SADASDASDASDSADA

1. ROLE OF PHYSIOTHERAPY ON PEDIATRIC CANCER

2. COMMON PEDIATRIC CANCER
• Leukemia(according to NCI.28% of cases)
• Brain and other central nervous system tumors (25% of cases)
• Lymphomas(12% of cases)
• Solid tumors (each year 400000)
• Bone cancer(ACS)

3. PREDISPOSING FACTORS
• Genetic
• Mutations
• Defects in DNA
• Neurocutaneous disorders
• Immuno deficiencies
• Chromosomal abnormalities
• Infections
• HIV
• Electromagnetic radiation

4. HOW TO INTERACT WITH A CHILD WHO HAS
CANCER?
• Be honest:- Answer question honestly and have ongoing conversations. Children may make up answers to
questions.And telling them something untrue can make them distrust you.(NCI.2023)
• Be clear :- Use simple , direct words and avoid euphemisms. (CCS)
• Be patient :-Children may not know how to express their feelings, so be patient and give them time to share.
(CCS)
• Be age-appropriate:-The amount of information you share should depend on the child’s age and understanding.
• Be supportive
• Be aware of siblings

5. WHAT ARE THE BENEFITS OF PHYSICAL ACTIVITY?
• Regular activity and exercise will:
• Keep muscle strong and flexible.
• Keep joints healthy.
• improve bone density and prevent bone thinning
• Improve posture and prevent problems caused by poor posture
• Prevent cancer related fatigue
• Stimulate circulation
• Prevent excessive weight gain in children taking steroids

6. ROLE OF PT INTERVENTION
Assessment
*Cardiopulmonary endurance
*Strength
*Fatigue
*Physical function
*Range of motion (ROM):- Ankle dorsiflexion if being treated with vincristine.
*Strength:-Floor to stand transfer(use of hands )
*Gait:- Ask if gait changes with fatigue
*Balance

7. TYPICAL MOTOR SKILLS
Age (yrs) Gross Motor Fine Motor
1 Walking,
Crawl up stairs
Picking up cheerio (pincer grasp);
Banging toys together
2 Squat to stand, early Running, Jumping, Walks
up/down stairs with rail,
Kicks ball, Throw/catch
Colors with whole-hand grasp; Uses
spoon
Undressing self
3 Heel-toe gait, Running,
Stairs with/without rail- step over step going up, One leg
balance 3 sec,
Riding a tricycle
Tripod grasp; imitating scribbles;
Puts on pants, socks, shoes; buttons
difficult
4 Hopping, Galloping, Catching using only hands; step-over-
step down stairs, Climb on play structures
Drawing circle/square
Using scissors; button/un-button large
buttons; zippers
5 Skipping, jumping jacks, Riding a bike, Long jump, Jump
rope, Climb
Copies triangle; cuts shapes; Draws
person/letters

8. TYPICAL MOTOR
SKILLS
Age Gross Motor Fine Motor
6-10 years Hopping side to side
Jump rope
Single leg stance 5-10 sec eyes
closed
Participates in youth sports
Write during school day without
hand fatigue
10-21 years Mile run
20 single leg calf raises
Completes Presidential Fitness
testing
Involved in sports teams, weight
training, etc.
Complete all daily tasks without
hand fatigue

9. • Age 1 – 3 years
• 30 minutes planned activity, 60 minutes unstructured activity / day
• Age 3 – 5 years
• 60 minutes planned activity, 60 minutes unstructured activity / day
• Age 6 – 17 years
• 60 minutes/day of moderate/vigorous physical activity
• Can add small increments to total 60 minutes
• Can include aerobic, strength, bone-building activities
• On a scale of 0-10, a 5-6 is moderate, a 7-8 is vigorous

10. PLAY THERAPY
• Play therapy is defined as dynamic interpersonal relationships between a child and a
therapist trained in play therapy procedures who provides selected play therapy
materials and facilities the development of safe relationship for the child to fully express
and explore self through play.

11. IMPORTANCE OF PLAY THERAPY FOR
PEDIATRIC CANCER PATIENTS
Playing is a natural way of building skills, confidence and personality in a child as well as a way to
instill social relations and proper behavior.
Children who are ill, particularly children with cancer, tend to lose interest in playing due to their
long-term stay at the hospital and isolation procedures.
Illness and hospitalization can be a major source of stress for young children. They meet many
strangers and have to undergo many tests and procedures. This affects them deeply and could cause
possible depression

12. PURPOSE OF PLAYTHERAPY
• Develop a more positive self concept
• Assume greater responsibility
• Become more self accepting, self directing and self reliant
• Become more trusting of self
• Experience a feeling of control
• Become sensitive to process of coping
• Develop a internal source of evaluation
• Engage in self determined decision making

13. PROCEDURE OF PLAY THERAPY
THE PLAY ROOM
• The Necessary elements within the play rooms are; The child, The therapist, and the play therapy
contents.
• The play therapy space is usually a designated room, set up in a particular and predictable way.
• Within the room, there are a wide range of expressive tools and toys,
• Toys including craft materials, dress ups and masks, musical instruments, puppets, toy animals, toy
weapons, medical equipment, doll houses and balloons.
• Therapy room as needing to contain something to represent everything in the child’s world.
• The range of toys allow a child to understand that a range of behaviors are permitted in the playroom.

14. PLAY ROOM

15. PARTEN’S SIX TYPES OF PLAY

16. PLAY IN ILLNESS
Therapeutic play
It is the use of play
specially on a language
for sick children to
communicate their thoughts
and feeling.

17. CREATIVE AND ARTISTIC ACTIVITIES
• Drawing and Coloring: Helps children express their feelings.
• Painting: Finger painting or using brushes can be soothing.
• Craft Projects: Making bracelets, origami, or collages.
• Clay Modeling: Offers tactile stimulation and creativity.
• Therapeutic Benefit: Encourages emotional expression and reduces stress.

19. IMAGINATIVE PLAY
• Role Play: Acting as doctors, nurses, or superheroes.
• Storytelling: Encourages creativity and lets children explore their feelings.
• Puppet Shows: A playful way to talk about emotions.
• Therapeutic Benefit: Helps children process their experiences and emotions.

21. PHYSICAL PLAY (ADAPTED FOR ENERGY LEVELS)
• Ball Games: Lightweight foam balls for gentle play.
• Yoga or Stretching: Promotes relaxation and gentle physical activity.
• Bubble Blowing: Encourages deep breathing.
• Therapeutic Benefit: Enhances motor skills, promotes relaxation, and improves mood

23. SENSORY PLAY
• Sensory Bins: Filled with rice, sand, or soft beads.
• Slime or Playdough: Offers a soothing tactile experience.
• Weighted Blankets orToys: Provides comfort.t
• Sensory mats
• Therapeutic Benefit: Calms anxiety and provides sensory stimulation.

25. COGNITIVE AND EDUCATIONAL PLAY
• Puzzles: Age-appropriate jigsaw puzzles or word puzzles.
• Board Games: Modified for shorter sessions if fatigue is a concern.
• Books: Reading together or audio books.
• Interactive Apps: Educational games designed for children.
• Therapeutic Benefit: Stimulates cognitive function and keeps them engaged.

27. RELAXATION AND MINDFULNESS ACTIVITIES
• Guided Meditation: Apps or videos designed for children.
• MusicTherapy: Listening to or creating music.
• Breathing Exercises: Easy techniques to manage stress.
• Therapeutic Benefit: Reduces anxiety and promotes emotional balance.

28. BREATHING EXERCISES FOR CANCER KIDS
AGE GROUP OF 1-5YEARS
• Bubble breathing technique
• Flower breathing
• Candle blowing
• Pinwheel breathing activity
• Belly buddies breathing
• ABOVE 5YEARS
• Square breathing technique
• Star breathing
• Belly breathing
• Hoberman sphere breathing
• Ballon blowing
• Diaphragmetic breathing exercise
• Thoracic expansion exercise

33. MEDICAL PLAY
• Toy Medical Kits: Helps demystify hospital equipment.
• Dolls or Stuffed Animals: Allows them to "treat" their toys.
• Interactive Books: Explaining medical procedures in a child-friendly way.
• Therapeutic Benefit: Reduces fear of medical environments and promotes
understanding.

34. TYPES OF MEDICAL PLAY

35. PROBLEMS OF CANCER CHILDREN
INTERNALIZING PROBLEMS
 Feelings of loss of control
 Hopelessness
 Depression
 Anxiety
 Frustrations

36. • EXTERNALIZING PROBLEMS
 Withdrawal
 Aggression
 Non-compliance
• OTHER COMMON DIFFICULTIES
 Poor self-esteem
 Poor self-image
 Changing sense of identity, more negative
 Decreasing social competence
 Learning problems

37. PLAY THERAPY ACTIVITIES FOR CANCER CHILDREN
ACCORDING TO AGE
• Share messy moments( babies to 12 year old)
• Trade something personal or special ( babies to 12 year old)
• Flying feeling balloons( 18 months to 6 year old)
• Reading books( 2 to 12 year old)
• Popping cancer bubbles( 3 to 12 year old)
• Hugging hand activity ( 6 years old and up)
• Plan a party( 3 to 16 years old)
• Make friendship bracelets( 4 to 12 years old)
• Play doctor( 6 to 12 years old)
• Write thank you card( 4 to 12 years)