Serving Physical Handicapped Children & Youth

1. Serving Physical Handicapped Children & Youth Barbara Chan Occupational Therapist I Prince of Wales Hospital

2. Planned activity ......

3. The common types of disabilities • Cerebral palsy (腦性麻痺/痙攣) • Muscular dystrophy (肌肉營養不良/　　肌肉萎縮) • Spina Bifida(脊柱裂) • Brain injury(腦受損) • Others: Hydrocephalus, epilepsy, brittle bone, congenital heart disease, tumor, burns, congenital abnormalities

4. Guess ...... A.腦麻痺 B.脊柱裂 C.肌肉萎縮 D.腦受損

5. Guess ......

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

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

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

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

10. 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.

11. Communication with Children • Listento the child. Respectthe child’s response and view. • Observethe child carefully. Body language will tell you a lot about the child’s mood or fears. • Always rememberthat the child may have misunderstanding or worries that you may not have thought about. • Each child will be different withspecial interests, likes or dislikes. You will need to find out the child’s interest to help you communicate. • The least lovable child needs the most love.

12. 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 don’t) • When setting limit, clearly define what you mean and be consistent.

13. Don’t ...... • Avoid using negative attitudeas 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 promisea 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 discussthe child in front of another child. Do not discuss the child in public place. • When commenting on child’s creativity,avoid wordslike “what is it?” Instead use words like “what beautiful color you used?”

14. 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 ......)

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

16. 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

17. Handling the Wheelchairs Ajax Lau

18. Manual wheelchair Power wheelchair

19. 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

20. 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

21. 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

22. 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.

23. 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

24. 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

25. Planned activities • Developmental age appropriate • Fun and playful • Safety issue • Copingi.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 theclient?

26. Needs of the Child

27. Relationship between physical handicapped children and planned activities Passive High Participation of clients Number of volunteers involved Low Active

28. Some suggestion on adapting for specific disabilities

29. Some suggestion on adapting for specific disabilities

30. 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)

31. Pass the parcel (Visual impairment)

32. Pass the parcel (Visual impairment)

33. When the cloth is putting down ....... (Physical handicapped)

34. When the cloth is putting down ....... (Physically handicapped)

35. 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 ......

36. Handling behavior

37. Handling behavior

38. Any questions?

39. Some suggestion • 特殊學校概覽: embhsc.hkedcity.net/spsp • 坐姿綜合診所: www.ort.cuhk.edu.hk/seating • 香港痙攣協會: www.spastic.org.hk • 脊髓肌肉萎縮症慈善基金: www.fsma.org.hk • 香港兒童脊柱裂互勵會: 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 ?

40. Thank You!