THE ROLE OF THE OT/PT IN
TREATING THE CHILD WITH
HEMIPLEGIA
Julia Maskery & Alison Mountstephen
JM/AM FFS May 2009
The Bobath Concept……..
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……. A way of thinking; not a method but a
concept.
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What is normal movement?
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What causes abnormal movement?
JM/AM FFS May 2009
Bobath Concept…
ABNORMAL MOVEMENT
PATTERNS
INFLUENCING
TONE
ABNORMAL
POSTURAL
TONE
ABNORMAL
SENSORY
FEEDBACK
LACK OF /
EFFORTFUL TASK
PERFORMANCE
JM/AM FFS May 2009
Bobath Concept
No two children are the same!
Treatment is Handling
Handling is Treatment
24 hour approach is essential
Early treatment is important
Brain knows nothing about a movement only a sense of a
movement
JM/AM FFS May 2009
JM/AM FFS May 2009
Early Development
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Working to improve head and trunk control
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Rotation and sequences of movement
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midline orientation
alignment/symmetry
equal weight bearing
Therapy = child's routine
Gradually withdraw hands-hand over control to the child
Body Awareness/ Spatial Awareness
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Begins hands to mouth.. hands together
How child perceives self … self in relation to objects
JM/AM FFS May 2009
Early Development
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Visual Abilities
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Fine Motor Skills / manipulation
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visual scanning / tracking
important to have eyes assessed
hand eye coordination
bilateral integration
bilateral weight bearing
Range of movement
hand isolation
finger isolation
Pre-hension patterns
Tactile Awareness
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sensation /sensitivity / discrimination
JM/AM FFS May 2009
Early Development
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Vocalisation/ Communication
–
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increased tone may alter how a child vocalises
which can effect how they interact with the
environment
Participation in Activities of daily living
–
lifting arm / placing limbs when dressing / messy
food play / bathing / toileting training
JM/AM FFS May 2009
Early Development
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Socialisation
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increase possibility to seek out and interact in their world
THE CONCEPT IS A WAY OF LIFE
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Parental involvement is essential for treatment
to have a carry over into everyday life
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A team approach
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Tapping into child's motivation, occupationplay
JM/AM FFS May 2009
School Life - Primary
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Mobility /Gross Motor skills- gait, balance and
coordination, ball skills, motor planning.
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Sense of two sidedness/ reduce neglect of
affected side.
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Awareness of associated reactions, self
inhibition
JM/AM FFS May 2009
School Life – Primary Cont:
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Seating and posture.
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Independence in activities of daily living.
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Fine motor skills/ dexterity.
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Pre writing skills.
JM/AM FFS May 2009
School Life – Primary Cont:
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Perception /cognition
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attention/concentration
visual perception,
spatial relations,
following instructions,
sequencing skills
memory/ recall
Emotional/ Behavioural
JM/AM FFS May 2009
School Life – Secondary
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Puberty/adolescence- growth spurts
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Independence
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Self management awareness
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Hobbies and interests – interacting with peers
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Adjusting to social norms
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WHAT NEXT?????
JM/AM FFS May 2009
Transition
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“Young People face many changes in their lives but one of the
most important and difficult is the move from school to adult life”
Transition planning is a partnership between the young person,
parents, school, statutory authorities and voluntary
organisations (cedar foundation, mencap, DEA etc..)
Transition planning involves the core team investigating work
experience opportunities and post school placements
Aim To Provide: Advice, Support, Training for the:
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Young Person
Family
Training providers in post school placements
JM/AM FFS May 2009
Occupational Therapy and Transitions
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Based on individual need
Home Assessments: family concerns, aspirations,
support
Priority areas identified for intervention: ADL,
Outdoor Independence, Upper Limb function,
Assistive Technology etc…
Independent living - advice re: care management
Referral to other agencies: social services, cedar,
DEA
Transfer to adult services etc..
JM/AM FFS May 2009