Thereapeutic Ways To Move a Child – Health Paper
Handling techniques refer to therapeutic ways of moving children from one position or place to another during regular activities throughout the day. When used correctly and consistently, proper handling techniques can reinforce the goals of direct treatment and help the child learn new movement patterns. Together with the family and caregivers, the PT/OT will make specific recommendations for each child.
The goal of handling is to give the child the most opportunities throughout their day to move with normal tone and with as normal patterns of stability and mobility as possible.
It is important to remember that the child must actively participate in an experience in order to learn effectively from it. This means that the child must experience what it is like to actively produce a normal or normalized movement pattern. Then, through repetition of these patterns during active movement, the child will internalize them and be able to use these patterns independently. The more opportunities the child has to experience “normal”, the more likely it will be that the child will learn to repeat them independently or with less facilitation. This requires instructing family, teachers and caregivers.
Components of Treatment:
Preparation: Preparation techniques prepare the body for movement. Before movement is possible, the body must have a stable base of support. *Stability is necessary for mobility.* The focus during the preparation phase of treatment is on normalizing tone and providing the child with a stable base of support from which movement will be possible.
Normalizing tone: For children whose tone is usually high, slow, rhythmic movements may help to reduce tone. Joint approximation and traction and slow, shaking movements away from the joint are also techniques that may help reduce tone. Weight shifting using patterns of dissociation may also help to reduce tone, as may weight bearing. Environmental and sensory influences may also affect tone. Music with a 60-beat-per-minute tempo (many baroque classical pieces) have been found to have a calming, centering effect that can help to normalize high muscle tone and increase the effectiveness of a treatment session.
Brisk movements such as quick bouncing or tapping can help to increase tone in children who are generally hypotonic. Resistance, as in activities that require a child to push or pull a heavy object, can also help increase tone. Vestibular stimulation can help increase tone in the child whose tone is usually low. As with hypertonic children, other environmental and sensory influences may also have an effect. Folk music with a brisk, clear, rhythmic beat has also been found to increase muscle tone and facilitate therapeutic activities.
Deep/light pressure: Your fingertip control can represent more or less difficulty for the child. Deep pressure through the whole hand is more reassuring for the child as he has the sensation of another in control and supporting their movements. But controlled movement must be initiated by the child, so it is necessary to slowly release the pressure of your hands until the pressure is so light it is only being applied through your fingertips. The progression from deep to light will depend solely on the response of the child. Hopefully the child will show less tension through decreased compensations in movements as you decrease your control and then show an enjoyment in taking over the movements themselves.
Placement: Proximal to distal is another important method of using your hands on the child to assist normalizing tone and allowing the child to take more control of their own movements. The more proximal your hand placement is, the more support and control you offer the child. The most supportive hand placement is on the trunk, which then moves to support the shoulder and hips, before supporting the distal joints of elbows or hands, knees or ankles. For example, holding the child’s hips to facilitate walking gives the therapist more control than holding the child’s hands. Likewise, supporting the child high up on the trunk gives the therapist more control than holding the child lower down on the body. Supporting a child at the waist positioned in sitting on a therapy ball gives the therapist more control over the movement than supporting the child at the hips. The hips and shoulders are often key points of control in facilitating more normalized movement patterns. In rolling, the therapist will facilitate the movement from the child’s hip (and shoulder if necessary) rather than from the knee or waist. As the child gains better control over a movement pattern, the therapist may facilitate from a position of less control or may reduce the amount of facilitation in other ways.
Facilitation/inhibition: Facilitation involves helping the child produce a response. Inhibition involves helping the child not produce a response. These two are used together and complement each other in treatment.
Facilitating Movement: A stable base of support is necessary for movement. The person must be well balanced in the position. The base should be wide enough to provide stability but not so wide as to inhibit free movements. Once the base of support is established, a person must shift weight before movement is possible. For example, a baby lying on its stomach must shift its weight to the left side, and especially onto the left forearm, in order to reach for a toy with its right hand. A child must shift all its weight onto the right foot to take a step with the left foot. During treatment, the therapist can often facilitate new movement patterns by helping the child shift weight appropriately. This requires hands on guidance but not force. The therapist’s hands very gently guide the child’s body rather than pushing or pulling. The therapist does as little as possible, letting the child experience as much control over the movement as possible.
Inhibiting Movement: Inhibition techniques involve the use of positions and movements that help to prevent certain responses or movements. These are used in combination with facilitation techniques when facilitation techniques alone are not effective. For example, the ATNR is triggered when a child turns its head to one side. Keeping the head in midline inhibits the ATNR. Keeping the neck flexed inhibits the total extensor pattern seen in children with very high tone.
Positioning: Positioning involves providing the child with external postural supports to help compensate for the child’s internal lack of postural stability. This may involve the use of adaptive equipment however, in many situations with young children, an adult’s body is used in place of adaptive equipment to provide additional support. Positioning is static rather than dynamic. Although in itself not an active form of treatment, positioning can greatly influence the child’s ability to perform in every developmental area.
Some important things to remember in regards to positioning:
1. The human body is designed for movement. A child cannot remain in any given position for long periods of time without becoming uncomfortable. The therapeutic benefits of a position begin to decrease as soon as the child begins to struggle to move into a different position, often using compensatory postures to change its position. Ideally, a child should remain inone position for no more than 20 minutes before shifting to a different position or movement activity.
2. Positions selected need to be age appropriate. Young children often play while sitting or even lying on the floor, whereas older children do so much less often. Also, the position should enable the child to participate in activities with the rest of his/her class. A child might fit well in a group activity at the water table when placed in a stander but would not be able to interact as well in the stander during a circle activity when the other children were seated on the floor.
3. Positions need to be selected for function. For example, you might want a child to work on improving head control in sitting. Supportive seating adapted to allow for head movement while providing good trunk support might give the child an opportunity to work on head control during story time, when the child is expected primarily to sit and listen. During mealtime, working on head control and independent finger feeding might be too demanding for the child, and seating that provides additional head support might be needed. Standing might be an appropriate position for play at the sand table but not during mealtime, when it is generally considered inappropriate for people to stand and the position is too demanding to allow the child to fully concentrate on mealtime activities.
4. Young children can tire very easily and children with heart problems, respiratory problems or other health conditions may tire more quickly still. When children are placed in positions that are new to them and then asked to use movement patterns that are also new, they use a lot more effort than with familiar positions and patterns. Staff and parents must always be alert to signal from the child that the position is too demanding or that the child has simply had enough for the time being.