Positioning Definition
Static process which improves one's ability to maintain postural control while doing an activity.
Handling Definition
Dynamic Process - Guided movements.
eg. tapping, stroking, vibration
What type of children are positioning and handling used with?
Children with movement disorders from damage to CNS.
What are the benefits of positioning?
Increased comfort and reduction of fatigue
To Promote skeletal alignment
Provide child with a range of sensory experience
Assist the child in learning the movements
Types of input for handling
Proprioceptive, Tactile, Vestibular
Input is provided at key body parts.
Why is inhibition used?
Reduce mm tone, state of arousal or sensitivity
Types of inhibition techniques
Neutral warmth
Slow stroke, gentle shaking or rocking, slow rolling, Trunk Rotation
Why is facilitation used
To increase mm tone, state of arousal or reactivity
Types of Facilitation techniques
Bouncing, swing, rocking
Moving child into upright antigravity position
Heavy jt. compression, quick stretch, Tapping, Vestibular stimulation
Is weight bearing facilitory or inhibitory?
It can be both
General Principles of Positioning
Provide support, Position for symmetry and skeletal alignment, variety, safety and comfort, developmentally appropriate positions, consider vision.
Three methods of positioning
Use of therapists hands or body
Equipment/Furniture to free hands
Custom equipment
Supine Positioning Methods
Common for infants-developes flexor tone.
Flat or incline, use wedges, pillows, etc to keep head midline and slight forward flex.
How are children with strong extensors positioned?
Supine with hips and knees in flexed position to break up tone
Why position prone?
Facilitates hand strength, neck and trunk extension and development of hand arches. Use wedges, pillows etc to keep head upright.
Why position side-lying?
For children whose mm tone is too hypo/hypertonic in prone or supine. Head midline, hands free and inline of vision.
Different ways to sit.
Long sitting, Ring Sitting, Taylor or crisscross
Use standard chair with mods or customized chair.
Principles of Sitting
Symmetric, head aligned with trunk - in midline
hips/knees, ankles flexed, feet supported, knees abducted and in good alignment, table or lapboard used (elbow height)
Pelvis positioned FIRST
Standing - Benefits of full Weight bearing
promotes good bone development, optimum movement in mm tissue, good circulation, tone reduction.
Supine Stander
Used to increase extensor tone and alignment, good for children with poor head control
Prone Stander
Need good head control, used to encourage flexion, increase gastroc stretch.
In forward tilt - strengthens upper thoracic, scap stabilizers and cervical extensors
Importance of play
Child learns and refines their FM and GM skills.
Process in more meaningful and therapeutic than the outcome.
Things to consider with Play
Children with disabilities may need assistance
May need longer time to respond and initiate
Build therapy into play
How does motor delays affect Intellectual development?
May limit access to or opportunity to participate in activities that promote the development of cognition.
Can affect self-awareness, social skills, spacial relations and communications.
PTA role in promotion for intellectual development
Look at reflexes and tone - Fostering motor development can lead to development in other areas (my words)
Some alternate mobility tools
Walkers, strollers, carts, rolling standers
Allows child to have opportunity to explore environment.
How does the PTA promote interaction with the environment?
Seating and positioning
Facilitate communication through activity
Incorporate what other team members are working on into your treatment.
What is impacted by the sensory system
Students ability and willingness to participate. Children with sensory differences may not want to participate in all activities.
Sensory modes
Hearing, taste, smell, sight, proprioception, touch and vestibular