Transcript Children with Severe / Profound Involvement

Children with Severe / Profound
Challenges
Margo Prim Haynes PT, DPT, MA, PCS
Mary Rose Franjoine PT, DPT, MS, PCS
Overview
Clinical Diagnostic Categories
NDTA Enablement Model: Functional
Integrity/ Impairments, Ineffective and
Effective Posture and Movement, Activities
and Activities Limitation, Participation and
Participation limitation
Treatment
Video / Pictures
Dimensions
NDT Enablement Classification
Model of Health and Disability
+
Domains
Dimension
Functional Domain
Disability Domain
A. Body structure &
functions
Structural &
functional integrity
Impairments
A.Primary
B.Secondary
B. Motor functions
Effective posture &
movement
Ineffective posture &
movement
C. Individual
functions
Functional activities Functional activity
limitations
D. Social functions
Participation
Participation
restriction
From: NDT Approach Theoretical Foundations & Principles of Clinical Practice, Table 2.1 pg. 82
Clinical Diagnostic Criteria
Medical Diagnosis:
IQ ranges:
– Severe : 40 – 25
– Profound: Less than 25
Educational Abilities:
– Self Contained Classrooms: Trainable
Motor Abilities:
Dimensions
NDT Enablement Classification
Model of Health and Disability
+
Domains
Dimension
Functional Domain
Disability Domain
A. Body structure &
functions
Structural &
functional integrity
Impairments
A.Primary
B.Secondary
B. Motor functions
Effective posture &
movement
Ineffective posture &
movement
C. Individual
functions
Functional activities Functional activity
limitations
D. Social functions
Participation
Participation
restriction
From: NDT Approach Theoretical Foundations & Principles of Clinical Practice, Table 2.1 pg. 82
Disability Domains (Categories)
Severe / Profound Motor Problems & Mild /
Typical Cognitive Difficulties
Severe / Profound Motor Problems &
Severe / Profound Cognitive Limitations
Fair Motor Difficulties & Severe / Profound
Cognitive Limitations
Children with Severe / Profound
Motor and/or Mental Functional
Activities / Limitations and
Participation / Restrictions
Dimensions
NDT Enablement Classification
Model of Health and Disability
+
Domains
Dimension
Functional Domain
Disability Domain
A. Body structure &
functions
Structural &
functional integrity
Impairments
A.Primary
B.Secondary
B. Motor functions
Effective posture &
movement
Ineffective posture &
movement
C. Individual
functions
Functional activities Functional activity
limitations
D. Social functions
Participation
Participation
restriction
From: NDT Approach Theoretical Foundations & Principles of Clinical Practice, Table 2.1 pg. 82
2009
M R Franjoine & M P Haynes
9
Body Structure & Body Function
Global Damage
– Unknown prenatal condition
– Asphyxia
– Prematurity
Intracranial bleeds, infection, medical
conditions
Cognition Challenges
Cries: may be only means of
communication
Motivation: (Self- /Regulation) ???
Behavior: Self abusive or destructive
Bonding difficulty: poor facial expression &
lack of eye contact
Startle Response: Difficulty adjusting to
the world around them
Videos
Neuromuscular System
Impaired Muscle Activation
Co-activation from excessive to moderate
Impaired muscle synergies: Stereotyped
patterns of movement
Latency in initiating, sustaining and
terminating postural muscle activity
Neuromuscular System
Impairment of Timing and Sequencing:
Insufficient Force Generation (muscle
strength): Postural and Movement
Muscles
Sensory System
Somatosensory Issues: Proprioception /
Tactile Information
Vestibular
Visual Issues:
Auditory Issues:
Musculoskeletal System
High Risk for…
Contractures
Hip subluxations /dislocations
Shoulder dislocations
Scoliosis / excessive lordosis
Bone Growth Impaired
Cardiopulmonary / Respiratory
System
Cardiovascular Disease (Decoufle)
Cardiorespiratory endurance
Other Systems
Gastrointestional (GI) System
Integumentary System
Dimensions
NDT Enablement Classification
Model of Health and Disability
+
Domains
Dimension
Functional Domain
Disability Domain
A. Body structure &
functions
Structural &
functional integrity
Impairments
A.Primary
B.Secondary
B. Motor functions
Effective posture &
movement
Ineffective posture &
movement
C. Individual
functions
Functional activities Functional activity
limitations
D. Social functions
Participation
Participation
restriction
From: NDT Approach Theoretical Foundations & Principles of Clinical Practice, Table 2.1 pg. 82
2009
M R Franjoine & M P Haynes
19
Posture and Movement
General Characteristics: Posture
Postural tone = varies from high to
medium
Asymmetry = poor midline orientation
Alignment: UE= may remain in high-low
guard position
Alignment: LE = may see" windswept” legs
Pictures
Posture and Movement
General Movement Characteristics
Movement options limited
Which comes first: lack of motivation or
unsuccessful attempts to move ???
Feeding Challenges
Feeding Difficulty
– P & M:
– Impairment
Nutrition
– P & M: Physical Traits of Malnutrition
– Impairment: Blood chemistry
Aspiration
– P & M:
– Impairment:
Pneumonia
Dimensions
NDT Enablement Classification
Model of Health and Disability
+
Domains
Dimension
Functional Domain
Disability Domain
A. Body structure &
functions
Structural &
functional integrity
Impairments
A.Primary
B.Secondary
B. Motor functions
Effective posture &
movement
Ineffective posture &
movement
C. Individual
functions
Functional activities Functional activity
limitations
D. Social functions
Participation
Participation
restriction
From: NDT Approach Theoretical Foundations & Principles of Clinical Practice, Table 2.1 pg. 82
2009
M R Franjoine & M P Haynes
24
Activities & Activities Limitation
Locomotor Skills
Non Ambulatory
Communicates
Limited Communication
usually Non Verbal
Basic ADL’s
Totally dependent on
caregivers for all ADLs
Dimensions
NDT Enablement Classification
Model of Health and Disability
+
Domains
Dimension
Functional Domain
Disability Domain
A. Body structure &
functions
Structural &
functional integrity
Impairments
A.Primary
B.Secondary
B. Motor functions
Effective posture &
movement
Ineffective posture &
movement
C. Individual
functions
Functional activities Functional activity
limitations
D. Social functions
Participation
Participation
restriction
From: NDT Approach Theoretical Foundations & Principles of Clinical Practice, Table 2.1 pg. 82
2009
M R Franjoine & M P Haynes
26
Participation & Participation
Limitations
Participation:
Equipment supports children out in
community with caregivers
Participation Limitations:
Difficult for families to get children out of
the home
Problem intensifies as Caregivers Age
Finances
Treatment
Think
Function
Equipment Critical for Child and Family
– Seating Systems
– Standers
Essential for Child’s Health and Well Being
Prevention of Secondary Impairments
Treatment: Pros
Positively Influences Quality of Life:
– Hygiene and Ease of Care by Caregivers
– Respiratory function
– Cardiac function
– Caregiver and Child Bonding /
Interactions
– Childs Personality
– Comfort of Child and Play Options
Treatment: Pros
Decreases medical complications:
– Illness
– Contractures
– Pressure areas
Treatment Concerns
Therapist perspective:
Behavior: Cries,
Motivation:
Progress Slow:
Feedback: Difficult to Read
Frequent Illness: Frequent Missed
Appointments
Medical Issues:
Treatment Videos
Medical Issues
Team Approach Critical
Nutritional Needs
Seizure Medications
Spasticity Management
Surgical Issues
Pain Management
Bibliography
Caulton JM. A randomised controlled trial of
standing programme on bone mineral density in
non-ambulant children with cerebral palsy. Arch
Dis Child. 2004;89:131-135.
Decoufle P and Autry A. Increased mortality in
children and adolescents with developmental
disabilities. Paediatric and Perinatal
Epidermiology.2002;16:375-382.
Gajdosik, CG, Cicirello N. Secondary Conditions
of the Musculoskeletal System in Adolescents
and Adults with Cerebral Palsy. Physical &
Occupational Therapy in Pediatrics.
2001;21(4):49-68
Bibliography
Gudjonsdottir B, Mercer VS. Effects of a
dynamic versus a static prone stander on bone
mineral density and behavior in four children
with severe cerebral palsy. PEDIATR PHYS
THER. 2002;14:38-46.
Henderson RC. Bone density and metabolism in
children and adolescents with moderate to
severe cerebral palsy. Pediatrics. 2002;110:e5.
Hadden, KL. Pain in children with cerebral palsy:
common triggers and expressive behaviors.
Pain. 2002 Sep;99(1-2):281-8.
Bibliography
Krakovsky et al. Functional changes in children,
adolescents, and young adults with cerebral
palsy. Res Dev Disabil. Jun 10, 2006;
Persson-Bunke, M. Windswept hip deformity in
children with cerebral palsy. J Pediatric
Orthopedic, Part B. 2006 Sep;15(5):335-8.
Pin TW. Effectiveness of static weight-bearing
exercises in children with cerebral palsy.
PEDIATR PHYS THER. 2007;19:62-73.
Bibliography
Schwartz, Lauren; Engel, Joyce M. and Mark P.
Jensen MP. Pain in persons with cerebral palsy.
Archives of Physical Medicine and
Rehabilitation. Oct 1999; 80:10 (1243-1246).
Ward K. Low magnitude mechanical loading is
osteogenic in children with disabling conditions.
Journal of Bone and Mineral Research.
2004;19:360-369.
Children with Severe / Profound
Challenges
Adapted from
Margo Prim Haynes, PT, DPT, MA, PCS
Pam Cannon PT