On the vision of achieving our goals, group as well as individual therapies were conducted at the Swayam Therapy Centre. The spectrum of patients ranged from a minor case of attention deficit disorder to cases like autism & cerebral palsy. It is team effort as individual participation of the child and the caregiver, the team of Professionals like Occupational therapist, Physiotherapist, Speech Therapist, Social Workers, academic tutoring and support staff are involved.
Each patient was analyzed and assessed before the beginning of therapy at swayam; after which individual goals, short term as well as long term goals and targets were set with the aim to provide quality services.
In group therapy all therapists set the goals, Occupational therapist, academic tutoring, and physiotherapist. The treatment should engage the child’s special interest to keep them involved in the task and structure each task as a series of simple step with regular positive reinforcement of behaviour.
A typical child with spasticity has a lot of tightness in the muscles that are affected as a result of damage to the brain at the time of birth. Each child is unique and therefore the work done on each of them specifically depends on their functional condition and the work is done to achieve more functional goals so that they become as independent as possible and make it a lot easier for the parents and the caretakers to handle them at home.
We at Swayam centre for spastics work on each child’s posture and movement. The child is observed how she or he moves about. Can the child control his head and neck? Can the child roll over on her own? Can the child come to sit, or pulls to stand? If the child can stand, can they balance and move forward while maintaining the alignment of their posture. Other sensory issues also need to be carefully monitored such as auditory and visual processing, cognitive and perceptual skills. The therapist initially works to obtain a good head and neck control with the child’s hands weight bearing in front of her. This can be either achieved on a therapy ball or various exercises on mat or other therapeutic equipments. On the ball the child is made to lie down on her stomach and the head neck and trunk is facilitated using various neuro-developmental techniques so that the child will be encouraged to look up and sustain the position for some time. A regular work on the child will help her achieve the particular developmental milestone.
Some children have difficulty to sit independently. Some lack a proper eye hand co ordination to perform a task. Some children have difficulty to bring both their hands to the midline to clap or to hold a toy or any other object. We use therapeutic techniques to teach them to relax the muscles which help to use their hands. Once the child learns to use their hands it becomes easier to learn to sit. A lot of work and facilitation is required at the trunk to help them achieve a good control while sitting. Also some children have tightness around their hips making it difficult to sit on a mat with their legs folded. So these children need to be assisted even at their lower extremities. The parents are also taught about these so that they can work with their children at home.
Likewise we at swayam strive together to make the child attain as many functional goals as possible. A lot of hand use is encouraged so that the child learns to use it to sit or pull herself to stand and even to perform her everyday occupation like dressng bathing eating etc. The therapist also works on the childs fine motor skills for finer activites for writing, handling a spoon, buttoning a shirt etc. These activities are achieved by making the child perform tasks with theraband, theraputty, beads, clay, grains, sand, wheelbarrow, swing, ball etc.
The use of splints are important to maintain the alignment of the extremity and to prevent secondary complications. Commonly ankle foot orthosis are used to help the child stand and bear weight on her feet. A push knee brace may be required if the child has difficulty to keep her knees straight while standing. The child is made to stand either independently or with a support in front. Standing frames are also used to make a child stand and maintain weight on her legs. The child is made to walk either independently or on parallel bars, or with the help of walkers or elbow crutches.
The children who are hyperactive require calming techniques using ball or compression using mat, or activities on a tilt board, swing, hammock, ball pool etc. the child is made to do a lot of pushing and pulling activities and the attention is diverted to purposeful activities. This helps the child to increase his attention span and reduce the hyperactivity. Once the child learns a small task the child is encouraged to do more and more till remarkable progress is seen in his day to day activities.
A child with a lot of fear and insecurity is also helped to overcome with a lot of therapeutic activities like platform swing, disc swing, bolster swing, ball pool, a ladder, a mesh for climbing, a tunnel etc. Table top activities are also done to work on the sensory integration. The child is helped with cognitive abilities, memory, writing, math and language, perceptional skills, visual and auditory skills, praxis on command etc.
Children who require a lot of help are taught to identify self and family members with the help of photographs. Special efforts are taken to help them identify their own body parts and also their spatial orientation. Children also need special attention with regard to their visual tracking and attention and numbers alphabets, colours, shapes, sizes etc are introduced to them. The child is taught to coordinate the eye and hand movements to be able to complete a task successfully for this purpose various software games (from Laptop to Screen) are used.
Work of speech therapist in group sessions :
Speech therapy involves much more than simple teaching a child to correctly pronounce a words.
Non-verbal Communication –
This includes teaching gestural communication or training with picture exchange cards, electronic talking devices and other non-verbal communication tools.Speech pragmatics- this includes practical training on the appropriate context for speech. Concept skills- Students with this have difficulty understanding abstract ideas, speech therapist may work on building concept skills.
Occupational Therapist work in group session : work with these people as they often lack some of the basic social & personal skills required for independent living. Occupational Therapist have developed techniques for working on all of these needs.
Provide interventions to help a child appropriately respond to information coming through the senses. Intervention may included swinging, brushing, playing in a ball bit and other activities For example teaching typing when handwriting is difficult and selecting a weighted west to decrease anxiety.
Work on postural & motor control.
To work on fine motor skill, stretching for both upper and lower extremity activities to improve fine motor function. For that we used Neuro-developmental techniques and sensory integration therapy.
Physiotherapy in work group session : Neuro-developmental Therapies, stretching breathing exercises, splinting, to develop postural control in sitting, to improve head, neck and trunk motor units initiation and sustenance, to develop upper extremity strength and function.
Social skills therapy in Group : Social skill therapy work in a group activities usually involve games and conversations. It mainly focus on game playing, sharing and conversation, identification, follow instructions, responding name, focus on tasks till its completion.
Academic Tutorial mainly work on, in group sessions that identification of body parts, family members, identification of basic concepts of shapes, colours, basic animals,fruits,with the use of technique of rhymes, exercise videos dances, art-crafts colour coding, puzzle time, educational toys, Software games on screen using Laptop.
Then we work as individual therapy programme
Physiotherapist in individual therapy session, we provided physiotherapy for cerebral palsy child and therapy treatment includes ball therapy, supine flexion, prone extension, weight bearing, wedge exercise, standing, sitting, Neuro-Developmental Therapy technique to develop postural control to develop head neck and trunk motor units intimation and resistance.
Occupational therapy, snoezelen therapy provided interventions to help a child appropriately respond to information coming through the senses.
Sensory integration therapy for proprioception vestibular and tactile, auditory impulses by various swings, using ball pool for tactile impulses, tunnel walking. Wheelbarrow walking, pushing, pulling, holding, carrying and many other exercises for proprioceptive inputs. Stretching, ball exercises, work on fine motor skills.
Speech therapist provide intervention on oro-motor skills, for feeding & communication .Mouth & tongue exercises work on new words or sentence formation according to the abilities of the child and also development of some pragmatic language.