DR. MOHD. QADEER THERAPIST IN CHARGE ,SAMVEDNA TRUST

ALLAHABAD [U.P.] – 9415215394www.samvednatrust.com

Fb:samvednatrust.cerebralpalsyYoutube:jjain999

https://www.youtube.com/channel/UC5h-gRf8sFpf-k60_kwyrgg

Therapeutic Technique to improve neck holding in cerebral palsy

Introduction

Developmental milestones reflect the growth and integration of the central nervous system in the child.

Head control is the first motor milestone to be achieved.

Good head control lays the foundation for the development and refinement of other milestones.

It also enables the child to explore the environment effectively in play and to develop more advanced skills.

Definition & importance

Brenneman (1999) defined head control as the ability to keep the head aligned with respect to gravity

Bobath (1980) describes head control as the ability to maintain head in space face vertical and mouth horizontal

Scherzer (1990) recognize that lack of head control is often the first sign of abnormality in children with atypical development .

Thus, attaining head control is frequently used as the starting point in therapeutic intervention for the children with cerebral palsy or other developmental disabilities by the pediatric occupational therapist (Kramer, 1992) .

Cont.

Detail evaluation of the quality of posture, movement in three positions: prone, supine, and supported sitting is

must before starting any therapy.

CLINICAL SCALE FOR HEAD CONTROL IN PRONE

Grade 0 no responseGrade 1(immature response): unable to lift and hold

(sustain) the head upright.Grade 2 (partial response): lacks in either lifting or

holding (sustain) the head upright.Grade 3 (mature response): ability to lift and hold

(sustain) the head upright.The responses in each position tend to progress from immature responses

towards mature responses. Grade zero specifies the immature responses and grade three specifies the mature responses in each of the three

positions

Precaution during Mx

No CollarNo Range of movement exercise

Do not encourage sitting for neck controlDo not use Pediatric ball therapy for hydrocephalus baby

Don’t encourage other activity till you have fair neck control

Therapeutic technique

Pulling the shoulder blades forward as you lift him up.

Press firmly on the muscles on each side of the backbone and slowly bring your hand from her neck toward her hips.

You can also do taping & stimulation of para-vertebral muscle

Floor Based Supine

PRONE POSITION

SUPINE TO SIDE LYING

Moving a child with head control from prone to sitting

Moving a child with head control from sitting to prone

INTEGRATION OF HEAD UP IN TO DAILY LIFE

Conclusion

We should have detail evaluation of developmental milestone Brain mature in Cephalo-caudal direction so neck holding

came first then trunk control and extremity maturity came in last

We should not encourage other activity till the child have fair neck control

It is very important to have neck holding before the age of 2 year for future development of ambulatory capability

Sensory feed back, stimulation & proper posture is the key in management of immature neck holding

Kangaroo care in infancy is excellent way to improve neck holding in early infancy

For more info Visit www.samvednatrust.com &

www.trishlaortho.comFb:samvednatrust.cerebralpalsy

Youtube:jjain999Blogs: https://samvednatrustcom.wordpress.com

Thanks