PHYSIOTHERAPY IN EDUCATIONAL SETTINGS FOR CHILDREN WITH NEUROMUSCULAR DISORDERS
Presented by Robyn Sheppard, Physiotherapist
Physiotherapy is mainly consultative, working with parents in the home environment; Class Teachers and Aides in the school environment.
Management, not treatment.
There is no recipe – problems arise and then solved.
– Intense 1:1 therapy is not necessary
1.Stretches to muscles in danger of becoming tight should be done daily. Usually this is homes based; in some instances it becomes school based or a program in addition to the home program.
2.Maintenance and Encouragement Activity –
(i) General involvement in all activities, morning aerobics groups.
Children have their own fatigue level, will have a short rest and continue, when they tire.
3.Swimming – weekly swimming program for boys from local schools.
(i) Water confidence – swimming safety.
(ii) Maintenance of strength and independence.
(iii) Peer support.
(iv) Support group for parents.
(v) If run by Physiotherapist, the opportunity in on-threatening environment for questions.
(vi) Ideal opportunity for monitoring progress.
(vii) Encouragement of breathing exercises.
4.General function in the School –
(i) Adapted physical education programs.
(ii) Classroom seating (position).
(iii) Chair and table heights – as boys weaken, chair and table height adjustment to maintain independence.
(iv) Floor activities/classroom mobility. Chairs to help getting up from the floor, preceding others out of the classroom or staying until the last.
(v) Advice in conjunction with O.T.’s – ramps, toilets.
5.General Principles – (i) Don’t help (more help given – greater weakness).
(ii) Give them time to complete the task.
(iii) Encourage games and recreation pursuits they will be able to maintain, ie. table games, commuter games, graphics.
(iv) Lifting advice.
(v) Advice to parents re types of mobility aids (wheelchair or buggy) through wheelchair clinic or another P.A.D.P. outlet.
Difficult for the boys. There is a gradual transition to spending more time in wheelchair.
1.More time in wheelchair increases chances of going off their feet more quickly.
Mobility versus Socialization issue.
Mobility versus Safety issue.
This needs to be a joint decision between the parents, teachers, therapist and child. Chairs at lunch times,walking mornings,wheelchair in the afternoon.
2.Wheelchair access to all part of the school, on camps, and excursions.
3.Family support and opportunity to talk of needed. May be behavioural difficulties. Muscular Dystrophy Association is a good resource.
4.Therapy may look at caliper walking. It is an option but not always successful in local school. Some families have utilised calipers at home.
5.As with walking stage, exercises maintaining strength, mobility, lung expansion, introducing more careful monitoring of back and exercises maintaining ability to weight transfer in sitting, (tilt board etc.).
6.Problem-solving – mobility, access, etc. Transfer techniques.
Continue with appropriate areas from walking – transition stage.
1.Standing program – tilt table. This is to give a prolonged stretch to hip flexions, hamstrings, and calves.
2. Tilt board exercises.
3. Tables heights and position in chairs.
4. Rotation of control boxes on motorised chairs.
5. In conjunction with O.T. – ramps, wheelchair restraints and other transport considerations.
6. Lifting, transferring techniques.
7. Pressure care for bottoms and circulatory problems.
8. Wheelchair sports, maintenance.
1. Management problems with mobility and coping with deterioration.
2. Do not have all answers but we can try to help.
3. Praise and emphasize all the positives. Encourage activities they will be able to continue and success in, ie. art graphics, reading, computer options, table games. Be guided by the boys’ strengths.