From my practice I could see that the therapy hall, in which the children are being treated has an impact in the outcome of neurologically deficit children like cerebral palsy. Most often what the kid observes from his or her surroundings varies in case of an open therapy (where all kids gets treated in a large hall) and closed therapy (where each kid gets treated in a separate room or partitioned) environment. How can you judge this from your clinical practice treating children?
dear Joshua,
It is very dependent on where you live, what is normal in your culture and what is possible.
In some cases I have worked with children at home, but I have also worked in a large room with more therapists and children and in the sole treatment room.
Sometimes there is no choice.
It can be fun in a large room with more children but it can also distract. It will depend on what the child's possibilities and problems are.
What is imminent for treatment to succeed is that it can be repeated regularly and A LOT. PRACTICE PRACTICE PRACTICE meaning that parents or caregivers have to be present to learn how to handle their child at home. We now know that simply treating the child 1x or even 3x week for a certain time is not as functional as being able to incorporate the 'training/exercises' into daily routine.
I would argue that the contact with mother/child/therapist is THE most vital component of the training. That the therapist must be skilled in assessing and addressing the problem AND teaching how to handle to the parents and/or caregivers...
My first preference in young children is to do this at home, but if need be, it can be done anywhere.
I do agree with you that some children need an environment that is free of too much colour and stimulus but other's do not.
Another question is the room colour: in the clinic, we notice the differences. I am not aware of any studies into the effects of colour on therapy. Would like to hear if there are any.
Dear Joshua,
it will probably depend on what kind of treatment you intend to apply. For treatments based on skill motor learning (evidences of improvement of upper extremity functioning in literature, see Novak 2013 for a review), for instance CIMT or HABIT for children with hemiplegic cerebral palsy, a large room with the presence of other children is generally a good stimulation. Children are witnessing progress of each other during these days of intensive therapies and it provides motivation. This can be less interesting if you have an attentional deficit.
This can be also adapted regarding the age of the child. While having other patients in the same room does not seem crucial for a baby (you may prefer there an environment with less distractions and with one of the parents), it can be crucial for motivation teenagers with neurological disease to have contact and to encounter therapy in a room where other teenagers are treated.
Hope it can help.
More information about treatment rooms in papers about CIMT or bimanual therapy (see Andy Gordon work at Columbia University).
Dear Esther & Yannick,
I understand your views, but when we look at the negative side of this issue as in where on one side the open therapy atmosphere gives motivation, the same may also lead to frustration.. for example a child who sees other kid's progressing very well and he / she couldn't able to progress that much comparatively.. Added to that there is always an issue like forcing the child to perform like the kid who is progressing well, by the parents.. As we know that all CP kids doesn't have the same physical ability, how can it be judged by having a mix of all in one treatment hall.. I agree totally about the positive sides of this issue.. But we need to take into consider these negative influences also and how to overcome it.. ..
Dear Sivakumar sir,
Yes sir, I agree that making the environment more enriched has a positive influence on the child's outcome.. But what about the influence of activities of the kids who are undergoing therapy at that time?? For example, a child during his therapy observes another child in the same hall who is walking and unfortunately that child falls down.. This would obviously have a negative impact on the child like he / she would also have a chance of falling down while walking.. and this would be a hindrance in the child's progression towards recovery..
dear Joshua,
Every child, with or without a handicap of any sort will have to deal with his/her peers. In every situation, it will be dependent on the child's character, the child's background and the parental reactions as to whether seeing other that can 'do more'' is perceived as detrimental. I have found that children accept who they are very easily and accommodate. I am not too afraid of the negative impact you speak of.
Dear Esther,
Very well said about the acceptance nature of children.. That is very true.. But from my practice what I observed would cause the detrimental issues are the "fear factor" which the child develops.. It can be fear or fall, fear of therapists, fear of heights, etc.. And these are more available in case of an open environment therapy hall..
I agree with you on this. On the other hand. Are you sure there is nothing else wrong?
Are you sure they are fearful of heights? In these children I would certainly want to check their vision and visiomotor perception.
If they are fearful of therapists: that must have a reason and should be able to be addressed.
If the child is hypersensitive to noise it could appear fearful as well.
I would say we need to be very sure that there is not a anatomical/physiological reason behind this behaviour before we know in which surroundings the child should be treated.
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