Chapter 7: Physical Management in the Classroom By: Sarah Daniels

For a child with severe and multiple disabilities who have limited motor skills, classroom participation and learning will depend on how the environment supports performance through a daily physical management program that addresses the child’s unique motor needs.

Focus of chapter O Understanding the physical management of children with cerebal palsy and other neuromotor involvement O Practical information for teachers and classroom staff to help children participate in learning environment O Addressing the child’s unique physical and motor needs need to be addressed so they are able to participate in classroom activities

Physical needs to address O Muscle Tone O Muscle Co-activitation O Joint Alignment O Postural Control O Primitive Reflexes O Weight Shift O Sensory Input O Volitional Control

Muscle Tone O The readiness of the muscles in the body to act, every movement requires some degree of muscle tone. O Example: To sit in a chair, the student muscles in their trunk must be high enough to align the trunk and spine in an upright position against gravity but low enough to adjust one’s posture to reach and use arms and hands O A child may have muscle tone that is too high or too low which makes it difficult to stabilize joints and maintain position O A student may require a classroom chair with supported back and pelvic seat belt or may require total assistance to use arms and hands depending on the needs. O Hypotonia- muscles need to be activated O Spasticity- diminished muscle tone

Muscle Co-activity Muscle Co-activity is movement and posture require a balance of muscle activation around a joint. Ex: Independent sitting requires a balance of muscle activation in the front, back, and sides of the trunk for the student to maintain a static sitting position. If the student has abnormal muscle tone they will require assistance from person or adaptive equipment to provide stability.

Joint Alignment In order for muscles to preform their typical action around a joint, the joint must be in proper proper alignment or have the ability to be moved into an aligned position by the actions of the muscles. Example: For a student to sit up, the vertebrae of the spine must be aligned over the pelvis. If a student has atypical muscle tone and poor postural alignment they may sit with a rounded spine.

Postural Control To maintain postural control a student makes slight adjustments such as movement in the trunk or shifts in body weight. Postural reactions are an integral component of dynamic movement in space, such as reaching, changing positions, crawling, walking or riding a bike

Primitive Reflexes O A primitive reflex is an involuntary response of the body to a specific sensory stimulus that appears in early development (birth to 6 months) but disappears with maturation of the central nervous systems. O In some children with severe and multiple disabilities, abnormal muscle tone and the presence of involuntary primitive reflexes interfere with the development of postural control.

Weight Shift O The movement that involves change in the center of the body to adjust for most activities O A child with abnormal muscle tone and poor postural control has difficulty with weight shift

Sensory Input O A student must be able to process visual, tactile proprioceptive (from muscles and joints), and vestibular (awareness of movement) information for postural control. O Example of visual and auditory information O Teacher calls on a student O Teacher shows a picture O Atypical muscle tone affects the quality of internal sensory feedback generated from movement

Volitional Control O Volitional control is the ability to initiate and carry out active and purposeful movement. O Example: sitting in a chair using a manual sign to communicate a desire, taking a cookie from a platter, or reaching towards a communication board are all activates requiring volatile motor control. O Examples on next page….page 259 in book

Things to do… O Encourage purposeful and meaningful activities in the classroom O Position the student so they can engage in classroom activities O Prepare a student to participate and provide physical assistance as needed during motor activities O Do motor activities designed to meet motor goals listed in IEP O Plan a schedule with a variety of positions to meet and work towards the student’s goals and physical needs

5 Basic general principles to apply when guiding acquisition of motor skills 1. Motor learning is enhanced when participation is active 2. Motor learning is enhanced when actions are goal oriented 3. Motor learning is enhanced when sessions include both repetition and problem solving 4. Motor learning is enhanced by practice in meaningful contexts 5. Performance is enhanced when the performer assumes an optimal state of readiness for action

When developing a physical management plan ask the questions… O What are the functions of the motor goals for the child that will maximize participation in the education environment? O Example: sitting for classroom activities, changing positions, use of arms and hands, personal care, etc. O What areas need to be developed? O Are there health concerns that need to be addressed? O What is the child’s positioning plan and schedule? O What roles do people play outlined in the IEP? O How are the goals achieved in inclusive environment and daily routines?

Before handling (touching/assisting) a child know their needs O Children with spasticity: O Make sure environment is calm O Tell the child who is going to help them and what/how they will be moved O Firm touch that the child anticipates is best O Children with hypotonia: O Benefit from an environment that generates excitement or increase in muscle tone O Stimuli that is alerting or arousing O Quick, a-typical movements

Before starting an activity ask yourself… O What movement does the student need to do to participate? O Does the student need to prepare to participate? O What assistance/handling does the child need during the activity? How should the child be handled?

Many students will need adaptive seating, use the checklist for seating positioning (chart on page 274)

When choosing a seat consider the following… O Positioning of the trunk O Positioning of the head O Positioning of the lower exterminates O Positioning of the arms

The book has detailed movements for the teacher here is one of them…

Forward weight shift Daily activities for a child when forward weight shift should be encouraged includes: Leaning forward to put on or take off a jacket Washing hands Leaning forward on the toilet to wipe Pick up something from the floor The book provides detailed instruction on how to do this movement on page 277

O Floor sitting is generally not appropriate for an inclusive environment O It is suggested that children need floor time experience to achieve functional sitting and mobility goals that are documented in IEP O Independent sitting requires.. O Sufficient mobility and stability in head and trunk O Needs to have postural control to maintain position O Joint mobility to be placed in sitting position O Page 296 has floor sitting positions Floor sitting

Positioning Schedule Positioning and meeting the physical needs of a classroom of children with severe and multiple disabilities can be challenging The teacher should develop a schedule that meetings each students needs and matches the classroom routines Things to think of … What postures should be avoided and/or what should be reinforced? What positions should the child be in to participate in the activity Will the position allow the child to participate? Is the staff trained? Do they know what they are doing Example of positioning schedule for pre-school age student that requires adaptive seating (page 299)

THE END!!!