Ergo-therapy for Cerebral Palsy
Ivan Chavdarov
Specialized Hospital for Rehabilitation of Children with Cerebral Palsy “Santa Sofia”
The cerebral palsy (CP) describe a group of disturbances in the development of the movements and posture limited the daily activities, in connection withnon-progressive damagesof the embryo-development or the development of the child brain.The motor damages by CP are accompanied very often of the aberration in the emotions, cognition, communication, perception and/or behavior and/or coordination. The service of CP-patientsalways require the multidiscipline team. The ergo-therapy with its diagnostic and therapy approaches, take a place in the complex rehabilitation of CP according to the needs and ages of the patient (infant, toddler, child, adolescent, young adult) as well as CP-form – spastic, dyskinetic or ataxic.
Ergo-therapy affects different daily activities, learning, play, social skills, work and behavior using a variety of approaches. The service my be provided in home, school, hospital or community settings. The ergo-therapist specified the individual patient out-come to sensory information from his/her body or from the environment, using standard or non-standard tests, clinical observation or the information of caregivers/teachers.
Basic part of the typical child development is the process of interpretation and out-come to the sense information they received. Ergo-therapy look for the sensory needs of the child, recognized the registration, modulation, organization and interpretation of the information of the senses: sight, sound, smell, taste, touch and perception of movement and position.Basically, the therapeutical methods are directed for stimulation of the tactile (touch, compression, vibration), the proprioceptive (schema of the body and its position in the space) and the vestibular (perception of the movement – idea of start/stop action, anticipate time and planning, sequence of motions, realization of unfamiliar movement) systems.
The ergo-therapy hone the ability of the fine-motor skills and small muscles, include hands, feet, fingers and toes as well the mouth. The ergo-therapist train CP-child at daily living skills as: dressing; toilet/bath/combing; eating/serving/cooking; play-draw/cut/paste/shape and everyday mobility. His/her obligation is a properly positioned of the CP-child in different devices such a: standing frames, walking frames, baby walkers, wheelchairs, pushchairs, braces, one/tree-point sticks and others, etc. to maximized the benefits and to minimize the positions that could contribute to more spasms, uncontrolled movements and instability. Further more, the ergo-therapist has to find the most appropriate equipment, assisting the daily activities of the CP-child, including and the modification of the cutlery, toilet-set, school-set, chairs and others.
The ergo-therapy secure the ability,by regulating of the sensory system – input/output, to co-operate for serious achievements in the development of physical, communicational, emotional, social, cognitive and adaptive skills as well the self-care by CP-child in different ages.
The special pedagogic as a part of ergo-therapy in the training of children with cerebral palsy (CP) for school activities – necessity, principles, methods and results.
Zdravka Topalova, Ivan Chavdarov,
Specialized Hospital for Rehabilitation of Children with Cerebral Palsy “St. Sofia”
The training of CP-children with the methods of special pedagogic forpreparing and participation in the school-activities is an important period in their development. In this period the child build-up school manners and skills and prepare its-self for incorporation in a lager social life.
In the Specialized hospital for rehabilitation of children with cerebral palsy there are prepared standards for inclusion of CP-child in pre-school training and therapy.The methods used for training and stimulation of verbal and non-verbal CP-children specified them-self with hard individual approach. Manufactured materials for personal interventions are conformable to the age of the child, the form of cerebral damage, the abilities of gross and fine motor activities as well the level of cognitive functioning. It is very important the right positioning of the child during the therapy, as well the using of adequate devices and materials for writing or communicating and an up to date equipment.
The CP-child trained for school-activities achieved results, minimal or maximal, according its own abilities based on near or longitudinal tasks applied in its rehabilitation program. Every CP-child have to has a chance to develop its own cognitive, behavior and communication abilities and every success, bigger or less, is an evidence that, the concerns for the CP-children have to be so much intensive as those for children with a standard developing. The activities of special-pedagogic training covered particularly the activities of ergo-therapy for CP-children.
Disturbances of the oral movements and the feeding activities in cerebral palsy (CP) - the place of the ergo-therapist.
Tania Nedyalkova, Ivan Chavdarov,
Specialized Hospital for Rehabilitation of Children with Cerebral Palsy “St. Sofia”
The development of the oral activities started in prenatal period yet and continued during the first few years of life. During this period the healthy child gain a motor experience, set up and improves feeding mechanisms, which are the base to build up the speaking skills.
By the infants with central coordination disturbances and for the children with CP these processes are directly related to neurokinesiological status. The absence or the late occurrence of sucking and swallowing reflexes, and the deviations in the muscular tone (hyper, hypo and dystonia), including and oro-facial muscles, create prerequisites for disturbances in oral movements and feeding mechanisms. These problems make an application for subsequent speech difficulties, and outline the clinical features of dysarthria, which is the most common communicative disorder in the children with CP. The volume of movements in the organs involved in the articulation is often limited, as well the abilities to achieve, to hold and to switch the articulation posture. The coordination between breathing and swallowing, and the control of the salivation is impaired too. The disturbances in sucking and swallowing are happened very often in infants and toddlers and they are also a subject for feeding and oro-facial therapy.
In the Specialized hospital for rehabilitation of children with cerebral palsy “St.Sofia”, the diagnosis and the treatment of disturbances in the oral-motor and feeding mechanisms is a part of the complex rehabilitation of the CP-children. The rehabilitation strategy is prepared individually, for each child according the chronological age, neurokinesiological status and oro-motor dysfunction, by a rehab-team of professionals, including doctor for physical and rehabilitation medicine, neurologist, speech therapist with experience in feeding-therapy and clinical psychologist. It is very important to find the place of the ergo-therapist in that team for more qualitative service and rehabilitation.