“If you feel you cannot make a change in every second, do something else and do not waste the child’s time”The Bobath couple
Before beginning movement therapy, a complex diagnostic assessment must be carried out. The interdisciplinary team consists of physicians, movement therapists, as well as special education teachers and psychologists with experience in assessing psychomotor development. In optimal cases, the medical assessment is carried out by a pediatric neurologist specialised in developmental neurology, whose tasks are to take detailed familiar, pre-, peri-, and postnatal anamnesis; to carry out the neurological assessment after eliciting information from the parents; to plan the examinations necessary for the etiological diagnosis; and to establish and communicate the diagnosis.
The movement therapist involved in the assessment can be a physiotherapist, a physical disability specialist, or a conductor teacher, whose tasks are to assess the level of motor development and to explore the deficits reducing both movement performance and quality. These assessments are complemented by the examinations conducted by the special education teacher, which look at other characteristics of psychomotor development, such as visual and auditory attention, levels of cognitive development, communication, speech development, and socialisation, as well as general behaviour and discipline.
On the whole, these assessments make up the developmental diagnosis. It must be underlined that therapy can be planned only after the establishment of the etiological and developmental diagnoses and their clear communication to the parents. It is considered fundamental that the parents have the right to know as much as possible about their child’s condition and disease. The help providers must inform the parents about the etiological diagnosis and the therapeutic options in detail.
Several forms of movement therapy are available in Hungary. A non-exhaustive list of these methods and therapies is presented in Table 1.
Methods used in movement development and movement therapy in Hungary
|Neurodevelopmental treatment approach (NDT/NDTA) – Bobath therapy||Dynamic Sensory Integration Therapy (DSZIT/DSIT)|
|Katona’s method||Ayres Sensory Integration Therapy|
|Conductive education – Pető method||Body–mind centering|
|DSGM – Dévény Special Manual Technique and Gymnastics Method||Hydrotherapies|
|Pfaffenrot therapy||Kinesio Taping|
|Massage therapy techniques||Botulinum toxin|
|Basic therapy||Surgery (orthopaedic and neurological)|
|Sensorimotor training (planned SMT)||Therapeutic aids (splints and seating and standing systems)|
To date, no therapeutic guidelines have been set forth that would suggest practices in accordance with the diagnoses. An interventional approach must be adopted in the therapy that puts the child with the developmental disorder and the family in the focus. The treatment is selected based on the child’s condition and the family’s socioeconomic status, resulting in an individually planned therapy. First, we tell the parents which therapeutic options would be the most beneficial for their child based on our experiences, and then we select together the therapy that fits the family’s place of living and financial status. It is important to set the date of the follow-up visit and have the parents understand that the repeated examinations may suggest necessary changes or additions to the therapy.
During the selected movement therapy, the providers must always consider the child’s neurological status and assess the child’s tolerance level on each session. The parent must be present throughout each treatment session. During the discussions and in case of counseling, movement therapists must be aware of their competencies and stay within their professional boundaries.
Based on the experiences in the Early Intervention Centre Budapest, our therapeutic guidelines are the following:
- –In case the infant or child presents with muscle tone disorder, asymmetric posture, or impaired motor development, manual therapy is recommended, such as the DSGM therapy, Bowen technique, Pfaffenrot therapy, etc.
- –If the delayed motor development is not associated with severe muscle tone disorder, active individual or group physiotherapy is suggested.
- –If balance and coordination problems or other sensory symptoms (e.g., tactile sensitivity) are found, sensorimotor therapy is advised, i.e., Ayres, sensorimotor training (planned SMT), or Dynamic Sensory Integration Therapy (DSZIT/DSIT). These methods can be effective in delayed speech development or in behaviour problems, as well as in social development problems.
- –If the complex examination shows other psychomotor impairments, individual special education therapy is recommended. We pay special attention to the early detection of sensory organ impairments, because early special education therapy (e.g., tiflopedagogy and surdopedagogy) is crucial.
An important part of the care is documentation, which should not only be used as notes for the providers, but also the parents must be offered the chance to look into them. Furthermore, it can provide information for other care providers treating the child, enhance process diagnostics, and contribute to research.
The profession must ensure that the various therapeutic methods provide clear definitions of their activities and that their findings are supported by objective investigations. The care of the child with the developmental disorder can be effective only if the parents have a clear understanding of the therapeutic methods and if the therapists provide care to the child with appropriate professional experience and humbleness. We must always remember that the children’s human dignity is independent of their physical condition – even if they have severe impairments, their human dignity should be considered as equal to a healthy child’s.
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. Lányiné EA A korai életszakasz és a korai intervenció [Early childhood and early intervention]. In: , ed. Intellektuális képességzavar és pszichés fejlődés [Intellectual Disability and Psychological Development]. Lányiné EA Budapest: Medicina Könyvkiadó; 2009. p. 147– 205.
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