Serving Physical Handicapped Children & Youth Barbara Chan Occupational Therapist I Prince of Wales...
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Transcript of Serving Physical Handicapped Children & Youth Barbara Chan Occupational Therapist I Prince of Wales...
Serving Serving Physical Handicapped Physical Handicapped
Children & YouthChildren & Youth
Barbara ChanBarbara Chan
Occupational Therapist IOccupational Therapist I
Prince of Wales HospitalPrince of Wales Hospital
Planned activity ......Planned activity ......
Volunteers Resources
Clients
Activity
The common types of disabilitiesThe common types of disabilities
Cerebral palsy (Cerebral palsy ( 腦性麻痺腦性麻痺 //痙攣痙攣 )) Muscular dystrophy (Muscular dystrophy ( 肌肉營養不良肌肉營養不良 // 肌肉萎縮 肌肉萎縮 ))
Spina Bifida(Spina Bifida( 脊柱裂脊柱裂 )) Brain injury(Brain injury( 腦受損腦受損 )) Others: Hydrocephalus, epilepsy, brittle Others: Hydrocephalus, epilepsy, brittle
bone, congenital heart disease, tumor, bone, congenital heart disease, tumor, burns, congenital abnormalitiesburns, congenital abnormalities
Guess ......Guess ......
A. 腦麻痺 B. 脊柱裂 C. 肌肉萎縮 D. 腦受損
Guess ......Guess ......
ClientsClients
Understand the common types of disabilityUnderstand the common types of disability Accept and consider disabilityAccept and consider disability Understand abilities and disabilitiesUnderstand abilities and disabilities Knowing how to communicate and play with Knowing how to communicate and play with
themthem
Major problemsMajor problems
Impaired motor Impaired motor controlcontrol
In-coordination In-coordination problemsproblems
Tonal problemsTonal problems Joint contractures & Joint contractures &
deformitiesdeformities Skeletal Skeletal
malformationmalformation Muscle weaknessMuscle weakness
Associated problemsAssociated problems Cognitive impairmentCognitive impairment Visual / auditory problemsVisual / auditory problems Oral motor dysfunctionOral motor dysfunction
Communication problems (speech problems)Communication problems (speech problems) DroolingDrooling Feeding problemsFeeding problems
Behavioral problemsBehavioral problems
StrengthStrength
Normal to moderate Normal to moderate IQIQ
Varied physical Varied physical abilitiesabilities
Same as normal Same as normal childrenchildren
Communication with ChildrenCommunication with Children
Introduce yourself and give the reasonIntroduce yourself and give the reason for you for you are being there.are being there.
Call the child by nameCall the child by name when giving direction or when giving direction or interacting with the child.interacting with the child.
When meeting or interacting with the child, When meeting or interacting with the child, bend or stoopbend or stoop so that you are on eye level with so that you are on eye level with the child.the child.
When speaking to a child, When speaking to a child, use words and tone use words and tone of voiceof voice that will help the child feel confident that will help the child feel confident and reassured. and reassured.
Communication with ChildrenCommunication with Children ListenListen to the childto the child. . RespectRespect the child’s response the child’s response
and view.and view. ObserveObserve the child carefully. Body language will tell the child carefully. Body language will tell
you a lot about the child’s mood or fears.you a lot about the child’s mood or fears. Always rememberAlways remember that the child may have that the child may have
misunderstanding or worries that you may not have misunderstanding or worries that you may not have thought about.thought about.
Each child will be different withEach child will be different with special interests, special interests, likes or dislikeslikes or dislikes. . You will need to find out the child’s You will need to find out the child’s interest to help you communicateinterest to help you communicate..
The least lovable child needs the most love.The least lovable child needs the most love.
Do ......Do ......
Give a child a choiceGive a child a choice when there is a choice. when there is a choice. Allow child to be independentAllow child to be independent with minimal with minimal
help. Give verbal encouragement and make help. Give verbal encouragement and make sure he or she has opportunity to try.sure he or she has opportunity to try.
Give positive reinforcementGive positive reinforcement.. State suggestion or direction in a positiveState suggestion or direction in a positive
rather than a negative form. (refrain from rather than a negative form. (refrain from saying don’t)saying don’t)
When setting limit, When setting limit, clearly defineclearly define what you what you mean and be consistent.mean and be consistent.
Don’t ......Don’t ......
Avoid using negative attitudeAvoid using negative attitude as tool for as tool for redirecting behavior. Never use words which make the redirecting behavior. Never use words which make the child feels less respect such as blaming, shaming or child feels less respect such as blaming, shaming or making him feel guilty, e.g. “only babies cry, be good.”making him feel guilty, e.g. “only babies cry, be good.”
Do not promiseDo not promise a child anything you are not a child anything you are not absolutely sure will happen. If you make a promise, be absolutely sure will happen. If you make a promise, be sure you are able to do it.sure you are able to do it.
Be professional.Be professional. Do not discussDo not discuss the child in front of the child in front of another child. Do not discuss the child in public place.another child. Do not discuss the child in public place.
When commenting on child’s creativity,When commenting on child’s creativity, avoid wordsavoid words like “what is it?” Instead use words like “what beautiful like “what is it?” Instead use words like “what beautiful color you used?”color you used?”
ClientsClients
How many clients involved? How many clients involved? Selected some or allSelected some or all participated participated Consider the Consider the age, IQ level, physical abilities aage, IQ level, physical abilities a
nd disabilitiesnd disabilities (need walking aids / wheel-chai (need walking aids / wheel-chair users / special seating system – proper handr users / special seating system – proper handling of wheel-chairs both manual and electric ling of wheel-chairs both manual and electric wheel-chairs, proper transfer to sit)wheel-chairs, proper transfer to sit)
Special needsSpecial needs (food reinforcement ......) (food reinforcement ......)
VolunteersVolunteers
How many volunteers involved?How many volunteers involved? How to How to distribute duties distribute duties among volunteers?among volunteers? Assign Assign somebody to handlesomebody to handle problematic child problematic child
during activityduring activity
ResourcesResources - environment - environment
SpaceSpace Enough space for activityEnough space for activity Enough space for wheel-chair usersEnough space for wheel-chair users
Available facilitiesAvailable facilities (furniture or equipment) (furniture or equipment) AccessibilityAccessibility – wheel-chair users, those with – wheel-chair users, those with
walking aids and special seating system, walking aids and special seating system, access to toiletaccess to toilet
Handling the WheelchairsHandling the Wheelchairs
Ajax LauAjax Lau
Manual wheelchairManual wheelchair Power wheelchairPower wheelchair
Safety & Wheelchair HandlingSafety & Wheelchair Handling ““Safety and Handling” of the wheelchair requires the closSafety and Handling” of the wheelchair requires the clos
e attention of the wheelchair user as well as the assistane attention of the wheelchair user as well as the assistantt
Be sure that the occupant Be sure that the occupant has fasten the seat belthas fasten the seat belt while while doing doing ALLALL activities activities
Notes to Wheelchair AssistantNotes to Wheelchair Assistant Keep your Keep your back straightback straight and and bend your kneesbend your knees whenever tilting w whenever tilting w
heelchair or traversing curbs or other impedimentsheelchair or traversing curbs or other impediments Be aware of Be aware of detachable partsdetachable parts such as arms or leg rests. These such as arms or leg rests. These
must must NEVER be used to move the wheelchairNEVER be used to move the wheelchair or as lifting suppo or as lifting supports, as they rts, as they may be inadvertently releasedmay be inadvertently released, resulting in possible i, resulting in possible injury to the user and/or assistantnjury to the user and/or assistant
Wheelchair ManipulationWheelchair Manipulation Folding frameFolding frame
Swing away footrestSwing away footrest With both hands, grasp the middle of the seat upholstery at the With both hands, grasp the middle of the seat upholstery at the
front and back edge and lift upfront and back edge and lift up Unfolding frameUnfolding frame
Push downward on the top of the seat railPush downward on the top of the seat rail
Tilt-in-Space SystemTilt-in-Space System Engage wheel lockEngage wheel lock Inform occupantInform occupant Pull up on the trigger release Pull up on the trigger release
levers to release the tilt levers to release the tilt mechanism from the tilt slidemechanism from the tilt slide
SLOWLY, push down on the SLOWLY, push down on the back canesback canes
Reaching, Leaning & BendingReaching, Leaning & Bending
DO NOT attempt to DO NOT attempt to reach objects if you reach objects if you have to move have to move forward in the seat forward in the seat or pick them up or pick them up from the floor by from the floor by reaching down reaching down between your knees.between your knees.
Kerb ClimbingKerb Climbing
Place foot on the step tube and begin to tilt the Place foot on the step tube and begin to tilt the wheelchair toward you. Apply a continuous wheelchair toward you. Apply a continuous downward motion until the balance point is downward motion until the balance point is achieved and the front casters clear the curbachieved and the front casters clear the curb
The first assistant should stand on the sidewalk and turn The first assistant should stand on the sidewalk and turn the wheelchair so that the rear wheels are against the the wheelchair so that the rear wheels are against the curbcurb
The wheelchair should be tilted back to the balance point The wheelchair should be tilted back to the balance point and, in one continuous upward movement, the rear and, in one continuous upward movement, the rear wheels should be pulled up and over the curb.wheels should be pulled up and over the curb.
DO NOTDO NOT return the front casters to the ground until the return the front casters to the ground until the wheelchair has been pulled backward far enough for the wheelchair has been pulled backward far enough for the front casters to clear the edge of the curbfront casters to clear the edge of the curb
Planned activitiesPlanned activities
Developmental age appropriateDevelopmental age appropriate Fun and playful Fun and playful Safety issueSafety issue CopingCoping i.e. the client manages and gets rewarding i.e. the client manages and gets rewarding
result from it.result from it. SuccessSuccess: It builds confidence and the desire to try : It builds confidence and the desire to try
something a bit harder next time. Does the activity something a bit harder next time. Does the activity
allows a high rate of success to be achieved by theallows a high rate of success to be achieved by the client?client?
Needs of the ChildNeeds of the Child
SocialSocialPlaying with others
Group playTeam games
ImaginativeImaginativeRole PlayCreating
Pretending
SkilfulSkilfulDexterity
ManipulationConstruction
ExploratoryExploratoryMotivation
Interest
IntellectualIntellectualClassifyingLanguage
Development
PhysicalPhysicalAgility
Co-ordination
Needs of the ChildNeeds of the Child
Relationship between physical Relationship between physical handicapped children and handicapped children and
planned activitiesplanned activities
Severe physical handicapped
Moderate physical handicapped
Mild physical handicapped
Normal
Particip
ation
of clien
ts
Passive
Active
High
Low
Nu
mb
er of vo
lun
teers in
volved
Some suggestion on adapting Some suggestion on adapting for specific disabilitiesfor specific disabilities
Physical Physical handicappedhandicapped
Positive reinforcementPositive reinforcement Breaking down tasks to achieve Breaking down tasks to achieve reinforcementreinforcement Materials and equipment Materials and equipment adaptationadaptation
Mental handicappedMental handicapped Positive reinforcementPositive reinforcement Breaking down tasks into sequenceBreaking down tasks into sequence SShowing, guiding throughout the howing, guiding throughout the activityactivity MMay require some physical ay require some physical adaptationadaptation
Some suggestion on adapting Some suggestion on adapting for specific disabilitiesfor specific disabilities
Visual impairmentVisual impairment Positive reinforcementPositive reinforcement Guiding throughout the actionGuiding throughout the action Descriptive instructionDescriptive instruction Equipment / material adaptationEquipment / material adaptation
Hearing impairmentHearing impairment Positive reinforcementPositive reinforcement Breaking down the tasksBreaking down the tasks Facing the child while talkingFacing the child while talking Using sign languageUsing sign language Physical adaptationPhysical adaptation
Emotional Emotional impairmentimpairment
Positive reinforcementPositive reinforcement Keep a small groupKeep a small group Arrange activity that are Arrange activity that are short in length short in length and easy-to-succeedand easy-to-succeed so that the child does so that the child does not become frustratednot become frustrated
DiscussionDiscussion
Q1: Suggest an activity for Q1: Suggest an activity for physical handicapped physical handicapped childrenchildren
Q2: Suggest an activity for Q2: Suggest an activity for mental handicapped mental handicapped childrenchildren
Q3: Suggest an activity for Q3: Suggest an activity for children with visual children with visual impairmentimpairment
Q4: Suggest an activity for Q4: Suggest an activity for children with hearing children with hearing problemproblem
Q5: Suggest an activity for Q5: Suggest an activity for children with children with communication problemcommunication problem (can understand simple (can understand simple command but can not verbally express himself)command but can not verbally express himself)
Pass the parcel (Visual impairment)Pass the parcel (Visual impairment)
Age groupAge group Above 6 yrsAbove 6 yrs
Client/volunteers Client/volunteers ratioratio
1 volunteer is responsible for controlling 1 volunteer is responsible for controlling the musicthe music
1 leader is responsible for the activity1 leader is responsible for the activity
Approximate Approximate lengthlength
30 minutes30 minutes
Therapeutic Therapeutic rationale rationale
To increase concentration by:To increase concentration by:Identifying an object by touchIdentifying an object by touchListening to the music stops Listening to the music stops
Precautions & Precautions & restrictionsrestrictions
This activity requires the use of both This activity requires the use of both hands.hands.
Do not use objects with sharp edges.Do not use objects with sharp edges.
Pass the parcel (Visual impairment)Pass the parcel (Visual impairment)
Required skillsRequired skills NoneNone
EquipmentEquipment A parcel with many layers of A parcel with many layers of wrapping with little present in wrapping with little present in each layereach layer
Tape recorder with musicTape recorder with music
ImplementationImplementation 1.1. Everyone sits in a circle and Everyone sits in a circle and passes round a parcel.passes round a parcel.
2.2. When the music stops, the When the music stops, the one holding the parcel starts one holding the parcel starts unwrapping it and guess the unwrapping it and guess the little present inside.little present inside.
When the cloth is putting down ....... When the cloth is putting down ....... (Physical handicapped)(Physical handicapped)
Age groupAge group Above 6 yrsAbove 6 yrs
Client/volunteers ratioClient/volunteers ratio 2 volunteers holding the 2 volunteers holding the cloth at each endcloth at each end
1 leader in each group1 leader in each group
Approximate lengthApproximate length 30 minutes30 minutes
Therapeutic rationaleTherapeutic rationale To increase social To increase social interactioninteraction
Precautions & Precautions & restrictionsrestrictions
Large room i.e. enough Large room i.e. enough space to see each client’s space to see each client’s faceface
When the cloth is putting down ....... When the cloth is putting down ....... (Physically handicapped)(Physically handicapped)
Required skillsRequired skills Good communication skills (verbal Good communication skills (verbal expression)expression)
EquipmentEquipment A big clothA big cloth
Head band with a star on each teamHead band with a star on each team
ImplementationImplementation 1.1. Divide the clients into two teams sitting Divide the clients into two teams sitting opposite to other team.opposite to other team.
2.2. Assign one of the team members to Assign one of the team members to wear the head band in each team.wear the head band in each team.
3.3. When the cloth is putting down, the one When the cloth is putting down, the one with head band has to call the name of with head band has to call the name of the one wearing head band of the the one wearing head band of the opposite team. The one who is quick opposite team. The one who is quick to call the other’s name wins the game.to call the other’s name wins the game.
How to handle ......How to handle ......
Case 1: During activity, a child Case 1: During activity, a child cries cries ............ Case 2: Suddenly, a child has Case 2: Suddenly, a child has
epilepsyepilepsy ...... ...... Case 3: Two children Case 3: Two children fightingfighting ...... ...... Case 4: One of the children Case 4: One of the children lostlost ...... ......
Handling behaviorHandling behaviorCategoryCategory BehaviorBehavior TreatmentTreatment
When behavior occurred
When not occurred (socially appropriate)
Self-Self-stimulatorystimulatory
Loud vocalization, biting Loud vocalization, biting self, hitting self, self, hitting self, scratching self, hand scratching self, hand licking, spinning around licking, spinning around the room or masturbationthe room or masturbation
InterruptInterrupt
Redirect Redirect
Reinforce the Reinforce the appropriate appropriate behavior behavior
Attention Attention seekingseeking
Screaming, crying without Screaming, crying without tear when asked to do tear when asked to do something, temper something, temper tantrum, muttering, tantrum, muttering, negative comment, negative comment, throwing chair / garbage, throwing chair / garbage, whining whining
Clearly state limit one Clearly state limit one timetime
Ignore behaviorIgnore behavior
Enforce limit as pre-Enforce limit as pre-agreed agreed
Reinforce Reinforce appropriate appropriate behaviorbehavior
Handling behaviorHandling behaviorCategory Behavior Treatment
When behavior occurred When not occurred (socially appropriate)
Non-Non-compliantcompliant
Loud voice, Loud voice, avoidance, passive avoidance, passive resistance, fail to resistance, fail to comply, breaking comply, breaking down rules, child down rules, child refusing to talk, refusing to talk, give eye-contact, give eye-contact, comply slowly, comply slowly, poor or incomplete poor or incomplete job performance job performance
Firmly and calmly restate the Firmly and calmly restate the expectationexpectation
Allow the child to respondAllow the child to respond
Verbally or physically assistedVerbally or physically assisted “I will “I will do it with you”do it with you”
Help the child get involved in the Help the child get involved in the activityactivity and positively reinforce and positively reinforce appropriate behavior appropriate behavior
Positive Positive reinforce reinforce compliant compliant behavior behavior
AggressiveAggressive Yelling loudly, Yelling loudly, hitting, kicking, hitting, kicking, biting, spitting, biting, spitting, throwing things, throwing things, verbally abuse verbally abuse
Verbally or physically stopVerbally or physically stop the the behavior (ensure everyone is safe and behavior (ensure everyone is safe and OK)OK)
Clearly state the limitClearly state the limit
Reflect what the child may be feeling Reflect what the child may be feeling (allow the child to respond)(allow the child to respond)
Deal with the individual situationDeal with the individual situation
Sincerely Sincerely positive positive reinforcereinforce socially socially appropriate appropriate behavior behavior
Any questions?Any questions?
Some suggestionSome suggestion 特殊學校概覽 : : embhsc.hkedcity.net/spspembhsc.hkedcity.net/spsp 坐姿綜合診所 : : www.ort.cuhk.edu.hk/seatingwww.ort.cuhk.edu.hk/seating 香港痙攣協會 : : www.spastic.org.hkwww.spastic.org.hk 脊髓肌肉萎縮症慈善基金 : : www.fsma.org.hkwww.fsma.org.hk 香港兒童脊柱裂互勵會 : : www.spinalbifida.org.hkwww.spinalbifida.org.hk
Search information on planning activities from libraries or booSearch information on planning activities from libraries or book storesk stores
Approach and discuss with special school occupational theraApproach and discuss with special school occupational therapistpist Special needs or behavioral problems of individual childreSpecial needs or behavioral problems of individual childre
nn Activities Activities
• Appropriate or not ?Appropriate or not ?• Any special arrangement ?Any special arrangement ?
Thank You!Thank You!