DOCUMENT RESUME ED 377 656 EC 303 584 AUTHOR Miles, M.; Frizzell, Yvonne TITLE Handling the Cerebral Palsied Child: Multi-Level Skills Transfer in Pakistan. REPORT NO ISSN-0031-9406 PUB DATE Mar 90 NOTE 5p. PUB TYPE Journal Articles (080) Reports Descriptive (141) JOURNAL CIT Physiotherapy; v76 n3 p183-186 Mar 1990 EDRS PRICE MFO1 /PCO1 Plus Postage. DESCRIPTORS *Cerebral Palsy; *Developing Nations; Early Childhood Education; Evaluation; Foreign Countries; Group Activities; Group Experience; Motor Development; *Parent Education; *Physical Therapy; *Rehabilitation; *Skill Development; Training Methods IDENTIFIERS *Pakistan ABSTRACT The majority of children with cerebral palsy in developing countries have no access to trained therapists; for example, in Pakistan, there is less than one trained general physiotherapist per million population. In Pakistan, cerebral palsy handling skills were taught to a group of parents, teachers, and paraprofessionals in a series of practical training sessions. A pediatric physiotherapist led the group, in which a total of 37 children, with an average age of 6 years, took part in one or more 3-hour sessions. Assessment of each child was continuous throughout the handling and observation by the therapist. The sessions, designed to meet the needs of the poor and nonliterate mothers, covered developmental patterns, exercises, purposeful positioning for daily living activities, feeding techniques, and appropriate play materials. It was believed that the feeling of group support may have helped sustain and motivate the mothers. Clinic staff enhanced their skills in the group sessions as well, in order to provide more ongoing support for the families. As some mothers traveled long distances to come to the clinic, their attendance was erratic, requiring the group leader to assess as quickly and accurately as possible the degree of disability, the child's mental level, and the family's capacity to absorb and implement a practical plan. (Contains 12 refe ences.)(JDD) ****A--;,*AA********************************************************** * Reproductions supplied by EDRS are the best that can be made * from the original document. HC) .) *********************************************************** U.S. IMPAIRMENT OF EDUCATION nir=01, Offtoe of F.lucationsl Research and Improvement EDUCATIONAL RESOURCES INFORMATION CENTE diMs document has been reproduced as received from the person or organization originating it. 0 Minor changes have been maid, to improve Handling the Cerebral PalsiedChild: reproduction quality Rants of view or opinions stated in this docu- mant do xit necessarily represent official Multi-level skills transfer in Pakistan OERI posnion or policy M MILES radio broadcasts have been used at the Mental HealthCentre Administrator (MHC), Peshawar, Pakistan. This paper discusses the three- dimensional transfer of cerebral palsy handling skillsto a YVONNE FRIZZELLMCSP group of parents, teachers and para-professionals, in a series Private Practitioner and Advisory Consultant of practical training sessions. Mental Health Centre. Peshawar. Pakistan Background Data Cerebral palsy and polio paralysis account for 71% of Key words: Cerebral palsy,skillstransfer, developing countries, the physically impaired children examined at the MHC information-based rehabilitation. physiotherapy clinic. Polio paralysis is diagnosed onaverage Summary: The severe shortage of skills for handlingcerebral palsied four times as often as cerebral palsy. Data fromclinics children in developing countries means that most families receiveno elsewhere in Pakistan's North West Frontierconfirm the appropriate help for home management. In Peshawar, Pakistan, efforts have importance of these two conditions (see been made to identify and transfer the basic necessary skills in table). The group work Government's immunisation campaign has with mothers and allied professionals, so as to makemore effective use of yet to result in specialist time. Some problems and issues are discussed. a reduction in polio paralysis (Miles, 1989b). Infantmortality rates exceeding 100 per 1,000 indicate suchdeficiencies Biography: Mr Miles has been administrator in charge ofthe Mental in post-natal care that the incidence ofcerebral palsy is Health Centre, Peshawar, since 1978, engaging in resource mobilisation for unlikely to decline appreciably forsome years. disabled children,publication of rehabilitationliterature and policy development with international agencies in the disability field. Mrs Frizzell (née O'Toole) qualified from The London Hcispital, Disabled children assessed at Frontier physiotherapyclinics Whitechapel, in 1977, worked two years in The London Hospital and then (1986-88) in ^ommunity paediatrics in Newham, East London. In Pakistan since 1984, Clinic Total Polio she has engaged in part-time private physiotherapy practice and hasbeen CerebralPP + CP as advisory consultant to the Mental Health Centre, Peshawar. paralysis palsy % of total MHC Peshawar 1,572 881 236 71 SAH Mingora 497 243 79 65 "PERMISSION TO REPRODUCETHIS RCPD Bare Gate 352 195 56 71 MATERIAL HAS BEEN GRANTEDBY MWCK Kohat 333 282 27 93 The MHC clinic began in 1982 with a policy of encouraging family involvement in rehabilitation. In polio paralysiscases, TO THE EDUCATIONAL RESOURCES simple low-cost methods of massage and exercisesare taught to the mother or other family members immediately Strategic Framework INFORMATION CENTER (ERIC)." after the initial assessment of the child. Suchmethods, THE majority of cerebral palsied children indeveloping applied by families at home with periodic check-upsat the countries have no access to trained therapists. rho number clinic, have consistently shown positive results(Rashid, of children with disabilities is increasingmore rapidly than 1986). the pool of available skills. To reverse this trend, strategies Compared with polio paralysis, therange and variety of are needed that will multiply and distribute information and the needs of cerebral palsied childrenare very much greater. skillseffectively. The concept of'information-based It is hard to formulate a universal package oftechniques rehabilitation' has been developed in Pakistan to give such that can rapidly be taught to mothers for homeuse. Levitt strategies a theoretical framework (Miles, 1987, 1989a). (1984) draws attentionto some ofthe cultural and Some of the media such as advice booklets, attitude-change environmental factors causing variations indevelopmental posters and cartoon strip pamphlets, permit rehabilitative sequence, apart from the effects of supplementary impair- information to be multiplied and distributed rapidly, where ments. The Bobaths state that 'No child with cerebralpalsy Nis.,_there is the motivation to do so. Yet their effectiveness is is like another and general advice thatmight apply to all limited in societies where few people can read and fewer children is not of much use' yet this remark appears in I,r) seek knowledge from print. Werner 119871, addressing these their foreword to Finnie's classic (1974)where specific limitations, emphasises that his massive rural rehabilitation handling advice is given for 'varioustypes of children' with c\-) manual is not intendedto be a substitute for 'learning cerebral palsy. 0 through guided practice'. For maximum benefit, a paediatricphysiotherapist should CnThat is especially true when trying to develop therapeutic spend repeated intensive sessions with eachcerebral palsied skills for the complex problems of cerebral palsy. An array child and its family, in normal home-likeconditions. Resource of methods is needed to turn two-dimensional information constraints prevent the attainment of this idealeven in "-I into three-dimensional practice,at a variety of skill levels. 1,11 nations with well-developed healthsystems. The dilemma Two-dimensional media such as pamphlets, manualsand appears in Andrada's discussion of cerebral palsy in Portugal Physiotherapy, March 1990, vol 76, no 3 2 183 (1986). Andrada emphasises the importance of Ow mother's Method and Comments role, the Parents' Association, integration, normalisation and Sessions took place in an exercise room with 19 large decentralised resource allocation. Yet she asserts that inter- canvas covered foam rubber mat. Activities were conducted disciplinary teams are essential and requires postgraduate entirely on and around the mat, mothers and professionals specialism for therapists, while seeming to recognise that this desire is unlikely to be fulfilled in the foreseeable future. working with each child in turn and discussing problems in Pakistan, with less than one trained general physio-and solutions as they arose. Assessment of each child therapist permillion population and practically none was continuous throughout the handling and observation specialised in paediatrics, very few families with a cerebral by the therapist, not formal and dissociated from teaching the parent how to help her child achieve goals. Itwas palsiedchild can receive any specialist advice c.:- emphasised that each activity was done with a clear purpose demonstration of handling techniques. Even wherea trained person may be available, the situation described in mind, which was explained to mothers and staff and by Hamblin (1987) in India is typical: 'The ove, worked discussed with them. Each new idea or activity that should physiotherapist spent five to ten minutes running throughbe used at home was first demonstrated by the therapist a few exercises before sending the child