TREATMENT APPROACHESDhruv Mehta

TREATMENT APPROACHESBRONSON CROTHERSIndividualized assessment, then appropriate activities which are realistic, stressed on active movement, encouraged participation even in the most severely involved children. Enabling child to become more independent and active, avoid overprotection. Prevent contractures, stimulate child to be active.

TREATMENT APPROACHESWINTHROP PHELPS.Orthopedic approach derived from treatment of poliomyelitis. Therapy of individual muscles was stressed. Also training of gross movement patterns and inhibition of abnormal movements. Deep massage used for muscle stimulation. Auditory and kinaesthetic activities used-combination of rhymes Rhythm, extensive bracing (metal). Relaxation techniques used for dyskinesias,synergistic movement patterns used to achieve movement in synergy (Finks conscious letting go for relaxation) and (Jacobson's tensing and relaxing). Weights for ataxia, stretching for spasticity,emphasis on use of full control braces.Goal was to reduce the extent of bracing as control was achieved about a particular joint.Relaxation, rest, reciprocation, balance, reach - grasp-release, skill for ADL, massage for hypertonic muscles, passive motion, active assisted motion, active motion, resisted motion.

TREATMENT APPROACHES

Deaver emphasized functional ability rather than patterns of movement,objectives included1) performance of bed and wheel-chair activities.2)maximum use of hands3)performance of ambulation and stair climbing.4)Achievement of adequate speech and hearing.5)Achievement of near normal appearance as possible.Extensive bracing,reduction as functional control achieved.Intensive training for ADL ,particularly wheel-chair use (at times periods of residential care.)Surgery for cosmesis.

NEUROMOTOR DEVELOPEMENTEirene CollisCp therapist.Management not treatment.Strict developmental sequence followedPostural security first, placing in normal postures.

KABAT-KNOTT-VOSS.KABAT AND KNOTT: Kabat and Knott(1953) introduced the idea of using a summation of facilitation of motor centers for neuromuscular education. They used active, active-assistive and resistive mass movement patterns for therapeutic exercise. This advocated manual resistance to muscle contraction. This exercise excluded individual muscles and used total movements of the limb(Proprioceptive stimulation to build up tonus)

FAY-DOMAN-DELACATO

Fays (Neuro-surgeon ,Philadelphia) method was based upon the then accepted evolution of the human crawling, crawling first as an amphibian, the progressing to the crossed movement pattern of reptiles, lizards and alligators. His treatment was to elicit these early evolutionary form s of locomotion. He recommended use of spinal automatisms in spastic paralysis at the primitive level of function. Ontogeny recapitulates phylogeny. Reptilian squirming, amphibian creeping, mammalian all fours) Unlocking of reflexes at pons, mid-brain level. His method implied passive manipulation to obtain progressive evolution of the damaged brain.

FAY-DOMAN-DELACATOThe Doman-Delacato method consists of passive exercises designed to repeat the evolutionary progression of movement in evolution from fish, to amphibian ,to reptile and finally to primates. The theory postulates that the brain is organized in a series of evolutionary layers, each of which corresponds to a form of locomotion specific for the species. Parents are instructed on the passive exercises (Patterning) in which 2 people alternatively flex and extend the upper and lower limbs in cross pattern (several hours a day)Medulla fish newborn levelPons amphibian 4 months creping level.Midbrain reptile crawling (10 months)Cortex primate/human walking 12 months/abstract thinking 8 years.

VOJTAS METHODTHE VOJTA METHOD.This theory holds that the child with CP has the same reflex movements that can be provoked in a normal newborn.These movements have a common neurogenic pattern in the subcortex.The treatment program elicits pattern of reflex motion by manual pressure on trigger zones.Nine such trigger zones,5 on the trunk and 4 on the limbs are delineated, to induce reflex creeping and turning.Nine other zones for side-lying patterns and combinations and variations of sequences to excite these points of pressure.There are thousands of possibilities of activating the CNS. These patterns of motion are then supposed to be imprinted in the CNS (particularly in the cerebral hemispheres), and apparently used by the infant.The storage of the normal induced reflex patterns in the child with CP presumably allows normal rather than pathological patterns.Either tonic or phasic muscle action is provoked.(Treatment to be done 2/4 times a week,for 4-6 weeks.)

ROODS METHODTHE ROODS METHOD. This was an attempt to reduce spasticity and activate contraction of antagonist muscles by tactile stimulation with heat, cold and brushing.I t is presumed that the vibration of muscles stimulates the primary endings of the muscle spindles, the golgi tendon organs and secondary spindle endings. The principle is to relieve certain motor neuron pools from excessive excitation and others from excessive inhibition.

SENSORY INTEGRATION-JEAN AYRESAYRES SENSORY INTEGRATIVE THERAPY. The theory behind the method is that children who are unable to integrate the sensory inputs (tactile and Proprioceptive) from the trunk and limbs.Because of this defect, the vestibular system fails to provide correct information about the movement and postures of the body, consequently the movement disorder in CP persists.Thus primitive reflexes persist, and child is unable to motor plan.This theory is based upon dysfunction of the Brainstem centres, which are considered the primitive sites of massive patterned responses. Evolutionary progression of cerebral hemispheres allows individual and discrete motor patterns.The treatment is one of passive and active tactile and Proprioceptive stimulation, reprogramming and new connections by tereatment are presumed(eg,swinging, whirling in a swivel chair, hammock)

CARR AND SHEPHERD.MOTOR CONTROL THEORY CARR AND SHEPHERD. It evaluates the kinematics and kinetics of human motor performance, movement biomechanics .Motor learning, i.e how we learn to control movements and acquire skill in specific motor actions studied. How muscles adapt to immobility studied, and attentional demands of actions the relationship between intention, action and environment taken into account.i.e task and context specific training of motor control advocated to optimize functional performance in CP.

PETOS METHODCONDUCTIVE EDUCATION The system is basically educational and goal-oriented towards maximum independence. Thre are principles of rhythmic intention which means involving the children in their own learning, who thus obtains feedback of his/her performance, so that brain can restructure itself. Slatted plinth, petos chair-ladder backed chairs used to assist transfers, hold, turn over and adjust their posture.

MOVEMovement opportunities via education theory founded by Linda Bidabe emphasizing ability to sit, stand, walk for those with profound cerebral palsy

BOBATH METHOD NDTAbnormal Patterns With Abnormal ToneAs Over action Of Tonic Reflex ActivityInhibition, than Facilitation Of Normal Movement PatternsSensory Feedback, key Points Of Control, handling, multi-modal Input.

NEURO-DEVELOPEMENTAL THERAPYConstantly evolving, basic premise of the bobathsDynamic, active approach, interaction of child from moment to moment.Studies interaction of various systems i.e. neural, musculoskeletal, respiratory, cardiovascular, gastrointestinal, intugementary, attention/arousal and how they affect the childs posture and movement.Talks of primary and secondary impairments, functional limitations, ensuing disability, societal limitations.Takes a broader perspective of analyzing the childs condition in various settings viz home, school, recreation.Also talks about negative signs like weakness, fatigue. Dynamic weight shifts, rotatory movement patterns, biomechanical alignment, maintaining center of gravity, grading of movement for functional outcome