Feeding children with athetoid and hypotonic cerebral palsy

Children who are floppy (hypotonic) and those with strange uncontrollable movements (athetoid) also have eating problems. When dealing with these two groups of children, the most important thing to ensure is that they are sitting up with there head in good position, so that swallowing is made easier. There are intrinsic and extrinsic sensory isseues in child with cerebral palsy which the therapist has to consider in facilitation of particular activity.The therapist must do assessment of hypotonic and athetoid child and make a goal to improve upper extremity so that the child can learn to feed himself.

The therapist must encourage and teach all following activities to feed the child himself:

1. Head control- the therapist must improve head control in hypotonic child so that child can raise his head and can be able to see his food.

2. To correct positioning of child and therapist- The therapist must concentrate on their good positioning of himself and child with their shoulders strapped back against the chair, hips strapped back so that the hips are at 90 degrees, feet on the ground, a foot strap may be needed to keep them here, hands and arms supported on a table in front of them.

3. To improve hand grip strength- the grip spoon handles can be adjusted for gripping using a velcro strap or increasing the size of the handle, a cup with handles will encourage the child to drink with both hands, he should keep his elbows on the table for extra support, the vegetables and fruits can be given to improve grip strength.

4. Sensory integration in upper limb- the therapist should give superficial and deep sensory stimulation by massage, brushing pin pricking, crude and firm touch, cold and heat temperature, vibration sense.

5. To control involuntary in athetoid child- to control involuntary movements should be controlled by stabilizing the joints, passive movements should be encouraged during feeding time.

6. To improve strength in upper extremity- muscle strength can be improved with push ups, weight bearing exercises, range of motions exercises with weight cuffs, holding heavy toys during hand activities, strength can be improved with reaching activities against gravity in upper limb, the child who cannot lift their wrist because of wrist drop can be corrected by using electrotherapy(muscle stimulator), passive movements and strength training in wrist extensors, NDT (neuro developmental therapy) is also helpful in improving strength in upper extremity.

7. To encourage active exercises- hypotonic muscles of upper limb can be activated by facilitating antagonist muscles, the tone of hypotonic muscles of upper limb can be improved by resisted exercises by using therabands.

8. Coordination exercises – Flexion. extension, pronation and supination should be coordinated from holding spoon , taking food from plate to mouth and from mouth to plate. Proper timing has a important role in coordination.

9. Massage therapy with light sensory stimulus and pressure at joints in upper extremity and neck.

10. To improve confidence in child- Intrinsic sensory feedback comes from the child’s own visual, vestibular, and somatosensory systems. The therapist or caregiver can put mirror in front of child to improve his confidence while eating and drinking. In front of mirror ask him to correct his position of trunk and hand during the feed.

11. Regular exercises should be maintained so that the child will never forget the taught exercises.

12. Revisions, repititions and hold time should be maintained.

13. Use of electrotherapy- it can be used to stimulate all small and large muscles of upper limb.

The therapist must always teach and demonstrate all above techniques and exercises to the parents or caregivers to keep practicing at home. All home remedies, do and don’ts must be explained to the parents and caregivers.