Volume 29, No.1, June, 2006

Title: An approach to a premature low-birth-weight child with cerebral palsy presenting symptoms of athetosis

Organization: Akita prefectural rehabilitation and nursery center for children with disabilities
Author:Uki Kawanobe, RPT
Key words:immaturity, environmental adaptation, and self-control

This paper reports an approach to a premature low-birth-weight child with cerebral palsy presenting symptoms of athetosis. This case involves a five-year-old girl. She was diagnosed as cerebral palsy. Her type was a mixed type of quadriplegia. She adopted a cervical hyper-extensive position in every posture, even when she was carried in someonefs arms. She often extended her body and had a difficulty in changing her extended posture to a different posture by herself. When she was put forward into a flexion posture, she extended her body to push herself backward. Because her skin function was premature, she had a difficulty to accommodate herself on a solid surface. She had difficulty in organizing her sensations from her base of support, which was needed to control her antigravity posture. Her difficulty in organizing her sensations was considered to be related to trauma caused by sensory impact she had undergone while she was in a neonatal intensive care unit. Therefore, the physical therapist in charge of her thought that it was important to treat her remaining immature components. During the treatment sessions, her physical therapist could have her perform exercises without effort and have her repeat smooth motor learning exercises to achieve certain goals. As a result of the treatment, the base of support in her back and buttocks were stabilized and she became able to accommodate various postures. She became able to control her spasms and extensions and able to make voluntary movement when she communicated. Her immaturity caused by preterm delivery and later environmental factors had effect on developmental adjustment to various sensations and postures in this case. By taking these factors into consideration, the physical therapist repeated treatments, and the physical therapist eventually succeeded in improving QOL for this case. In the treatment of this case, it was important to be cautious of her developmental deterioration, while stimulating reconstruction on feed-forward system that is seen in the normal development.

Title:Physical therapy for children with spastic diplegia in their childhood

Organization: Tokyo metropolitan fuchu medical center for the severely handicapped
Author: Masahide Watanabe, RPT
Key words: infant, setting of the therapeutic situation, and physical therapy

This paper reports a physical therapy intervention aiming at acquiring an ability to walk with PCW (postural control walker) in children with spastic diplegia during their childhood. Different from adults, it is difficult to get children to voluntarily participate in their physical therapy sessions and to think about their gprospects for futureh. Therefore, the setting of the therapeutic situations and the contents of activities (plays) becomes important to encourage their voluntary participation in the therapy sessions. This case involves a four-year-old boy and he was going to a day nursery school. He moved by bunny hopping indoors and was pushed on a wheelchair outdoors to move about. During treatment sessions, when he walked with assistance from his therapist, within two or three steps his legs crossed and he was not able to continue walking. His major behavioral problem was that he had difficulty in changing situations and moving to the next situation after finishing one activity. During the treatment sessions, the therapist tried not only to improve his motor disability but also to solve his behavioral problem. The therapist assumed the cause of his behavioral problem as gbeing unable to act with anticipationh. For his behavioral problem, the therapist made the order of therapeutic situations in the treatments the same and conducted the treatment sessions under the same therapeutic situation every time. The therapist thought these tactics would help to him anticipate what he would do next, and as a result, he would be able to switch situations smoothly. As the treatment progressed for six months, he gradually became able to anticipate what he should do next. As a result, he became able to switch from an activity standing at the table (play) to walking practice. In this case, the child was able to more easily move from the preparatory therapeutic situation for walking practice to the actual walking practice, and eventually, he became able to walk about five meters with PCW.

Title: Long term support for children/adults with cerebral palsy ?Corresponding to each patientfs life cycle stage-

Organization:Himeji city center for the disabled
Author: Yuzo Sato, RPT Mutsumi Arai, RPT Tamami Yamasaki, RPT
Key words:cerebral palsy, long term support, and life cycle

Therapeutic intervention during infancy and childhood requires an aspect to promote childrenfs development as well as other supportive aspects to give parents a motivating force to nurture their children. At the same time, centers for children with disabilities are required to provide long term support corresponding to changes in each childfs living environment and physical conditions. In the three cases of this article, long term support for children/adults with cerebral palsy in their life cycle is divided into the following five periods based on the standpoint of support and therapy provision according to their living environment and growth.
E Infancy: Support and establishment for the mother-child relationship allowing for easier nurturing.
E Childhood: Preparation for group living.
E Preschool period: Goal-setting based on prognosis and preparation for school life.
E School-age period: Support for school life.
E Adulthood: Support for an independent life and social participation.
Support for infancy/childhood has been better developed technically and systematically as therapeutic and nurturing system are being developed. However, there are many cases in which support is ceased after school-age period. We, therapists, must not only provide therapeutic intervention, but also take a role in giving the appropriate support to children/adults with cerebral palsy according to changes in their living environment and physical condition, while keeping their life cycle stage in mind.

Title: Physical therapy for children with cerebral palsy caused by PVL

Organization:Osaka medical center for handicapped children
Author: Azuma Uenoya, RPT Masahiro Takeshita, RPT
Key words: PVL, low-birth-weight children, and cerebral palsy

PVL (periventricular leukomalacia) is often seen with newborns who have a low-birth-weight. PVL is said to account for half of the causes of cerebral palsy. However, not so many children who are diagnosed as PVL are actually among those children with cerebral palsy. Although the result of examining 73 children with cerebral palsy showed that the total number of children who were diagnosed as PVL has been increasing in the last ten years, the rate of children who were diagnosed as PVL were low among children who were born within 32 weeks of gestation. PVL is also said to be a main cause of spastic diplegia. However, after examining premature newborn babies within 32 weeks of gestation with suspected PVL, taking into account that the rate of spastic diplegia tended to be increasing in the last 10 years, in this population there were also many cases with spastic quadriplegia and/or involuntary movements. In reality, it is probable that among children with cerebral palsy caused by PVL, the rate of children with symptoms other than spastic diplegia is higher than it is currently considered. This paper involves three cases; A child with athetoid-type quadriplegia who was born at 32 weeks of gestation and was diagnosed as PVL, a child with spastic quadriplegia who was born at 27 weeks of gestation and was diagnosed as PVL, and a child with spastic diplegia who was born at 24 weeks of gestation and was not diagnosed as PVL. What these three cases have in common is that the children couldnft obtain an architectural stability of the pelvis and lower body trunk, because of hypoplasia of motor organs around the lower body trunk due to premature birth. The immaturity of postural control function was caused by the combined problem of a central nerve system factor and an architectural factor. Therefore, in order to understand the clinical features of such children born prematurely, it would be better to describe these children with cerebral palsy caused by PVL as premature infants described in the Bobath concept than to describe them according to types of cerebral palsy.

Title:The role of mother-and-child hospitalized treatment: The therapeutic experience of a child with cerebral palsy accompanied by autism

Organization:Kitakyushu rehabilitation center for children with disabilities
Author:Hisako Kobayashi, RPT
Key words:mother-and-child hospitalization, cerebral palsy, and autism

This article reports the case of a child who underwent seven mother-and-child hospitalizations at the Kitakyushu Rehabilitation Center for Children with Disabilities, while also receiving treatment based on the Bobath approach at a local rehabilitation center for children with disabilities. The boy in this case had cerebral palsy and was in his first year of school at a special local school for children with disabilities. He had spastic diplegia with mental retardation and autism. His complications included convulsions, asthma, high myopia and obesity. His verbal IQ was 65 and his performance IQ was immeasurable with WISC III. Although he was able to express and communicate his own desires, he had difficulty understanding the communication of others. He could communicate with words, and he could also read and understand words. During the first hospitalization, programs were made for him to follow at home so that he could perform ADLiactivities of daily livingjin the sitting and standing positions, and so that his ankle joints should be regularly stretched at home. During the second hospitalization, the ankle joints of his AFOsiAnkle Foot Orthosisj were fixed at 0 degrees of ankle dorsiflexion to prevent his crouching posture in a standing position. Frequency of his walker gait with assistance was also increased. Additionally, home programs made during the previous hospitalization were checked. During the third hospitalization, obturator nerve block and motor point block of his hamstrings were performed to evaluate his feasibility of a surgical operation. Additionally his parents were informed that he would not be a community walker in the future. During the fourth hospitalization, he underwent an orthopedic surgical operation and consecutive rehabilitation programs. As a result, his crouching posture in a standing position and his scissorsf gait pattern were reduced. During the fifth hospitalization, home programs were made to improve his function while sitting, standing, transferring and walking. His need of anti-obesity strategy was also emphasized. During the PT sessions in the sixth hospitalization, it was observed that he did not panic when challenging tasks were presented to him as long as the tasks were explained to him beforehand in words. During the seventh hospitalization, the teacher in charge of him at the local special school for children with disabilities was directly and strongly informed of the importance of programs that could encourage him to achieve functional goals that can be applied within the school and community. He also became able to move from his wheelchair to a Japanese-style floor and vice versa. Additionally, he became able to stand up from his wheelchair by holding onto a handrail.