INTRODUCTION
Locomotor disabilities are caused by orthopaedic and/or
neurological impairments.According to the Persons with Disabilities Act 1995, "locomotor disability" means disability of the bones, joints or muscles leading to substantial restriction of movement of the limbs or any form of cerebral palsy.
Orthopaedic disabilities include deformities in the body, birth defects, accidents leading to removal of limbs or deformed
limbs or due to diseases or poliomyelitis which result in
difficulty in the day-to-day functioning of the person. Usually, children so affected have normal intelligence and are capable of learning in schools like other children. The teacher should be aware of the specific problem in the movements of these children so that suitable seating arrangement in the class, mobility aids, writing aids and other assistive devices can be provided for them.Cerebral palsy is one form of neurological impairment. Children with cerebral palsy may have mental retardation also. However, not all children with cerebral palsy (CP) are mentally retarded.
Some have average or above average intelligence.
Cerebral Palsy is a disability affecting the child at a very early age.
The medical term for 'spastic' is Cerebral Palsy - CP - It is a group of disabling conditions that result from damage to the growing brain/to the Central Nervous System; 'Cerebral' refers to the Brain and 'Palsy' describes the lack of muscle control which is many times, not always, a symptom.
Incidence - A child with C.P. is born generally once in every 400 births without any distinction of sex, race, maternal age or soal background. It can be severe or mild. Cerebral Palsy may have associated problems in vision, hearing, speech, mental ability and social adjustment.
CP is not 1) usually hereditary, 2) contagious, 3) progressive or 4) primary cause of death.
It may be caused, Before Birth - due to causes such as rubella or other infectious disease, over-exposure to X-rays, R.H. Incompatibility. During Birth - due to causes such as prolonged labour; misuse of instruments;
excess of anesthesia; lack of oxygen to brain; or excessive bleeding. After
Birth - early in life due to head injuries; high fever, fits, child abuse,
complications such as measles, leprosy, meningitis, or encephalitis.Drugs and surgery cannot cure this condition. Early detection and treatment is vital as it will lead to reducing developmental handicap to the minimum and thus to better adjustment to life.
A child with cerebral palsy can be a Spastic - with tense contracted
muscles, Athetoid with constant uncontrolled motion of head, limbs and eyes. Rigid with tight muscles that resist efforts to make them move, Ataxic with poor sense of balance causing stumbling and/or falls.Depending on the involvement of the limbs, they are c3lled as children with monoplegia, diplegia, quadriplegia or hemiplegia.
The child may have Tremors too. A child may have more than one type of Cerebral palsy.
Management of a C.P. child is best accomplished by specially trained people, individualised teaching and therapy supported by specially designed furniture and a spacious school. The team consists of a special educator, physiotherapist, occupational therapist, speech therap;st, general health worker and social worker.
Taking it as a challenge to develop the whole child can be an exciting and enriching experience. Finally it is the Attitude that matters - it should be positive and then there are really no barriers at all.
hemiplegia Paraplegia quadriplegia
(The shaded area in the figures refers to affected limbs)
The parent can treat the following physical and behavioural symptoms as cues to seek further medical advice.
Physical Symptoms
a child may have some of the following:
- difficulty in sucking.
- difficulty in breathing.
- poor muscle control.
- muscle tone stiff, floppy or having spasms.
- scissoring of lower limbs (legs).
- poor reflexes.
- clumsy finger and grasp movements.
- husky/hoarse voice.
- poor neck control or balance.
- has motor problems.
- sensory problems of ear, eyes, speech, touch or spatial orientation.
- drooling of saliva. "I
- fits or seizures.
- does not bend knees and thighs or bring to extension posture.
- delayed milestones - turning, crawling, etc.
Readiness activities for children with locomotor disabilities
Children with locomotor disabilities require physiotherapy. Certain simple motor activities at the advice of professionals can be incorporated in the school activities. It is important to give chances to these children to participate in all activities like other children. Caution should be exercised
to prevent them from bumping into objects and people and avoid activities in slippery areas. In the classroom, sufficient moving space and seating in the place near the exit will be convenient for these children. They will learn academics like other children if given opportunities and teacher should encourage their involvement in all activities.
Furniture, aids and appliances for children with locomotor disabilities Furniture - chairs with back support and rest, support in front, grip handle on front board, high back chair, bed props with pillows, all help in correct and comfortable positioning.
High back for
proper posture for corner seats
Normal children move around, look, observe, ask and learn. A child with difficulty in mobility takes time to move about to be aware of self and environment.
Bamboo/card board box
Toilet training : Toilet Training is an essential pre-requisite for entering school and therefore it is important that this task is given priority.
The normal age for awareness of wetness
Indication of toilet need Unbutton, pull down pantie Flush toilet
Turn door knob
Independent toileting
Points to remember while toilet training - stress on - proper seating position
- proper standing position - held by parent when needed Access to toilet to be easy;
- more space, less slippery floor, - railings support along the walls,
- railings near commode or water closet - broad door/sliding door - for more space - easy flush-out handle or knob
In a child with cerebral palsy, delays and difficulties will be present.
Note : See sketches of low-cost toilet aids.
Bricks in the ground
- 3 months - 1-1 1/2 yrs - 2 - 2 1/2 yrs - 3 1/2 - 4 yrs - 3 yrs
- 4-5 yrs
Tyre
Low-stool-with potty
Chair with potty
urinal for male children