Children with Severe / Profound Challenges Margo Prim Haynes PT, DPT, MA, PCS Mary Rose Franjoine...
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Transcript of Children with Severe / Profound Challenges Margo Prim Haynes PT, DPT, MA, PCS Mary Rose Franjoine...
Children with Severe / Profound Children with Severe / Profound Challenges Challenges
Margo Prim Haynes PT, DPT, MA, PCSMargo Prim Haynes PT, DPT, MA, PCS
Mary Rose Franjoine PT, DPT, MS, PCSMary Rose Franjoine PT, DPT, MS, PCS
OverviewOverview
Clinical Diagnostic CategoriesClinical Diagnostic Categories
NDTA Enablement Model: Functional NDTA Enablement Model: Functional Integrity/ Impairments, Ineffective and Integrity/ Impairments, Ineffective and Effective Posture and Movement, Activities Effective Posture and Movement, Activities and Activities Limitation, Participation and and Activities Limitation, Participation and Participation limitationParticipation limitation
TreatmentTreatment
Video / PicturesVideo / Pictures
NDT Enablement Classification NDT Enablement Classification Model of Health and DisabilityModel of Health and Disability
DimensionDimension Functional DomainFunctional Domain Disability DomainDisability Domain
A. Body structure & A. Body structure & functionsfunctions
Structural & Structural & functional integrityfunctional integrity
ImpairmentsImpairments
A.A.PrimaryPrimary
B.B.SecondarySecondary
B. Motor functionsB. Motor functions Effective posture & Effective posture & movementmovement
Ineffective posture & Ineffective posture & movementmovement
C. Individual C. Individual functionsfunctions
Functional activitiesFunctional activities Functional activity Functional activity limitationslimitations
D. Social functionsD. Social functions ParticipationParticipation Participation Participation restrictionrestriction
+ Domains -
Dim
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From: NDT Approach Theoretical Foundations & Principles of Clinical Practice, Table 2.1 pg. 82
Clinical Diagnostic CriteriaClinical Diagnostic Criteria
Medical Diagnosis:Medical Diagnosis:
IQ ranges:IQ ranges:
– Severe : 40 – 25Severe : 40 – 25
– Profound: Less than 25 Profound: Less than 25
Educational Abilities:Educational Abilities:
– Self Contained Classrooms: TrainableSelf Contained Classrooms: Trainable
Motor Abilities:Motor Abilities:
NDT Enablement Classification Model of Health and Disability
DimensionDimension Functional DomainFunctional Domain Disability DomainDisability Domain
A. Body structure & A. Body structure & functionsfunctions
Structural & Structural & functional integrityfunctional integrity
ImpairmentsImpairments
A.A.PrimaryPrimary
B.B.SecondarySecondary
B. Motor functionsB. Motor functions Effective posture & Effective posture & movementmovement
Ineffective posture & Ineffective posture & movementmovement
C. Individual C. Individual functionsfunctions
Functional activitiesFunctional activities Functional activity Functional activity limitationslimitations
D. Social functionsD. Social functions ParticipationParticipation Participation Participation restrictionrestriction
+ Domains -
Dim
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From: NDT Approach Theoretical Foundations & Principles of Clinical Practice, Table 2.1 pg. 82
Disability Domains (Categories)Disability Domains (Categories)
Severe / Profound Motor Problems & Mild / Severe / Profound Motor Problems & Mild / Typical Cognitive Difficulties Typical Cognitive Difficulties
Severe / Profound Motor Problems & Severe / Profound Motor Problems & Severe / Profound Cognitive Limitations Severe / Profound Cognitive Limitations
Fair Motor Difficulties & Severe / Profound Fair Motor Difficulties & Severe / Profound Cognitive LimitationsCognitive Limitations
Children with Severe / Profound Children with Severe / Profound Motor and/or Mental Functional Motor and/or Mental Functional
Activities / Limitations and Activities / Limitations and Participation / RestrictionsParticipation / Restrictions
2009 M R Franjoine & M P Haynes 9
NDT Enablement Classification NDT Enablement Classification Model of Health and DisabilityModel of Health and Disability
DimensionDimension Functional DomainFunctional Domain Disability DomainDisability Domain
A. Body structure & A. Body structure & functionsfunctions
Structural & Structural & functional integrityfunctional integrity
ImpairmentsImpairments
A.A.PrimaryPrimary
B.B.SecondarySecondary
B. Motor functionsB. Motor functions Effective posture & Effective posture & movementmovement
Ineffective posture & Ineffective posture & movementmovement
C. Individual C. Individual functionsfunctions
Functional activitiesFunctional activities Functional activity Functional activity limitationslimitations
D. Social functionsD. Social functions ParticipationParticipation Participation Participation restrictionrestriction
+ Domains -
Dim
ensi
ons
From: NDT Approach Theoretical Foundations & Principles of Clinical Practice, Table 2.1 pg. 82
Body Structure & Body FunctionBody Structure & Body Function
Global DamageGlobal Damage
– Unknown prenatal conditionUnknown prenatal condition
– AsphyxiaAsphyxia
– PrematurityPrematurityIntracranial bleeds, infection, medical Intracranial bleeds, infection, medical conditionsconditions
Cognition ChallengesCognition Challenges
Cries: may be only means of Cries: may be only means of communicationcommunication
Motivation: (Self- /Regulation) ??? Motivation: (Self- /Regulation) ???
Behavior: Self abusive or destructive Behavior: Self abusive or destructive
Bonding difficulty: poor facial expression & Bonding difficulty: poor facial expression & lack of eye contact lack of eye contact
Startle Response: Difficulty adjusting to Startle Response: Difficulty adjusting to the world around them the world around them
VideosVideos
Neuromuscular SystemNeuromuscular System
Impaired Muscle ActivationImpaired Muscle Activation
Co-activation from excessive to moderateCo-activation from excessive to moderate
Impaired muscle synergies: Stereotyped Impaired muscle synergies: Stereotyped patterns of movementpatterns of movement
Latency in initiating, sustaining and Latency in initiating, sustaining and terminating postural muscle activity terminating postural muscle activity
Neuromuscular SystemNeuromuscular System
Impairment of Timing and Sequencing:Impairment of Timing and Sequencing:
Insufficient Force Generation (muscle Insufficient Force Generation (muscle strength): Postural and Movement strength): Postural and Movement MusclesMuscles
Sensory SystemSensory System
Somatosensory Issues: Proprioception / Somatosensory Issues: Proprioception / Tactile InformationTactile Information
VestibularVestibular
Visual Issues: Visual Issues:
Auditory Issues: Auditory Issues:
Musculoskeletal SystemMusculoskeletal System
High Risk for…High Risk for…
ContracturesContractures
Hip subluxations /dislocationsHip subluxations /dislocations
Shoulder dislocationsShoulder dislocations
Scoliosis / excessive lordosisScoliosis / excessive lordosis
Bone Growth Impaired Bone Growth Impaired
Cardiopulmonary / Respiratory Cardiopulmonary / Respiratory System System
Cardiovascular Disease Cardiovascular Disease (Decoufle)(Decoufle)
Cardiorespiratory enduranceCardiorespiratory endurance
Other Systems Other Systems
Gastrointestional (GI) SystemGastrointestional (GI) System
Integumentary SystemIntegumentary System
2009 M R Franjoine & M P Haynes 19
NDT Enablement Classification NDT Enablement Classification Model of Health and DisabilityModel of Health and Disability
DimensionDimension Functional DomainFunctional Domain Disability DomainDisability Domain
A. Body structure & A. Body structure & functionsfunctions
Structural & Structural & functional integrityfunctional integrity
ImpairmentsImpairments
A.A.PrimaryPrimary
B.B.SecondarySecondary
B. Motor functionsB. Motor functions Effective posture & Effective posture & movementmovement
Ineffective posture & Ineffective posture & movementmovement
C. Individual C. Individual functionsfunctions
Functional activitiesFunctional activities Functional activity Functional activity limitationslimitations
D. Social functionsD. Social functions ParticipationParticipation Participation Participation restrictionrestriction
+ Domains -
Dim
ensi
ons
From: NDT Approach Theoretical Foundations & Principles of Clinical Practice, Table 2.1 pg. 82
Posture and MovementPosture and Movement
General Characteristics: PostureGeneral Characteristics: Posture
Postural tone = varies from high to Postural tone = varies from high to mediummedium
Asymmetry = poor midline orientationAsymmetry = poor midline orientation
Alignment: UE= may remain in high-low Alignment: UE= may remain in high-low guard positionguard position
Alignment: LE = may see" windswept” legsAlignment: LE = may see" windswept” legs
Pictures
Posture and MovementPosture and Movement
General Movement CharacteristicsGeneral Movement Characteristics
Movement options limited Movement options limited
Which comes first: lack of motivation or Which comes first: lack of motivation or unsuccessful attempts to move ???unsuccessful attempts to move ???
Feeding ChallengesFeeding ChallengesFeeding Difficulty Feeding Difficulty – P & M: P & M: – ImpairmentImpairmentNutritionNutrition– P & M: Physical Traits of MalnutritionP & M: Physical Traits of Malnutrition– Impairment: Blood chemistry Impairment: Blood chemistry AspirationAspiration– P & M:P & M: – Impairment:Impairment:PneumoniaPneumonia
2009 M R Franjoine & M P Haynes 24
NDT Enablement Classification NDT Enablement Classification Model of Health and DisabilityModel of Health and Disability
DimensionDimension Functional DomainFunctional Domain Disability DomainDisability Domain
A. Body structure & A. Body structure & functionsfunctions
Structural & Structural & functional integrityfunctional integrity
ImpairmentsImpairments
A.A.PrimaryPrimary
B.B.SecondarySecondary
B. Motor functionsB. Motor functions Effective posture & Effective posture & movementmovement
Ineffective posture & Ineffective posture & movementmovement
C. Individual C. Individual functionsfunctions
Functional activitiesFunctional activities Functional activity Functional activity limitationslimitations
D. Social functionsD. Social functions ParticipationParticipation Participation Participation restrictionrestriction
+ Domains -
Dim
ensi
ons
From: NDT Approach Theoretical Foundations & Principles of Clinical Practice, Table 2.1 pg. 82
Activities & Activities Limitation Activities & Activities Limitation Locomotor Skills Locomotor Skills Non Ambulatory Non Ambulatory
CommunicatesCommunicates Limited Communication Limited Communication usually Non Verbalusually Non Verbal
Basic ADL’s Basic ADL’s Totally dependent on Totally dependent on caregivers for all ADLscaregivers for all ADLs
2009 M R Franjoine & M P Haynes 26
NDT Enablement Classification NDT Enablement Classification Model of Health and DisabilityModel of Health and Disability
DimensionDimension Functional DomainFunctional Domain Disability DomainDisability Domain
A. Body structure & A. Body structure & functionsfunctions
Structural & Structural & functional integrityfunctional integrity
ImpairmentsImpairments
A.A.PrimaryPrimary
B.B.SecondarySecondary
B. Motor functionsB. Motor functions Effective posture & Effective posture & movementmovement
Ineffective posture & Ineffective posture & movementmovement
C. Individual C. Individual functionsfunctions
Functional activitiesFunctional activities Functional activity Functional activity limitationslimitations
D. Social functionsD. Social functions ParticipationParticipation Participation Participation restrictionrestriction
+ Domains -
Dim
ensi
ons
From: NDT Approach Theoretical Foundations & Principles of Clinical Practice, Table 2.1 pg. 82
Participation & Participation Participation & Participation LimitationsLimitations
Participation:Participation:
Equipment supports children out in Equipment supports children out in community with caregiverscommunity with caregivers
Participation Limitations: Participation Limitations:
Difficult for families to get children out of Difficult for families to get children out of the home the home
Problem intensifies as Caregivers AgeProblem intensifies as Caregivers Age
FinancesFinances
TreatmentTreatment
Think Think
FunctionFunction
Equipment Critical for Child and FamilyEquipment Critical for Child and Family
– Seating SystemsSeating Systems
– StandersStanders
Essential for Child’s Health and Well BeingEssential for Child’s Health and Well Being
Prevention of Secondary ImpairmentsPrevention of Secondary Impairments
Treatment: ProsTreatment: Pros
Positively Influences Quality of Life:Positively Influences Quality of Life:– Hygiene and Ease of Care by CaregiversHygiene and Ease of Care by Caregivers
– Respiratory functionRespiratory function
– Cardiac functionCardiac function
– Caregiver and Child Bonding / Caregiver and Child Bonding / InteractionsInteractions
– Childs Personality Childs Personality
– Comfort of Child and Play Options Comfort of Child and Play Options
Treatment: ProsTreatment: Pros
Decreases medical complications:Decreases medical complications: – IllnessIllness
– ContracturesContractures
– Pressure areasPressure areas
Treatment Concerns Treatment Concerns
Therapist perspective:Therapist perspective:Behavior: Cries, Behavior: Cries, Motivation: Motivation: Progress Slow:Progress Slow:Feedback: Difficult to ReadFeedback: Difficult to ReadFrequent Illness: Frequent Missed Frequent Illness: Frequent Missed Appointments Appointments Medical Issues: Medical Issues:
Treatment VideosTreatment Videos
Medical Issues Medical Issues
Team Approach CriticalTeam Approach Critical
Nutritional NeedsNutritional Needs
Seizure Medications Seizure Medications
Spasticity ManagementSpasticity Management
Surgical IssuesSurgical Issues
Pain ManagementPain Management
BibliographyBibliography
Caulton JM. A randomised controlled trial of Caulton JM. A randomised controlled trial of standing programme on bone mineral density in standing programme on bone mineral density in non-ambulant children with cerebral palsy. non-ambulant children with cerebral palsy. Arch Arch Dis ChildDis Child. 2004;89:131-135.. 2004;89:131-135.Decoufle P and Autry A. Increased mortality in Decoufle P and Autry A. Increased mortality in children and adolescents with developmental children and adolescents with developmental disabilities. disabilities. Paediatric and Perinatal Paediatric and Perinatal Epidermiology.Epidermiology.2002;16:375-382.2002;16:375-382.Gajdosik, CG, Cicirello N. Secondary Conditions Gajdosik, CG, Cicirello N. Secondary Conditions of the Musculoskeletal System in Adolescents of the Musculoskeletal System in Adolescents and Adults with Cerebral Palsy. and Adults with Cerebral Palsy. Physical & Physical & Occupational Therapy in Pediatrics.Occupational Therapy in Pediatrics. 2001;21(4):49-68 2001;21(4):49-68
BibliographyBibliography
Gudjonsdottir B, Mercer VS. Effects of a Gudjonsdottir B, Mercer VS. Effects of a dynamic versus a static prone stander on bone dynamic versus a static prone stander on bone mineral density and behavior in four children mineral density and behavior in four children with severe cerebral palsy. with severe cerebral palsy. PEDIATR PHYS PEDIATR PHYS THERTHER. 2002;14:38-46.. 2002;14:38-46.Henderson RC. Bone density and metabolism in Henderson RC. Bone density and metabolism in children and adolescents with moderate to children and adolescents with moderate to severe cerebral palsy. severe cerebral palsy. PediatricsPediatrics. 2002;110:e5.. 2002;110:e5.Hadden, KL. Pain in children with cerebral palsy: Hadden, KL. Pain in children with cerebral palsy: common triggers and expressive behaviors. common triggers and expressive behaviors. Pain.Pain. 2002 Sep;99(1-2):281-8. 2002 Sep;99(1-2):281-8.
BibliographyBibliography
Krakovsky et al. Functional changes in children, Krakovsky et al. Functional changes in children, adolescents, and young adults with cerebral adolescents, and young adults with cerebral palsy. palsy. Res Dev DisabilRes Dev Disabil. Jun 10, 2006;. Jun 10, 2006;
Persson-Bunke, M. Windswept hip deformity in Persson-Bunke, M. Windswept hip deformity in children with cerebral palsy.children with cerebral palsy. J Pediatric J Pediatric OrthopedicOrthopedic, Part B. 2006 Sep;15(5):335-8. , Part B. 2006 Sep;15(5):335-8.
Pin TW. Effectiveness of static weight-bearing Pin TW. Effectiveness of static weight-bearing exercises in children with cerebral palsy. exercises in children with cerebral palsy. PEDIATR PHYS THERPEDIATR PHYS THER. 2007;19:62-73.. 2007;19:62-73.
BibliographyBibliography
Schwartz, Lauren; Engel, Joyce M. and Mark P. Schwartz, Lauren; Engel, Joyce M. and Mark P. Jensen MP. Pain in persons with cerebral palsy. Jensen MP. Pain in persons with cerebral palsy. Archives of Physical Medicine and Archives of Physical Medicine and Rehabilitation. Oct 1999; 80:10 (1243-1246). Rehabilitation. Oct 1999; 80:10 (1243-1246). Ward K. Low magnitude mechanical loading is Ward K. Low magnitude mechanical loading is osteogenic in children with disabling conditions. osteogenic in children with disabling conditions. Journal of Bone and Mineral ResearchJournal of Bone and Mineral Research. . 2004;19:360-369.2004;19:360-369.
Children with Severe / Profound Children with Severe / Profound ChallengesChallenges
Adapted from Adapted from
Margo Prim Haynes, PT, DPT, MA, PCS Margo Prim Haynes, PT, DPT, MA, PCS Pam Cannon PT Pam Cannon PT