what is th PT of CP patients?

[Dr.givenchy]

السلام عليكم ..

لو سمحتم ممكن اعرف العلاج الطبيعي للـ Cerberal palsy patients

:confused:

i want know the problems that occur in the upper limb and specific physical therapy

mangement for it.. by using Bobath ,temple fay ,thera suit , spider cage

or simply treatment by using the reflexes for facilitation ..

pleas help me

:surrender:

[dr.reham]

The suit itself is made up of a breathable, soft support material. Each component is connected by a series of elastic bands. The bands are adjustable to securely and comfortably fit your child. By tightening or loosening each band, your child enjoys customized pressure and correct body alignment and muscle control. If her body needs more support in one area than another, you simply adjust the bands.
The main idea of this brace type fit is to improve and change the pressure on your child’s joints, ligaments, and muscles. This creates an improved pattern of movement that in turn normalizes the nervous system. The nervous system communicates information about her muscles, joints, and tendons.
By repeatedly placing your child’s body in proper alignment, she has a chance to develop and master new gross and fine motor skills. The process is similar to any other child learning how to sit, walk, or crawl; mastery is attained through repetition.
In Picture 1, the girl’s body is not properly aligned. In Picture 2, the TheraSuitâ„¢ places her body in correct alignment.
http://www.cerebralpalsy.org/wp-content/uploads/2007/04/therasuit_1.jpg
The main difference between your child and a child without CP is that your child will need to repeat an action—such as learning to crawl—many more times over. During this process, with his body properly aligned, his muscles are receiving “correct signals” on how to master his task. Over time, this process will become easier for your child.
TheraSuitâ„¢ Components:

cap
vest
shorts
knee pads
shoe attachments
SizeAgeHeightsmall3-5 years old34 to 44 inches tallmedium5-8 years old44 to 51 inches talllarge8-12 years old51 to 56 inches tallx-large12 to adulthood56 to 66 inches tallxx-largeadultsover 66 inches tall
Even though TheraSuitâ„¢ looks different, it is very comfortable and offers sizing to last your child well into adulthood. Of course, she’s sure to love the fun, bright colors too.
Is Suit Therapy Right for My Child?

Starting a new therapy can be exciting for both you and your child. However, before starting, you need to make sure this alternative is the best choice for her unique needs.
If your child suffers from any of the following conditions, please contact your child’s doctor before starting suit therapy:

Heart conditions
Uncontrolled seizures
Hip subluxation
VP shunt (hydrocephalus)
Diabetes
Kidney problems
High blood pressure
Even though TheraSuitâ„¢ is proven to be a safe and affective therapy method, pressure from the elastic cords can be potentially harmful to some children with additional delicate health issues.

[dr.reham]

mangement for it.. by using Bobath
ميكانيزم
عن طريق Proximal $Distal key point for UL$LL to control spastisty
ملحوظه البروكسيمال كاي بوينت بتتحكم ف السباستيستي بتاع الجسم كله ولكن ال distalبس بتتحكم ف الجزء من الجسم اللي شغاله عليه
U L distal key point is thumb
proximal key point head $neck $ shoulder

LL distal key point is 3 lat toes
proximal is hip

thumb ext .abd do control of spastisty of involved UL

مثال أما آجي أقعد الطفل بحط
my thumb on balmof child and do ext .abd to his thumb to facilitate UL flex so sitting become easier

وفي LL distal key point
do ext to 3 lat toes so mass flex of LL occur

وده بعمله لو فجأه رجل الطفل خشبت وأنا شغاله معاه ومش عارفه أتنيها .

UL proximal key point
if you do all out word rotation toUL you will controle spastisty all over the body

do bi latral elevation of UL during UL rolling to break spastisty all over body

bi lat horizontal abd to UL during sitting on roll so control trunk spastisty during sitting

لو جيت أعمل مثلاً
hand WB
الايد اللي ع الارض بحطها في وضع
out word rotation

ملحوظه ال
all inword rotation
بتستخدم في الاطفال اللي عندهم
hypo tonia

[dr.reham]

سوري نسيت أكتب أمثله لل LL
during pull to sit or static sitting you should do all out word rotation toLL(cross sitting
to control spastisty

if child hemipligic do half ring sitting
لو حبيت مثلاً أمشيه وفي نفس الوقت اتحكم ف الاسباستيستي ممكن أمشيه وبين رجليه الroll
لان كده انا محافظه ع bilatral abd of LL
أو أعمله bi lat abd of UL

ومثل الاطراف العليا all inword rot used to facilitate ext sinergy of hpo tonic child

[dr.reham]

temple fay
هو عباره عن خمس خطوات هقول اللي أنا متذكراه منهم
5 stages
1-
tilt head right $ lift
2-
أنا مش متأكده منها خالص إني بنيم الطفل ع ظهره وبعمل Homolatral flex of UL thumb to mouse$get LL to abdomine

3-contralatral يعني نفس 3 بس الايد اليمين مثلا والرجل الشمال
4-
elephant creeping
يعني بينقل ايد ورجل من نفس الناحيه للأمام أثناء الحبو ويليهم الإيد والرجل ف الطرف الآخر مثل الفيل
5-
الطبيعي يعني أثناء الحبو بتكون كل ايد مع الرجل المعاكسه ليها
أخي التاني والتالت أنا مش متاكده منهم بس غالباً أهم حاجه الخامسه هي اللي بتستخدم ف العلاج وياريت لو حدا يقدر يفيدنا أكتر يقول اللي عنده وبستأذن اني مش هكمل الأسئله النهارده يوم تاني ويارب أكون أفادتك .

[dr.reham]

There are a wide variety of diagnoses that can benefit from suit therapy. They include, but are not limited to:http://s314892821.onlinehome.us/uploads/image/PPTS4620.jpg

Cerebral Palsy
Developmental Delay
Traumatic Brain Injuries
Ataxia
Athetosis
Hypertonicity
Hypotonicity
Spina Bifida
Post-Stroke
Down syndrome
Contraindications to use of the suit include hip subluxation greater than 50% and severe scoliosis. However, patients with these conditions may be eligible for a modified intensive treatment session without use of the suit.

Precautions are necessary for use of the suit in individuals with:

Hip subluxation less than 50%
Uncontrolled seizures
High blood pressure
Hydrocephalus with a V-P shunt
Diabetes
Heart conditions
Kidney problems
Osteoporosis/ Osteopenia
http://s314892821.onlinehome.us/uploads/image/PPTS0095.jpgPatients with any of these conditions will require special medical clearance to participate in an intensive suit therapy session.
Please contact us if you have any questions about whether your child is eligible for intensive suit therapy.
Intensive Therapy

Why do intensive Therasuit™ therapy?
Many children in the United States only receive school-based therapy that is educationally focused. It often does not address a child's ability to move independently of a wheelchair or other assistive devices. If school-based therapy is not enough, some children may receive in-home or out-patient therapy. Many parents find even with this additional therapy that progress is slow or that their child may plateau in their progress after gaining a skill.
The dramatically increased potential for a child to progress in the intensive suit therapy environment is amazing. Three weeks in an intensive therapy program can bring about progress in a child's motor skills that may normally take six to eight months with traditional therapy. Our program focuses on a child's abilities and works on building their skills to further enhance their motor development.
Our programs's focus on repetition of gross motor movements trains the child's brain to make these movements automatic. Once a child has mastered that movement they can utilize it in their everyday activities of sitting, rolling, crawling, transitioning, walking and playing. Intensive suit therapy provides the push a child needs to move to the next level in their development.
The Monkey Cage

The monkey cage is used for isolating and strengthening specific muscles necessary to produce functional movement. It uses a system of pulleys and weights to target specific muscles. It allows the therapist to facilitate strengthening of weak muscles while preventing compensatory use of other muscles. It is also used for vestibular activities such as "flying" and swinging. It can be used with a treadmill for unweighted gait training. The monkey cage is a very effective tool for teaching children how to activate and use their muscles for functional activities such as sitting, changing positions, and walking.http://s314892821.onlinehome.us/uploads/image/PPTS0093.jpg
The Spider Cage

The spider cage uses a belt and bungee cords to provide dynamic assistance to maintain an upright position. The spider cage can allow a child to stand without a therapists's assistance while allowing freedom of movement and facilitating balance. It is useful for learning to transition between positions, to acquire the weight-shift needed for functional movement, and to improve proprioception and arousal with jumping. The spider cage can also be used with the pulleys and weights of the monkey case to perform strengthening exercises in more challenging positions. The goals of the exercises performed in the spider are to improve functional skills such as sitting, crawling, and walking. It also helps to improve balance, coordination, and sensory-motor integration. The ultimate goal of the spider case is to promote independent movement.

[dr.reham]

Spider Cage
http://triblocal.com/hinsdale/files/1275924643_928e-140x105.jpg (http://tabeae.org/vb/#3)


http://triblocal.com/hinsdale/files/1275924702_7203-140x105.jpg (http://tabeae.org/vb/#4)


http://triblocal.com/hinsdale/files/1275924580_3f06-140x105.jpg (http://tabeae.org/vb/#2)

http://triblocal.com/hinsdale/files/1275924788_5ff5-140x105.jpg (http://tabeae.org/vb/#6)


http://triblocal.com/hinsdale/files/1275924748_ea74-140x105.jpg (http://tabeae.org/vb/#5)

[f4fm]

how great are you reham....

[dr.reham]

No
how great are you f4fm

[dr.reham]

أما المشاكل اللي بتكون موجوده سواء UL أو LL
اما Hypo or Hyper tonia
Symptoms of cerebral palsy can be very different between people with this group of disorders. Symptoms may:

Be very mild or very severe
Only involve one side of the body or both sides
Be more pronounced in either the arms or legs, or involve both the arms and legs

Symptoms are usually seen before a child is 2 years old, and sometimes begin as early as 3 months. Parents may notice that their child is delayed in reaching, and in developmental stages such as sitting, rolling, crawling, or walking.
There are several different types of cerebral palsy. Some people have a mixture of symptoms.
Symptoms of spastic cerebral palsy, the most common type, include:

Muscles that are very tight and do not stretch. They may tighten up even more over time.
Abnormal walk (gait): arms tucked in toward the sides, knees crossed or touching, legs make "scissors" movements, walk on the toes
Joints are tight and do not open up all the way (called joint contracture)
Muscle weakness or loss of movement in a group of muscles (paralysis)
The symptoms may affect one arm or leg, one side of the body, both legs, or both arms and legs
The following symptoms may occur in other types of cerebral palsy:

Abnormal movements (twisting, jerking, or writhing) of the hands, feet, arms, or legs while awake, which gets worse during periods of stress
Tremors (http://tabeae.org/vb/003192.htm)Tremors
Unsteady gait
Loss of coordination
Floppy muscles, especially at rest, and joints that move around too much
Other brain and nervous system symptoms:

Decreased intelligence or learning disabilities are common, but intelligence can be normal
Speech problems (dysarthria)
Hearing or vision problems
Seizures (http://tabeae.org/vb/003200.htm)Seizures
Pain, especially in adults (can be difficult to manage)
Eating and digestive symptoms

Difficulty sucking or feeding in infants, or chewing and swallowing in older children and adults
Problems swallowing (at all ages)
Vomiting or constipation
Other symptoms:

Increased drooling
Slower than normal growth
Irregular breathing (http://tabeae.org/vb/000007.htm)Irregular breathing
Urinary incontinence (http://tabeae.org/vb/003142.htm)Urinary incontinence
عامة الوضع الخطأ اللي واخد ه الجسم أقدر أستخدم ليه quadriped position
لان الوضع ده ليه فوايد كتير جداً التالي
break flexor tone of elbow $wrist
trunk control
head control
inhipite positive support reaction
improve negative support reaction
release grasp reflex
ممكن أعمل منه
approximation to UL$LL
counter rot to shoulder $pelvis so facilitate rolling
يعني وحاجات كتير
طبعاً أنا بعمل للطفل ده حاجات كتير زي الاطاله والتقويه ووضع الطفل في جبيره تعدل وضعه وطبعاً بستخدم reflexes للعلاج زي
righting and protective
يعني ال posural reflexes
وأخيراً أخي أكون عرفت أفيدك أخي وطبعاً في حاجات كتير مقلتهاش ف العلاج بس تقدر تلاقيها ف كتب في قسم الاطفال بالمنتدي وياريت لو حدا عنده اضافات يتفضل بيها ويفيدك أكتر مني والسلام عليكم ورحمة الله وبركاته

[Dr.Sultan]

رائع دكتورة ريهام ...توضيح جدا دقيق ومفيد
شكرا لك ولردوك المستمرة وشكرا لحضورك المميز و الدائم
دمتي بود

[dr.reham]

أسعدني مرورك مشرفنا الغالي والشكر لك أنت نعم لك أنت د"سلطان ولمجهوداتك الأكثر من رائعه وفرحني تشجيعك ليا .

[abo-roaa]

100

100

[dr.reham]

مرسي أبو رؤي انت اللي
100
100

[DR.SAHAR]

لا أبو رؤي
1000000
100

[dr.reham]

أسعدني مرورك ياسحر ويارب أكون أفادتك.

[Dr.givenchy]

^__^

اول شيء أحب اشكر د/ ريهام ع المساعده الهائلة بجد مررره ميرسي...

بالنسبة للتمبل فاي كلها صح بس بالمرحلة التانيه بتكون زي ATNR يعني face side يصير فيها اكستينشن والعكس..

والتالته نفس الشيء بس lower limB تكون عكس الحركه ^_^

انا في التريتمينت استخدمت تمبل فاي ,, سبايدر كيج_ شكرا ع الصور والمفهوم لنفس هدي التقنيه افادني جدا

وراح استفيد منها في البرزنتيشن بتاعي..

مشكورة على كل شيء وبخاصة spider cage مره مهم بالنسبة ليه

وشكرا للجميع ع المرور.. يعطيكم العافيه

[dr.reham]

الحمد لله إني عرفت أساعدك ومبسوطه جداً لهذا
وكمان متشكره فكرتني بالتمبل التاني والتالت كنت بحاجه لمعرفته .