Ataxic cerebral palsy is a rare form of cerebral palsy affecting around 5% to 10% of all people diagnosed. It gets its name from the word ataxia, which means lack of coordination and without order.
The term ‘cerebral palsy’ includes a group of disorders that result from permanent non-progressive brain damage during early development and are characterized by abnormalities of movement and posture.
A brief introduction to the topic cerebral palsy, prepared by Dr Yash Oza, PG resident in MS Orthopaedics
Etiology, Classification, assessment, diagnosis, treatment
Ataxic cerebral palsy is a rare form of cerebral palsy affecting around 5% to 10% of all people diagnosed. It gets its name from the word ataxia, which means lack of coordination and without order.
The term ‘cerebral palsy’ includes a group of disorders that result from permanent non-progressive brain damage during early development and are characterized by abnormalities of movement and posture.
A brief introduction to the topic cerebral palsy, prepared by Dr Yash Oza, PG resident in MS Orthopaedics
Etiology, Classification, assessment, diagnosis, treatment
THE NEUROLOGICAL SYSTEM -
The neurological system controls body functions and is
inter-related to other body systems i.e. a patient with diabetes
may suffer a stroke
Habilitation Perspective in the management of Cerebral Palsy.pptxICDDelhi
Institute for Child Development (ICD) is a private company registered under section 25 of company registration act, 1956. ICD is the brain child of Dr. Mansoor Alam, a pediatric developmental specialist who has treated more than 50,000 children with special needs during the last 25 years. ICD is a premier organization which provides the best treatment to children with complex health issues, developmental delay, neurodevelopmental disorders and childhood onset disabilities. ICD’s facility is available to children from birth to 21 years of age. Adult with disabilities are specially supported in case of need. ICD is the only organization in India which practices integrated approach of treatment, named as Multimodal treatment / Combination Therapy for children with developmental disorders. Combination Therapy combines the best available treatments into one treatment plan to get the best result. Researches have proved that combination therapy is better than isolated therapy. In fact, pediatric developmental disorders cannot be treated in isolation. It requires a team of professionals with varied specialization.
Presently ICD has its model centre named as “PediaMed” in Malviya Nagar (South Delhi), New Delhi. The model centre has capacity to treat 100 children in daily basis.
ICD is going to have its branches in the following places
North Delhi
West Delhi
East Delhi
Noida ( UP)
Ghaziabad (UP)
Faridabad (Haryana)
Gurugram /Gurgaon (Haryana)
Bahadurgarh (Haryana)
ICD is open to collaborate with other organizations with similar interests in rest of India
Pediatric physical therapy is a specialized form of physical therapy where a pediatric physiotherapist deals with the wide variety of diagnoses which affect overall development of a developing child.
Pediatric physiotherapy helps a number of children with Neurodevelopmental disorders, orthopaedic disorders, neuromuscular disorders, genetic disorders and metabolic disorders. Following conditions are treated successfully with pediatric physical therapy at ICD, New Delhi
• Cerebral Palsy
• Autism Spectrum Disorder
• Spina bifida
• Infantile spasm
• Hydrocephalus
• Seizure disorders
• Traumatic brain injury
• Bow legs
• Knock knees
• Spinal injury
• CTEV, etc
AS ICD has a dedicated team of physiotherapists with basic qualification in physiotherapy and advance training in pediatric physiotherapy, they are responsible for this unique pediatric physiotherapy program. You will never get overlapping of services with occupational therapist in ICD, New Delhi.
When you are in ICD, Delhi, your child’s therapy program is always a combination of the following physiotherapy approaches according to the need of your child (Eclectic Approach).
1. Breathing / Scotson Technique
2. Stretching Protocol
3. Strength Training
4. Therapeutic Taping / Kinesotaping
5. Tone Reducing Positioning ( TRP)
6. Neuro-Enhancing Positioning (NEP)
7. Neuro-Developmental Therapy (NDT)
8. Neuro-Dynamic Facilitation Technique (NDFT)
9. Rood Approach
10. Vojta Approach
11. Proprioception Neuro-Faciltation Technique(PNF)
12. Brunnstorm Approach
13. Carr and Shepherd Approach
14. MNRI
15. FeldenKraish Method
16. Frankles Exercises
17. Goal Directed Functional Therapy
18. Vibration Therapy
19. Thera-Suit Therapy ( Modified Adeli Suit Therapy)
20. Biofeedback Therapy
21. Move Therapy
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
Contact us if you are interested:
Email / Skype : kefaya1771@gmail.com
Threema: PXHY5PDH
New BATCH Ku !!! MUCH IN DEMAND FAST SALE EVERY BATCH HAPPY GOOD EFFECT BIG BATCH !
Contact me on Threema or skype to start big business!!
Hot-sale products:
NEW HOT EUTYLONE WHITE CRYSTAL!!
5cl-adba precursor (semi finished )
5cl-adba raw materials
ADBB precursor (semi finished )
ADBB raw materials
APVP powder
5fadb/4f-adb
Jwh018 / Jwh210
Eutylone crystal
Protonitazene (hydrochloride) CAS: 119276-01-6
Flubrotizolam CAS: 57801-95-3
Metonitazene CAS: 14680-51-4
Payment terms: Western Union,MoneyGram,Bitcoin or USDT.
Deliver Time: Usually 7-15days
Shipping method: FedEx, TNT, DHL,UPS etc.Our deliveries are 100% safe, fast, reliable and discreet.
Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
2. Cerebral Palsy: Definition
Cerebral palsy is a static encephalopathy
Encephalopathy = Brain Injury that is non-
progressive disorder of posture and movement
Variable etiologies
Often associated with epilepsy, speech
problems, vision compromise, & cognitive
dysfunction
3. Cerebral Palsy: Prevalence
2-4/1000; 7-10,000 new babies each yr
150 years ago described by Dr. Little an
orthopedic surgeon and known as Little’s
Disease
During past 3 decades considerable
advances made in obstetric & neonatal
care, but unfortunately there has been
virtually no change in incident of CP
6. Types of Cerebral Palsy
Spastic (70%)
Quadriplegia, hemiplegia, diplegia
Athetoid (15%)
Choreoathethoid, Dystonic
Ataxic (5%)
Mixed (10%)
Combination of any two types of CP
Hypotonic
Early stages of the Spastic, Dyskinetic and
Ataxic forms
7. CP Spastic Hemiplegic
Clinical features are those of pyramidal
release involving one side of the body
Posture and gait
Tone & Deep tendon reflexes
Contractures and Deformities
Wasting of affected limbs
Note any facial muscle weakness
Cortical sensory loss
Visual field defect
Speech defects
8. Ataxic Cerebral Palsy
Rare form of CP
Hypotonic and hyporeflexic in infancy
Ataxic – Titubation( a tremor of the head
and sometimes trunk, commonly seen in
cerebellar disease )
Intention tremors and Incoordination
Mental deficit is Mild
Nystagmus is uncommon
11. Causes of Cerebral Palsy
90% of the causes are Idiopathic
Prenatal (Before delivery)
Maternal Infection, Genetic, Developmental,
Vascular problems
Natal (During the time of Delivery)
Anoxia, Asphyxia, Birth Trauma such as
Dispropotion , Forceps, Rapid or Breech
delivery
Postnatal (After Delivery)
Trauma to Skull, Kernictures (Jaundice after
birth), Infections, Vascular complications such
as Thrombosis, Embolism, Haemmorhage
15. On Examination
1.Assessment of higher functions
Orientation-Normal (except in MR cases)
Speech- Dysarthria , Aphasia
Vision-Squint or Blindness
Learning – May be lost
Memory-will be impaired in most of the
cases
Emotional State- Apathic , Frightened
16. Contd….
2.Assessment of Muscular System
Tone – Spastic
Flaccid
Rigid
Mixed (depends on the type of
CP)
Muscle Power- Assessed by MRC Grading
Girth Of the Muscle- Its is usually reduced
due to DISUSE .
17. Contd….
3.Assessment of Sensory System
1.Spinothalamic sensations are Normal
2.Posterior column is involved.
So Joint position sense, Vibration sense
are usually affected
18. Contd….
4.Assessment of Reflexes
Deep Tendon Reflex – exaggerated in
spastic CP
Neonatal reflexes – Delayed or Absent
Superficial reflexes may be affected in
spastic CP.
5.Assessment of Chest
Normal .
6.Assessment of limbs
1.Alteration of Tone in both upper and
Lower limb.
19. Contd….
7.Assessment of Co-ordination
In co-ordination is seen in Athetoid,
Ataxic & Mixed type.
8.Assessment of Spine
Spinal deformity – Scoliosis or Lardosis is
seen
9.Assessment of Balance
Affected.
20. Contd….
10.Assessment of Posture
Three types of posture are usually seen
according to the type of CP. They are
1.Flexion posture
2.Extension Posture
3.Adduction Posture
11.Assessment of compound
movements Affected
21. Contd….
12.Assessment of Gait
Scissoring gait – The patients try to catch their
own centre of Gravity.
This is due to weakness of Abductors and
Spasm of Adductors
13.Assessment of Other Problems
1.Ortho Problems-Stiffness, Pain & Deformity in
Joints
2.Pressure sores – Ulcers over the Bony
prominence
22. Cerebral Palsy: Management
Neurologic and Physiatric
OT and PT
Speech
Adaptive equipment
Surgical
Rhizotomy, Baclofen pumps, Botoxin
23. Different approaches to
Neuromuscular education
W M Phelps-diagnosed five types of CP
Specific combinations of muscle education &
bracing were prescribed for different types of
CP.
Muscles were assessed,classified as
spastic,weak,normal or atonic & re-education
was given based on their condition.
In this system muscles antagonistic to spastic
ones are activated.
24. Neuro developmental treatment
with Reflex inhibition & facilitation
(NDT)
Berta Bobath-
This technique is based on the inhibition of tonic
reflexes,such as symmetrical& asymmetrical
tonic neck reflexes,tonic labyrinthine reflex.
Ones the reflex patterns of abnormal tone are
inhibited the child is said to have been prepared
for movements.
Various primitive reflexes of infancy should also
be inhibited.
25. Features of the approach are
Reflex inhibitory patterns-
Selected to inhibit abnormal tone associated with
abnormal movement patterns & abnormal posture.
Sensory Motor Experience-
The reversal of these abnormalities gives the child
the sensation of more normal tone.
Sensory stimuli are also used for inhibition &
facilitation & voluntary movement.
Facilitation Techniques For Mature Postural Reflex.
26. `
Key points of control
Are used to attempt to change the patterns of
spasticity so the child is prepared for
movements.
The key points are usually head&
neck,shoulder & pelvic girdles.
Developmental Sequences
All-day management –should supplement
treatment session.parents &others are advised
on daily management & trained to treat the
children.
27. Proprioceptive neuromuscular
Facilitation (PNF)
Herman Kabat,with Margret Knott & Dorothy Voss-
Developed a system of movement facilitation
techniques &methods for inhibition of hypertonus.
The main features are :
Movements patterns (called mass movements
patterns)-
Patterns observed with functional activities as
walking ,feeding, playing sports. These patterns
are spiral (rotational)& diagonal.
The movements patterns consist of the following
components-
28. (1) Flexion or Extention
(2) Abduction or Adduction
(3) Internal or External rotation
Sensory (afferent) stimuli:
Those muscle group working in synergy with
rotational& diagonal patterns were identified &
with a combination of touch & pressure, traction
& compression. stretch , proprioception
,auditory& visual stimuli are given to muscles to
contract against resistance.
29. Special Techniques
1. Irradiation-this is the predictable overflow of
action from one muscle group to another within
a synergy.
2. Rhythmic stablizations-which use stimuli
alternating from the agonist to its antagonist in
isometric muscle work.
3. Stimulation of reflexes- such as the mass
flexion or extension.
4. Repeated contractions- of one pattern using
any joint as a pivot.
5. Reversals-from one pattern to its antagonist.
30. 6. Relaxation techniques- such as
contract-relax & hold-relax. Ice treatment
are used for relaxation of hypertonus.
31. Sensory Stimulation for
Activation & Inhibition
It is a sensory approach in which Rood’s
technique-By Margret Rood
muscles are classified according to their
function & the appropriate stimuli for their
action are given.
The various nerves & sensory receptors are
described & classified into types, location,
effect, response, distribution & indication.
32. Techniques of stimulation, such as
stroking, brushing (tactile) icing, heating
(temp.) pressure, bone pounding, slow &
quick muscle stretch, muscles contractions
(proprioception) are used to activate,
facilitate or inhibit motor response.
Sensory motor technique uses a series of
eight clearly defined developmental
patterns which children learn in sequence.
33. These patterns are spine withdrawal,
rolling over, pivot prone, neck co-
contraction, elbow weight bearing, all four
weight bearing, standing upright &
walking.
Vital functions-A developmental sequence
of respiration, sucking, swallowing,
phonation, chewing & speech is followed.
34. Reflex creeping&Other Reflex
Reactions
By Vaclav Vojta-
Trigger points are points on the body
which facilitate movement patterns
involving the head,trunk & limbs.
These reflex zones ( 9 in number) are
activated with sensory stimuli & creeping
is seen as a response to this triggering.
35. Sensory integration treatment
approach
Developed by A.J.Ayers
The goal of this technique is to teach the
children how to integrate all their sensory
feedback & then produce useful &
purposeful motor response.
Activities like catching a ball in different
position uses integration of visual,
vestibular & joint proprioception feedback
system at the same time.
36. Theory of this system is that sensory input
followed by appropriate motor function
will contribute to the improved
development of higher cortical motor
sensory function.
37. Orthopaedic Management
For improvement of functional mobility and
appearance after conservative therapy has
failed
Correction of contractures – Tenotomy
Correction of deformities from muscle
imbalance Eg. Tendon transfer
Correction of functional handicaps of
hands and feet – Arthrodesing operations
38. Gentle Stretching
Stretching is the activity of gradually applying tensile
force to lengthen, strengthen, and lubricate muscles,
often performed in anticipation of physical exertion and
to increase the range of motion within a joint. Stretching
is also believed to help to prevent injury to tendons,
ligaments and muscles by improving muscular elasticity
and reducing the stretch reflex in greater ranges of
motion that might cause injury to tissue.
39. Strengthening exercises
These exercises are done to increase the power &
strength of the muscle. They usually done as
Resisted Exercises both Manually and Mechanically.
40. Rolling
Contd…..
The patient is made to move from one side to another
side by his side. This is known as rolling
Crawling
The child is made to move on his four limbs
Standing with support
Posture Correction
Gait Training
41. Speech Rehabilitation
VERBAL APPROACH-
Initiating auditory-verbal therapy as early
as possible is essential because the child's
greatest capacity for learning language
auditorily, occurs during the first two to
three years of life. In order to effectively
learn spoken language, a child's hearing
and listening skills must be stimulated
during this critical time.
42. Parent-Centered Modeling
Parents are the major influence in a young
child's development, acting as primary role
models and the most effective teachers.
For this reason, the verbal approach is
parent-oriented. The verbal therapist
develops a working partnership with
parents to teach speech and language to
the child at home
43. Oral Sensory motor facilitation
techniques
Proper neural development of oral
movements and oral sensory function is
vital for providing the foundation for good
speech production and mature feeding
patterns.
44. Oral Sensitivity (based on these domains -
Temperatures, Textures, Tastes)
Hypersensitivity - Over-sensitive
Hyposensitivity - Under-sensitive
45. Jaw Stability
Position of the jaw and presence/absence of stability or weakness
during oral sensory-motor activities, such as chewing.
Lip Function
Position and action/movement of the lips during oral sensory-
motor activities, such as drinking, sucking, chewing or blowing.
Tongue Function
Position and action/movement of the tongue during oral sensory-
motor activities, such as chewing, drinking, sucking or blowing.
46. TONGUE EXERCISES
Range of Motion
1. Tongue Extension
Protrude tongue between lips.
Sticking out tongue as far as you can.
Hold tongue steady and straight for 3 to 5
seconds.
Relax and Repeat 5 times.
47. 2. Tongue Retraction
Retract tongue, touching the back of your
tongue to the roof of your mouth (as if
producing the /k/).
Hold for 1 to 3 seconds.
Relax and Repeat 5 times.
3. Tongue Extension and Retraction
Combine the two procedures above, holding
each position for 1 to 3 seconds.
Relax and Repeat 5 times. .
48. 4. Tongue Tip Up
Place tongue on alveolar ridge, (the area behind
your top teeth.)
If you don't have any teeth, move your tongue
tip up to your gum where your top teeth would
be.
Open mouth as wide as possible maintaining
tongue contact.
Hold for 3 to 5 seconds.
Relax and Repeat 5 times
49. 5. Tongue Elevation Along The Palate
Tongue tip to alveolar ridge, (The area behind your top
teeth.)
Move tongue front to back along the roof of your mouth.
Relax and Repeat 5 times.
6. Tongue Side To Side
Tongue tip to left side of mouth, hold for 3 to 5 seconds.
Tongue tip to right side of mouth, hold for 3 to 5
seconds.
Relax and Repeat 5 to 10 times.
50. Tongue Resistance:
1. Tongue Push Forward
Stick out your tongue as far as you can.
Put something flat (back of a spoon or a tongue depressor) against
your tongue
Push against your tongue with the flat object at the same time as
you push against the flat object with your tongue
Hold for 1 to 2 seconds.
Repeat 5 times.
2. Tongue Push Up
Push down on your tongue with the flat object, while, at the same
time, you push up with your tongue.
Hold 1 second.
Repeat 5 times.
51. JAW EXERCISES
Range of Motion
1. Jaw Opening
2. Side-to-Side Movement
3. Increasing Circular Jaw Movement
52. LIP EXERCISES
Range of Motion:
1. Lip Retraction
Smile. Hold for 5 seconds.
Relax and Repeat 5 times.
2. Lip Protrusion
Pucker your lips as if you were going to give someone a
kiss.
Hold for 5 seconds.
Relax and Repeat 5 times.
3. Lip Retraction and Protrusion
Smile then pucker your lips. Use exaggerated
movements.
Relax and Repeat 5 times.
53. Lip Closure:
1. Lip Press
Press lips tightly together for 5 seconds.
Relax and Repeat 5 times.
2. Lip Press on Tongue Depressor
Tightly press lips around tongue depressor,
while the clinician tries to remove it.
Perform for 3 to 5 seconds.
Relax and Repeat 5 times.
54. Compensatory Techniques:
Correction of Respiratory errors:
Attention should be given to the development of speech-
breathing patterns before the child is a year old.
The following techniques are used for improvement of
breathing patterns for speech :-
1.Break Up Persistent Tonic Reflex Patterns
Abnormal distribution of muscle tone is found in
abdominal, thorax & neck muscles of CP Children.When
strong tonic reflexes persist they should be weakened or
broken up through systematic use of such techniques as
reflex inhibition or sensory facilitation.
55. 2.Facilitate Developmental Sequences
Which Lead To Good Sitting Posture
Many of the cerebral palsied children seem to
collapse on sitting because much of the weight
of the trunk and head bears down on the
abdominal areas, thus interfering with function
of the diaphragm & abdominal musculature.
The back is rounded & the head is flexed so that
the chin rest on the chest.
56. In this position elevation of the rib cage
for inhalation is difficult.
Therefore taking the child through the
developmental sequences leading to
unsupported sitting with good posture is
basic fo developing speech breathing.
3.Maintaining Proper Postural
Relationships between Abdomen,
Trunk, Neck & Head.
57. Seating in a properly fitted & adjusted
relaxation chair will help the child maintain
a more satisfactory postural relationship
between head & neck, trunk & abdominal
areas.
In physical therapy ,attention must be
given to the flexors & extensors muscles
of the neck & shoulders.
58. 3.Develop a Breathing Rate of Less Than
30 Cycles/minute
Several procedure are suggested for imposing a
slower rest-breathing rate on child.
A) Crossing the child’s forearm across his chest
& pressing them tightly enough against his
thorax to encourage a deeper exhalation.For
inhalation the pressure is released.
59. The therapist times his movement of pressure &
relaxation of pressure to control the normal
breathing pattern.
B) With the child lying on his back, flex the
knees & press the front portion of the upper legs
against the abdomen by flexing the hips.Quickly
extend the legs at the hips, thus releasing the
pressure on the abdominal area. This pattern of
movements should be repeated at a rate
corresponding to the normal breathing rate i.e.
about 20 cycles/ minute.
61. Some CP children seem to have difficulty in
learning to inhale quickly and then produce the
controlled, prolonged exhalation required for
continuous speech (as in yawning & crying).It is
difficult to modify these breathing patterns for
speech production.
Momentary interference with inhalation-by
holding a tissue over the nose & mouth-will
cause the child to breath deeply when the
interference is removed.
62. Producing deep inhalation on a reflex basis is
only a first step.
Next learning is to hold the inhaled air until
given a signal to exhale.
At first the exhalation will be rapid &
uncontrolled.
Having the child imitate a prolonged sigh, a
prolonged phonation, babbling or sustained
blowing will help him develop controlled,
prolonged phonations.
63. 5.Counteract Abdominal Movements Which
are Asynchronous with Thoracic
Movements
Sometimes CP children are unable to produce
prolonged exhalations because the abdominal-
diaphragmatic movements are antagonistic to
the thoracic movements.
Because of this asynchrony the child will be able
to produce phonation of short duration.
64. To overcome this difficulty, a corset or
girdle is wrapped around which extends
from lower border of sternum to the ileac
crest.
This helps in stronger voices & longer
exhalations.
65. 6.Functional Techniques for
Developing Control of Respiration
Many techniques & pieces of equipments
have been developed to encourage the
child to produce prolonged exhalations
such as sustained blowing or sustained
phonations.
66. Correction Of Phonatory Errors
1.Encouraging Vocalization:
Parents should learn not to respond to the
crying so quickly so that the child get
sufficient practice to use his larynx.
Laughing also exercises larynx.
For “quite babies “ positioning is useful in
facilitating vocalization.
67. 2.Coordinate Phonation with exhalation
Audible sigh on the exhalation.
After the child learned to hold a deep
inhalation ,he should be taught to phonate a
vowel sound on the exhalation.
If the child has difficulty initiating phonation,
different techniques for breaking up the
laryngeal block should be tried.
68. Positioning may also be used to good
advantage.
3.Develop Prolonged Phonation
without Undesirable Tension:
Before encouraging the child to develop
longer phonation, the therapist should be
sure that the child inhales sufficiently
immediately before beginning phonation.
69. The therapist should be sure that the child
has learned to hold the inhaled air & to
coordinate phonation with exhalation.
4.Develop Variation of Loudness &
pitch:
Practice in producing tones at different
levels of loudness & pitch levels helps the
child to increase his laryngeal function
70. Only a little imagination is required to
think of many ways to motivate the child
to vary the loudness, pitch or inflection
patterns of his voice.
For example- whispering, ordering like
police man, cheering at something or
singing.
71. 5. Counteract Undesirable postural
pattern:
The postural pattern interfere with laryngeal
function. as the child phonates, he extends
the leg, arch the back and throw back his
head.
These can be detected by placing one’s hand
against the soles of the child’s feet, on his
shoulders or behind his head
72. The therapist must learn how to feel these
changes in flexors and extensor tone.
When increase in extensor tone or
associated with phonation, he should use
appropriate reflex –inhibiting postures or
appropriate sensory stimulation for
activation and inhibition of selected
muscle group.
73. CORRECTION FOR
ARTICULATORY ERRORS
Before going for articulatory correction the
therapist should be sure that the child has
sufficient control over speech breathing
and phonation.
The patterns of neural organization as in
sucking and swallowing must also be
developed.
1.Encourage and facilitate babbling
74. While an infant is crying it is possible to produce
approximation of the lips by placing the hand
beneath the mandible and gently elevating it.
Repetition of this technique enables the child to
hear and feel the consonantal modification of his
vocalization.
Bilabial consonants may be added by rapidly
vibrating the lips with the therapist’s or parent’s
fingers.
75. 2. develop sucking, swallowing and
chewing patterns
Attention should be given to the develop
of sucking, swallowing and chewing
patterns in CP children.
The mother can use several techniques
which facilitate maturation of oral
activities.
76. When spooned foods are added to the
child’s diet, it is to be placed in the front
of the mouth, thus encouraging the child
to develop the tongue movements which
are essential for the first stage of chewing
and swallowing.
Touching the child’s lips spoon will make
him aware of his lips and thus facilitate
and maintenance of lip closure.
77. 3. Improving the Function of the
Lips, Mandible and Tongue as
articulators
The therapist should help the child about
his awareness of his movement of the
various articulators.
By using the mirror the child can see the
movement of his mandible moves with his
tongue movement.
78. Stabilization of the mandible with small
object placed between the molars, aids
the child in developing free tongue
movements.
79. Team Approach To
Rehabilitation
A comprehensive management plan will
pull in a combination of health
professionals with expertise in the
following:
physical therapy to improve walking
and gait, stretch spastic muscles, and
prevent deformities;
80. occupational therapy to develop
compensating tactics for everyday
activities such as dressing, going to
school, and participating in day-to-day
activities;
speech therapy to address swallowing
disorders, speech impediments, and other
obstacles to communication;
81. counseling and behavioral therapy to
address emotional and psychological
needs and help children cope emotionally
with their disabilities;
drugs to control seizures, relax muscle
spasms, and alleviate pain;
surgery to correct anatomical
abnormalities or release tight muscles
82. braces and other orthotic devices to
compensate for muscle imbalance,
improve posture and walking, and
increase independent mobility;
mechanical aids such as wheelchairs
and rolling walkers for individuals who are
not independently mobile; and
83. communication aids such as computers,
voice synthesizers, or symbol boards to
allow severely impaired individuals to
communicate with others.
84. The members of the treatment team for a
child with cerebral palsy will most likely
include the following:
A physician, such as a pediatrician,
pediatric neurologist, or pediatric
psychiatrist, who is trained to help
developmentally disabled children
85. An orthopedist, a surgeon who specializes in
treating the bones, muscles, tendons, and other
parts of the skeletal system. An orthopedist is
often brought in to diagnose and treat muscle
problems associated with cerebral palsy.
A physical therapist, who designs and puts
into practice special exercise programs to
improve strength and functional mobility.
86. An occupational therapist, who teaches
the skills necessary for day-to-day living,
school, and work.
A speech and language pathologist,
who specializes in diagnosing and treating
disabilities relating to difficulties with
swallowing and communication.
87. A social worker, who helps individuals and
their families locate community assistance and
education programs.
A psychologist, who helps individuals and their
families cope with the special stresses and
demands of cerebral palsy. In some cases,
psychologists may also oversee therapy to
modify unhelpful or destructive behaviors.
An educator, who may play an especially
important role when mental retardation or
learning disabilities present a challenge to
education.
88. Surgical options in CP
Intrathecal baclofen therapy uses an
implantable pump to deliver baclofen, a muscle
relaxant, into the fluid surrounding the spinal
cord. Baclofen works by decreasing the
excitability of nerve cells in the spinal cord,
which then reduces muscle spasticity throughout
the body. Because it is delivered directly into
the nervous system, the intrathecal dose of
baclofen can be as low as one one-hundredth of
the oral dose. Studies have shown it reduces
spasticity and pain and improves sleep.
89. Orthopedic surgery is often
recommended when spasticity and
stiffness are severe enough to make
walking and moving about difficult or
painful. For many people with cerebral
palsy, improving the appearance of how
they walk – their gait – is also important.
90. Selective dorsal rhizotomy (SDR) is a
surgical procedure recommended only for
cases of severe spasticity when all of the
more conservative treatments – physical
therapy, oral medications, and intrathecal
baclofen -- have failed to reduce spasticity
or chronic pain. In the procedure, a
surgeon locates and selectively severs
overactivated nerves at the base of the
spinal column.