My first placement was paediatrics, therefore consisting of all areas of physiotherapy but applied to children (0-18yrs). The most difficult area i found was any neurological condition which caused multiple functional problems to the children. At first all i could see was their horrible conditions and how much it had ruined their lives but i soon learnt that children are children and if you can make them comfortable for even an hour, effect their lives just a little you can make them smile and see the child underneath.
On a particular child with Cerebral Palsy i had no idea what i could do after the assessment to help him, his tone was very high and i was having a lot of difficulty moving his arms for assessment let alone any treatment. Luckily for me, my supervisor was with me and reminded me (as im sure weve been told this somewhere along the way) that when it comes to tone, if you find the childs inhibitory position, the tone lessens and the assessment and treatment is so much easier and being in that position is more comfortable for the child. As my supervisor used to be the little boys physio she knew this 'magical' position which happened to be simply sidelying... Simple as that, rolled him over and gained 40 degrees in each shoulder movement as well as full elbow extension from 50 degrees flexion, the child simply relaxed and sighed with a big grin on his face. This position in most children is usually sidelying or curled up into a ball but it can be different depending on the child. I learnt that once you find the tone inhibiting position, you treatment that day and any following days is easier and more effective than struggling against high tone. I'm pretty sure this applies for all high tone but i have not had the chance to see it in an adult yet therefore look forward to my neurology placement.
CW
3 comments:
I find this really interesting! I knew that tone is dependent on body position, but I had no idea that this could dependend on the individual. It would have been interesting to have read a bit more about your treatment with this child. Specifically how long did he lie in sidelying, and did this positon help to decrease his tone in more functional positions? Obvioulsy, you need to practice functional activities, so it would be interesting to know how his tone affected this and if you learnt other strategies to deal with it. I wonder too if the strategy you used with the child will be useful in an adult. I would imagine that a head injured patient, with high tone, may benifit fom it.
Thanks for that also, as I am on my paeds prac at the moment and I'm sure that information will be good if I get a chance to see a child with high tone. I did my neuro placement in neurosurgery so I dealt alot with head injured patients with high tone. Obviously positioning does help with patients with high tone, but with most of my patients they had underlying problems (eg dysarthia, dysphagia etc) so putting them in these positions and keeping them there was the most challenging part. In adults positioning to 'relax' the patient is probably not as noticeable than it is in a child and it does take some time for tone to go down and most positions need a lot of weight bearing/stretch (eg tilt table, POP). Also some of the positions are really quite stressful for the patient and painful.
I hope that helps in some way!
To reply to the two comments, the childs tone went down in a minute or so. Although you couldnt do too much functionally with him (he had a more severe CP) by decreasing his tone STM could be applied on his neck which when put back in his chair and back in class meant he could actually see the board, rather than just the ceiling. also thanks for the heads up in neuro, i have that next so its good to know that it does apply to some extent to adults.
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