This document discusses physical handicap in children, specifically cerebral palsy. It defines cerebral palsy as a permanent condition resulting from brain lesions before, during, or after birth. Common symptoms include motor dysfunction and spasticity. Risk factors include prematurity and infections. Treatment involves physiotherapy, occupational therapy, bracing, and assistive devices to improve mobility and prevent deformities, with the overall goals of maximizing function and community integration. Rehabilitation requires a team approach and family education to help the child develop skills and parents adjust to the disability.

1. Muhammad Shahzad

2. Objective
 Basic Knowledge of Special Students, Definition
and Characteristics Of
 Physical Handicap Children

3. Physical Handicap Children
 loss of or failure to develop a specific bodily function
or functions, whether of movement, sensation,
coordination, or speech, but excluding mental
impairments or disabilities

4.  Physical Impairment: “The physical capacity to move,
coordinate actions, or perform physical activities is
significantly limited, impaired, or delayed and is exhibited
by difficulties in one or more of the following areas:
 physical and motor tasks;
 independent movement;
 performing basic life functions.
The term shall include severe orthopedic impairments or
impairments caused by congenital anomaly, cerebral palsy,
amputations, and fractures if such impairment adversely
affects a student's educational performance”.

5.  Hundreds of physical impairments and health
conditions can adversely affect children’s education
performance. A few include:
 cerebral palsy,
 spina bifida,
 muscular dystrophy,
 spinal cord injuries, epilepsy,
 amputation and
 diabetes.

6. Cerebral palsy
 Permanent condition resulting from a lesion to the
brain or an abnormality of brain growth. Many
diseases can affect the developing brain and lead to
cerebral palsy. Also attributed to the occurrence of
injuries, accidents or illnesses that are before birth, at
or near the time of birth or soon after birth and result
in decreased oxygen to low-birth-weight newborn.

7.  Non progressive injury to the immature brain
 Leading to motor dysfunction
 Lesion is not progressive, but
 The clinical manifestations change over time.

8. Risk factors
Prenatal
 Prematurity (< 36 weeks)
 Low birth weight (less than 2500 g)
 Maternal epilepsy
 Infections
 Bleeding in the third trimester
 Multiple pregnancies
 Placental insufficiency
 Drug abuse and trauma

9. Perinatal
 Prolonged and difficult labor
 Premature rupture of membranes
 Presentation anomalies
 Vaginal bleeding at the time of labor
Postnatal
 CNS infection (encephalitis, meningitis)
 Neonatal hyperbilirubinemia
 Head trauma
 Coagulopathies

10. Clinical classification
 Spastic
 Dyskinetic
 Hypotonic
 Mixed

11. Anatomical classification
Location Description
Hemiplegia Upper and lower extremity on one side of body
Diplegia Four extremities, legs more affected than the arms
Quadriplegia Four extremities plus the trunk, neck and face Both
Triplegia lower extremities and one upper extremity
Monoplegia One extremity (rare)

12. Spastic CP
 Increase in the physiological resistance of muscle to
passive motion.
 Spastic CP is the most common form of CP.
 Approximately 70% to 80% of children with CP are
spastic.
 Spastic CP is anatomically distributed into
Hemiplegia
Diplegia
Quadriplegia

13. Early signs of CP
Abnormal behaviour
 Excessive irritability
 Poor eye contact
 Poor sleep
Poor mobility
 Poor head control
 Abnormal tone

14. Neuromotor problems in CP
 Difficulty with flexing and extending the body against
gravity
 Sitting
 Functional ambulation

15. Impairments
Primary impairments (due to the brain lesion)
 Muscle tone (spasticity, dystonia)
 Balance
 Strength
 Selectivity
 Sensation
Secondary impairments
 Contractures (equinus, adduction)
 Deformities (scoliosis)

16. Tertiary impairments
 Adaptive mechanisms (knee hyperextension in
stance)

17. Common Contractures and
deformity
Upper extremity
 Pronator
 Wrist and finger flexor
 Thumb adductor
Lower extremity
 Hip adductor-flexor
 Knee flexor
 Ankle plantar flexor

18. Spine
 Scoliosis and kyphosis
Hip
 Subluxation, Dislocation
Femur & tibia
 Internal or external torsion
Foot
 Equinus, valgus and varus.

19. Epileptic seizures
 Seizures affect about 30 to 50% of CP patients
 They are most Common in the
Quadriplegics and
Hemiplegics,
Patients with mental retardation Postnatally
acquired CP.

20. Psychosocial problems
 Extremely stressful for the family and the child when he
grows up.
 Stress leads from denial to anger, guilt and depression.
Coping with the emotional burden of disability is easier if
the family has strong relationships, financial security, and
supportive members of the community.
 The child and the family need to find ways to connect to
each other.
 A healthy relationship between the mother and the child
forms the basis of future happiness.
 Prevention or appropriate treatment of associated
problems Improves the quality of life of the child and the
family.

21. Other impairment
 Visual
 Nutritional and oromotor issues
 Urinary problems

22. Rehabilitation of CP child
 Rehabilitation is the name given to all diagnostic and
therapeutic procedures
 Which aim to develop maximum physical social and
vocational function in a diseased or injured person

23. Goals Objective of Rehabilitation
Improve mobility Teach the child to use his remaining potential Teach
the child functional movement Gain muscle strength
Prevent deformity Decrease spasticity Improve joint alignment
Educate the parents To set reasonable expectations Do the exercises at
home
Teach daily living skills Have the child participate in daily living activities
Social integration Provide community and social support

24. Components of rehabilitation
 Physiotherapy
 Occupational therapy
 Bracing
 Assistive devices
 Adaptive technology
 Sports and recreation
 Environment modification

25. Rehabilitation planning
Example: Independent standing
 State the necessary time period
 Plan the methods to achieve this goal
 Evaluate the end state.
 Revise the treatment program

26. Age group Program
Infant (0-1) Stimulating
Advanced postural equilibrium Balance reactions for head
and trunk control
Toddler & pre-
schooler (1-3)
Stretching the spastic muscles
Strengthening the weak ones
Promoting mobility
Adolescent
(teenager)
Improving cardiovascular status

27. Principles of therapy methods
 Support the development of multiple systems such as
Cognitive Visual
Sensory
Musculoskeletal
 Involve play activities to ensure compliance
 Enhance social integration
 Involve the family
 Have fun

28. Exercises
 Active and passive range of motion
 Stretching
 Strengthening
 Fitness

29. Neurofacilitation techniques
 Sensory input to the CNS produces reflex motor
output.
 Various neurofacilitation techniques are based on this
basic principle.
 All of the techniques aim to normalize muscle tone
 To establish advanced postural reactions and to
facilitate normal movement patterns.

30. method of therapy
 18 points in the body – crawling and reflex rolling.
 placing the child in particular positions and
stimulation of the key points in the body would
enhance CNS development
 In this way the child is presumed to learn normal
movement patterns in place of abnormal motion.
 Applied by the primary caregiver at home at least 4-5
times daily and stopped after a year if there is no
improvement

31. Occupational therapy
 OT aims to improve hand and upper extremity
function in the child through play and purposeful
activity .
 There are defined systematic treatment methods for
occupational therapy.
 Sensory integration therapy aims to enhance the
child’s ability to organize and integrate sensory
information.
 In response to sensory feedback, CNS perception and
execution functions may improve and the motor
planning capacity of the child may increase.

32.  Constraint induced movement therapy Where the
normal hand is constrained Paralytic hand is forced to
function Useful in children with hemiplegia.
 Begin therapy toward one year of age when the child
can feed himself using a spoon and play with toys.
 Teach the child age appropriate self care activities
such as dressing, bathing and brushing teeth.
 Encourage the child to help with part of these
activities even if he is unable to perform them
independently

33. play
 Always include play activities in the rehabilitation
program.
 Play improves mental capacity and provides
psychological satisfaction.
 Organized play can address specific gross and fine
motor problems
 This increases the child’s compliance with therapy.
 Riding a toy horse may improve Weight shift over the
pelvis Swinging may improve sensation of movement

34. OTHERS
 Advantages of swimming
 Horseback riding Improves
 Recreational programs
 Speech therapy
 Hearing aids and implants
 Drugs

35. Goals of brace
 Increase function
 Prevent deformity
 Keep joint in a functional position
 Stabilize the trunk and extremities
 Facilitate selective motor control
 Decrease spasticity
 Protect extremity from injury in the postoperative
phase

36. Braces in CP
 Ankle foot orthoses
 Knee-ankle foot orthoses
 Hip abduction orthoses
 Thoracolumbosacral orthoses
 Supramalleolar orthoses
 Foot orthoses
 Hand splints

37. Function of AFO
Main function Keep the foot in a plantigrade
position
Stance phase Stable base of support
Swing phase Prevent drop foot
At night Prevent contracture

38. Spinal braces
 To slow the progression of deformity
 To delay surgery
 To allow skeletal growth
 To assist sitting balance
 To protect the surgical site from excessive loading
after surgery

39. Mobility aids
Example Standers
 Walkers
 Crutches
 Canes
Advantages of mobility aids
 Develop balance
 Decrease energy expenditure
 Decrease loads on joints
 Improve posture

40. Family Education
 Therapy along with peers
 No aggressive therapy
 Don’t give false hopes
 Include sports and recreational activities
Successful rehabilitation includes
 Prevention of additional problems
 Reduction of disability Community integration.
Rehabilitation is successful if Child is happy Parents
are well adjusted

41. Thanks