Serving Serving Physical Handicapped Physical Handicapped

Children & YouthChildren & Youth

Barbara ChanBarbara Chan

Occupational Therapist IOccupational Therapist I

Prince of Wales HospitalPrince of Wales Hospital

Planned activity ......Planned activity ......

Volunteers Resources

Clients

Activity

The common types of disabilitiesThe common types of disabilities

Cerebral palsy (Cerebral palsy ( 腦性麻痺腦性麻痺 //痙攣痙攣 )) Muscular dystrophy (Muscular dystrophy ( 肌肉營養不良肌肉營養不良 //　　　肌肉萎縮　肌肉萎縮 ))

Spina Bifida(Spina Bifida( 脊柱裂脊柱裂 )) Brain injury(Brain injury( 腦受損腦受損 )) Others: Hydrocephalus, epilepsy, brittle Others: Hydrocephalus, epilepsy, brittle

bone, congenital heart disease, tumor, bone, congenital heart disease, tumor, burns, congenital abnormalitiesburns, congenital abnormalities

Guess ......Guess ......

A. 腦麻痺 B. 脊柱裂 C. 肌肉萎縮 D. 腦受損

Guess ......Guess ......

ClientsClients

Understand the common types of disabilityUnderstand the common types of disability Accept and consider disabilityAccept and consider disability Understand abilities and disabilitiesUnderstand abilities and disabilities Knowing how to communicate and play with Knowing how to communicate and play with

themthem

Major problemsMajor problems

Impaired motor Impaired motor controlcontrol

In-coordination In-coordination problemsproblems

Tonal problemsTonal problems Joint contractures & Joint contractures &

deformitiesdeformities Skeletal Skeletal

malformationmalformation Muscle weaknessMuscle weakness

Associated problemsAssociated problems Cognitive impairmentCognitive impairment Visual / auditory problemsVisual / auditory problems Oral motor dysfunctionOral motor dysfunction

Communication problems (speech problems)Communication problems (speech problems) DroolingDrooling Feeding problemsFeeding problems

Behavioral problemsBehavioral problems

StrengthStrength

Normal to moderate Normal to moderate IQIQ

Varied physical Varied physical abilitiesabilities

Same as normal Same as normal childrenchildren

Communication with ChildrenCommunication with Children

Introduce yourself and give the reasonIntroduce yourself and give the reason for you for you are being there.are being there.

Call the child by nameCall the child by name when giving direction or when giving direction or interacting with the child.interacting with the child.

When meeting or interacting with the child, When meeting or interacting with the child, bend or stoopbend or stoop so that you are on eye level with so that you are on eye level with the child.the child.

When speaking to a child, When speaking to a child, use words and tone use words and tone of voiceof voice that will help the child feel confident that will help the child feel confident and reassured. and reassured.

Communication with ChildrenCommunication with Children ListenListen to the childto the child. . RespectRespect the child’s response the child’s response

and view.and view. ObserveObserve the child carefully. Body language will tell the child carefully. Body language will tell

you a lot about the child’s mood or fears.you a lot about the child’s mood or fears. Always rememberAlways remember that the child may have that the child may have

misunderstanding or worries that you may not have misunderstanding or worries that you may not have thought about.thought about.

Each child will be different withEach child will be different with special interests, special interests, likes or dislikeslikes or dislikes. . You will need to find out the child’s You will need to find out the child’s interest to help you communicateinterest to help you communicate..

The least lovable child needs the most love.The least lovable child needs the most love.

Do ......Do ......

Give a child a choiceGive a child a choice when there is a choice. when there is a choice. Allow child to be independentAllow child to be independent with minimal with minimal

help. Give verbal encouragement and make help. Give verbal encouragement and make sure he or she has opportunity to try.sure he or she has opportunity to try.

Give positive reinforcementGive positive reinforcement.. State suggestion or direction in a positiveState suggestion or direction in a positive

rather than a negative form. (refrain from rather than a negative form. (refrain from saying don’t)saying don’t)

When setting limit, When setting limit, clearly defineclearly define what you what you mean and be consistent.mean and be consistent.

Don’t ......Don’t ......

Avoid using negative attitudeAvoid using negative attitude as tool for as tool for redirecting behavior. Never use words which make the redirecting behavior. Never use words which make the child feels less respect such as blaming, shaming or child feels less respect such as blaming, shaming or making him feel guilty, e.g. “only babies cry, be good.”making him feel guilty, e.g. “only babies cry, be good.”

Do not promiseDo not promise a child anything you are not a child anything you are not absolutely sure will happen. If you make a promise, be absolutely sure will happen. If you make a promise, be sure you are able to do it.sure you are able to do it.

Be professional.Be professional. Do not discussDo not discuss the child in front of the child in front of another child. Do not discuss the child in public place.another child. Do not discuss the child in public place.

When commenting on child’s creativity,When commenting on child’s creativity, avoid wordsavoid words like “what is it?” Instead use words like “what beautiful like “what is it?” Instead use words like “what beautiful color you used?”color you used?”

ClientsClients

How many clients involved? How many clients involved? Selected some or allSelected some or all participated participated Consider the Consider the age, IQ level, physical abilities aage, IQ level, physical abilities a

nd disabilitiesnd disabilities (need walking aids / wheel-chai (need walking aids / wheel-chair users / special seating system – proper handr users / special seating system – proper handling of wheel-chairs both manual and electric ling of wheel-chairs both manual and electric wheel-chairs, proper transfer to sit)wheel-chairs, proper transfer to sit)

Special needsSpecial needs (food reinforcement ......) (food reinforcement ......)

VolunteersVolunteers

How many volunteers involved?How many volunteers involved? How to How to distribute duties distribute duties among volunteers?among volunteers? Assign Assign somebody to handlesomebody to handle problematic child problematic child

during activityduring activity

ResourcesResources - environment - environment

SpaceSpace Enough space for activityEnough space for activity Enough space for wheel-chair usersEnough space for wheel-chair users

Available facilitiesAvailable facilities (furniture or equipment) (furniture or equipment) AccessibilityAccessibility – wheel-chair users, those with – wheel-chair users, those with

walking aids and special seating system, walking aids and special seating system, access to toiletaccess to toilet

Handling the WheelchairsHandling the Wheelchairs

Ajax LauAjax Lau

Manual wheelchairManual wheelchair Power wheelchairPower wheelchair

Safety & Wheelchair HandlingSafety & Wheelchair Handling ““Safety and Handling” of the wheelchair requires the closSafety and Handling” of the wheelchair requires the clos

e attention of the wheelchair user as well as the assistane attention of the wheelchair user as well as the assistantt

Be sure that the occupant Be sure that the occupant has fasten the seat belthas fasten the seat belt while while doing doing ALLALL activities activities

Notes to Wheelchair AssistantNotes to Wheelchair Assistant Keep your Keep your back straightback straight and and bend your kneesbend your knees whenever tilting w whenever tilting w

heelchair or traversing curbs or other impedimentsheelchair or traversing curbs or other impediments Be aware of Be aware of detachable partsdetachable parts such as arms or leg rests. These such as arms or leg rests. These

must must NEVER be used to move the wheelchairNEVER be used to move the wheelchair or as lifting suppo or as lifting supports, as they rts, as they may be inadvertently releasedmay be inadvertently released, resulting in possible i, resulting in possible injury to the user and/or assistantnjury to the user and/or assistant

Wheelchair ManipulationWheelchair Manipulation Folding frameFolding frame

Swing away footrestSwing away footrest With both hands, grasp the middle of the seat upholstery at the With both hands, grasp the middle of the seat upholstery at the

front and back edge and lift upfront and back edge and lift up Unfolding frameUnfolding frame

Push downward on the top of the seat railPush downward on the top of the seat rail

Tilt-in-Space SystemTilt-in-Space System Engage wheel lockEngage wheel lock Inform occupantInform occupant Pull up on the trigger release Pull up on the trigger release

levers to release the tilt levers to release the tilt mechanism from the tilt slidemechanism from the tilt slide

SLOWLY, push down on the SLOWLY, push down on the back canesback canes

Reaching, Leaning & BendingReaching, Leaning & Bending

DO NOT attempt to DO NOT attempt to reach objects if you reach objects if you have to move have to move forward in the seat forward in the seat or pick them up or pick them up from the floor by from the floor by reaching down reaching down between your knees.between your knees.

Kerb ClimbingKerb Climbing

Place foot on the step tube and begin to tilt the Place foot on the step tube and begin to tilt the wheelchair toward you. Apply a continuous wheelchair toward you. Apply a continuous downward motion until the balance point is downward motion until the balance point is achieved and the front casters clear the curbachieved and the front casters clear the curb

The first assistant should stand on the sidewalk and turn The first assistant should stand on the sidewalk and turn the wheelchair so that the rear wheels are against the the wheelchair so that the rear wheels are against the curbcurb

The wheelchair should be tilted back to the balance point The wheelchair should be tilted back to the balance point and, in one continuous upward movement, the rear and, in one continuous upward movement, the rear wheels should be pulled up and over the curb.wheels should be pulled up and over the curb.

DO NOTDO NOT return the front casters to the ground until the return the front casters to the ground until the wheelchair has been pulled backward far enough for the wheelchair has been pulled backward far enough for the front casters to clear the edge of the curbfront casters to clear the edge of the curb

Planned activitiesPlanned activities

Developmental age appropriateDevelopmental age appropriate Fun and playful Fun and playful Safety issueSafety issue CopingCoping i.e. the client manages and gets rewarding i.e. the client manages and gets rewarding

result from it.result from it. SuccessSuccess: It builds confidence and the desire to try : It builds confidence and the desire to try

something a bit harder next time. Does the activity something a bit harder next time. Does the activity

allows a high rate of success to be achieved by theallows a high rate of success to be achieved by the client?client?

Needs of the ChildNeeds of the Child

SocialSocialPlaying with others

Group playTeam games

ImaginativeImaginativeRole PlayCreating

Pretending

SkilfulSkilfulDexterity

ManipulationConstruction

ExploratoryExploratoryMotivation

Interest

IntellectualIntellectualClassifyingLanguage

Development

PhysicalPhysicalAgility

Co-ordination

Needs of the ChildNeeds of the Child

Relationship between physical Relationship between physical handicapped children and handicapped children and

planned activitiesplanned activities

Severe physical handicapped

Moderate physical handicapped

Mild physical handicapped

Normal

Particip

ation

of clien

ts

Passive

Active

High

Low

Nu

mb

er of vo

lun

teers in

volved

Some suggestion on adapting Some suggestion on adapting for specific disabilitiesfor specific disabilities

Physical Physical handicappedhandicapped

Positive reinforcementPositive reinforcement Breaking down tasks to achieve Breaking down tasks to achieve reinforcementreinforcement Materials and equipment Materials and equipment adaptationadaptation

Mental handicappedMental handicapped Positive reinforcementPositive reinforcement Breaking down tasks into sequenceBreaking down tasks into sequence SShowing, guiding throughout the howing, guiding throughout the activityactivity MMay require some physical ay require some physical adaptationadaptation

Some suggestion on adapting Some suggestion on adapting for specific disabilitiesfor specific disabilities

Visual impairmentVisual impairment Positive reinforcementPositive reinforcement Guiding throughout the actionGuiding throughout the action Descriptive instructionDescriptive instruction Equipment / material adaptationEquipment / material adaptation

Hearing impairmentHearing impairment Positive reinforcementPositive reinforcement Breaking down the tasksBreaking down the tasks Facing the child while talkingFacing the child while talking Using sign languageUsing sign language Physical adaptationPhysical adaptation

Emotional Emotional impairmentimpairment

Positive reinforcementPositive reinforcement Keep a small groupKeep a small group Arrange activity that are Arrange activity that are short in length short in length and easy-to-succeedand easy-to-succeed so that the child does so that the child does not become frustratednot become frustrated

DiscussionDiscussion

Q1: Suggest an activity for Q1: Suggest an activity for physical handicapped physical handicapped childrenchildren

Q2: Suggest an activity for Q2: Suggest an activity for mental handicapped mental handicapped childrenchildren

Q3: Suggest an activity for Q3: Suggest an activity for children with visual children with visual impairmentimpairment

Q4: Suggest an activity for Q4: Suggest an activity for children with hearing children with hearing problemproblem

Q5: Suggest an activity for Q5: Suggest an activity for children with children with communication problemcommunication problem (can understand simple (can understand simple command but can not verbally express himself)command but can not verbally express himself)

Pass the parcel (Visual impairment)Pass the parcel (Visual impairment)

Age groupAge group Above 6 yrsAbove 6 yrs

Client/volunteers Client/volunteers ratioratio

1 volunteer is responsible for controlling 1 volunteer is responsible for controlling the musicthe music

1 leader is responsible for the activity1 leader is responsible for the activity

Approximate Approximate lengthlength

30 minutes30 minutes

Therapeutic Therapeutic rationale rationale

To increase concentration by:To increase concentration by:Identifying an object by touchIdentifying an object by touchListening to the music stops Listening to the music stops

Precautions & Precautions & restrictionsrestrictions

This activity requires the use of both This activity requires the use of both hands.hands.

Do not use objects with sharp edges.Do not use objects with sharp edges.

Pass the parcel (Visual impairment)Pass the parcel (Visual impairment)

Required skillsRequired skills NoneNone

EquipmentEquipment A parcel with many layers of A parcel with many layers of wrapping with little present in wrapping with little present in each layereach layer

Tape recorder with musicTape recorder with music

ImplementationImplementation 1.1. Everyone sits in a circle and Everyone sits in a circle and passes round a parcel.passes round a parcel.

2.2. When the music stops, the When the music stops, the one holding the parcel starts one holding the parcel starts unwrapping it and guess the unwrapping it and guess the little present inside.little present inside.

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

Age groupAge group Above 6 yrsAbove 6 yrs

Client/volunteers ratioClient/volunteers ratio 2 volunteers holding the 2 volunteers holding the cloth at each endcloth at each end

1 leader in each group1 leader in each group

Approximate lengthApproximate length 30 minutes30 minutes

Therapeutic rationaleTherapeutic rationale To increase social To increase social interactioninteraction

Precautions & Precautions & restrictionsrestrictions

Large room i.e. enough Large room i.e. enough space to see each client’s space to see each client’s faceface

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

Required skillsRequired skills Good communication skills (verbal Good communication skills (verbal expression)expression)

EquipmentEquipment A big clothA big cloth

Head band with a star on each teamHead band with a star on each team

ImplementationImplementation 1.1. Divide the clients into two teams sitting Divide the clients into two teams sitting opposite to other team.opposite to other team.

2.2. Assign one of the team members to Assign one of the team members to wear the head band in each team.wear the head band in each team.

3.3. When the cloth is putting down, the one When the cloth is putting down, the one with head band has to call the name of with head band has to call the name of the one wearing head band of the the one wearing head band of the opposite team. The one who is quick opposite team. The one who is quick to call the other’s name wins the game.to call the other’s name wins the game.

How to handle ......How to handle ......

Case 1: During activity, a child Case 1: During activity, a child cries cries ............ Case 2: Suddenly, a child has Case 2: Suddenly, a child has

epilepsyepilepsy ...... ...... Case 3: Two children Case 3: Two children fightingfighting ...... ...... Case 4: One of the children Case 4: One of the children lostlost ...... ......

Handling behaviorHandling behaviorCategoryCategory BehaviorBehavior TreatmentTreatment

When behavior occurred

When not occurred (socially appropriate)

Self-Self-stimulatorystimulatory

Loud vocalization, biting Loud vocalization, biting self, hitting self, self, hitting self, scratching self, hand scratching self, hand licking, spinning around licking, spinning around the room or masturbationthe room or masturbation

InterruptInterrupt

Redirect Redirect

Reinforce the Reinforce the appropriate appropriate behavior behavior

Attention Attention seekingseeking

Screaming, crying without Screaming, crying without tear when asked to do tear when asked to do something, temper something, temper tantrum, muttering, tantrum, muttering, negative comment, negative comment, throwing chair / garbage, throwing chair / garbage, whining whining

Clearly state limit one Clearly state limit one timetime

Ignore behaviorIgnore behavior

Enforce limit as pre-Enforce limit as pre-agreed agreed

Reinforce Reinforce appropriate appropriate behaviorbehavior

Handling behaviorHandling behaviorCategory Behavior Treatment

When behavior occurred When not occurred (socially appropriate)

Non-Non-compliantcompliant

Loud voice, Loud voice, avoidance, passive avoidance, passive resistance, fail to resistance, fail to comply, breaking comply, breaking down rules, child down rules, child refusing to talk, refusing to talk, give eye-contact, give eye-contact, comply slowly, comply slowly, poor or incomplete poor or incomplete job performance job performance

Firmly and calmly restate the Firmly and calmly restate the expectationexpectation

Allow the child to respondAllow the child to respond

Verbally or physically assistedVerbally or physically assisted “I will “I will do it with you”do it with you”

Help the child get involved in the Help the child get involved in the activityactivity and positively reinforce and positively reinforce appropriate behavior appropriate behavior

Positive Positive reinforce reinforce compliant compliant behavior behavior

AggressiveAggressive Yelling loudly, Yelling loudly, hitting, kicking, hitting, kicking, biting, spitting, biting, spitting, throwing things, throwing things, verbally abuse verbally abuse

Verbally or physically stopVerbally or physically stop the the behavior (ensure everyone is safe and behavior (ensure everyone is safe and OK)OK)

Clearly state the limitClearly state the limit

Reflect what the child may be feeling Reflect what the child may be feeling (allow the child to respond)(allow the child to respond)

Deal with the individual situationDeal with the individual situation

Sincerely Sincerely positive positive reinforcereinforce socially socially appropriate appropriate behavior behavior

Any questions?Any questions?

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

Search information on planning activities from libraries or booSearch information on planning activities from libraries or book storesk stores

Approach and discuss with special school occupational theraApproach and discuss with special school occupational therapistpist Special needs or behavioral problems of individual childreSpecial needs or behavioral problems of individual childre

nn Activities Activities

• Appropriate or not ?Appropriate or not ?• Any special arrangement ?Any special arrangement ?

Thank You!Thank You!