TREATMENT

APPROACHES
Dhruv Mehta
 TREATMENT APPROACHES
 BRONSON CROTHERS
 Individualized 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
APPROACHES
 WINTHROP 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 included
1) performance of bed and wheel-chair activities.
2)maximum use of hands
3)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
DEVELOPEMENT
 Eirene Collis
 Cp therapist.
 Management not treatment.
 Strict developmental sequence followed
 Postural 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-DELACATO
 The 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 level
 Pons amphibian 4 months creping level.
 Midbrain reptile crawling (10 months)
 Cortex primate/human walking 12 months/abstract
thinking 8 years.
 VOJTA’S METHOD
 THE 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 METHOD
 THE ROOD’S 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
AYRES
 AYRES 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 METHOD
 CONDUCTIVE 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.
 MOVE
 Movement opportunities via education theory
founded by Linda Bidabe emphasizing ability
to sit, stand, walk for those with profound
cerebral palsy
 BOBATH METHOD NDT
 Abnormal Patterns With Abnormal Tone
 As Over action Of Tonic Reflex Activity
 Inhibition, than Facilitation Of Normal Movement Patterns
 Sensory Feedback, key Points Of Control, handling, multi-modal
Input.
 NEURO-DEVELOPEMENTAL
THERAPY
 Constantly evolving, basic premise of the bobaths
 Dynamic, 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 child’s posture and movement.
 Talks of primary and secondary impairments, functional limitations,
ensuing disability, societal limitations.
 Takes a broader perspective of analyzing the child’s 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