.
      T. KISHORE JEBASINGH, MPT, MSW, PGDHM PHYSIOTHERAPIST KHORFAKKAN HOSPITAL
    • REHABILITATION
      • Rehabilitation is process to restore or helping an individual achieve the highest level of independence and quality of life possible physically, emotionally, socially and spiritually
      T. KISHORE JEBASINGH, MPT, MSW, PGDHM PHYSIOTHERAPIST KHORFAKKAN HOSPITAL
    • REHABILITATION TEAM
      • “ COMING TOGETHER IS THE BEGINNING, STAYING TOGETHER IS PROGRESS, WORK TOGETHER IS SUCESS,.” – HENRY FORD
      T. KISHORE JEBASINGH , MPT, MSW, PGDHM PHYSIOTHERAPIST KHORFAKKAN HOSPITAL
    • MULTIDISCIPLINARY TEAM
      • Family
      • Rehabilitation physician
      • Specialized physician
      • Behavioral psychologist
      • Nurse
      • Nutritionist
      • Physical therapist
      • Occupational therapist
      • Speech therapist
      • Dental hygienist
      • Social worker
      • Orthotic and prosthetics
      • Rehabilitation engineers
      T. KISHORE JEBASINGH, MPT, MSW, PGDHM PHYSIOTHERAPIST KHORFAKKAN HOSPITAL
    • How does the team work
      • Assessment
      • Planning, Referral and Follow-up
      • The family centered approach
      T. KISHORE JEBASINGH, MPT, MSW, PGDHM PHYSIOTHERAPIST KHORFAKKAN HOSPITAL
    • Assessment
      • The interdisciplinary team provides comprehensive assessment of motor, nutritional, functional and eating habits
      • Direct or videotaped observation
      • Individual assessments by team members
      T. KISHORE JEBASINGH , MPT, MSW, PGDHM PHYSIOTHERAPIST KHORFAKKAN HOSPITAL
    • Planning, Referral and Follow-up
      • The team works with the family to make a written plan for intervention
      • The team communicates closely with community professionals already involved
      • Appropriate referrals are made at the family’s request
      • Periodic follow-up is provided to address changing needs
      T. KISHORE JEBASINGH, MPT, MSW, PGDHM PHYSIOTHERAPIST KHORFAKKAN HOSPITAL
    • The family centered approach
      • The team works with the family to prioritize goals for the child
      • The team works together to make consistent recommendations
      • The team helps consolidate appointment to the family
      • Team evaluations and planning are sensitive to the cultural background of the family
      T. KISHORE JEBASINGH, MPT, MSW, PGDHM PHYSIOTHERAPIST KHORFAKKAN HOSPITAL
      • Working together, the family and team produce positive outcomes…….
      • A recent study of community teams showed the following positive outcomes
      • Appropriate growth
      • Improved dietary intake decreased illness and hospitalization
      • Improved feeding skills
      • Improved health status
      T. KISHORE JEBASINGH, MPT, MSW, PGDHM PHYSIOTHERAPIST KHORFAKKAN HOSPITAL
    • Occupational therapy service
      • Working directly in partnership with person to maintain or develop their occupational performance skills that are meaningful to them to lead productive adult lives
      • Provide specialist assessments appropriate to learning disabilities
      • Provide specialist intervention carried out in most appropriate disabilities
      T. KISHORE JEBASINGH, MPT, MSW, PGDHM PHYSIOTHERAPIST KHORFAKKAN HOSPITAL
    • Physiotherapy services
      • Physiotherapy outcomes
      • Which treatment and intervention strategies have been most successful
      • Evaluate the long-term outcomes of early interventions including exercise, electro therapy splint and brace etc..
      T. KISHORE JEBASINGH, MPT, MSW, PGDHM PHYSIOTHERAPIST KHORFAKKAN HOSPITAL
      • Physiotherapy Treatments
      • Electrical stimulation
      • Strength training
      • Motor control approaches
        • Rood
        • The Bobaths- NDT
        • Brunnstrom
        • PNF
        • Carr & Shepherd
      T. KISHORE JEBASINGH, MPT, MSW, PGDHM PHYSIOTHERAPIST KHORFAKKAN HOSPITAL
    • Need of oromotor rehabilitation
      • A poor Oromotor activity leads to poor nutrition.
      • Poor oral hygiene may leads to frequent (upper) respiratory tract infection
      • Poor coordination between swallowing and breathing leads to excessive chocking
      • Inadequate tongue movement biomechanically affects neck control
      • Oral tonicity also influence facilitation techniques by other approaches
      • Oromotor problem leads high social stigma
      T. KISHORE JEBASINGH, MPT, MSW, PGDHM PHYSIOTHERAPIST KHORFAKKAN HOSPITAL
    • Oromotor problem in CP ? / !
      • One hundred children (76 boys and 24 girls) with cerebral palsy of mean age 2.5 years (range 1 to 9 years) and mean developmental age of 7.6 months (range 1 to 36 months) were included for the Indian study on Oromotor problem on 2001. The oral motor dysfunction was found in all cases and in each category. Spastic quadriplegic cerebral palsy and hypotonic patients had significantly poor feeding skill score (p < 0.001)
      • - Gangil A. Indian Pediatr. 2001 Aug;38(8):839-46
      T. KISHORE JEBASINGH, MPT, MSW, PGDHM PHYSIOTHERAPIST KHORFAKKAN HOSPITAL
    • Common symptoms of poor Oromotor control
      • Poor strength and coordination of the lips, tongue, and jaw.
      • Poor speech clarity (&quot;muddled&quot; speech)
      • Drooling
      • Poor muscle tone in the face (muscles appear to be &quot;sagging&quot;)
      • Difficulty with chewing and swallowing
      • Voice changes - speech sounding hoarse, nasal, or soft
      • Unable to perform coordinated oral movements
      T. KISHORE JEBASINGH, MPT, MSW, PGDHM PHYSIOTHERAPIST KHORFAKKAN HOSPITAL
      • Developmental - Presence of malocclusions
      • Teething (Problems for effective lip sealing.)
      • Nausea
      • Foods
      • Emotional stimuli
      • Central nervous system and muscular disorders
      • Mental retardation
      • Oro-pharyngeal lesions
      • Esophageal lesions
      • Gastroesophageal reflux
      • Drugs and chemicals (Antecedents of seizures and the use of antiseizure drugs
      Common cause for Oromotor problem - Drooling T. KISHORE JEBASINGH, MPT, MSW, PGDHM PHYSIOTHERAPIST KHORFAKKAN HOSPITAL
    • Common treatment techniques I Bite Chew activities Gauze methods
    • Common treatment tools I Tongue Depressors NUK Brush
    • Common treatment tools II Textured Grabber XT No name
    • Selection of food
      • Thicken the liquid by adding fruits or sugar with juice/milk will help to increase the oral alertness.
      •  
      • Strong acid base juice like orange will increase the saliva production.
      •  
      • Milk and milk based products tends to increase the mucos production, leads to difficult in swallowing respiration and swallowing.
      T. KISHORE JEBASINGH, MPT, MSW, PGDHM PHYSIOTHERAPIST KHORFAKKAN HOSPITAL
    • Management of too tight cheek
      • Facial moulding before meal time
      • Shaking of face muscles
      • Proper positioning (sitting -Head in neutral position and allow head extension)
      • Applying the sustained compression on the top of the head towards the spine will facilitate the contraction of all musculature around neck and encourage the swallowing
      T. KISHORE JEBASINGH, MPT, MSW, PGDHM PHYSIOTHERAPIST KHORFAKKAN HOSPITAL
    • Management of too floppy cheek
      • Face rubbing before meal
      • Vibration of face muscles
      • Encourage quick stretch of face muscles
      • Cheek tapping before meal
      • Can also try/use
        • NUK brushing
        • Infra dent finger tooth brush
        • Gum massager
      T. KISHORE JEBASINGH, MPT, MSW, PGDHM PHYSIOTHERAPIST KHORFAKKAN HOSPITAL
    • Management of too tight tongue
      • Positioning
      • Maroon spoon
      • Beckman spoon
      • NUK massager
      • Avoid tongue over activity
      T. KISHORE JEBASINGH, MPT, MSW, PGDHM PHYSIOTHERAPIST KHORFAKKAN HOSPITAL
    • Management of too floppy tongue
      • Iced food and liquid
      • strong flavor
      • Infra dent finger brush
      • Gum massager
      • Pressure with NUK massager
      • Downward pressure on tongue by spoon
      T. KISHORE JEBASINGH, MPT, MSW, PGDHM PHYSIOTHERAPIST KHORFAKKAN HOSPITAL
    • Working for tongue lateralization
      • Bite chew activity
      • Gauze bite activity
      • Tooth brush
      • NUK massager
      • Hide food in cheek pouches
      T. KISHORE JEBASINGH, MPT, MSW, PGDHM PHYSIOTHERAPIST KHORFAKKAN HOSPITAL
    • Working for tongue tip elevation
      • Tongue cheek education
      • Encourage jaw control
      • Biting and chewing activities
      • Tongue lateralization
      • NUK, infra dent brushing
      T. KISHORE JEBASINGH, MPT, MSW, PGDHM PHYSIOTHERAPIST KHORFAKKAN HOSPITAL
    • Working for spontaneous mouth opening
      • Arousal techniques
      • Elicit rooting reflex
      • Assist mouth opening
        • gentle downward pressure and traction to jaw
      • Inhibit jaw clenching
        • vibration to the mouth
        • touch/pressure to gums
      T. KISHORE JEBASINGH, MPT, MSW, PGDHM PHYSIOTHERAPIST KHORFAKKAN HOSPITAL
      • Electrical stimulation
      • NMES activates a greater number of motor units and produces higher firing rates of the active motor units than can be obtained volitionally
      T. KISHORE JEBASINGH, MPT, MSW, PGDHM PHYSIOTHERAPIST KHORFAKKAN HOSPITAL
      • Exercise
      • Muscles can adapt to training stimuli that target specific muscle architectural parameters, such as fascicle length and cross-sectional area
      T. KISHORE JEBASINGH, MPT, MSW, PGDHM PHYSIOTHERAPIST KHORFAKKAN HOSPITAL
      • Exercise intervention
      • Engagement
      • Enjoyable
      • Targeted
      • Based on sound theories of motor learning
      • Include sensory-perceptual components
      • Require anticipatory planning
      • Develop cognitive aspects of motor planning for action prediction
      • Computerized music games ‘Magic’ hand tricks
      T. KISHORE JEBASINGH, MPT, MSW, PGDHM PHYSIOTHERAPIST KHORFAKKAN HOSPITAL
    • T. KISHORE JEBASINGH, MPT, MSW, PGDHM PHYSIOTHERAPIST KHORFAKKAN HOSPITAL
    • Motor control approaches
      • Focus
      • Treatment of paralysis, flaccidity & spasticity of muscles resulting from damage or disease to the central nervous system
      • Treatment of movement disorder
      • Each theorist has a somewhat different approach, assessment technique, and intervention strategies
      T. KISHORE JEBASINGH, MPT, MSW, PGDHM PHYSIOTHERAPIST KHORFAKKAN HOSPITAL
      • Principles of rood Approach
      • Sensory input is required for normalization of tone and evocation of desired muscular response
      • Sensory motor control is developmentally based
      • Movement is purposeful, engagement in activities is required to produce a normal response
      • Repetition of movement is necessary for learning
      T. KISHORE JEBASINGH, MPT, MSW, PGDHM PHYSIOTHERAPIST KHORFAKKAN HOSPITAL
      • Facilitation techniques
        • Light stroking
        • Brushing
        • Icing
        • Joint compression
      • Inhibition technique
        • Joint approximation
        • Neutral warmth
        • Pressure on tendon insertion
        • Slow rhythmical movement are used to inhibit unwanted movement
      T. KISHORE JEBASINGH, MPT, MSW, PGDHM PHYSIOTHERAPIST KHORFAKKAN HOSPITAL
      • The Bobaths approach
      • NDT focuses on the sensation of movement
      • Reflex inhibiting postures are used to inhibit primitive reflexes
      • Sensory stimulation is regulated with great care
      • Weight bearing, placing and holding, tapping and joint compression are used
      • Compensation using the noninvolved side
      T. KISHORE JEBASINGH, MPT, MSW, PGDHM PHYSIOTHERAPIST KHORFAKKAN HOSPITAL
      • Brunnstrom approach
      • Focuses on reflexes which provide the components of normal movement
      • Patients are encouraged to think about the movement and to gain control
      • Brunstrom also uses associated reactions and synergies
      • Stages of recovery
      T. KISHORE JEBASINGH, MPT, MSW, PGDHM PHYSIOTHERAPIST KHORFAKKAN HOSPITAL
      • PNF
      • Uses diagonal & spiraling patterns movement
      • Guides thinking about the sequence of normal development
      • Uses two diagonal pattern patterns crossing the mid-line for each major body part, often incorporating verbal commands
      T. KISHORE JEBASINGH, MPT, MSW, PGDHM PHYSIOTHERAPIST KHORFAKKAN HOSPITAL
      • Carr & Shepherd’s motor relearning program
      • Uses dynamical systems model or motor control
      • Emphasize interaction between performer and environment
      • Acknowledge critical role of cognition in motor learning
      • Movement pattern practiced in context of tasks, rather than exercises
      T. KISHORE JEBASINGH, MPT, MSW, PGDHM PHYSIOTHERAPIST KHORFAKKAN HOSPITAL
    • Rehabilitation Engineering and Assistive Technology
      • Rehabilitation engineering
      • the application of science and technology to improving the quality of life of people with disabilities
      • Assistive technology
      • products, devices or equipment … that are used to maintain, increase or improve the functional capabilities of individuals with disabilities
      T. KISHORE JEBASINGH, MPT, MSW, PGDHM PHYSIOTHERAPIST KHORFAKKAN HOSPITAL
    • T. KISHORE JEBASINGH, MPT, MSW, PGDHM PHYSIOTHERAPIST KHORFAKKAN HOSPITAL Augmentative communication Computer access
    • T. KISHORE JEBASINGH, MPT, MSW, PGDHM PHYSIOTHERAPIST KHORFAKKAN HOSPITAL Ergonomics Prosthetics and Orthotics
    • T. KISHORE JEBASINGH, MPT, MSW, PGDHM PHYSIOTHERAPIST KHORFAKKAN HOSPITAL Recreation transportation
    • T. KISHORE JEBASINGH, MPT, MSW, PGDHM PHYSIOTHERAPIST KHORFAKKAN HOSPITAL Universal design The design of products and environments to be usable by all people, to the greatest extent possible, without the need for adaptation or specialized design.
      • Sensory stimulation pop beads
      T. KISHORE JEBASINGH , MPT, MSW, PGDHM PHYSIOTHERAPIST KHORFAKKAN HOSPITAL
      • Beads light up, vibrate, and play a song for 5-10 seconds when connected or disconnected
      • This makes the task more fun
      Inside of bead Battery recharging stand
      • Sensory stimulation
      T. KISHORE JEBASINGH, MPT, MSW, PGDHM PHYSIOTHERAPIST KHORFAKKAN HOSPITAL
      • If poor arm and trunk strength
      • used sensory stimulation to encourage to reach forward and up
      • Work chair
      T. KISHORE JEBASINGH , MPT, MSW, PGDHM PHYSIOTHERAPIST KHORFAKKAN HOSPITAL Face forward, and steps retract Turn to side, and steps extend
      • Uses file drawer slides, springs, and pulleys
      • When chair rotates, it changes the angle of the file drawer slides
      • Simple, safe, inconspicuous
      • Orientation device
      T. KISHORE JEBASINGH, MPT, MSW, PGDHM PHYSIOTHERAPIST KHORFAKKAN HOSPITAL Young children do not have the cognitive ability to use ultrasonic cane that helps to navigate