Community Based Rehabilitation Services for a
Child with Cerebral Palsy through Non Formal
Approach - A Case Study
1
a non formal practical approach and convenient for
parents. [Fig.1]
Ms. Djodybascarane, L. and 2Dr.P. Swarnakumari
1
Research Scholar
2
Associate Professor& Research Guide
Research Department of Rehabilitation Science
Holy Cross College (A), Tiruchirappalli - 620002
Abstract
Cerebral palsy is not a new disorder in terms of
existence, but rather in knowledge of the condition.
In fact, there have probably been children with
cerebral palsy since the beginning of human existence.
However, the medical profession did not begin to
study cerebral palsy as a distinct medical condition
until 1861. It was in that year, an English orthopedic
surgeon, Dr. William John Little, published the first
paper describing the neurological problems of children
with spastic diplegia, and one of the first case studies
on cerebral palsy.
Fortunately, in the past few decades, information
on the many aspects of cerebral palsy has significantly
increased due to case studies. Today, the medical
community has great interest in studying cerebral
palsy to determine its causes and the most effective
ways to treat it. As knowledge and treatment
techniques have expanded and improved through case
studies on cerebral palsy, so too have the prospects on
education and other therapeutic modalities of all
children with cerebral palsy. This paper attempts to
describe the case study of a child with cerebral palsy
in a community based rehabilitation programme. This
case study research article will give a glimpse into the
Indian perspective of rehabilitating the children with
special need through non formal approach in rural
area, which is a challenging chore for the child as well
as for rehabilitation professionals.
Keywords : Cerebral palsy, Occupational Therapist,
Disability Rehabilitation Service
Introduction
Cerebral palsy is a non-progressive neurological
disorder of children affecting locomotors system. It is
not a single entity but a heterogeneous collection of
clinical syndromes, characterized by abnormal motor
patterns and posture. Cerebral palsy (CP) is the most
common cause of physical disability affecting
children, with a worldwide incidence of 2 to 2.5 per
1000 live births.1 Managing Cerebral palsy child
involves various disciplines including pediatrician,
physiatrist, physiotherapist, occupational therapist,
speech and language pathologist, orthopedic surgeon
and vocational counselor, care givers, parents and peer
groups. But home based therapy, by trained parents is
Figure 1
This case study research article will give a glimpse
into the Indian perspective of rehabilitating the
children with special need through non formal
approach in rural area, which is a challenging chore
for the child as well as for rehabilitation professionals.
One of the best sources for providing intervention
services for children with cerebral palsy is through
community based rehabilitation services. Community
based rehabilitation is a strategy within the
community development for the rehabilitation,
equalization of opportunities and social integration of
all people with disabilities.
Case Study
A Three and half year old male child residing at
Sithalapathy village of Kudavasal Taluk, Thirurvarur
district, Tamil Nadu, India, second in birth order,
product of non-consanguineous marriage born by
normal vaginal delivery in Government Hospital,
Thiruvarur. The pre-natal history revealed that mother
did not feel proper movements of the foetus. His
parents are hailing from a lower socio-economic status
and belong to below poverty line living in rural area.
The child was identified and screened by Community
Based Rehabilitation multidisciplinary Team of
District Differently Abled Welfare Office, Thiruvarur.
The child was brought with complaint of delayed
development in motor, cognitive and speech abilities
and was diagnosed as Cerebral Palsy with Spastic
Type. The child had difficulties like Lack of fine
motor skills, poor in ADL, poor posture, and
decreased range motion and muscle spasm in upper
and lower limb.
Various CBR Interventions had been given by
multi disciplinary team. Community based Medical
intervention was given through Telemedicine with
support of mobile services. The child had also
received medical services under National Rural Health
Mission Programme in his village itself. The trained
village health guide recorded the vital parameters like
BP, heart rate, pulse etc routinely.
Madurai
Meenakshi Mission Hospital’s rural tele care subcenters assisted the doctors during consultation with
the help of the trained village health guides who are
available at the remote site.
Our occupational therapist provided home based
intervention services and we guided parents in
dressing, self feeding, toileting, bathing and grooming.
We trained the child for picking up clothes, shoes,
paper, and other available resource in home
environment. Speech and audiologist trained parents
for speech therapy. The Child was trained with the
support of care giver and mother under Community
Based Yoga Therapy Intervention. First we taught
Tadasan asana for balance improvement, and we also
trained mother to teach child Pachimothangasan asana
to touch ankle joint without bending knee joint. These
two asana were done by the child passively with
support of parent. Community based Music therapy
was given through locally available audio visual aids
like TV and radio. Play therapy was given by his
father with support of peer group. It was given using
a specialized traditional concept in which CP chair
was used in home environment with play way method
to improve proper sitting posture. Various methods of
play therapy were followed as mentioned in
Community based special education Intervention
service was done through non formal approach and it
was achieved by mobile van special education service.
We taught all areas like ADL, Social, Personal,
Communication, Academic and Recreational. Various
teaching practices that were given to the child are 1.
Calendar System: Special educator trained his parents
to use this approach by placing the objects or pictures
available at home, representing separate activities in
separate boxes or compartment. 2. Picture exchange
communication system- PECS: PECS begun with
teaching a child to exchange a picture of a desired
item with his parent who immediately honors the
request. In this training strategies prompting and
reinforcement strategies were used largely to enhance
independent communication.
Physiotherapist had given intervention services
through non formal approach using low cost materials
available in the child’s environment and local
community. The child was encouraged to crawl using
push-pull toys, to kneel without support using swings,
to support on hands and feet using ladder steps, to roll
and swing in a blanket, to roll down on sandy or grass
slopes, to sit with support, to bring hands together
using textured balls. Gait Training was given using
walker. Balance board training was also given to him
using wooden sheet placed on center of wood piece.
Discussion
The results of the study clearly indicate that a child
with Cerebral Palsy has succeeded through
community based rehabilitation services and showed
significant improvement in self help, fine motor skills,
socialization, cognitive and academic skills.
Occupational therapist has to be innovative in his
approach and incorporate play activities to give
therapy to child; it is given mainly to improve ADL
activities using available resource in the community.
We taught parents mainly for child Activities of daily
living which included tasks of self maintenance,
mobility, communication and community living that
enables an individual to achieve personal
independence. Yoga is the science of, right living.
It works on all aspects of the person, the physical,
mental, emotional and spiritual. “Yoga’ the word
derived from Sanskrit word ‘Yuj’ means ‘to join’
unity. It is balancing, harmonizing the body and mind
and emotions. Education is considered to be birth right
of every individual. However there are constraints and
obstacles in achieving this goal.
Physical and mental abilities which are
prerequisites for normal education become the
limitations
for
achieving education among
developmental delay challenged children. But for the
CP children non formal education will be the best way
of teaching. A comprehensive rehabilitation program
may include physical therapy, and therapy involves
stretching, physical exercises, and other activities that
develop muscle strength, flexibility, and control. The
goal is to maximize function and minimize children
with cerebral palsy contractures. The focus is on
developing specific skills such as holding the head up,
sitting unsupported, or walking. Braces, splints, and
casts may be used to help reach these goals. Special
equipment that may be helpful to people with CP
includes walkers, positioning devices, customized
wheelchairs, scooters, and tricycles. Reduction of
spasticity can improve range of motion, improve
response to occupational and physical therapy.
The calendar system enables the children to learn from
the immediate environment which reduces the
children stress level and learn the activity with clear
understanding on Start and finish. The calendar may
be represented by placing the objects or pictures,
representing separate activities in separate boxes or
compartment.
The advantages of this calendar
teaching system is that children with disabilities could
learn more appropriately by understanding next
schedules and to understand past and the future.
The Picture Exchange Communication System
(PECS) is a unique augmentative/ alternative training
package that teaches children and adults with autism
and other communication deficits to initiate
communication. PECS begins with teaching a child to
exchange a picture of a desired item with a
teacher/parent who immediately honors the request.
In this training strategies prompting and reinforcement
strategies are used largely to enhance independent
communication (verbal prompts are not used, thus
building immediate initiation and avoiding prompt
dependency). The child is also taught on
discrimination of symbols and then how to put them
all together in simple sentences. In the most advanced
Phases, individuals are taught to comment and answer
direct questions. Many preschoolers using PECS also
begin developing speech.
A disability rehabilitation service in India is
undergoing progressive changes in its implementation.
Community based intervention services through non
formal approach have gained a lot of attention and
focus in recent years. We attempted holistic
multidisciplinary intervention services which will
improve the condition of child compared to formal
approach. By implementing the non formal approach
the child will develop normalization of tone, improved
ADL activities, speech and communication skills the
child had also improved social skill. From this study
parent got positive impact about the child’s
improvement and non formal approach is the best
approach for children with severe disability and it
should be a continuous process.
References
1.
Choudary, B. (1995). Women and Society in the
Novels of Anita Desai. Creative Books, New
Delhi.
2.
Government of India. (1999). The National Trust
for Welfare of Persons with Cerebral Palsy,
Mental Retardation and Multiple Disabilities
Act.
3.
www.cerebral palsy-web.org