Always.include.play.activities.in.the.rehabilitation.program.[A,. B]..Play.improves.mental.capacity.and.provides.psychological. satisfaction..Organized.play.can.address.specific.gross.and.fine. motor.problems.in.the.child.and.take.the.place.of.boring.exercise. protocols..This.increases.the.child’s.compliance.with.therapy.. For.example,.riding.a.toy.horse.may.improve.weight.shift.over. the.pelvis,.swinging.may.improve.sensation.of.movement.. Sports and recreation
Disabled. children. need. to. be. involved. in. sports. and. recreational.activities.just.like.their.able.bodied.peers..Sports. and.recreational.activities.also.form.part.of.the.rehabilitation. program..Physical.activity.plays.an.important.role.in.physical. development,. general. fitness. and. health.. It. provides. fun. and. recreation..Physical.and.occupational.therapy.combined.with. recreational.activities.or.adapted.physical.education.increases. efficiency.of.rehabilitation.and.assist.the.disabled.child.to.use. his.potential..It.is.difficult.and.time.consuming.for.a.child.to. continue.physiotherapy.once.he.is.in.school..If.he.does,.he.will. be. alienated. from. his. friends.. Sports. and. recreation. benefit. the.child.because.they.save.him.from.going.to.long.hours.of. physiotherapy.and.being.apart.from.his.friends,.from.loss.of. valuable. time. for. lessons. and. play.. In. the. meantime. sports. provides.the.only.means.of.improving.the.child’s.neuromotor. abilities. and. preventing. deformities. when. he. is. at. school.. Through. sports. and. recreational. activities,. the. child. has. the. ability. to. participate. in. the. world. of. normal. children,. will. not. feel. left. out. because. of. hours. of. physiotherapy. and. will. improve.his.neuromuscular.functional.status..
There.are.a.variety.of.summer.and.wintertime.sports.that. the. disabled. child. can. participate. in. [C,D].. The. competitive. aspects.of.involvement.in.sports.and.games.is.basic.to.human. nature,. however. many. physically. handicapped. individuals. frequently. do. not. have. the. physical. attributes. to. participate. fully.in.different.sport.activities..Therefore.most.of.the.modern. games.and.sports.are.modified.for.handicapped.persons..The. rules.of.the.sport.or.the.game.are.modified.to.meet.the.needs. of.disabled.person.(wheelchair.tennis),.or.specially.designed. adapted.devices.are.used.for.physically.disabled.to.compensate. or.substitute.the.loss.of.muscle.strength.or.function.(downhill. skiing).[E]..Some.modern.sports.require.very.high-technology. equipment,. but. most. adapted. equipment. and. devices. can. be. easily.made.or.adjusted.locally.[F]..
Sports. scientifically. shown. to. have. significant. therapeutic. effects.in.CP.are.swimming.[G,H].and.horseback.riding..They. help. to. increase. muscle. strength. and. range. of. motion. in. the. joints,.improve.sitting.balance.and.body.control.and.provide.fun.. Swimming.[A.on.next.page].starts.with.basic.pool.exercises..In. the.whole.body.involved.child,.it.helps.normalize.muscle.tone. and.decreases.rate.of.contracture..In.hemiplegic.and.diplegic. children,. it. can. strengthen. muscles,. improve. cardiovascular. fitness.and.efficiency.of.gait..
Horseback. riding. [B. on. next. page]. improves. head. control. and.trunk.balance,.normalizing.muscle.tone..It.creates.a.lot.of. positive.emotions.in.interaction.with.the.horse..It.also.improves. self.esteem.in.the.child.[C.on.next.page].
Children can learn simple tasks at home. They can learn how to look after themselves. They need coaching to master bath- ing, grooming and toileting skills.
Summertime sports Swimming Athletics Wheelchair basketball Tennis Table tennis Wheelchair racing Shooting Archery Canoeing Kayaking Sailing Weightlifting Football Wintertime sports Downhill Two track skiing Three track skiing Four track skiing Mono-and bi-skiing Sit-skiing
Cross-country skiing The child develops hand-eye coordination by playing with simple toys. She also experi- ences a sense of accomplish- ment, improving self image.
Most children love to swim, or at least be in the water. The buoyancy of water helps movement and inhibits muscle tone. Splashing about is a lot of fun. Prescribe aquatic exercises as therapy in the less severely involved child.
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Horseback riding Improves head control Trunk balance Normalize muscle tone Positive emotions Self esteem
Advantages of swimming Normalizes muscle tone Decreases rate of contracture Strengthens muscles
Improves cardiovascular fitness Improves walking
Even. vigorous. sports. activities. do. not. cause. or. increase. orthopaedic.deformity..In.developed.countries.adapted.physical. education. and. sport. are. included. in. public. school. programs.. In. developing. countries. adapted. sport. and. recreation. [D]. is. organized. by. special. NGO’s. (non-government. organizations). or.sport.organizations..The.Bridge.of.Hope.from.Armenia.is.a. good.example.[E].
Rehabilitation strategy and goals according to age Rehabilitation. aims. to. prevent. disability. by. minimising. the. effects. of. impairments,. preventing. secondary. disabilities. and. maximising. motor. function. throughout. the. child’s. life.. The. focus. of. treatment. shifts. over. the. years. but. the. principles. remain.the.same..
Functional.goals.change.as.the.baby.becomes.a.child.and. the.child.matures.into.an.adult..Younger.children.focus.mainly. on.mobility.whereas.adults.shift.their.focus.to.communication. and.activities.of.daily.living..The.first.four.years.are.spent.in. physiotherapy. and. bracing,. orthopaedic. surgical. procedures. are. performed. between. 5. to. 7. years. of. age,. education. and. psychosocial.integration.become.main.issues.in.the.school.age. (7-18.years)..
Reach. mobilization. goals. by. the. time. the. child. is. ready. to. go. to. school.. The. child. needs. aggressive. physiotherapy. in. the. growth. spurt. period. and. after. orthopaedic. surgery.. Communicate.with.the.school.physiotherapist.or.the.physical. education.teacher.to.enable.an.active.life.for.the.child.at.school.. Early intervention
Early.intervention.is.the.general.name.given.to.many.therapy. modalities. including. exercise. and. caregiver. education.. Early. intervention. programs. involving. infant. stimulation. and. caregiver. education. [F]. may. retard. or. reverse. the. central. nervous.system.lesion.causing.the.clinical.picture.of.CP.and.thus. prevent.or.minimise.neuromotor.delay..There.is.no.established. routine.and.no.proven.value.of.these.programs,.however.until. we.know.which.babies.are.going.to.be.normal.on.their.own,.it. is.better.to.let.them.have.the.benefit.of.early.treatment.so.that. any.improvement.potential.is.not.lost..Despite.the.controversies. early.treatment.benefits.the.parents..They.receive.a.great.deal. of.practical.advice.and.support.this.way..The.child’s.functional. status. may. improve. with. parental. support.. Early. treatment. creates. more. opportunity. for. the. potential. to. develop. any. normal.abilities.and.for.decreasing.the.defects.. Infancy Rehabilitation.goals.are.to.educate.the.family.about.the.child’s. problem,.to.improve.parental.bonding,.to.help.the.mother.care. for.the.baby.and.to.promote.optimal.sensorimotor.development. through.positioning,.stimulation.and.exercises.[A.on.next.page]. if. possible.. Increase. mobility. and. help. the. baby. explore. his. surroundings.
Use. positioning,. carrying,. feeding. and. dressing. techniques. which. promote. bodily. symmetry. in. the. infant.. These. limit. abnormal. posture. and. movements. and. make. functional. activity. possible..Provide.sensory.stimulation.using.various.movements.and. postures..Some.positions.lengthen.the.spastic.muscles.and.make. voluntary.movement.easier..Add.weight.shifting,.weight.bearing,. trunk.rotation.and.isolated.movements.into.the.exercise.regimen.. Recreational programs
Arts and crafts Music Dancing Wheelchair dancing Drama, camping Fishing Scuba diving Riding a horse is benefi- cial for the child in many ways. It gives the child self confidence, a feeling of responsibility, improves balance and posture.
Teach the parents to take care of the baby. Infancy is a time for parent-infant bonding. ‘Bridge of Hope - Mobile Theatre’ was founded in Armenia. It is a dra- ma group in which disabled children act and have a chance to express themselves in art. Courtesy of G. Koloyan
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