The goal of occupational therapy is to enable children with cerebral palsy to participate in activities of daily living that are meaningful for them. Occupational Therapy can provide children with positive, fun activities to enhance their cognitive, physical, fine motor skills and increase their self esteem and sense of accomplishment. Occupational Therapist also prescribes orthosis, seating equipment and wheelchairs according to individual needs. Children with cerebral palsy also have Sensory Integration dysfunction. Sensory Integration is the ability to organise and process sensory information from our body as well as from the environment, to perform goal oriented behaviour. Children with cerebral palsy may experience decreased sensation or a limited understanding of how the brain interprets what it sees.
To improve the services provided, Sensory Integration unit was set up to provide sensory-perceptual-motor (SPM) training for children with cerebral palsy who have sensory integration dysfunction. This sensory-perceptual-motor training teach the children to process the sensory inputs and produce organized behaviour which will improve their daily functional abilities.
WHAT IS SENSORY INTEGRATION?
Sensory integration is about how our brain receives and processes sensory information so that we can do the things we need to do in our everyday life. Jean Ayres defined sensory integration as: “The neurological process that organises sensation from one’s own body and from the environment and makes it possible to use the body effectively with the environment” (1972)
THE 8 SENSES
In sensory integration we are interested in all 8 senses. You can probably immediately think of 5 only – seeing, hearing, tasting, smelling and the sense of touch. The other three are proprioception, vestibular and interoception, these are defined below.
Our muscles and joints have tiny sensory receptors that tell our brain where our body parts are. When you put a spoon to your mouth, you don’t need to look at the spoon to see where it is or feel for your mouth to know where to place the spoon; you know where your hand is in relation to your mouth. Your brain then uses this information to plan movements so that you can coordinate your body.VESTIBULAR – In our inner ear we have small, fluid filled canals, the fluid in these canals moves every time we move our head. Receptors in these canals pick up the direction of movement and send this information on to our brain. So we know if we are moving forwards, backwards, side to side, tilting our head, turning round or moving up and down. Once again, our brain uses this information to plan for movements and help us maintain our balance.
Interoception is how our body tells our brain what is going on inside our body, when we are hungry or feel full, when our heart is beating fast or when we have that sensation of butterflies in the stomach. Jean Ayres was particularly interested in the interaction between and development of the vestibular, proprioception, touch, vision, and hearing. She saw these as important in supporting our ability to use our body, concentrate, develop self-esteem and confidence as well as having self-control and academic skills. We continue to see the link between poorly developed senses and these abilities both in research and in practice.
SENSORY INTEGRATION PROBLEMS
Recently Parham and Mailloux (2015) identified four categories of sensory integration problems
1. Problems With Sensory Modulation
Problems with sensory modulation occur when our brain either over responds to, or under responds to sensory information. Problems with modulation can cause the person to become anxious, fearful, angry and frustrated.
2. Sensory Discrimination and Perceptual Problems
This is when the brain has difficulties with making sense of the sensory information it receives. The person then struggles to interpret subtle differences in the sense.
3. Vestibular-Bilateral Functional Problems
These problems are a result of problems with our vestibular sense and can result in poor balance and difficulties with coordinating two sides of the body.
Speech Therapy Department provides therapy services that are family-centered and culturally competent using evidence-based approaches. Our main objective is to enhance the capabilities of families to meet the speech, language, communication and feeding needs of the children with cerebral palsy.
The major feeding problems which the children with cerebral palsy have are the insufficient mouth, head and trunk control, lack of sitting balance and poor eye-hand coordination skills for independent eating. The parents are being trained in learning various feeding techniques and together with therapists discussing the child’s diet to ensure proper food intake for the child’s overall growth.
For the children with cerebral palsy, it is not lack of intelligence or effort which prevents them from speaking correctly but their difficulties are due to sensorimotor impairment. Play is a form of learning for children. It is normal that a child just to enjoy playing a different kind of toys and objects, listen to what we say but not “say” anything. All this will help to develop sensory avenues which are necessary for the formation of language.
When the child attempts to speak but not successful, don’t try to immediately correct his speech. Let the child play with his speech and sound, although his speech may sound unintelligible to us. Urging them to say the correct sound or to repeat a word will take away all the joy and pleasure they have in talking. The parents are encouraged to talk to their child naturally and guide the child to experience speech in day-to-day living in a fun and interesting way.
Pphysiotherapy – The aim of physiotherapy is to achieve maximum independence in activities of daily life. Children with cerebral palsy have both motor and sensory issues. After detailed assessment treatment plans are drawn up based on the children and family needs. Through specific handling skills and modification of environment more normal movement pattern are practiced within play, providing more sensorimotor experiences. Family members and caregivers are trained, so that therapy becomes a part of daily routine. Therapists implement strategies that can be incorporated into functional activities. The therapist also collaborates and guide teachers about effective posture and movement in the classroom to enhance.
We have recently added a Whole-Body Vibration (WBV) machine. WBV training is a method for muscle strengthening and it is being widely applied in a variety of clinical situations. During a typical vibration session, the user stands on the device in a static position or performs dynamic movements. Based on the researches done it is believed that vibrations stimulate muscle spindles and alpha-motoneurons, which initiate a muscle contraction. Most studies on the impact of vibration treatment in various disorders focused more or three therapeutic aims:
HYDROTHERAPY – At CPCAP we use The Halliwick Swimming Method, which is based on scientific principles of hydrostatics, hydrodynamics and body mechanics for hydrotherapy. It was developed by James McMillan in 1949. The principles behind the swimming method can be applied to all people regardless of age or mental or physical ability.