Serving Physical Handicapped Children

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Serving Physical Handicapped Children Youth

• Barbara Chan
• Occupational Therapist I
• Prince of Wales Hospital

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Planned activity ......
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The common types of disabilities

• Cerebral palsy (????/??)
• Muscular dystrophy (??????/ ????)
• Spina Bifida(???)
• Brain injury(???)
• Others Hydrocephalus, epilepsy, brittle bone,
  congenital heart disease, tumor, burns,
  congenital abnormalities

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Guess ......
A.??? B.??? C.???? D.???
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Guess ......
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Clients

• Understand the common types of disability
• Accept and consider disability
• Understand abilities and disabilities
• Knowing how to communicate and play with them

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Major problems

• Impaired motor control
• In-coordination problems
• Tonal problems
• Joint contractures deformities
• Skeletal malformation
• Muscle weakness

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Associated problems

• Cognitive impairment
• Visual / auditory problems
• Oral motor dysfunction
• Communication problems (speech problems)
• Drooling
• Feeding problems
• Behavioral problems

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Strength

• Normal to moderate IQ
• Varied physical abilities
• Same as normal children

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Communication with Children

• Introduce yourself and give the reason for you
  are being there.
• Call the child by name when giving direction or
  interacting with the child.
• When meeting or interacting with the child, bend
  or stoop so that you are on eye level with the
  child.
• When speaking to a child, use words and tone of
  voice that will help the child feel confident and
  reassured.

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Communication with Children

• Listen to the child. Respect the childs
  response and view.
• Observe the child carefully. Body language will
  tell you a lot about the childs mood or fears.
• Always remember that the child may have
  misunderstanding or worries that you may not have
  thought about.
• Each child will be different with special
  interests, likes or dislikes. You will need to
  find out the childs interest to help you
  communicate.
• The least lovable child needs the most love.

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Do ......

• Give a child a choice when there is a choice.
• Allow child to be independent with minimal help.
  Give verbal encouragement and make sure he or she
  has opportunity to try.
• Give positive reinforcement.
• State suggestion or direction in a positive
  rather than a negative form. (refrain from saying
  dont)
• When setting limit, clearly define what you mean
  and be consistent.

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Dont ......

• Avoid using negative attitude as tool for
  redirecting behavior. Never use words which make
  the child feels less respect such as blaming,
  shaming or making him feel guilty, e.g. only
  babies cry, be good.
• Do not promise a child anything you are not
  absolutely sure will happen. If you make a
  promise, be sure you are able to do it.
• Be professional. Do not discuss the child in
  front of another child. Do not discuss the child
  in public place.
• When commenting on childs creativity, avoid
  words like what is it? Instead use words like
  what beautiful color you used?

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Clients

• How many clients involved?
• Selected some or all participated
• Consider the age, IQ level, physical abilities
  and disabilities (need walking aids / wheel-chair
  users / special seating system proper handling
  of wheel-chairs both manual and electric
  wheel-chairs, proper transfer to sit)
• Special needs (food reinforcement ......)

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Volunteers

• How many volunteers involved?
• How to distribute duties among volunteers?
• Assign somebody to handle problematic child
  during activity

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Resources - environment

• Space
• Enough space for activity
• Enough space for wheel-chair users
• Available facilities (furniture or equipment)
• Accessibility wheel-chair users, those with
  walking aids and special seating system, access
  to toilet

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Handling the Wheelchairs

• Ajax Lau

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• Manual wheelchair

• Power wheelchair

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Safety Wheelchair Handling

• Safety and Handling of the wheelchair requires
  the close attention of the wheelchair user as
  well as the assistant
• Be sure that the occupant has fasten the seat
  belt while doing ALL activities
• Notes to Wheelchair Assistant
• Keep your back straight and bend your knees
  whenever tilting wheelchair or traversing curbs
  or other impediments
• Be aware of detachable parts such as arms or leg
  rests. These must NEVER be used to move the
  wheelchair or as lifting supports, as they may be
  inadvertently released, resulting in possible
  injury to the user and/or assistant

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Wheelchair Manipulation

• Folding frame
• Swing away footrest
• With both hands, grasp the middle of the seat
  upholstery at the front and back edge and lift up
• Unfolding frame
• Push downward on the top of the seat rail

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• Tilt-in-Space System
• Engage wheel lock
• Inform occupant
• Pull up on the trigger release levers to release
  the tilt mechanism from the tilt slide
• SLOWLY, push down on the back canes

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Reaching, Leaning Bending

• DO NOT attempt to reach objects if you have to
  move forward in the seat or pick them up from the
  floor by reaching down between your knees.

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Kerb Climbing

• Place foot on the step tube and begin to tilt the
  wheelchair toward you. Apply a continuous
  downward motion until the balance point is
  achieved and the front casters clear the curb

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• The first assistant should stand on the sidewalk
  and turn the wheelchair so that the rear wheels
  are against the curb
• The wheelchair should be tilted back to the
  balance point and, in one continuous upward
  movement, the rear wheels should be pulled up and
  over the curb.
• DO NOT return the front casters to the ground
  until the wheelchair has been pulled backward far
  enough for the front casters to clear the edge of
  the curb

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Planned activities

• Developmental age appropriate
• Fun and playful
• Safety issue
• Coping i.e. the client manages and gets rewarding
  result from it.
• Success It builds confidence and the desire to
  try something a bit harder next time. Does the
  activity allows a high rate of success to be
  achieved by the client?

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Needs of the Child
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Relationship between physical handicapped
children and planned activities
Passive
High
Participation of clients
Number of volunteers involved
Low
Active
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Some suggestion on adapting for specific
disabilities
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Some suggestion on adapting for specific
disabilities
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Discussion

• Q1 Suggest an activity for physical handicapped
  children
• Q2 Suggest an activity for mental handicapped
  children
• Q3 Suggest an activity for children with visual
  impairment
• Q4 Suggest an activity for children with hearing
  problem
• Q5 Suggest an activity for children with
  communication problem (can understand simple
  command but can not verbally express himself)

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Pass the parcel (Visual impairment)
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Pass the parcel (Visual impairment)
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When the cloth is putting down ....... (Physical
handicapped)
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When the cloth is putting down .......
(Physically handicapped)
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How to handle ......

• Case 1 During activity, a child cries ......
• Case 2 Suddenly, a child has epilepsy ......
• Case 3 Two children fighting ......
• Case 4 One of the children lost ......

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Handling behavior
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Handling behavior
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Any questions?
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Some suggestion

• ?????? embhsc.hkedcity.net/spsp
• ?????? www.ort.cuhk.edu.hk/seating
• ?????? www.spastic.org.hk
• ??????????? www.fsma.org.hk
• ?????????? www.spinalbifida.org.hk
• Search information on planning activities from
  libraries or book stores
• Approach and discuss with special school
  occupational therapist
• Special needs or behavioral problems of
  individual children
• Activities
• Appropriate or not ?
• Any special arrangement ?

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Thank You!