7/31/2019 Early Identification and Treatment Techniques in Babies With
1/47
Early Identification and
Treatment For Babies with High
Risk of Neurological Impairment
By
7/31/2019 Early Identification and Treatment Techniques in Babies With
2/47
Aim
To understand the importance of primitivereflex in early identification and to know
the intervention techniques
7/31/2019 Early Identification and Treatment Techniques in Babies With
3/47
Objectives
To Know the Incidence level.
To know the Developmental Profile. To know about Primitive reflexes.
To know the Pointers to CNS Insult.
To understand the Treatment principles.
7/31/2019 Early Identification and Treatment Techniques in Babies With
4/47
Incidence
Children with neurological impairment is not completelypreventable as in other childhood diseases likePoliomyelitis, Smallpox etc.
The incidence of Cerebral Palsy in undeveloped areas ofthe world, where infant mortality is very high, is the sameas in northern Europe, where infant mortality is thelowest.
It also explains why modern obstetrical care, includingmonitoring and a high rate of Cesarian section, haslowered infant mortality rates but not the incidence ofcerebral palsy.
This gives a message that preventing completely is likelynot possible.
7/31/2019 Early Identification and Treatment Techniques in Babies With
5/47
Incidence
One important reason again goes to moderndevelopments in Medicine, where prematurebabies and high risk babies are now able tosurvive, with some babies compromised withtheir nervous system.
Also it throws light on the tunnel vision ofhypoxic brain damage as a primary reason forbrain injury.
There are many genetic causes stillundiscovered.
7/31/2019 Early Identification and Treatment Techniques in Babies With
6/47
7/31/2019 Early Identification and Treatment Techniques in Babies With
7/47
Neuroanatomi-
cal structures
Postural Reflex
Development
Motor
Development
Cortex EquilibriumReactions
Voluntary Control
Midbrain Righting
Reactions
Excitatory &
Inhibitory Control
Brainstem/
Spinal Cord
Primitive
Reflexes
Stretch Reflexes
7/31/2019 Early Identification and Treatment Techniques in Babies With
8/47
The Developmental Profile
Sophisticated Cortex
Primitive Cortex
Early Cortex Initial Cortex
Mid Brain
Pons Medulla and spinal Cord
7/31/2019 Early Identification and Treatment Techniques in Babies With
9/47
The Developmental Profile
Sophisticated cortex Using a leg in a skilled
role which is consistent
with the dominant hemi
Primitive Cortex Walking and running incross patterns
Early Cortex Walking with arms freed
from the primary
balance role
Initial Cortex Walking with arms used
in a primary balance role
7/31/2019 Early Identification and Treatment Techniques in Babies With
10/47
The Developmental Profile
Midbrain Creeping on hands and
knees (cross pattern)
Pons Crawling in the prone
position(cross pattern)
Medulla and cord Movements controlled
by primitive reflexes
7/31/2019 Early Identification and Treatment Techniques in Babies With
11/47
Role of Primitive Reflex in
Development The above profile tells us that when the baby is born the
CNS is not fully matured. The tone, posture andmovements are under the unopposed control of thelower centers of the CNS.
The baby is influenced by primitive/postural reflexes. The body responds mechanically and automatically to a
no. of influences, such as head or body position.
The baby at birth is motorically at a primitive, crude level,a reflex level.
The movements are automatic with no component ofvoluntary control or meaningful direction.
7/31/2019 Early Identification and Treatment Techniques in Babies With
12/47
7/31/2019 Early Identification and Treatment Techniques in Babies With
13/47
Early Identification
Can be made Clinically examining the primitive reflexes
Going by the development of the Baby
With C.T (computerized Tomography) Scans and
M.R.I studies.
All the above has to be matched with the
prenatal and birth histroy.
7/31/2019 Early Identification and Treatment Techniques in Babies With
14/47
Early Identification
The evaluation of pathological motordevelopment had remained the source ofdiagnosis in the early 80s.
A standardized classification for the varioussymptoms and neuromuscular reactivity had notbeen available.
It was Vojta who developed a standardized
diagnostic procedure through which it is possibleto detect the development of neurologicalimpairment in early stages of life.
7/31/2019 Early Identification and Treatment Techniques in Babies With
15/47
Early Identification-VOJTA BASIS
The common basis for classification,according to vojta, is the ability of thecentral nervous system to react
appropriately to postural changes. For this purposes, vojta has chosen 7
postural reflexes that inform us about thequality and extend of neurologicaldevelopment from the newborn period untilupright coordinated walking is possible:
7/31/2019 Early Identification and Treatment Techniques in Babies With
16/47
Early Identification-Vojtas Reaction
The traction reaction
The landau reaction
The axillary suspension reaction
The vojtas side-tilt reaction
The collis horizontal suspension reaction
The peipers and isberts verticalsuspension reaction
The collis vertical suspension reaction
7/31/2019 Early Identification and Treatment Techniques in Babies With
17/47
Early Identification
One may not diagnose cerebral palsy in the first6 months of life. However with the help ofpostural reflexes, it is possible to diagnose areduction of the ability to regulate automatically
the bodys position in space. Vojta has created a diagnostic category for this
inability: disturbance of central coordination.
This is not an etiological diagnosis.
Neurological impairment may develop from adisturbance of central coordination, but notnecessarily.
7/31/2019 Early Identification and Treatment Techniques in Babies With
18/47
Early Identification
It is always noted the same stereotypicalabnormal patterns in a case of disturbedcentral coordination.
Such pattern are similar to the fixedpathological patterns of fully developedchildren with cerebral palsy.
Eg. Rigid extension or rigid flexion of thearms with retraction of shoulders andclenched fists;
7/31/2019 Early Identification and Treatment Techniques in Babies With
19/47
Early Identification
Opisthotonos or extreme hypotonicity of
the trunk.
Rigid extension combined with adduction
of the legs.
7/31/2019 Early Identification and Treatment Techniques in Babies With
20/47
Baby with Normal patterns and
Stereotypical patterns
7/31/2019 Early Identification and Treatment Techniques in Babies With
21/47
Early Identification
Grading a disturbance of central
coordination has proven very important for
clinical practice.
The gradation is based on the thesis that
the more the brains coordination ability is
disturbed, the greater the number of
abnormal postural reactions will be.
7/31/2019 Early Identification and Treatment Techniques in Babies With
22/47
Pointers to CNS Insult
Grading
Central coordination
Mildest 1,2 or 3
Reactions abnormal
Mild 4 0r 5 reactions
abnormal
Moderate 6 or 7
Reactions abnormal
Severe- more than seven
Reactions abnormal
7/31/2019 Early Identification and Treatment Techniques in Babies With
23/47
Pointers to CNS Insult
This understanding will help us to know how to
identify a new born baby with high risk.
Further as their basic function is survival, if they
are suppressed or absent it is a pointer to aninsult to the CNS.
These reflexes has to be integrated at a certain
period of time, if they are present beyond the
normal time it again is a pointer to insult to the
CNS.
7/31/2019 Early Identification and Treatment Techniques in Babies With
24/47
Early Intervention
Early intervention aims at giving normal sensory-
motor feedback for normal development.
Persistence of primitive reflexes blocks the
development of higher level reactions. So early intervention techniques focuses on
inhibiting abnormal reflexes and facilitating
normal reactions.
Which can be done with the activities of daily
living.
7/31/2019 Early Identification and Treatment Techniques in Babies With
25/47
Early Intervention Techniques
Positioning Nest Positioning
Hammock
Handling Lifting Carrying
Feeding
Dressing
Sensori-motor Intervention Lap Treatment
Vestibular Stimulation
7/31/2019 Early Identification and Treatment Techniques in Babies With
26/47
Positioning
Proper Positioning of the child is essential
to ensure the appropriate environment
which enhances the psychomotor and
sensori-motor development.
The child can be positioned in supine,
prone and side lying.
7/31/2019 Early Identification and Treatment Techniques in Babies With
27/47
Positioning Goals
FLEXION
To facilitate midline orientation & develop bodyimage.
To endorse ventral muscle activity. Facilitate stability in longitudinal axis of the body.
Enable and stimulate activity of diaphragm.
Facilitate respiration and feeding reactions.
Promote spontaneous activity of the child and togive him the chance to practice and strengthenphysiological postural and movement patterns.
7/31/2019 Early Identification and Treatment Techniques in Babies With
28/47
Positioning in different positions
In Supine, a nest is build with the help of atowel or a u-shaped pillows, the baby can
safely and comfortably be brought into
flexion. The child feels safe as she issafely surrounded by comfortable material.
She can feel her body and relate to her
dimensions.
7/31/2019 Early Identification and Treatment Techniques in Babies With
29/47
7/31/2019 Early Identification and Treatment Techniques in Babies With
30/47
Positioning in Side lying
In side lying, the pillow/towel snuggleslike a half moon against the back, between
legs and against the chest. This way, the
child experiences containment and thussecurity and stabilization in a flexed
position.
7/31/2019 Early Identification and Treatment Techniques in Babies With
31/47
Positioning in Prone Lying
In prone a towel is rolled and placed under
the sternum to avoid retraction of the arms
and to offer the possibility of a slight
weight-bearing on the forearms.
7/31/2019 Early Identification and Treatment Techniques in Babies With
32/47
HANDLING
Handling is the carry-over from treatmentto everyday life. While being handled i.e,
being dressed, undressed, picked up,carried, fed etc., the child has to adjust tobeing moved.
Depending on the degree of theimpairment ,the child can either participateor is totally dependent on the caretaker. .
7/31/2019 Early Identification and Treatment Techniques in Babies With
33/47
Handling
Handling will have a direct influence on
tone and movement. Hence ,it is crucial
that handling is related to treatment;
To facilitate active and normal participation.
To inhibit abnormal reactions and responses tobeing handled.
7/31/2019 Early Identification and Treatment Techniques in Babies With
34/47
Child carried with minimal support
7/31/2019 Early Identification and Treatment Techniques in Babies With
35/47
Promoting Sitting with Head in
Midline
7/31/2019 Early Identification and Treatment Techniques in Babies With
36/47
SENSORIMOTOR
INTERVENTION
The foremost goals of sensorimotor intervention
are to help the child deal with mass of different,
strange and often unpleasant, if not frighteningstimuli.
To develop the best possible intervention
between child and parents/ caregivers as well as
to offer the opportunity of experiencing normal
postural and movement patterns.
7/31/2019 Early Identification and Treatment Techniques in Babies With
37/47
SENSORIMOTOR
INTERVENTION
The aim is to achieve a calm and alert state to
let the child experience normal movement as
well as visual and auditory interaction.
This normal movements, for ex, consists ofhand-hand/ hand-mouth contact, free movement
of the limbs and positioning of the head and
trunk in midline.
This can be achieved either on the lap or on the
floor.
7/31/2019 Early Identification and Treatment Techniques in Babies With
38/47
Lap Treatment
7/31/2019 Early Identification and Treatment Techniques in Babies With
39/47
Promoting Midline Activities on the
Floor
7/31/2019 Early Identification and Treatment Techniques in Babies With
40/47
VESTIBULAR STIMULATION
(ROCKING)
Abnormalities of movement and behaviour may
be positively influenced through graded
vestibular stimulation. When the child is put intoa towel, with the limbs in mid position, flexion
and H/H, H/M co-ordination are promoted whilst
jittery and unorganized movements are inhibited.
This vestibular stimulation can be done in a
towel or in hands of the therapist or caregivers.
7/31/2019 Early Identification and Treatment Techniques in Babies With
41/47
Vestibular Stimulation
7/31/2019 Early Identification and Treatment Techniques in Babies With
42/47
Carry-over
Carry over of treatment is very important in
early intervention, which can be achieved
only by involving parents or caregivers in
therapy.
Involving Parents in Therapy
7/31/2019 Early Identification and Treatment Techniques in Babies With
43/47
Involving Parents in TherapyChild Walking Independently in a
Parallel Bar
7/31/2019 Early Identification and Treatment Techniques in Babies With
44/47
Child transferring from the Balance
Board to a Stool
7/31/2019 Early Identification and Treatment Techniques in Babies With
45/47
Conclusion
Since Early Intervention is Very important
for babies with high risk for neurological
impairment, its very important to identify
these babies as early as possible, tomaximize their potential to the maximum.
7/31/2019 Early Identification and Treatment Techniques in Babies With
46/47
7/31/2019 Early Identification and Treatment Techniques in Babies With
47/47
Top Related