You steadily, and to crawl. Mrs. Jones is

You are an infant development consultant visiting the Joneses, a First Nations family living in North Vancouver. Two-year Johnny, the youngest of four children, was born prematurely and has spastic diplegia. He has not yet been referred to an orthopedic specialist. He does not sit well or crawl, but loves to pull to stand and walks around the furniture on his toes. His mother is angry because his physiotherapist has recommended that he be discouraged from walking until he can walk more “normally”. She is emphasizing exercises to help him to sit steadily, and to crawl. Mrs. Jones is proud that her son has gained the skill of walking, and has no intention of stopping him.In your paper, describe five possible ways to help this situation under the following headings:1.Helping Mrs. Jones understand the physiotherapist’s point of viewIn the above mentioned situation, the kid has spastic diplegia which is a type of Cerebral Palsy, which is because of harm in motor cortex because of which muscles seem hardened and tight. Johnny’s both legs seem to be influenced by the same. The mother comes from a First Nations community who (generally) do not believe in western medicine. They have traditional healing practices due to which mother may be emphasizing on exercises for Johnny to sit steadily.  The mother has to be explained the Physiotherapist’s way to deal with treatment, as well as his view by giving her information clearly, this information must be given by a counselling therapist who can empathetic at the same time objective. She needs to understand that the treatment has more to do with tending to the physical wellspring of damage to the tissues and muscles. Physiotherapist  intervention strategies for children with spastic diplegia may vary however here the attention is on assessing the influence of motor improvement, alongside Johnny’s physical limits and restrictions. In this case the physiotherapist is trying to understand the movement patterns and the movement strategies. I agree, for parents walking and standing is so much more important that they forget the adverse effects of forcing it in play. In this scenario the physiotherapist might believe that because of tone-difference Johnny is taking time to walk. But, the parents forget that  to motivate the child to start standing/walking if he has short muscles tendons may be more pathological. Therefore, a specific time period for normal development should be given. Moreover, the  mother also needs to realize that the physiotherapist needs to get a feedback of  how the kid is getting along at home and afterward judge the adequacy of his proposals. Later if there is no benefit the kid’s program could be revised.2.Suggesting possible ways the physiotherapist might make Johnny’s motor program more meaningful to his mother-The mother needs to be realized that there is no standardized approach to spasticity management of cerebral palsy.  In this scenario, Johnny’s legs are more affected than the arms. Therefore, he is able to pull to stand and hold objects and walk around furniture. The physiotherapist needs to make a proper intervention program about Johnny and explain it to the mother. She needs to be explained the basis of Spastic Diplegia and how forceful activities might be harmful for him for future. The physiotherapist needs to explain that  the complex interactions between the brain and the spinal cord nerves, muscles, tendons, ligaments, bones and joints can be inherently complicated. Forced movement can also lead to cause problems, such as muscle pain or spasms, trouble moving in bed, difficulty with transfers, poor seating position, impaired ability to stand and walk, dystonic posturing muscle, contracture leading to joint deformity, bony deformation, joint subluxation or dislocation and diminished functional independence. The physiotherapist needs to provide all the above information however, in simpler terms in which the mother can understand; more importantly, the mother must be taught to track the child development and benefits of the treatment so as to understand the impact of the treatment fully.3. Appliances or equipment that might be helpful- “The broad term assistive technology, sometimes called “AT,” is used to describe a variety of devices and services that help children with disabilities to be included in a full range of social experiences and to function more independently.  For example: using an enlarged spoon handle to compensate for a weak grasp, as commonplace as a wheelchair to promote mobility within the environment”.Other equipments could be:Cloth hammocks can help in keeping the child in a flexed posture.Old stools and boxes can be adapted to provide support during sitting.parallel bars can be constructed with logs of wood to help gait training.Specially designed shoes,calipers may be required to provide stability to the joints for Johnny who is learning to stand and walkLightweight splints may at times be required to maintain normal postures.Adaptive Tricycle for could be used strengthening anti-gravity muscles, improving eye-hand coordination and self-esteem.Eventually, Stool scooters might be used for assisting with movement and promoing stabilityAdaptive dressing aidsLong handle bath sponges and brushesAdaptive bath benchesRaised or lowered toilet seatsSafety grab bars in roomsWeighted silverware, cups, bowls and platesReaching aidsNon-slip matsPull-out tables next to bed, couch, chairsBed positioning aids and pillows4. Measures that the orthopedic specialist might implement to improve Johnny’s potential for ambulation.-Many of the ways of the orthopaedic specialist might be similar to those of the physical therapist. However, the orthopedic specialist will focus more on the diagnosis and the functional skills of Johnny. The diagnosis by the orthopedic specialist could be confirmed with history taking, physical examination, conducting and reviewing specific investigations together with other members of the team. The specialist might produce a comprehensive treatment plan for Johnny which may include: continued observation, recommendations for bracing (orthotics), recommendations for interventions such as botulinum toxin injections which decreases in muscle stiffness, serial casting, or surgical intervention involving the bones and muscles, Surgery for bones and muscles, Postoperative follow-up in the clinic, participate in hip surveillance, refer to a Gait Lab where a detailed 3D testing of how a child walks will be done and also referral  to other specialists when necessary 5. Activities that you might carry out, using suggestions from the physiotherapist and the occupational therapist.The activities for Johnny could be -Crawl using a commando-type movement (pulling themselves around by their forearms with legs dragging behind)Try sitting with head support, sitting cross-legged, and using child-size chairs to help develop good sitting postures and avoid hip and gait problemsPrefer sitting in a W position.As Johnny is 2 years old and is using pulling to a stand. Regularly standing an hour or two a day can improve balance, and stimulate the normal development of bones and joints in the legs.Play games that encourage crawling. Weight-bearing on one hand or both hands and on legs is beneficial for developing good muscle tone. Placing toys at some distance so Johnny has to reach out to pick them or crawl over to fetch them. Making sure the toys are stimulating in color, shape, texture and smell, as well as easy to play with. As Johnny is into toe walking to prevent that ankle braces can be used. Aqua-therapy might be helpful like swimming. It helps in improving flexibility.Swinging can also be quite helpful for the child. If your child is not able to sit properly, hold him and swing him slowly.Play games with colorful balls to develop good coordination and motor skills. Teach him to kick and throw the ball which would be a good exercise for both hands and legs.References:Cerebral palsy. (2016, August 25). Retrieved January 25, 2018, from https://www.mayoclinic.org/diseases-conditions/cerebral-palsy/diagnosis-treatment/drc-20354001.Das, P. (n.d.). Cerebral Palsy Physiotherapy. Retrieved January 25, 2018, from https://www.physiotherapy-treatment.com/cerebral-palsy-physiotherapy.html Green, C., Cooperman, D. R., Gara, S. E., & Proch, C. (2014). Management of Spasticity in Children with Cerebral Palsy. Clinical Evaluation and Management of Spasticity, 269-286. doi:10.1385/1-59259-092-6:269Miller, F. (2017). Hip Problems in Children with Cerebral Palsy: An Overview. Cerebral Palsy, 1-7. doi:10.1007/978-3-319-50592-3_124-1M. (2018, January 25). When did you make your child stand and walk? Retrieved January 25, 2018, from https://www.inspire.com/groups/cerebral-palsy/discussion/when-did-you-make-your-child-stand-and-walk/?ga=freshenMartin,S. (2006). Road to independence skills guideline (Teaching motor skills to children with cerebral palsy and similar movement disorders: A Guide for Parents And Professionals).Woodbine HouseMartin S. (2006) Happy baby in back lying, Helping your child to sit, Up onto hands and knees, and Supporting your child in standing. In Teaching motor skills to children with cerebral palsy. Bethseda, MA : Woodbine House Geralis, Elaine(1998) Early intervention and special education (Children with cerebral palsy: a parent’s guide).Woodbine House Kurtz, Lisa A(2007) Physical Therapy and Occupational Therapy (Children with disabilities). Paul H. Brookes Pub

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