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
This document discusses spasticity management. It defines spasticity as a hypertonic motor disorder caused by injury to the corticospinal pathways. Signs of upper motor neuron syndrome include hyperactive stretch reflexes and involuntary flexor/extensor spasms. Spasticity is assessed using measures like the modified Ashworth scale and is treated using a multidisciplinary approach including oral medications, injections, surgery, and physiotherapy. Treatment aims to reduce spasticity and improve function and range of motion.
Rood's approach is a neurophysiological technique developed in 1940 based on reflex models of motor control. It uses sensory stimulation to normalize tone and elicit desired muscle responses based on developmental sequences. The key concepts are:
1. Categorizing muscles as tonic or phasic for stability or mobility.
2. Using ontogenic sequences of motor and vital functions development.
3. Applying appropriate sensory stimuli like touch or vibration to proprioceptive, exteroceptive, and vestibular receptors.
4. Manipulating the autonomic nervous system with techniques like icing or warming.
Introduction, principles of sensory re-education hypersensitivity and hyposensitivity, stages of training after nerve repair, uses and benefits, sensory reeducation in stroke - its principle. Actve and passive Sensory reeducation in stroke, orofacial sensory retraining
This presentation give an upto date insightful information on balance/postural assessment and key domains of Occupational Therapy during assessment of balance using different scales.
The document discusses neuropathodynamics and neuromobilization techniques. It covers:
- Flexion and extension of the spine and their effects on neural tissues, producing tension and sliding.
- Lateral flexion and its effects of increasing tension on the convex side and reducing tension on the concave side.
- Various mechanical interface and neural dysfunctions that can occur.
- Objectives, clinical tests, and techniques used in neuromobilization to restore normal neuromechanical function.
- Contraindications for neuromobilization include acute injuries or infections of the nervous system.
- Different levels of neurodynamic testing based on symptoms and neurological status.
Ankle-foot orthoses (AFOs) are external devices that attach to the lower leg and foot to improve function by controlling motion and providing support. The main components are a calf band, medial and lateral bars that articulate with ankle joints, and a stirrup that anchors to the shoe. There are 5 types of artificial ankle joints prescribed according to muscle strength: free ankle, dorsiflexion stop, plantarflexion stop, fixed dorsiflexion stop, and fixed hinge. AFOs are used to treat drop foot and other conditions involving muscle weakness, deformities, or instability by maintaining proper foot and ankle positioning during gait.
This document discusses spasticity management. It defines spasticity as a hypertonic motor disorder caused by injury to the corticospinal pathways. Signs of upper motor neuron syndrome include hyperactive stretch reflexes and involuntary flexor/extensor spasms. Spasticity is assessed using measures like the modified Ashworth scale and is treated using a multidisciplinary approach including oral medications, injections, surgery, and physiotherapy. Treatment aims to reduce spasticity and improve function and range of motion.
Rood's approach is a neurophysiological technique developed in 1940 based on reflex models of motor control. It uses sensory stimulation to normalize tone and elicit desired muscle responses based on developmental sequences. The key concepts are:
1. Categorizing muscles as tonic or phasic for stability or mobility.
2. Using ontogenic sequences of motor and vital functions development.
3. Applying appropriate sensory stimuli like touch or vibration to proprioceptive, exteroceptive, and vestibular receptors.
4. Manipulating the autonomic nervous system with techniques like icing or warming.
Introduction, principles of sensory re-education hypersensitivity and hyposensitivity, stages of training after nerve repair, uses and benefits, sensory reeducation in stroke - its principle. Actve and passive Sensory reeducation in stroke, orofacial sensory retraining
This presentation give an upto date insightful information on balance/postural assessment and key domains of Occupational Therapy during assessment of balance using different scales.
The document discusses neuropathodynamics and neuromobilization techniques. It covers:
- Flexion and extension of the spine and their effects on neural tissues, producing tension and sliding.
- Lateral flexion and its effects of increasing tension on the convex side and reducing tension on the concave side.
- Various mechanical interface and neural dysfunctions that can occur.
- Objectives, clinical tests, and techniques used in neuromobilization to restore normal neuromechanical function.
- Contraindications for neuromobilization include acute injuries or infections of the nervous system.
- Different levels of neurodynamic testing based on symptoms and neurological status.
Ankle-foot orthoses (AFOs) are external devices that attach to the lower leg and foot to improve function by controlling motion and providing support. The main components are a calf band, medial and lateral bars that articulate with ankle joints, and a stirrup that anchors to the shoe. There are 5 types of artificial ankle joints prescribed according to muscle strength: free ankle, dorsiflexion stop, plantarflexion stop, fixed dorsiflexion stop, and fixed hinge. AFOs are used to treat drop foot and other conditions involving muscle weakness, deformities, or instability by maintaining proper foot and ankle positioning during gait.
Upper crossed syndrome is a postural condition caused by prolonged forward head positioning from activities like computer use, driving, and phone use. It involves tightness in the upper trapezius and levator scapula muscles crossing with tightness in the pectoralis muscles, and weakness in the deep cervical flexors crossing with weakness in the middle and lower trapezius. Exercises like foam rolling, rows, and chin tucks can help correct muscle imbalances, as can improving posture awareness and taking breaks from aggravating activities.
Deformities related to cerebral palsy and their orthoticAinaa Khan
This document discusses orthotic treatment for deformities related to cerebral palsy. It describes common deformities such as scoliosis, hip adduction/flexion, knee flexion, and foot equinus. It outlines treatments including splinting, bracing with ankle-foot orthoses, and corrective bracing to prevent deformity progression and improve function. Orthoses aim to stretch shortened muscles and resist deforming forces to help align the spine and lower extremities.
Temple fays and phelps approach in neurophysiotherapy and cerebral palsySusan Jose
Dr. Winthrop Phelps developed an approach to cerebral palsy treatment in 1932 in Baltimore. His goals were economic independence and self-care ability. His approach involved accurate diagnosis, mental assessment, and a multidisciplinary rehabilitation team. Fifteen treatment modalities were used, including passive range of motion, active assisted motion, muscle education, relaxation techniques, and braces. Movement progressed from simple to complex patterns based on a child's abilities.
Tarsal tunnel syndrome is caused by entrapment of the tibial nerve in the tarsal tunnel behind the medial malleolus. It causes burning, tingling sensations on the sole of the foot, worse at night. Electrodiagnostic studies can diagnose it, while treatment options include non-surgical approaches like injections and orthotics, as well as surgery if non-surgical methods fail.
Neurodevelopemental Therapy (Bobath approach)- Principles and EvidenceSusan Jose
Here we present a widely used neurophysiotherapeutic approch - NDT, exploring its current principles and throwing a glance at the historical development and why it is being so widely practice.
does it really have that evidance base?
Find more as you click on. Give a like if I helped you learn or clear concepts. Thankyou. Love you all. Lets learn more.
This document discusses biomechanics and activities of daily living. It defines biomechanics as the study of mechanics in the human body. Functional biomechanics looks at the link between the human body and its environment. Biomechanics consists of kinematics, the description of motion, and kinetics, the forces producing motion. Common activities like running, lifting, and walking are analyzed in terms of joint motion and ground reaction forces. Proper form and muscle engagement can reduce stresses, as seen in squat lifting versus stoop lifting.
The document discusses different approaches to brain and neurological rehabilitation over time, from the 1920s to today. It covers hierarchical theories of treatment, from top-down approaches to concepts like normalization of muscle tone. Various sensory stimulation techniques are also outlined that can be used to modulate muscle tone and reeducate movements, including PNF, vestibular stimulation, and different types of touch like rolling, compression, and stretching. While such elementary sensory methods can provide immediate short-term effects, the document notes they are limited as a standalone approach and have been outdated by newer knowledge about brain recovery processes.
This document outlines the physiotherapy management of brachial plexus injuries in children at different stages of development. It describes the brachial plexus and types of injuries. Rehabilitation is divided into 5 stages focused on improving range of motion, muscle strength, sensation and age-appropriate milestones through techniques like passive and active movement, splinting and functional activities. Complications are addressed and techniques like electrical stimulation are used. The overall goal is to prevent deformities and learned non-use while regaining optimal function.
این ارائه توسط دکتر خیاط زاده در کارگاه رویکرد جدید بوبات در توانبخشی کودکان مبتلا به فلج مغزی ارائه گردیده است.
برای مطالعه مطالب بیشتر در این زمینه، به وب سایت فروردین مراجعه نمایید.
https://www.farvardin-group.com
This document discusses several primitive and tonic reflexes seen in infants, including their typical onset, integration period, grading scales, and clinical descriptions. The reflexes discussed include the asymmetric and symmetric tonic neck reflexes, positive support reflex, tonic labyrinthine reflex, and others. The document provides details on techniques for eliciting each reflex and what physical findings correspond to different grades of response.
Therapeutic Technique to improve neck holding in cerebral palsy jitendra jain
Head control is the first motor milestone to be achieved in early life. Good head control lays the foundation for the development and refinement of other milestones. It also enables the child to explore the environment effectively in play and to develop more advanced skills. Thus attaining head control is frequently used as the starting point in therapeutic intervention for the children with cerebral palsy or other developmental disabilities by the pediatric occupational therapist. It also very important to have good neck control before the age of two year because if child dont develop good neck vontrol before the age of two year then developemnent of ambulatory capability in child became remote pssiblity.
This document discusses the prevention and physiotherapy management of hemiplegic shoulder pain (HSP) in stroke patients. It defines HSP and outlines its epidemiology, causes, clinical presentation and findings. The document emphasizes that HSP is a largely preventable complication that prolongs rehabilitation and reduces quality of life. It recommends several prevention strategies including proper handling, positioning the shoulder in abduction and external rotation, use of slings or strapping, and early physiotherapy including range of motion exercises. The ideal management is to prevent HSP from occurring in the first place through diligent and careful handling of the hemiplegic upper limb.
A detailed presentation from our Trigger Point Therapy workshop for sport's and massage therapist's. This event was held at our St John Street clinic on the 30th April 2016.
This scale is used to categrise spinal cord injury patients. it helps prognosticate the spinal cord injuires. it also helps define the treatment protocols for spinal cord injury patients. American Spinal Cord Injury Association made this scale so as to make a standardization in assesemnent technique in acute spinal cord injury patients.
This document provides an overview of neural mobilization including:
1. It discusses the anatomy and physiology of the nervous system as a continuous tissue tract including the central and peripheral nervous systems.
2. Key concepts in neurodynamics are introduced such as tension, sliding, compression and how nerves move with joint movements.
3. Physiological events related to neural mobilization techniques like intraneural blood flow and its maintenance during movement are covered.
4. Examples of specific neural mobilization techniques like neurodynamic sliders and tensioners are given as well as how the spine moves in flexion, extension and lateral flexion.
Muscle energy techniques (MET) involve voluntary muscle contractions by the patient against a counterforce applied by the practitioner. The goal is to move restrictive barriers and normalize muscle and fascial restrictions. Key elements include controlled joint positioning, patient-applied muscle contractions in a specific direction, and operator counterforce. MET can be used to lengthen shortened muscles, strengthen weakened muscles, reduce pain and edema, and increase joint mobility. It relies on principles like post-isometric relaxation and reciprocal inhibition. Careful technique and patient/practitioner coordination are important for success. MET can help many somatic dysfunctions but requires an understanding of indications and contraindications.
This document provides information on cerebral palsy, including its causes, types, clinical manifestations, diagnostic evaluation, and management. Cerebral palsy is a group of disorders that affect movement and posture, caused by non-progressive brain damage early in development. It involves motor impairments as well as disturbances of sensation, perception, communication, cognition, and behavior. Common types include spastic, dyskinetic, and ataxic cerebral palsy. Treatment is multidisciplinary and focuses on medical management, therapies, surgery, and nursing care to improve symptoms and quality of life.
CP-Care curriculum, training course and assessment mechanism (ECVET based)
Website: http://cpcare.eu/en/
This project (CP-CARE - 2016-1-TR01-KA202-035094) has been funded with support from the European Commission. This communication reflects the views only of the author, and the Commission cannot be held responsible for any use which may be made of the information contained therein.
Upper crossed syndrome is a postural condition caused by prolonged forward head positioning from activities like computer use, driving, and phone use. It involves tightness in the upper trapezius and levator scapula muscles crossing with tightness in the pectoralis muscles, and weakness in the deep cervical flexors crossing with weakness in the middle and lower trapezius. Exercises like foam rolling, rows, and chin tucks can help correct muscle imbalances, as can improving posture awareness and taking breaks from aggravating activities.
Deformities related to cerebral palsy and their orthoticAinaa Khan
This document discusses orthotic treatment for deformities related to cerebral palsy. It describes common deformities such as scoliosis, hip adduction/flexion, knee flexion, and foot equinus. It outlines treatments including splinting, bracing with ankle-foot orthoses, and corrective bracing to prevent deformity progression and improve function. Orthoses aim to stretch shortened muscles and resist deforming forces to help align the spine and lower extremities.
Temple fays and phelps approach in neurophysiotherapy and cerebral palsySusan Jose
Dr. Winthrop Phelps developed an approach to cerebral palsy treatment in 1932 in Baltimore. His goals were economic independence and self-care ability. His approach involved accurate diagnosis, mental assessment, and a multidisciplinary rehabilitation team. Fifteen treatment modalities were used, including passive range of motion, active assisted motion, muscle education, relaxation techniques, and braces. Movement progressed from simple to complex patterns based on a child's abilities.
Tarsal tunnel syndrome is caused by entrapment of the tibial nerve in the tarsal tunnel behind the medial malleolus. It causes burning, tingling sensations on the sole of the foot, worse at night. Electrodiagnostic studies can diagnose it, while treatment options include non-surgical approaches like injections and orthotics, as well as surgery if non-surgical methods fail.
Neurodevelopemental Therapy (Bobath approach)- Principles and EvidenceSusan Jose
Here we present a widely used neurophysiotherapeutic approch - NDT, exploring its current principles and throwing a glance at the historical development and why it is being so widely practice.
does it really have that evidance base?
Find more as you click on. Give a like if I helped you learn or clear concepts. Thankyou. Love you all. Lets learn more.
This document discusses biomechanics and activities of daily living. It defines biomechanics as the study of mechanics in the human body. Functional biomechanics looks at the link between the human body and its environment. Biomechanics consists of kinematics, the description of motion, and kinetics, the forces producing motion. Common activities like running, lifting, and walking are analyzed in terms of joint motion and ground reaction forces. Proper form and muscle engagement can reduce stresses, as seen in squat lifting versus stoop lifting.
The document discusses different approaches to brain and neurological rehabilitation over time, from the 1920s to today. It covers hierarchical theories of treatment, from top-down approaches to concepts like normalization of muscle tone. Various sensory stimulation techniques are also outlined that can be used to modulate muscle tone and reeducate movements, including PNF, vestibular stimulation, and different types of touch like rolling, compression, and stretching. While such elementary sensory methods can provide immediate short-term effects, the document notes they are limited as a standalone approach and have been outdated by newer knowledge about brain recovery processes.
This document outlines the physiotherapy management of brachial plexus injuries in children at different stages of development. It describes the brachial plexus and types of injuries. Rehabilitation is divided into 5 stages focused on improving range of motion, muscle strength, sensation and age-appropriate milestones through techniques like passive and active movement, splinting and functional activities. Complications are addressed and techniques like electrical stimulation are used. The overall goal is to prevent deformities and learned non-use while regaining optimal function.
این ارائه توسط دکتر خیاط زاده در کارگاه رویکرد جدید بوبات در توانبخشی کودکان مبتلا به فلج مغزی ارائه گردیده است.
برای مطالعه مطالب بیشتر در این زمینه، به وب سایت فروردین مراجعه نمایید.
https://www.farvardin-group.com
This document discusses several primitive and tonic reflexes seen in infants, including their typical onset, integration period, grading scales, and clinical descriptions. The reflexes discussed include the asymmetric and symmetric tonic neck reflexes, positive support reflex, tonic labyrinthine reflex, and others. The document provides details on techniques for eliciting each reflex and what physical findings correspond to different grades of response.
Therapeutic Technique to improve neck holding in cerebral palsy jitendra jain
Head control is the first motor milestone to be achieved in early life. Good head control lays the foundation for the development and refinement of other milestones. It also enables the child to explore the environment effectively in play and to develop more advanced skills. Thus attaining head control is frequently used as the starting point in therapeutic intervention for the children with cerebral palsy or other developmental disabilities by the pediatric occupational therapist. It also very important to have good neck control before the age of two year because if child dont develop good neck vontrol before the age of two year then developemnent of ambulatory capability in child became remote pssiblity.
This document discusses the prevention and physiotherapy management of hemiplegic shoulder pain (HSP) in stroke patients. It defines HSP and outlines its epidemiology, causes, clinical presentation and findings. The document emphasizes that HSP is a largely preventable complication that prolongs rehabilitation and reduces quality of life. It recommends several prevention strategies including proper handling, positioning the shoulder in abduction and external rotation, use of slings or strapping, and early physiotherapy including range of motion exercises. The ideal management is to prevent HSP from occurring in the first place through diligent and careful handling of the hemiplegic upper limb.
A detailed presentation from our Trigger Point Therapy workshop for sport's and massage therapist's. This event was held at our St John Street clinic on the 30th April 2016.
This scale is used to categrise spinal cord injury patients. it helps prognosticate the spinal cord injuires. it also helps define the treatment protocols for spinal cord injury patients. American Spinal Cord Injury Association made this scale so as to make a standardization in assesemnent technique in acute spinal cord injury patients.
This document provides an overview of neural mobilization including:
1. It discusses the anatomy and physiology of the nervous system as a continuous tissue tract including the central and peripheral nervous systems.
2. Key concepts in neurodynamics are introduced such as tension, sliding, compression and how nerves move with joint movements.
3. Physiological events related to neural mobilization techniques like intraneural blood flow and its maintenance during movement are covered.
4. Examples of specific neural mobilization techniques like neurodynamic sliders and tensioners are given as well as how the spine moves in flexion, extension and lateral flexion.
Muscle energy techniques (MET) involve voluntary muscle contractions by the patient against a counterforce applied by the practitioner. The goal is to move restrictive barriers and normalize muscle and fascial restrictions. Key elements include controlled joint positioning, patient-applied muscle contractions in a specific direction, and operator counterforce. MET can be used to lengthen shortened muscles, strengthen weakened muscles, reduce pain and edema, and increase joint mobility. It relies on principles like post-isometric relaxation and reciprocal inhibition. Careful technique and patient/practitioner coordination are important for success. MET can help many somatic dysfunctions but requires an understanding of indications and contraindications.
This document provides information on cerebral palsy, including its causes, types, clinical manifestations, diagnostic evaluation, and management. Cerebral palsy is a group of disorders that affect movement and posture, caused by non-progressive brain damage early in development. It involves motor impairments as well as disturbances of sensation, perception, communication, cognition, and behavior. Common types include spastic, dyskinetic, and ataxic cerebral palsy. Treatment is multidisciplinary and focuses on medical management, therapies, surgery, and nursing care to improve symptoms and quality of life.
CP-Care curriculum, training course and assessment mechanism (ECVET based)
Website: http://cpcare.eu/en/
This project (CP-CARE - 2016-1-TR01-KA202-035094) has been funded with support from the European Commission. This communication reflects the views only of the author, and the Commission cannot be held responsible for any use which may be made of the information contained therein.
Ataxia is a neurological sign that refers to lack of voluntary coordination of muscle movements. It is caused by abnormalities in the cerebellum or proprioceptive pathways. The document defines and classifies ataxia, describes the clinical presentation and diagnostic process, and outlines treatment approaches including physiotherapy. Physiotherapy focuses on improving gait, balance, coordination and reducing fall risk through exercises targeting these areas, use of assistive devices, and addressing any spasticity issues.
Cerebral palsy is a group of disorders that affect movement and posture, caused by damage to the developing brain before or during birth. The main types are spastic, dyskinetic, and ataxic. Treatment is multidisciplinary and includes physical, occupational and speech therapy, orthotics, medication to reduce spasticity or seizures, and sometimes surgery. Nursing care focuses on supporting therapies, ensuring adequate nutrition, and educating families on providing care.
A brief introduction to the topic cerebral palsy, prepared by Dr Yash Oza, PG resident in MS Orthopaedics
Etiology, Classification, assessment, diagnosis, treatment
This document summarizes the evolution of various neurophysiological approaches in physiotherapy. It describes approaches that were popular prior to the 1940s, which focused on orthopedic interventions and compensation. It then outlines several approaches developed from the 1940s onward that recognized the potential for functional recovery of affected body parts, including Bobath, Peto, Kabbat and Knott, Voss, and Rood approaches. The document proceeds to define neurophysiological approaches and their role in central nervous system plasticity. It provides examples of historical and contemporary approaches, such as muscle re-education, neurodevelopmental approaches, sensory integration, and task-oriented approaches.
PNF is a technique that uses proprioceptive stimulation and neuromuscular facilitation to promote functional movement. It was developed in the 1940s-50s for neurological rehabilitation. PNF uses principles like resistance, stretch, and timing to activate afferent pathways and facilitate efferent motor responses. Key techniques include rhythmic initiation, combinations of muscle contractions, and reversals between agonists and antagonists. The goal is to improve motor control, coordination, strength, and range of motion.
Cerebral palsy is a group of disorders that affect movement and posture, caused by damage to the developing brain before or during birth. It causes lifelong disabilities including muscle stiffness, poor coordination, tremors and trouble walking. Common causes include complications during pregnancy or childbirth like premature birth, brain injuries during delivery, genetic conditions and infections. Treatment focuses on improving mobility through physical, occupational and speech therapy as well as medications, surgery and assistive devices. Raising awareness and support for those living with cerebral palsy is important.
Parkinson's disease is a progressive neurodegenerative disorder characterized by loss of dopaminergic neurons. Its primary symptoms include tremor, rigidity, slow movement, and impaired balance. While medications can provide symptomatic relief, there is no cure. Physical therapy focuses on improving mobility, balance, strength, and fall prevention through exercises like treadmill training, Tai Chi, stretching, and cueing strategies. Surgery such as deep brain stimulation may also help manage severe symptoms.
Cerebral palsy is a group of disorders that affect movement and posture, caused by damage to the developing brain before or during birth. It involves motor disturbances as well as disturbances of sensation, perception, cognition, communication, and behavior. The main types are spastic, dyskinetic, and ataxic. Cerebral palsy is diagnosed through physical examination, neurological assessment, and imaging tests like MRI and CT scan. Treatment involves physical, occupational, speech, and recreational therapy to improve mobility and function. Medications can help reduce spasticity and seizures, while surgery may correct orthopedic issues. Nursing care focuses on supporting therapies, ensuring nutrition, and educating families.
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.
Cerebral palsy (CP) is a neurological condition caused by brain injury before development is complete, affecting motor control and muscle tone. Exercise rehabilitation programs aim to improve motor skills, reduce symptoms like spasticity, and enhance independence. Programs are individualized and include stretching, strengthening, balance activities, and tasks practicing daily living skills. Regular exercise can maintain function and quality of life for those with CP.
Principles and application of various Neurological Approaches. Comprises of PNF, ROODS, NDT, BOBATH, SENSORY INTEGRATION, BRUNNSTORM, VOJTA, Motor Re-learning Approach , Neural Tissue Mobilization
FRAMES OF REFERENCE USED IN CEREBRAL PALSY.pptxUsha Bhojne
The document discusses frames of reference used in cerebral palsy rehabilitation. It describes cerebral palsy as a group of motor disorders arising from brain lesions or disorders. Two frames of reference discussed are neurodevelopmental treatment (NDT) and biomechanical. NDT uses handling techniques and a dynamic systems approach to improve motor control and coordination. Biomechanical focuses on improving impairments like strength and range of motion through techniques like handling and facilitation during functional activities.
This document discusses how chiropractic care and addressing neurological issues may help with learning difficulties. It provides an overview of chiropractic and cranial techniques, retained primitive reflexes, essential fatty acids like EPA and DHA, and other nutrients like zinc. The document recommends a multi-disciplinary approach including chiropractic, cranial work, exercises to integrate primitive reflexes, nutrition, and referrals to other therapists. The chiropractor assesses the spine, cranium, reflexes and nutrition to address structural and neurological factors that could impact learning.
Pediatric physical therapy focuses on assessing and treating children with movement disorders to promote optimal physical development. It utilizes evidence-based practices like early intervention, family-centered care, and motor learning principles. Therapists treat common conditions like cerebral palsy, muscular dystrophy, and developmental delay using techniques such as exercises, assistive devices, and aquatic therapy to improve mobility, strength, and function.
BASICS OF PROPIOCEPTIVE NEURO MUSCULAR FACILITATION.pptxRaghu Nadh
Proprioceptive neuromuscular facilitation (PNF) involves stimulating proprioceptors to promote or hasten neuromuscular responses. It was developed based on principles of neurophysiology. PNF techniques use patterns of muscle contractions like isotonic, isometric, and eccentric contractions to facilitate functional movement, increase strength and range of motion through mechanisms like the stretch reflex and successive induction. The therapist provides manual contacts, traction, approximation and timing to emphasize muscle contractions.
The document discusses neuro-developmental physiotherapy (NDT) offered at King Edward Preparatory for children with low muscle tone (LMT). NDT is an advanced hands-on physiotherapy approach used to address challenges with posture, movement, motor skills, muscle weakness and coordination. Children with LMT may exhibit poor posture, delayed motor skills, difficulty remaining upright, restlessness, tiring easily and avoiding physical activity. The physiotherapist works with the child, family, physicians and teachers to develop a comprehensive treatment program involving weekly sessions for 6 months to strengthen muscles and improve stability, movement and performance.
Similar to Physical Therapy in Cerebral Palsy.pptx (20)
Early Physiotherapy and Management of Deformities.pptxICDDelhi
The document discusses musculoskeletal deformities that are commonly seen in children with cerebral palsy, including scoliosis, hip dysplasia, knee flexion contractures, and foot/ankle equinus. It describes how these deformities develop from muscle spasticity and contractures over time. The management of these deformities involves physical therapy, stretching and strengthening exercises, orthotics, electrotherapy, chemodenervation, and orthopedic surgery as needed. Positioning, handling techniques, and postural aids are also important for treatment and prevention of deformities.
Pre-Operative and Post-Operative Assessments.pptICDDelhi
Dr. Mansoor Alam is a child developmental specialist from ICD, New Delhi. He is a medicine graduate with specialization in Developmental Disability Management. After his graduation, he joined Spastic Society of Northern India, New Delhi to have a Post-Graduation Diploma in Developmental Therapy under RCI. Later, he went to Bobath Centre in London, (United Kingdom) to have specialized training in Bobath Approach to the treatment of Children with Cerebral Palsy, which is popularly known as Neurodevelopment Treatment (NDT). While, he was in Sydney, Australia, he did an advance course on the Use of Botox in Spasticity Management. He is one of the few professionals in India who attended Gait Analysis Course in Australia. To have in-depth knowledge to work with children neurodevelopmental disabilities, he pursued specialized training programs on GMA (General Movements Assessment), Constrained Induced Manual Therapy (CIMT), Early Intervention, Sensory Integration Therapy, Clinical Pathology and Acupuncture.
He has been considered as one of the first combination therapists in India who bridged the gap between medical and rehabilitation science. He has supported more than 200 organizations technically to work scientifically with children with developmental disabilities. He has mentored more than 3000 professionals to work and lead in the field of Childhood Disability. He has conducted more than 50 workshops and conferences in India and abroad. He has presented his works in England, Australia and Pakistan. More than 4000 articles in different Journals / Websites / Books / Research Papers have mentioned his work and his website (www.icddelhi.org)
He can be contacted at:
Institute for Child Development, C-27, Malviya Nagar, New Delhi-110017
Landline No: 011-41012124, Mobile No: +91-7838809241
Mail: helpicd@gmail.com, Website: www.icddelhi.org
Orthoses, an integral part of assistive technology, are specially made splints which are being used to align abnormal joints or muscles. These are never bought from ready made shops. Each and every pediatric orthosis should be made by qualified orthoticians. In selected cases, orthoses should be made after taking a POP cast. In a developing child, the orthoses should be changed after every six to nine months and for older children, the splint should be changed after every 9-15 months. Most of the orthoses require modifications so consult your orthotician after every three months or as recommended. Please note, a faulty orthosis always harm the child.
We at ICD, Delhi provide orthotic support to the following condition whenever there is a need
CTEV (Club Feet)
Cerebral palsy
Spina bifida
Erb’s palsy
Brain injury
Spinal cord injury
Post-polio paralysis
Meningomyelocele
Arthrogryposis
Congenital Hip dislocation
Genu recurvatum / Genu varum / Genu valgum
Flat feet / Hallux valgus / Flexed wrist / thumb in palm, etc
Orthotic aids are an integral part of habilitation / rehabilitation therapy. It helps
• To correct and/or prevent deformity
• To provide a base of support
• To facilitate training in skills
• To improve the efficiency of gait
• To improve function
At ICD New Delhi , we have
• Provision for Orthoses for Lower Limbs
• Provision for Orthoses for neck, spine and trunk
• Provision for Orthoses for Upper Limbs
Why to choose ICD, Delhi and its associated centers as your first choice when you are looking for a habilitation / rehabilitation centre for your child with special needs or differently able
ICD and its all collaborated/ partner centers are monitored by Dr. Mansoor Alam, the most experienced professional in India for children with developmental disorders. Dr. M Alam is considered one of the best consultants in India for High risk infant screening through GMA (Prechtl’s Method), Infant stimulation therapy, Early Intervention, Developmental therapy, Botox therapy and post procedures habilitation programs.
ICD provides you combination therapy or multimodal treatment which assures you better result. ICD’s combination treatment plan always includes medicines / injection therapy / surgery with advance habilitation therapies.
ICD with its international associate professionals have developed a unique treatment approach known as Neuro-Enhancing Treatment (NET). NET is considered one of the best treatment methods for children with cerebral palsy, spina bifida and Arthrogryposis. Neuro-Enhancing Positioning (NEP) is the backbone of NET and best method for achieving dissociation in cases of spastic and dystonic cerebral palsy. This is why ICD is considered the best treatment institute / centre / clinic for children with cerebral palsy
ICD’s integrated approach of treatment has successfully treated thousands of children with complex developmental issues from not only India but also from countries like Nepal, Bangladesh, Afghanistan, Pakistan, Sri Lanka, Iraq, Iran, Malaysia, Indonesia, Nigeria, Kenya, Kuwait, Oman, Qatar, Saudi Arabia, Dubai, South Africa, Sudan, UAE, Turkey, Uzbekistan, Vietnam, Singapore, Yemen, Uk, Australia, USA, Canada.
ICD has been the preferred partner for introducing newer therapies in India. ICD has already supported Allergan to introduce Botox, Medtronic to introduce Intrathecal Baclofen Pump, UFTD Delhi to start HBOT, Bike / Reviva Cell to introduce stem cell treatment in India.
Experiences have made ICD perfect. 20 + years of experience have enabled ICD to associate with more than 400 highly qualified and experienced professionals from different specializations.
ICD is best known for its proper screening, right diagnosis and holistic treatment planning. Always remember, right diagnosis means right treatment.
ICD is the only organization in India which can provide you all required assistive technology such as orthotics ( AFO/ Calipers/ Splints / Braces, etc), Mobility Aids( Walker / Rollator / Tripods / Wheel Chairs / Crawler, etc), Postural Aids ( CP Chair / Standing Frame / Corner Chair / Aligner / stretching aid, etc), Toys and Training materials, etc . In case of Ads and appliances, People says “You name it-we have it”
Thousands of articles, dozens of books have included ICD as their primary and trusted source for information for researches / case studies.
Rehabilitation of Children with Special Needs.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
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
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Kat...rightmanforbloodline
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
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Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
3. PHYSIOTHERAPY
It is a form of therapy where the child is treated with
physical exercises and a few but limited external
modalities to be independent especially in movement
or mobility
4. OCCUPATIONAL THERAPY
It is a form of therapy where the child is trained to get
independence or to become capable to lead a
productive life
5. DEVELOPMENTAL THERAPY
It is a form of therapy where the child with delayed
milestones is being stimulated to achieve milestones
based on abilities and limitations of the child
6. REHABILITATION THERAPY
VERSUS
HABILITATION THERAPY
Rehabilitation Therapy is the process of helping a person who
has suffered an illness or injury to restore lost skills and so
regain maximum self-sufficiency. Generally adults are the main
beneficiaries in case of rehabilitation services
Therapies meant for cerebral palsy are popularly known as
habilitation therapy
Habilitative therapy is a type of treatment or service that seeks
to help patients develop skills or functions that they were
incapable of developing on their own. This type of treatment
tends to be common for pediatric patients who haven’t
developed certain skills at an age-appropriate level.
7. PURPOSE OF PHYSICAL THERAPY IN CP
MANAGEMENT
Maximizing the potentials of the child to become
independent in Mobility and ADLs so that the child
can lead normal or near normal life
8. HOW DOES PHYSICAL THERAPY HELP
CHILDREN WITH CEREBRAL PALSY?
Physical Therapy (PT / OT / PT+OT) can
Integrate primitive reflexes
Neutralize muscle tone
Increase ROM / Joint integrity
Enhance Strength
Enhance Balance
Enhance Coordination
Enhance Endurance
9. HOW DOES PHYSICAL THERAPY HELP CHILDREN
WITH CEREBRAL PALSY?
Physical Therapy (PT / OT / PT+OT) can
Improve postural ability
Increase independence
Integrate Sensory Dysfunction
Enhance Cognitive functioning
Reduce physical discomfort and pain
Overcome physical limitations and obstacles
Decrease the chances of bone deformity
13. NEURODEVELOPMENTAL WITH REFLEX INHIBITION
& FACILITATION (KARL BOBATH)
NDT is characterized by hands-on “therapist-guided” facilitation of
movement to provide sensory input and improve postural control; the
goal is to regain typical motor behaviours and minimize atypical ones
Once the reflex patterns of abnormal tone are inhibited the child is
said to have been prepared for movement.
Reflex inhibitory patterns specifically selected to inhibit abnormal
tone associated with abnormal movement patterns and
abnormal posture.
Sensory motor experience – The reversal or break down of these
abnormalities gives the child the sensation of more normal tone and
movements.
14. NEURODEVELOPMENTAL WITH REFLEX INHIBITION
& FACILITATION (KARL BOBATH)
The therapist tries to attempt to change the patterns of spasticity so
that child is prepared for movement and mature postural reactions
uses key-points of control.
The key-points are usually head & neck, shoulder & pelvic girdles, but
there is also work from distal key- points.
15. LIMITATIONS OF NDT APPROACH
Most references available that advocate the usage of the
approach mainly for post stroke adult with hemiplegia.
There is no evidence that NDT can promote functional
improvement of children with cerebral palsy (Novak 2013).
“Inhibition of abnormal movement patterns”, this
terminology is no longer used "Inhibition" was recognised
to be a confusing term in the 1990s and no longer used in
the paediatric approach as it was not an accurate
description of intervention
16. SENSORY INTEGRATION (AYER’S APPROACH-SIT)
Highlights of the Approach
1. Sensory integration therapy exposes children to
sensory stimulation in a structured, repetitive manner.
2. The theory behind this treatment approach is that, over
time, the brain will adapt and allow them to process and
react to sensations more efficiently.
3. Difficulties in planning and organizing behaviour are
attributed to problems of processing sensory inputs within
the CNS, including vestibular, proprioceptive, tactile,
visual, and auditory.
17. SENSORY INTEGRATION (AYER’S APPROACH-SIT)
4. Children with sensory integration dysfunction
frequently use different sensory combination
strategies.
5. Treatment focuses on integration of neurological
processing by facilitating the individual to process the
type, quality, and intensity of sensation
18. PROPRIOCEPTIVE NEUROFACILITATION APPROACH /
KABAT APPROACH (PNF)
Highlights of the Approach
Mass Movement Patterns: Based on patterns
observed with functional activities in daily Life.
Mass Movements Patterns are mostly described as
Spiral and diagonal
Mass Movement patterns can be flexion or extension,
abduction or adduction, internal rotation or external
rotation or combination with synergetic muscles
groups
19. PROPRIOCEPTIVE NEUROFACILITATION APPROACH
(PNF-KABAT APPROACH)
Sensory (afferent) stimuli are skilfully applied to
facilitate movement.
Stimuli used are touch & pressure, traction &
compression, stretch, proprioceptive effect of muscle
contracting against resistance and auditory and visual
stimuli.
Resistance to motion is used to facilitate the action of
the muscles, which form the components of the
movement patterns.
20. PROPRIOCEPTIVE NEUROFACILITATION APPROACH /
KABAT APPROACH (PNF)
Special techniques that can be used in cerebral palsy
physiotherapy
Irradiation
Muscle Irradiation is the ability of a muscle performing an
action to generate greater tension (i.e. force) by being
“innervated” from the surrounding muscles.
Rhythmic Stabilization
Stimulation of Reflexes
Repeated Contractions
Reversals
Relaxation techniques – Hold Relax & Contract Relax
21. SENSORIMOTOR TECHNIQUE (ROOD'S APPROACH)
Highlights of the Approach
Techniques of stimulation, such as stroking, brushing,
icing, heating, pressure, bone pounding slow & quick
muscle stretch, joint retraction & approximation, muscle
contractions (proprioception) are used to activate, facilitate
or inhibit motor response in cerebral palsy physiotherapy.
Ontogenetic developmental sequence is strictly followed in
the application of stimuli.
a. Total flexion or withdrawal pattern (in spine)
b. Roll over (flexion of arm & leg on the same side and roll
over)
23. SENSORIMOTOR TECHNIQUE (ROOD'S APPROACH)
c. Pivot prone (prone with hyperextension of head,
trunk & legs)
d. Co-contraction neck (prone head over edge for co-
contraction of vertebral muscles)
e. On elbows (prone & push backwards)
f. All fours (static, weight shift & crawl)
g. Standing upright (static, weight shifts)
h. Walking (stance, push off, pick up, heel strike)
24. VOJTA THERAPY (VOJTA APPROACH)
Highlights of the Approach
1. Reflex creeping: The creeping
patterns involving head, trunk and
limbs are facilitated at various
trigger points or reflex zones.
2. Touch, pressure, stretch and muscle action against
resistance are used in triggering mechanisms or in
facilitation of creeping.
3. Resistance is recommended for action of muscles.
25. CONSTRAINT INDUCED MANUAL THERAPY-CIMT
Highlights of the Approach
1. CIMT is used predominantly in the individual with
hemiplegic cerebral palsy to improve the use of
affected upper limb.
2. The stronger or non-affected upper limb is
immobilized for a variable duration in order to force
use of the impaired upper limb over time
26. TEMPLE FAY (PROGRESSIVE PATTERN
MOVEMENTS)
Highlights of the Approach
1. Temple Fay suggested building up motion from reptilian
squirming to amphibian creeping, through mammalian reciprocal
motion 'on all fours ' to the primate erect walking
This approach is also called Patterning / Doman-Delacato Method
2. They developed progressive pattern movements which consist of
five stages.
Stage 1: Prone lying
Stage 2: Homo-lateral stage
Stage 3: Contra lateral stage
Stage 4: On hands and knee
Stage 5: Walking pattern
27. PHELPS TECHNIQUE
(MUSCLE EDUCATION/BRACES)
Hch
Highlights of the Approach
Dr. W M Phelp emphasized on team work and habilitation. He
encouraged physiotherapists, occupational therapists and
speech therapists to form themselves into cerebral palsy
habilitation team.
He chose fifteen modalities and specific combinations of these
modalities were used for the specific type of cerebral palsy
1. Massage for hypotonic muscles, but contraindicated in
children with Spasticity and athetoid.
2. Passive motion through joint range for mobilizing joints and
demonstrating to the child the movement required. Speed of
movement is slower for children with spasticity, increased for
rigidity.
28. PHELPS TECHNIQUE
(MUSCLE EDUCATION/BRACES
3. Active assisted motion.
4. Active motion
5. Resisted motion followed according to the child's capability.
6. Conditioned motion is recommended for babies, young children
and mentally retarded children
7. Confused motion or synergistic motion which involves resistance
to a muscle group in order to contract an inactive muscle group in
the same synergy. Mass movements such as the extensor thrust
or the flexion withdrawal reflex are usually used. For example,
using the hip- knee flexion-dorsiflexion synergy, inactive
Dorsiflexors are stimulated by resistance given to hip flexors.
29. PHELPS TECHNIQUE
(MUSCLE EDUCATION/BRACES
8. Combined motion in training motion of more than
one joint such as a shoulder and elbow flexion.
9. Relaxation techniques used are those of conscious
'letting go' of the body and its parts (Levitt 1962),
tensing and relaxing parts of the body. These methods
are mainly used with athetoid. They attempt to lie still or
relaxed or use contract -, relax relaxation for grimacing
and other involuntary motion.
10. Movement from relaxation is conscious control of
movements once relaxation has been achieved. It is
mainly used for children to control involuntary movements.
30. PHELPS TECHNIQUE
(MUSCLE EDUCATION/BRACES
11. Rest – Periods of rest are suggested for athetoid and
children with spasticity.
12. Reciprocation in training movement of one leg after the
other in a bicycling pattern in lying, crawling, knee walking
and stepping.
13. Balance - Training of sitting balance and standing in braces.
14. Reach, grasp and release used for training of hand function.
15. Skills of daily living such as feeding, dressing, washing and
toileting. Many aids were devised by the occupational therapists.
31. PHELPS TECHNIQUE
(MUSCLE EDUCATION/BRACES
Special Consideration for Braces / Calipers
He prescribed special braces to correct deformity, to
obtain the upright position and to control athetosis.
The bracing is extensive and worn for many years.
The children are taught to stand and step long leg
braces with pelvic bands and back supports, or
sometimes spinal brace.
As they progress, the back supports are removed
then the pelvic band and finally they wear below - knee
irons.
The full - length brace has locking joints at hip and
knee so that control can be taught with them locked
or unlocked.
32. PHELPS TECHNIQUE
(MUSCLE EDUCATION/BRACES
Emphasis on Muscle Education
Children with Spasticity are given muscle education
based on an analysis of whether muscles are spastic,
weak, normal or zero cerebral, or atonic.
Muscles antagonistic to spastic muscle are activated.
This is to obtain muscle balance between spastic
muscles and their weak antagonists.
Athetoids are trained to control simple joint motion and do not
require muscle education.
Ataxic may be given strengthening exercises for weak
muscle groups.
34. DEAVER TECHNIQUE
(MUSCLE EDUCATION/BRACES)
Highlights of the Approach
This technique based on extensive use of braces.
He uses braces for ambulation, eliminating brace elements as
the child's control improves.
He concentrates on self care or activities of daily living,
particularly the independent use of wheelchairs.
He focused a special attention on teaching the hand activities by
the same idea of eliminating all but two arm's maneuvers and
gradual removal of restriction as control is established:
The major aims of his treatment system are:
Maximal use of the hands.
Usable speech.
Normal or near-normal appearance.
35. PHOL TECHNIQUE
(MUSCLE EDUCATION/BRACES)
Highlights of the Approach
1. General relaxation is first induced then isolated
relaxation is taught.
2. Muscle consciousness, function and coordination
are the three principles for the training of voluntary
muscle control.
3. The activities observed in the normal sequence of
development are the base of the functional phase of
his program.
4. Braces are not used, while crutches or canes
may be used for the walking training.
36. SCHWARTZ TECHNIQUE
(MUSCLE EDUCATION / BRACES)
Highlights of the Approach
He believed that the progression of the emotional
and intellectual level will be followed by the
progress in the physical motor level. This technique
based on simplifying the external environment and
providing motivation. He made specific devices to
eliminate obstacles
The motivation is provided by successful
performance of play activities.
He did not preferred to use braces, but crutches
and canes were used for independent
locomotion.
37. GILLETTE TECHNIQUE
(MUSCLE EDUCATION/BRACES)
Highlights of the Approach
This technique based on how to gain good skeletal alignment
for cerebral palsied children. Therefore, stretching is
performed daily to correct or to prevent contractures in spastic
muscle groups.
A specific exercise program (as forms for normal child to play)
is designed to provide optimal range, tone, strength and
functional activities.
He recommended braces and splints to prevent or correct
deformity, control movement and provide a stable base for
balance.
For the child who has involuntary movements, he provided a
teaching program by breaking the chain of abnormal reflex,
which may allow more purposeful acts.
He preferred the proprioceptive training (balance and position
sense) for ataxic cases to compensate lack of balance,
equilibrium, coordination and proprioceptions.
38. EIRENE COLLIS TECHNIQUE
(NEUROMOTOR DEVELOPMENT)
Highlights of the Approach
The mental capacity of the child would determine
the results.
Early treatment was advocated.
Management of CP child throughout the day
(feeding, dressing, toileting and other activities.
Strict developmental sequence.
She disliked the separation of treatment into
physiotherapy, occupational therapy and speech
therapy:
She established the idea of the "cerebral palsy
therapist“ and emphasized on eclectic approach
39. CONDUCTIVE EDUCATION
Highlights of the Approach
Conductive education is a comprehensive method
of learning by which individuals with
neurological and mobility impairment
learn to specifically and consciously
perform actions that children without
such impairment learn through
Normal life experiences
42. ADELI SUIT THERAPY
The suit uses a system of elastic bands and pulleys
that create artificial forces against which the body can
work, to prevent muscular atrophy and reduce
osteoporosis. It consists of a vest, shorts, knee pads,
shoes and sometimes a head piece, all connected in
a prescribed pattern with bungees of appropriate
tension.
43. MOVE ( MOVEMENT OPPORTUNITIES VIA
EDUCATION)
MOVE uses the combined approach of education,
therapy, and family knowledge to teach the skills of
sitting, standing, walking and transitioning between.
It is an integrated curriculum-based approach to the
development of motor skills and independence and
utilises the expertise of education and therapy to
address the functional needs of students.
44. CURRENT SCENARIO
Role Significance
Best Physiotherapy: 60%
Best Occupational Therapy: 60%
Best Developmental Therapy: 80%
Combination Therapy: 90%-100%
45. CURRENT SCENARIO
Dark Zone of Physical Therapy World
# Lack of Team Spirit
# Poorly trained in Pediatrics- Both Theoretical and
practical- Poor Course Contents and Assessment Skills
# Limited Knowledge in Reflex Integration
# Limited Knowledge in Assistive Technology
specially use of orthoses, postural and mobility aids
# Too much of Passive therapy or No contact Therapy
# Poor with documentation-specially hip surveillance
# Disliking to work for ADL Training
# Excessive or no use of electrotherapy
# No knowledge about side effects- Limitations of the
Approaches or Techniques
46. MALINA- AN ECLECTIC APPROACH
An eclectic therapy is a therapeutic approach that
incorporates a variety of therapeutic principles and
philosophies to create the ideal treatment program
to meet the specific needs of the child with cerebral
palsy.
Although most physiotherapists use an eclectic
approach to the treatment of CP, there have been
several major influences on therapeutic practice
during the last 50 years, including the Bobath
concept, conductive education and sensory
integration.
47. MALINA APPROACH
Highlights of the Approach
Eclectic Approach
Advance and updated
Evidence based
Extracted from the previous and well known pediatric
physical therapy approaches
Amalgamation of selected result oriented key points
ICF oriented
Exclusive for pediatric habilitation
Holistic Approach- Suitable for both HBS and CBS
Need Extensive Training
48. MALINA APPROACH
Highlights of the Approach
Key Worker Model / Appointing a Team Leader
Life Span Approach
Multidisciplinary / Interdisciplinary / Trans disciplinary
Approach- Need Based
Based on Functional Classification System
GMFCS / MACS / FMS / VFCS / CFCS / EDACS
5 Steps Management Approach- Standard of Practice
Screening
Assessments
Diagnosis Making- Domain Oriented
Intervention Program
Evaluation Technique
49. MALINA APPROACH
Highlights of the Approach
Documentation using internationally accepted screening and
assessment forms for universal acceptance
Usage of self designed / indigenous forms in case of non-
availability or non-affordability of standard and universally
accepted forms
Use of POMR / POL and SOAP methods
Goals Setting based on SWOT / SMART Approach
Use of GAS for re-evaluation and proceeding further
Parents- Professional Partnership Management
Home Management Program with 360 degree input through
parents empowerment training
50. MALINA APPROACH
Difference between Treatment Plan and Treatment Program
Treatment / Management Plan
Long Term Plan
Intermediate Plan / Short Term Plan
Immediate Plan
Treatment plans can provide a comprehensive outline of the
child’s abilities and allows for interdisciplinary teams to work
together to provide the care needed.
Treatment / Management Program
Treatment Programs have a series of activities based on the needs of
the individual with the following components
Preventive Measure
Functional Measure
Developmental Measure
51. MALINA APPROACH
Specific Age Oriented Protocol
Neonatal Therapy
Infant Stimulation Program
Early Intervention Program
Intensive Therapy Protocol
Maintenance Therapy Protocol
Procedure Oriented Protocol
Post Botulinum Injection Therapy / PBT
Post Orthopedic Surgical Therapy
Post Neurosurgical Therapy
Post Implant Therapy ( ITBP / DBS / Cochlear implant)
Post HBOT
Post SCT
52. MALINA APPROACH
Template of a Therapy Program
1. Handling / Lifting / Carrying Techniques
2. Breathing Exercises
3. Usage of Assistive Technology
a. Postural Aids
b. Orthotic Aids
c. Mobility Aids
d. Adaptive Aids
4. Reflex Integration / Sensory Stimulation and Integration
5. Muscles Education
a. ROM Exercises / Stretching
b. Strength Training
53. MALINA APPROACH
6. Postural Enhancement Through Positioning (Task Analysis Oriented)
a. Static Positioning / Anatomical Positioning
b. Neuroenhancing Positioning
c. Functional Positioning
d. Transitions
7. Equipotherapy
a. Use of Prone Wedge
b. Use of Bolster
c. Use of Swiss Ball / Medicinal Ball
d. Use of Vestibular / Balance Board
e. Use of Bench / Peto Bar / Malina Bar
f. Use of Swings
g. Use of Thera-band / Thera-loop / Thera-tube
h. Use of Trampoline
i. Use of Cycle (Both Static and Dynamic)
j. Uses of Aligner-Postural and Mobility Aligner
54. MALINA APPROACH
8. Mobility Training / Gait Training
a. Therapeutic Mobility
b. Functional Mobility
c. Floor Mobility
d. Off Floor Mobility
e. Aided Mobility
f. Ambulation
9. Electrotherapy
EMS
EMG Biofeedback
10. Hand Function Enhancement
a. Play
b. ADL
c. Hand Writing
d. Vocational Training
55. MALINA APPROACH
Postures
1. Lying Posture
Supine
Prone
Side Lying
2. Sitting Posture
Long Legs Sitting
Cross Legs Sitting
Side Legs Sitting
Squatting
High Sitting
3. Kneeling Postures
Quadruped
Kneeling Upright
Half Kneeling
4. Standing
Front Support Standing
Back Support Standing
Independent Standing
Mobility
1. Pivoting on abdomen
2. Rolling
3. Creeping
4. Crawling / Bottom Shuffling
5. Kneel Walking
6. Lateral Cruising / Side
Walking
7. Walker / Rollator Walking
8. Tripods / Quadripods Walking
9. Stick / Cane walking
10. Independent Walking
11. Wheel chair Mobility
59. THANKS FOR LISTENING
For all queries, doubts and explanations, please contact
us @
Institute for Child Development
C-27, Malviya Nagar
New Delhi-110017
Landline Number: 011-41012124
Mobile Number: 7838809241
Mail: helpicd@gmail.com
Website: www.icddelhi.org