Beginning of Swimming Lessons for Children

It is important to encourage any form of exercise at an early age, particularly if your child has limited spontaneous movement. “Babyswim” classes are an excellent way to introduce the baby to the water. The child can begin to attend swimming lessons as early as 6 months of age. These classes will give your child an early opportunity to begin exercising and strengthening their muscles (especially their hip muscles). Classes can also give you and your child an opportunity to socialist and form support networks with children of a similar age, enabling ‘play dates’.

Local pools generally have their own swim schools that cater from babies to adults. Small classes of up to 4 children are often available. The Center for Cerebral Palsy physiotherapists have developed a manual to assist swimming teachers in providing optimal swimming opportunities for children with cerebral palsy.

Physiotherapist can help you choose the most appropriate environment for your child to learn to swim.

Finding the ‘right’ pool for your needs

It is important to choose the right pool for your child’s needs. The facilities provided at community pools vary. It may be advisable to check with your local pool to ensure they can best meet your family’s needs. There are many factors to consider when selecting a pool. Water temperature Hydrotherapy pools are generally 33- 34 degrees. Some indoor pools are 30 degrees. Warm water has a relaxing effect and can help decrease muscle tone. Cold water can increase muscle tone. Water kept at a constant temperature of 35 degrees is most suitable for a child with plasticity. A pool kept at about 33 degrees is suitable for a child with low muscle tone

If your child has epilepsy, please discuss the most appropriate pool environment with your paediatrician.

Access

• How will you and your child enter the pool: - stairs /ramp / side of pool / hoist?

• Change rooms

• Facilities available

• A large change table

• Do you need to ask the centre to ensure one is available for your use?

• Noise level / echo -This could make your child tense or anxious and result in an increase in their tone.

Hydrotherapy is a water- based physiotherapy program.

Hydrotherapy programs are used by physiotherapists to:-

*   increase gross motor co- ordination
*   maintain or increase range of movement and flexibility
*   increase muscle strength
*   improve balance and posture
*   improve fitness and endurance
*   promote breathing control
*   promote water safety and awareness
*   develop basic swimming skills
*   reduce muscle spasm and encourage relaxation and enjoyment
*   encourage normal movement patterns.

A variety of swim rings, arm ‘floaties’, pool noodles and toys are incorporated into the hydrotherapy session to promote independence and freedom of movement in the water.

The children enjoy activities in the pool including acceptance of the water and buoyancy, bubble blowing and protection of the airway, kicking, splashing, floating, singing and playing.

The children’s skills are progressed with the aim to complete competencies required for swimming lessons.

Halliwick

The Halliwick Method is a specific swimming program used by physiotherapists. It is based on the scientific principles of body mechanics and the properties of water, aiming to teach people with special needs to become as safe and independent as possible in the water. The philosophy of the program is that the child is happy in the water and the emphasis is on the child’s ability, not disability.

Movement in water allows people with disabilities freedom from the constraints that they endure on dry land. No matter how severe the physical disability they can learn movement in the water.

The program consists of 10 specific progressive stages that are achieved without the use of floatation devices. Waterproof swimming pants are required to wear either awaterproof nappy or Eenee Swimmers if they are incontinent. Eenee swimmers have a stretchy waterproof inner sling for containing incontinence.

Electrical Stimulation for Cerebral Palsy

Electrical stimulation have given some positive results in the muscles of cerebral palsy children. Electrical stimulation is a type of therapy that provides the muscles with a low dosing of electric current. Electrical stimulation for cerebral palsy is used to decrease the effects of stiffness and plasticity in the muscles of the children. The effects of electrical stimulation are not long lasting and need to be given over a fairly long period of time.

The therapy is often used in combination with other types of treatments such as physical therapy. When the muscles are less stiff, physical therapy helps with movement and relieves associated symptoms. Electrical stimulation helps in reducing these symptoms. This combination therapy is effective in treating contractures in cerebral palsy patients.

Electrical stimulation alone may be effective in helping smaller body parts, such as the fingers and toes. Exercise and physical therapy are often combined with electrical stimulation to produce results in larger body parts, like the legs or hips. Some of the benefits of electrical stimulation for use in cerebral palsy are a marked reduction in muscle plasticity. Electrodes can be placed either over the muscle or near the offending body part. Skin electrodes send slight, almost unperceivable electronic impulses to the muscle tissue. Often other methods of reducing plasticity in cerebral palsy patients result in a weakened or damaged muscle, but electrical stimulation does not harm the muscle.

Electrical stimulation(ES) has also been successfully combined with positioning and voluntary effort, when possible, to correct contractures and maintain range of motion. It is critical to the success of ROM protocols to use a comfortable ES protocol one or more times each day. When the body segment to be moved is relatively small (fingers, wrist or ankle), the muscle pull created by ES alone may accomplish the goal. When the body segments are larger (knee or hip) ES may assist the patient in exercising to the end of their range. The therapist should combine ES with voluntary effort. It is important to remember that the maximum benefit of ES for spasticity may not be realized until ES has been used for 1-2 hours each day for 1-3 months.

If ES is discontinued, spasticity usually can be expected to return. For this reason, many patients elect to continue to use ES throughout their life. In addition to the modulation of interfering spasticity, ES can be incorporated into a variety of therapeutic strategies to enchance voluntary movement and function.

These activities can be carried into functional tasks such as using the hands, standing, shifting weight from one leg to the other, and walking. All electrical stimulation therapy should be done under the supervision or recommendation of a physiotherapist or any medical practitioner.

Diagnosis of Cerebral Palsy - Understanding Cerebral Palsy

Initial signs for parents to notice, that their infant is not developing normally. Infants with cerebral palsy perform movements slowly, take longer time to roll over, sit, crawl, or walk. When an infant develops comparatively slowly then it is called developmental delay.

Some of the skills that normal infants should have: Holding own head up when lying flat in a bed at 3 months, Sitting and rolling over by 6 months, Walking by 12-18 months, Speaking simple sentences by 24 months.

Earlier most children with cerebral palsy were diagnosed by the time they are two years old. But if a child’s Symptoms was mild; it would be hard for a doctor to make a true diagnosis before the child is four or five years old. With better understanding of patho-mechanism and presentation, now we can make suspicion as high risk baby at the time of birth and definite diagnosis at the age of three month so we can give much better response in these children by early intervention. 

Doctors diagnose cerebral palsy by obtaining a complete medical history of development and examining the child, paying special attention to the child’s movement pattern and associated medical problem like epilepsy, vision, hearing, speech problem& recurrent chest infection. In addition to checking for the most common symptoms

such as slow development, abnormal muscle tone, and unusual posture -- a doctor also has to make sure the child doesn’t have something else that could cause similar symptoms.

Some children have hypotonia, which means that their muscles are too relaxed. In this case, the Childs muscle may appear very flexible. Sometimes a child can have hypotonia that later become hypertonia two to 24 months after birth. Other children have hypertonia which makes their muscles seems stiff. Child can also have fluctuating pattern of tone known as dyskinetic pattern of movement disorder. Children may also have unusual posture or favouring one side of their body.

What’s most important to the doctor is making sure that the child's condition is not getting worse. Although cerebral palsy symptoms may change over time, children with cerebral palsy do not usually lose function at rapid pace. That means, if a child does seem to be losing motor skills, the problem is probably not cerebral palsy. It more likely a genetic or muscle disease, a metabolism disorder, or tumours in the nervous system. A complete medical history, special medical tests, and, in some cases, repeated check-ups can help confirm whether or not the child has cerebral palsy for certain. Usually the diagnosis of cerebral palsy has been made based on the basis of detail medical history and physical examination. Lab investigation is not required in most of the cases. But in few cases with doubtful cases and suspected brain lesion few investigation may required.

With recent advancements in technology and its reach, some time Doctors conduct brain scans (like MRI scans), that allow doctors to look into the brain, can find problems that may be able to be treated.  If it is cerebral palsy, an MRI scan can also show a doctor the location and type of injury to the brain. This test uses a computer, a magnetic field, and radio waves to create a picture of the brain's tissues and structures. Doctors prefer MRI imaging because it offers better detail and does not involve radiation. Other methods may include Cranial ultrasound. 

This test is used for high-risk premature infants because it is the least intrusive of the imaging techniques. However, it is not as effective as the two methods described below at seeing small changes in “white matter” – which is the type of brain tissue that is affected in cerebral palsy.

Computed tomography (CT) scan. This technique creates images that show brain injury. On rare occasions, metabolic disorders can be mistaken as cerebral palsy and some children will require additional tests to rule them out.

• Xray- xray of pelvis and spine are required to see hip and spinal problem

• Blood investigation are required to see metabolic causes and other associated medical problem.

• Genetic analysis is being advised in certain cases to see some genetic cause of neurological deficit.

To confirm a diagnosis of cerebral palsy, a doctor may send a child to other doctors who have specialized knowledge and training or to specialty clinics where these doctors work with a team of health professionals who specialize in working with children with cerebral palsy and other developmental delays. These doctors  Might be child neurologists, developmental paediatricians, ophthalmologists (eye doctors), or otologists (ENT doctors). Additional observations by these specialists can help the doctors make a more accurate diagnosis and begin to develop a specific plan for treatment.