Motricite Cerebrale最新文献

Objective

To analyze the different stages of the medical and rehabilitation follow-up of children with cerebral palsy (CP) before their admission to the PMR department.

Methods

Cross-sectional study analyzing the care pathway of 58 children with PC before their admission to the MPR department of the Yopougon University Hospital over the period from June to September 2018.

Results

The majority of children with male CP (58.6%) were the first or second child in the siblings. The parents lived as a couple (84%) and resided in the city of Abidjan (87%) but the children lived with both parents in 77.6%. Diagnosis made in a university hospital (46.5%) or in a clinic private (29.3%) by specialists in pediatrics (53.4%) and neurology (34.5%). The time to diagnosis was more than 6 months in 55.2 %. These parents used several therapies: medical (62.07%), traditional (31.03%) and spiritual (6.90%). The most used therapeutic route was medical-traditional-medical (29.3%). The factors influencing the choice of route were the parents’ culture and beliefs (75.9%) and family and economic factors.

Conclusion

Need to develop a precise therapeutic circuit for children with CP.

Basal stimulation is a humanistic and psycho-pedagogical approach that takes into account the fundamental and specific needs of people with severe disabilities. It invites people with restricted perception, movement and communication abilities to meet in their daily lives. The basal approach helps to find ways of meeting through touch and by a right physical and psychic proximity in the activities of daily life, taking into account the singularity of the person, as well as their difficulties and their motor, sensory, relational and cognitive skills. It is neither a manual nor a recipe book because the basal approach is not a method but a way of thinking and reflecting on the support of people (children and adults) in situations of great dependence and vulnerability by putting the person, his or her skills, resources and way of being in the world at the centre.

Introduction

Cerebral palsy is the largest cause of motor deficiency in children. However their best practice recommendations for rehabilitation spark debate. The relevance of the work of “motor development milestone” is criticized in this regard. This study aims to identify the professional practice expectations and to observe whether invariants can be observed during care built on the work of “motor development milestone” for children with cerebral palsy (CP) in order to know whether they meet these expectations.

Method

A literature review was conducted to identify the expectations of professional practice for the rehabilitation of CP children using qualitative analysis sorted by thematization to construct an analysis grid. An observational study of practice by a selfconfrontation interview with 3 independent physiotherapists was carried out. The interviews were analyzed using the grid in order to first identify possible invariants of practice and then, if necessary, to link them to the expectations of professional practice.

Results

Forty-one “sub-headings” were identified to describe the professional practice expectations for the rehabilitation of CP children. Analysis of the self-confrontation interviews showed that 24 subheadings were common to all 3 observations. The subheadings most represented in the literature review were most often encountered during the sessions.

Discussion/Conclusion

The results suggest that there are practice invariants in rehabilitation using NEM for CP children and that they partially meet practice expectations. The development of good practice guidelines, the EBP and patient expectations require justification of therapeutic choices and their performance. Their formalization must be developed in order to make them assessable according to validated scientific standards.

The prevention of swallowing disorders in the disabled person requires the neck to be flexed throughout the meal and the food and drink textures to be adapted to the person's abilities. This simple but complete assessment allows the collection of all the information that will enable the observation during the meals to be refined in order to adjust this installation and these textures. Easily achievable and reproducible, it can be redone as soon as the professional and family carers who participate in the meals realize that the person is not eating with pleasure, comfort and safety.

Adults with severe cerebral palsy and restricted autonomy are able to engage in meaningful activities suitable for their locomotor abilities and appropriate to stimulate their cognitive skills. Experimental assistive mobility with an electric wheelchair is one example. Here, we present seven case reports of adults with multiple and severe disabilities, living in institutions. They were proposed training sessions, guided by a multidisciplinary team and dedicated to the discovery of using an electric wheelchair. We show that the learning milestones that are described in children with motor deficiency when beginning to use an electric wheelchair are also observed in our adults. For each individual, depending on the severity of his/her neurological damage, this experiment revealed the level (exploratory or operative) of cognitive ability that was reached after training. For all of them, the discovery of a self-initiated mobility was a source of intense emotional and attentional mobilisation.

Neuromotor therapies, without belonging to a consensual definition, designate a heterogeneous set of rehabilitation proposals and are known and practiced by the majority of therapists working with children suffering from cerebral palsy. These therapies also sometimes simply inspire and complete the therapist's proposals. Nowadays, the evidence based practice model is challenging the use of these rehabilitative therapies. Indeed, the choice of a therapy is made according to a triptych made up of the skills and aspirations of the professional, but also according to the wishes of the parents and the child with cerebral palsy and the best available research data. The current scientific trends are not yet clear concerning the interest of these therapies for young children. There is a lack of evidence, due to the paucity of consensus concerning the description and practical implementation of the therapies, and also due to the deficiency of rigorous studies on which to base recommendations.