Module 5: Everyday Activities

 Page Outcomes 

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When you have finished this workshop, you should have a clearer understanding about: 

  • How to use everyday activities to develop your child with cerebral palsy.
  • You should be able to explain this to others in your family or community.

Introduction

A carer is the most important caregiver for a child with cerebral palsy. Think about the time that is spent every day with the child, doing everyday things with her.

Here is a list of some everyday activities:

  • Dressing the child
  • Cooking, cleaning, and doing the washing going on an outing
  • Toileting the child feeding your child
  • Giving the child medication helping her get to sleep
  • Visiting friends
  • Playing with the child going to the clinic…
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This is what the child needs to learn:
  • Moving and balancing, using her hands,
  • Communicating and interacting,
  • Learning to be as independent as possible in self care activities, relating to others,
  • Thinking and playing,
  • Moving from place to place.
  • With all the washing and feeding and dressing and giving medication and other things that you have to do with your child daily, you may already be very busy and feel quite stressed. And you may be caring for other children too.

A common thought is when the carer will find the time and energy to do a lot of exercises to help the child develop.

All of these daily things need to be done with the child anyway. So if they can do them in such a way that they are stimulating the child at the same time, this will help the child a lot with her development.

We will now learn how you can use these everyday activities to help your child develop. Look at these picture strip stories:


uMama KaSive:

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Pic strip 2.png

This story demonstrates how to communicate with a child in an everyday situation. We first discussed this in our session about communication. Look at these pictures again. They illustrate some of the things that we discussed about helping a child learn to communicate.
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Notice how Vuyo‟s mother in the second bathing picture strip uses these ideas to help her child to learn to communicate.

So far, we have concentrated on only one skill – communication. We now need to look at the other parts.

Movement

The caregiver is helping the child:

  • to sit by holding her in a helpful position while she moves her arm to reach up to her head.
  • by encouraging her to balance while moving her limbs. (In the top row, the caregiver always holds on to her child, as she has never become aware, or given the child opportunity, to learn some balancing for herself).

Using her Hands

  • The caregiver involves the child in the washing by helping her to hold the soap or wash cloth

Social and Emotional 

  • The child is learning a self-help skill, bathing. Over the months, this child is learning to bath herself, with just the amount of help and encouragement she needs on each occasion.

Thinking and Playing

  • The child is playing and having fun while learning.
  • The caregiver first performs the activity but involves her by communicating what she is doing - > then she involves the child by helping the child to do it with her - > then she lets the child do more by herself and only points out what is needed -> then makes the request and stands back while the child does it herself.

Summary
A helpful position makes it easier for a child to be more involved with everyday activities. She may be able to look around and watch what is happening in the room; or it may become easier to communicate with others. She can also use her arms more easily during activities

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Using a helpful position during everyday activities

In Module 3 we learned about positions that can either help or hinder a child‟s development. To refresh your memory take a look at Module 3. Now we are going to look at how to support each joint in turn: 

Shoulders:

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  • This works especially well for children who move a lot.
  • Notice that the child's feet are supported and in a good position

Chest:

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  • Notice that the child's feet are supported and in a good position.
  • Notice that the carer‟s other hand is on the child‟s back.

'Hips:

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'
Knees:

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Earlier we talked about you needing to do all the daily activities with your child. And that if you can do them in such a way that you are stimulating the child at the same time, then this will help the child a lot with her development.

Let's look at some examples of how we can use different everyday situations to help children to develop.


One of the things that a caregiver does many times a day is pick up and carry her child. Let‟s look at how to do this so that it helps her develop

Positions that Promote Development

Picking up

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  • Her head falls back
  • It's very uncomfortable for her
  • She can't help to be picked up
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  • Roll her to one side and support her head
  • Bend her legs
  • Lift her close to your body – encourage her to push herself upright on her arm if she can
  • Put her down in the same way
  • Remember to use both sides

Taking Care of your Back

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  • Bending forward with your legs straight will cause small injuries to your back every time you do it. Over time you may develop severe back pain.
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  • Bend your knees and keep your back straight or even slightly hollow.
  • It is sometimes easier with one foot slightly in front of the other one.
  • Hold the child as closely to your body as possible before lifting.
  • Lift by using the strong muscles of your legs and not your back
  • If your child becomes much bigger and heavier, preferably do not lift her alone, but ask someone to help you.
  • Count before lifting so that the two people lifting, do so at the same time.


Carrying

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Poor way
This picture shows a poor carrying position.
  • Her head is falling back
  • She can‟t see
  • Her body is stiff and straight
  • Her arms and hands can‟t do anything
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Helpful way

Head and body

  • A more upright position will help her to hold her head up and look around, even if it can only be for short periods at a time.

Legs and feet

  • Use positions that keep the hips and knees partially bent and the knees separate

Shoulders and arms

  • She can hold on with her arms
  • She can free her arms for playing


You can also try these positions if your child has uncontrolled movements.

And if your child is stiff and tends to curl forwards, try carrying her like this:

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And if one side is more stiff than the other, try to stretch that side. But don‟t always carry her only on one side. Sometimes change to the other side.


Try carrying your baby in this position on your forearm. It can help her to develop control of her head when lying face down.

                              

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And when she's bigger youcan still carry her in this face down position. Babies and children get very few opportunities these days to be face down. A

nd so the development of extension is becoming a problem. Even though the legs are straight, they are separate and relaxed. If the child‟s legs are stiff and crossed, this is not a good position to use.


However

  • If the child‟s legs are stiff and crossed, this is not a good position to use.
  • Remember what we said about children who push back strongly with their heads all the
time. In the same way, this carrying position may reinforce the pushing back of the head
instead of being helpful.



  

Have you tried these traditional positions?


  • Make sure her hips are open, but do not force them.
  • Wrap her arms around you with her thumbs facing up.
  • Each time you carry her, turn her head to the other side.
  • The blanket can provide full muscle support, or if you put it under her arms, she will have to work to keep her head up, and be able to move her arms.
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Dressing

Sitting is a useful position to use when dressing because:
  • The head is upright and in the middle, the child can look at what she is doing
  • The back is upright and straight and the child has to use her muscles to sit up
  • The shoulders are slightly forward and relaxed so it is easier for the child to bring her arms forward
  • The arms are forward and close to the body so the child can use her hands and the caregiver is encouraging her to help put her clothes on or take them off herself 
  • The hips are bent 
  • The legs are relaxed and not pressing together
  • By sitting the child everyday to wash and dress, the caregiver is doing “exercises” with the child that help her develop over time. The child doesn‟t have to sit on your lap as shown; she could sit next to you on the bed or in front of you on a low bench.

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Washing and bathing

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Cooking, cleaning and washing

  • Make sure that your child is in a comfortable, functional and helpful position.
  • Talk to your child about what you are doing
  • Give some cleaning or kitchen equipment to your child so that she can imitate what you are doing in play.
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To open legs that scissor or cross when washing or dressing Avoid pulling the legs apart while holding onto the feet, as in this picture. This will make the legs pull together more and may cause the child pain.                                                                                                          Opening ben.JPG

Ask a therapist to demonstrate the following helpful method, explaining how it could be done for your child specifically.

  • First put something under the head and shoulders to bring them forward a bit.
  • Hold the child's knees and bend the legs up. Bending the hips will help to relax the legs.
  • Hold at the knees and keep the legs apart as you straighten them. It may also help to turn the legs a bit outwards.
    Open ben right1.JPG Open ben right 2.JPG

How to open the hand for washing or activity
Avoid pulling the fingers and thumb out by their tips, as in this picture. This will make the hand close more tightly and may cause injury to the fingers!

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Ask a therapist to demonstrate the following helpful method, explaining how it could be done for your child specifically:

  • If the child's arms are pulled into a bent position, opening the hand will be easier if the arm is first straightened. To make it easier to straighten the arm, hold around the elbow and turn the arm outward as you bring it forward. (This means that the palm of the hand will turn upwards.)
  • Now it will be easier to open the hand.
  • Handling the thumb at its base, take it away from the hand.
  • Now open the other fingers gently.

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PDF Handout

Hambisela_Module_5_Everyday_Activities

Sources and References

Ideas from many sources have helped us to develop the Hambisela programme. The following material and references have been particularly helpful, either as sources or as inspiration on how to present training, and we gratefully acknowledge their use.
In many cases we have been given permission to use photographs. Where permission could not be obtained, the faces have been re-touched in order to protect identity.
1. “Disabled Village Children – A guide for community health workers, rehabilitation workers, and families”, David Werner, The Hesperian Foundation, Berkeley (1999).
2. “Promoting the Development of Young Children with Cerebral Palsy – A guide for mid-level rehabilitation workers”, World Health Organisation, Geneva (1993).
3. “Let‟s Communicate – A handbook for people working with children with communication difficulties”, World Health Organisation, Geneva (1997).
4. “Community Based Rehabilitation -- Training and Guide”, World Health Organisation, Geneva (1989).
5. “Cerebral Palsy, ga se boloi (it‟s not witchcraft)”, Physiotherapist Department of Gelukspan Center, Reakgona.
6. “Polokwane Hospital CP Group Manual”, Polokwane Hospital.
7. “Community-Based Rehabilitation Workers – a South African training manual”, Marian Loveday, SACLA Health Project, Cape Town (1990).
8. Foden Manuals 1-4, Foden Centre, East London (1999).
9. “Practicing the new ways of feeding your child at home”, Diane Novotny, Speech, Language and Feeding Therapist, Western Cape CP Association & Red Cross Children‟s Hospital, Cape Town (circa 2006)
10. “Learning for Life”, Masifunde 2002, Staff Development Special Care Centres, Cape Mental Health.
11. “The Education of Mid-Level Rehabilitation Workers”, World Health Organisation, Geneva (1992).
12. “Disability Prevention and Rehabilitation in Primary Health Care – A guide for district health and rehabilitation managers”, World Health Organisation, Geneva (1995).
13. “Disability Prevention and Rehabilitation – A guide for strengthening the basic nursing curriculum”, World Health Organisation, Geneva (1996).


Hambisela Project: Cerebral Palsy