Case Studies
Case Example A
Child G is a child of 3 who was diagnosed with Oligoarticular Juvenile Idiopathic Arthritis at 21 months. The diagnosis was made after 6 weeks of symptoms, which included limping and an eventual inability to weight bear. The child's condition has since developed further, so that the joints now affected include both ankles, both knees, both wrists, and several toes. It has been further aggravated by the additional condition, Hypermobility Syndrome, which causes the child's left and right elbows and left finger to dislocate regularly.
Treatment Provided
The child began to receive treatment at The Tiny Tim's Children's Centre approximately 6 months after being diagnosed with JIA. The child now receives massage therapy 3 times a week. Indeed both the Physiotherapist and Occupational Therapist who work with the child see massage as a positive complement to the therapy they provide, and as a good opportunity to "keep movement going".
Observations
The child's mother is quoted as saying that treatment provided by the Tiny Tim's Children's Centre, "is the only thing that gives her some relief. It eases her joints and assists with the Physio(therapy) we provide at home." Indeed, it was noted early on in the child's therapy programme that her level of pain decreased significantly after treatment. The child's mother also commented that although many of the benefits appear to be short term, while the child's range of movement is being worked on this has a significant impact on her long-term prognosis.
Psychosocial impact
A bond of trust has formed between the therapist and both the child and her mother and the child has become completely relaxed at the centre, which has facilitated the treatment sessions. The child has always had trouble sleeping and her sleep has further deteriorated as her condition has progressed. The mother of the child has noted that massage therapy gives the child some "relief and a chance to sleep", which gives her body a chance to heal, as well as contributing to her emotional well being.
Case example B
Child S came to the Tiny Tim Centre for treatment for a condition, which at the time, was not yet diagnosed. At 13 months she could not stand or sit unaided and had considerable stiffness in her arms which meant her mother was finding it difficult to dress and undress her.
Treatment provided
The charity provided regular treatment once a week for 3 months at the Tiny Tim's Children's centre in Coventry. The initial treatment concentrated on gaining the trust of the child and enabling her to acclimatise to her surroundings. Thereafter, the child received massage therapy on her arms and shoulders, including some neuromuscular work. At her third session it was revealed that the child's NHS consultant had made a diagnosis of cerebral palsy. The mother had also found stiffening in the child's lower limbs and as a result treatment was started on the legs.
Observations
After the first few sessions the child became a lot more relaxed in the centre environment and it was noted that she seemed to be enjoying the treatment. Her mother has also been using a few basic massage techniques at home with the child, which has complemented the treatment she receives at the centre. The child's mother has reported that her arms and legs are gradually becoming more flexible and after each session the child has more mobility in her upper body. Moreover, her temperament almost always improves by the end of a session and she becomes more relaxed.
Psychosocial Impact
It is very important to the charity that parents and care providers are given the opportunity to discuss their children and the treatment they are receiving. In this case we feel that this has been particularly beneficial. The opportunity to meet other parents in similar situations and speak to professionals who may be able to offer advice and encouragement is often very well received.
Case example C
Child R suffered a major spinal injury at the age of 3 since then he has no muscle motor control below T3. Most of his time is spent in a wheelchair that is used both for mobility and as a means of upper body support. The relatively sedentary life affected the general circulation and temperature control causing lower limb swelling and an apparent affect on his resistance to infection. On occasions the child had become despondent at being different, not being able to play football with his peers and not wanting to go outdoors. The aim in providing treatment was originally to help improve upper body strength.
Treatment Provided
This patient first came to the Tiny Tim's Children's Centre in July 2006, at the age of 5. Since then he has received ongoing free treatment on a weekly basis. The treatment includes neuromuscular massage followed by a series of upper body force resistant exercises. The boy has also been encouraged to play basket ball with his family. He requires repetitive encouragement to cooperate and focus on both the treatment and exercise sessions. A combination of reward therapy and self esteem techniques are used, as appropriate.
Observations
The amount of force he can move has steadily risen from an average of 9kg to 13.5kg using his arms on a C2 exercise machine. On occasions he can now move 15kg. "His mother has said that he is physically a much healthier and happier child. He seems a lot stronger; is more active and can now easily perambulate his wheelchair, which he found difficult before because of the heavy chest brace he wears. He now seems to be able to cough properly and recovers more quickly from colds. His feet and legs are less swollen and he can now wear his footwear more comfortably".
Psychosocial impact
The family describe the psychosocial benefits in terms of "he now has a better understanding of the world, because he sees other children with physical problems at Tiny Tim's. He is more confident and more willing to go outdoors and more outspoken in expressing his views".
As a result the family are very pleased that the charity has been able to help improve their child's physical condition, general well being and not least the social benefits that they now enjoy.
Working with children who have cerebral palsy
A significant number of the children who come for treatment at the Tiny Tim's Children's Centre have cerebral palsy. CP is a non progressive disorder affecting the immature brain, which often results in altered movement behaviours and patterns. It is estimated that CP affects approximately 1 in 400 births, the causes can be multiple and complex. Whilst CP is non progressive and cannot be cured it is important that the child receives early therapeutic intervention to help with the child's development. The charity endeavours to provide treatment at the earliest stage in a child's life following their diagnosis.
Cerebral Palsy is frequently categorised into three main types. Some children will have a combination of these types:
- Spasticity - Tightening and stiffness of the muscles.
- Athetoid - Involuntary movement, change of muscle tone from floppy to tense.
- Ataxic - Unsteady, uncoordinated shaky movement and irregular speech.
Treatment Provided
The charity provides weekly treatment free of charge for children with cerebral palsy. The treatment includes a range of neuromuscular massage, passive and active joint movement exercises and in some cases force resistant exercise. All of this treatment is aimed at improving muscle tone, access, mobility and fine and gross motor control. Although it is not possible to cure the incurable, the aim in providing treatment is to improve the quality of life and access to a more fulfilling lifestyle.
Some brief case history examples
Child C (2) is 13 months old, has hemiplegia CP affecting the left limbs, which tended to be stiff. He first came to the centre at 9 months and has been given regular neuromuscular massage and passive exercises. The child's limbs have progressively improve. Toys can now be grasped by both hands, the left leg is more flexible and stronger and the mother has reported it is easier to handle and dress her baby.
Child J (1) is 3 years old and has hemiplegia CP caused by a malformed brain. Although the child is active his left limbs tended to be floppy. He also tended to be tactile defensive when people touched his left hand side. This child was given weekly neuromuscular tissue massage to help improve muscle tone and circulation. His mother has reported that her son is less tactile defensive and has started to use his left hand more for holding toys and exploring his left finger with the right hand. His parents feel that it's important that the charity continues to provide this complementary treatment, in conjunction with his physiotherapy, to ensure his continued improvment.
Child J (2) has quadriplegia CP affecting all four limbs. He has benefited from regular treatment at the centre for 5 years and is now in his teens. A major problem faced by this patient was very tight flexion, particularly in the legs that tended to scissor. Getting out of bed ad dressing could be a significant task for this patient. Fortunately he responded to regular neuromuscular treatment that helped to reduce muscle tightness, such that, he can get up and dress more independently.
