Feeding and Positioning For Children With Cerebral Palsy

This past year, the very wonderful functional skills teaching assistant, Miss Amy took her love of the children and moved on to begin a career in Occupational Therapy.  She has been dearly missed in the classroom, but we know she can now help so many more children now that she is not limited by the school walls.  Any parent of a child with feeding issues already has a field education in Feeding Therapy and is always striving to make this little area of life easier, more efficient and even enjoyable.  Miss Amy kindly agreed to share her feeding therapy study with Riley as her partner.

Feeding and Positioning For Children With Cerebral Palsy

Amy G. Simeone

Keiser University

Introduction to Occupational Therapy

Cerebral Palsy

Above: Powerpoint presentation on Pediatric Feeding, Introduction to Occupational Therapy

Upon successful completion of the Occupational Therapy Assistant program my goal is to obtain a position in the field of pediatric occupational therapy. Much of my adult career has been spent working in the healthcare field, specifically in the area of rehabilitation. My career focused on office and clinic management, systems analysis; including the development and implementation of rehabilitation software, and business development and marketing. In other words, I have a fair amount of knowledge about the business end of therapy, but little knowledge about the role and function of therapy itself. In 2003, I put my career on hold and spent nine years at home with my two children. During this time, I was also the secondary caregiver for my father who was diagnosed with a primary brain tumor. My dad received several types of therapy during his battle with cancer. It was amazing for me to see the impact that the therapists were able to bestow upon him during his illness. I truly believe that the experience of his illness lit a spark deep inside me. I developed an overwhelming desire to help people in a “hands on” approach. After this experience I could not imagine going back to the business world and sitting at a desk.

Soon after my father’s passing, the opportunity presented itself for a position in my children’s school as a helping teacher in a self contained functional skills classroom. In the classroom, I worked closely with teachers, nurses, physical, occupation, and speech therapists to help children with varied diagnosis from cerebral palsy to autism disorders. I loved my job, and would have stayed in that position if not for the limited salary that is offered for such a critical and demanding job. I can’ recall the exact moment that I decided to enter back into school. I do truly believe that a higher power has directed me to this exciting profession, and that this is my true calling in life.

The role of the pediatric occupational therapist is to help children achieve maximal functional independence in order to increase their participation in daily activities and routines within the classroom, at home and in the community (Kornhaber,Ridgway, & Kathirithamby, 2007). One of the students in the functional skills classroom is a 12 year old boy, Riley, with a primary diagnosis of Spastic Quadriplegia Cerebral Palsy. Cerebral Palsy (CP) is a broad term that encompasses several neurological disorders that can occur during pregnancy, during delivery or shortly after delivery or in infancy. CP is caused by an insult or injury to a fetus or infant’s brain during brain development. Some causes of CP are: illness, injury, or inflammation of the brain, abnormal brain development, severe jaundice, CVA or anoxia. CP is the most common of childhood disabilities affecting two to three out of every 1000 children. CP can affect each individual differently. Although physical problems can be worse for some people than for others, the common affects are: muscle control, muscle coordination, muscle tone, reflex, balance and posture. CP can also impact fine and gross motor skills and oral motor functioning. How a brain injury affects a child’s motor functioning and intellectual ability is dependent on the severity, nature and location of the brain injury (Bower & Cahill, 2009; see also MyChild, 2015). Occupational therapy interventions are used to treat patients with cerebral palsy in many ways. Many different assessment tools can be used during evaluation and intervention. Common occupational therapy interventions may include: activities of daily, instrumental activities of daily living, education, leisure, accommodations and modifications, support for the development of muscle strength and motor development, support for the development of motor and communication and interaction skills, tone management, assistive technology and adaptive equipment, family coaching and training, support for the development of self-determination skills, support for the development of prevocational skills (Bower & Cahill, 2009).

Children with cerebral palsy may have decreased postural control which can be problematic when feeding and swallowing. Proper seating and positioning intervention can have a positive effect on the child’s postural stability and can improve their feeding and swallowing. According to the Journal of Pediatric Nursing, “Effective oral functioning for feeding begins with attaining better head stability to improve jaw control.” (Redstone & West, 2004, p.1). A client’s head control is greatly influenced by their trunk alignment and stability of the pelvic area. By maintaining proper seating and postural alignment a client may experience improved oral motor functioning for the safe intake of food. In the case of Riley, the school OTR/L trained the functional skills classroom personnel using a client developed feeding plan. During staff training, the occupational therapist monitored and evaluated each staff member for proper positioning of Riley and proper feeding techniques. Riley’s feeding plan states that he is to sit in his wheelchair while being fed; his head is to be in midline position; physical assistance to maintain his head in midline position due to musculature weakness/physical limitations; hips and knees should be maintained at 90 degrees; wheelchair slightly reclined; shoes on and feet strapped in wheelchair foot rest to reduce involuntary movement and to increase upright postural alignment when feeding. (Eating/Feeding plan, 2012). Riley is served a prepared meal sent from home due to his many allergies. His food is pureed to a coarse consistency using an emersion blender. Riley’s mom and dad make certain that Riley is receiving substantial calories and fat in his diet as to avoid the potential for a G-tube insertion. Careful positioning and monitoring means that feeding Riley a meal can take upwards of an hour. During feeding, the classroom staff are continuously monitoring for potential choking, aspirating and seizures, while maintaining Riley’s postural alignment during feeding. The area of pediatric positioning in feeding is essential to the client’s health, growth and well being.

Working in pediatric occupational therapy offers many unique and rewarding challenges and opportunities for the therapy professional. I feel determined to successfully complete my education, so that I can work with families and clients like Riley. The dynamic between the therapist and the family is one that is essential to a client’s success. From personal experience working with the therapists who treated my dad, the impact that the therapists made spanned not only to my dad’s success in maintaining function, but also to our families coping with and managing his ever changing illness. By addressing the client’s occupations, roles and life situations in all settings, the occupational therapist addresses the client with a holistic approach, supporting engagement in activities that affect health, well being and quality of life (Kornhaber et al., 2007). With successful feeding plan and implementation a client with CP can focus on gaining improvements in other areas of occupation.

 

Reference

Bowyer, P., & Cahill, S.M. (2009). Pediatric occupational therapy; Handbook; A guide to diagnosis and evidence-based interventions. St. Louis, Missouri: Mosby Elsevier.

Costigan, F.A., & Light, J. (2011). Functional seating for school-age children with cerebral palsy: An evidence-based tutorial. Language, Speech &Hearing Services in Schools (Online), 42 (2), 223-236A.

Kornhaber,L., Ridgway, E., & Kathirithamby, R. (2007). Occupational and physical therapy approaches to sensory and motor issues. Pediatric Annals, 36 (8), 484-93.

My Child, www.Cerebral Palsy.org

Redstone, F., & West, J.F. (2004). The importance of postural control for feeding. Pediatric Nursing, 30 (2), 97-100.

3 Responses to Feeding and Positioning For Children With Cerebral Palsy

  1. Lux says:

    This is really good and helpful information, dear. Thanks for sharing your knowledge to us.

    I’m always praying for you and your family.

  2. David Hunte says:

    Wow. That’s a lot of information, and I am Thank God there are people like Amy who would take on the task of caring for someone with Cerebral Palsy. Riley sounds like an amazing child. You are an inspiration along with Amy.
    Thanks once again for sharing.

  3. Debbie says:

    I have been fortunate enough not to have children with serious illness. What an incredible service you provide. As you state, therapists impact not only the patient, but the entire family. I believe all medicine needs to be approached holistically and it’s clear that you understand that key point as well. Very informative article!!

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