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Peds Handling

Positioning/Handling Ch.13

Handling Handling: tech’s are dynamic/guide a child’s movement by influencing the state of muscle tone or triggering new automatic movement responses that result in fxl actions. Used for children whose movement disorder stems from damage to CNS (CP).
Choosing a Handling Technique Handling is designed to produce an adaptive response from the child so that movements can be more fxl, exploratory, & appropriate for a task.
Choosing a Handling Technique Handling techniques encompass several active, hands-on interventions
Choosing a Handling Technique The techs are based on providing specific, graded sensory info to influence the parts of the CNS that govern/produce skilled, automatic movements
Choosing a Handling Technique Sensory input: the most frequently used are vestibular, proprioceptive, tactile in addition to visual input provided by the environment.
Choosing a Handling Technique Key points of control: Select body locations that provide therapeutic sensory input.
Indicators for Use of Inhibition Techniques Hypertonicity
Indicators for Use of Inhibition Techniques Active primitive reflexes
Indicators for Use of Inhibition Techniques Excessive activity/motion
Indicators for Use of Inhibition Techniques Behavioral excitation
Indicators for Use of Inhibition Techniques Excessive sensitivity or reactivity to handling/touch
Indicators for Use of Facilitation Techniques Hypotonicity
Indicators for Use of Facilitation Techniques Inactive primitive reflexes, lack of balance reactions
Indicators for Use of Facilitation Techniques Excessive relaxation, semiconscious state
Indicators for Use of Facilitation Techniques Behavioral nonresponsiveness, flat affect
Indicators for Use of Facilitation Techniques Decreased reactivity to handling/touch
Handling Techniques Handling techniques can either facilitate or inhibit muscle tone/levels of activity/alertness
Handling Techniques A combo of the various tech’s is often used.
inhibition handling techniques: Neutral Warmth: Gently wrap body in soft cotton or thermal blanket for 15-20mins to reduce extreme hypertonicity. 96°-98° can relax muscles= reduced muscle tone. Monitor alertness; create relaxed physical state without falling asleep.
inhibition handling techniques: Slow Stroking: Use open palm/pads of fingertips. Do stroking motion w/firm but lt. pressure down back,top-bottom 3-5mins. Keep motion rhythmic. Typ. positions: prone, side lying,relaxed/sitt. on floor betwn. OTs legs. May improve abn. muscle tone in UE/LE
inhibition handling techniques: Gentle Shaking: reduces tone in UE or LE. Use flat pads of fingertips, grasp top portion of UE or LE & gently/rhythmically shake while OTs hands move downward.Slow rocking: rhythmic/can incl. alternatng rotationl movemnts w/OTs hands put @ prox. key pnts.
inhibition handling techniques: Trunk/Hip Rotation: With one hand maintain stability on one side of body, with other hand assist child w/ making movements in diagonal planes. Using proximal key points of trunk/pelvis reduces hypertonicity.
inhibition handling techniques: Slow Rolling: Involves primarily handling trunk/pelvis. Place child in supine & slowly roll to side-lying and then back to supine. Repeat pattern alternating both sides rhythmically/slowly until muscles relax.
Facillitation handling techniques: Needed to increase low muscle tone, increase levels of alertness, or strengthen the intensity of sensory input to elicit a response.
Facillitation handling techniques: Include bouncing, swinging, rocking in an anterior-posterior movement plane and moving child into an upright antigravity position.
Facillitation handling techniques: Equipment to use: therapy balls, vestibular boards and themselves (for example).
Facillitation handling techniques: Protect child from potential dislocation
Facillitation handling techniques: Proceed slowly until you learn child’s behavioral patterns with sensory stimulation.
Using NDT: there’s 3 phases of tx process that are used w/children who need to develop improved movement skills.
3 phases of NDT: Preparation: Use positioning/handling tech’s to normalize muscle tone/inhibit abnormal reflex activity. I.D. optimal support needed to for child to use movement abilities available to them. Use comfortable postures for teaching new skills.
3 phases of NDT: Facilitation: strengthen existing skills/gradually decrease supports as new skills acquired. Grade act. demands so child pays attention 2 task and not how it’s done. Allow child 2 problem solve during task helps produce automatic, spontaneous movements.
3 phases of NDT: Adaptation: Gradually alter positioning/handling. Varying positions/change sensory cues to increase ability to use skills in various situations.
Created by: 100000007924890