Title of the project:
Increasing SelfReliance of People with Disabilities through Comprehensive Rehabilitation Model Project of the Polish Society for Intellectually Disabled (Polskie Stowarzyszenie na rzecz Osób z Upośledzeniem Umysłowym, PSOUU), Gdańsk unit
The project has been set up to address the needs of the chronically diseased — and therefore disabled — who suffer from (possibly severe) mental impairment and are clearly disadvantaged in accessing medical
services. The area of operation is the central and northeast parts of the Pomeranian Voivodeship. The territorial scope has been determined based on the applicant’s territory of activity and the possibilities of reaching out effectively to the appropriate people, and so it is limited to the districts of Gdańsk, Puck, Kartuzy, Kościerzyna, Starogard Gdański and Wejherowo.
Main objective of the project:
The project team is aiming at the decrease of the costs that ensue from improper rehabilitation of disabled people and thus at the decrease of the respective social burden. This goal can be accomplished in the long term, by increasing the effectiveness of therapies designed to raise both physical and psychological performance of the chronically diseased who are disabled, that is by applying and promoting innovative methods of cooperation with patients.
Project operations shall be divided as follows:
- Providing the Polish Society for Intellectually Disabled with increased possibilities of delivering comprehensive therapies for the chronically diseased and disabled, by renovating the facility and refitting it with specialist medical equipment. Ensuring appropriate housing conditions and enlarging the equipment inventory is a prerequisite for expanding the service offer and aligning it with high quality counselling in terms of choosing proper devices or organising patient care at home.
- Increasing the scope of services rendered at patients' homes, especially in the rural areas.
- Delivering more supportive and integrative environments for our patients.
- Disseminating appropriate methods of rehabilitation for the chronically diseased with intellectual disabilities.
Reconstructing the facility at Jagiellońska 11, in the Przymorze quarter, that is used by the Society, in order to transform it into the seat of the Society, as well as to increase the therapeutic support for the chronically diseased and disabled with developmental disorders, including an overhaul of the third storey so that it corresponds to its new functions.
ADVOCATING THE EFFECTIVE REHABILITATION MODEL FOR THE DISABLED
The team shall implement a programme for individual, continuous, multidisciplinary and comprehensive rehabilitation of children and adolescents who are chronically diseased and whose condition has caused linked disability resulting in lack of independence. Qualifying a child aged 3–7 or 8–18 for the project shall be based on the occurrence of at least three dysfunctions linked to such diseases. Adults shall be qualified if the additional requirement of concurrent, at least moderate intellectual disability is fulfilled.
The project shall include a programme for individual, continuous, multidisciplinary and comprehensive rehabilitation of children and adolescents who are chronically diseased and whose condition has caused linked disability resulting in lack of independence. The programme shall be carried out by the Early Intervention Center (OWI) seated in Gdańsk. Patients’ relatives and attendants shall also be included in the project.
Every patient shall be offered an individual plan of multidisciplinary treatment, prepared by the therapeutic team. The admission, the verification of the admission through repeated diagnoses and the evaluation of the effectiveness of applied methods shall be conducted by the following team members:
— shall diagnose the patient, determine types and volumes of exercises, as well as prescribe appropriate orthopaedic equipment, control rehabilitation and decide about the termination of treatment;
physiotherapist and physicotherapist
— shall schedule and carry out the treatment;
speech therapist and alternative communication specialist
— shall conduct speech therapy and/or lay foundations for speech development through supported and standardised feeding and selffeeding. They shall confirm if the following processes are correct: solid food consumption, phonation (creation of sounds), coordination of respiration and phonation. They shall evaluate the breathing pattern, and test tongue and lips for mobility and tension;
psychologist and/or pedagogue
— shall subject patient to observation, evaluate their cognitive, emotional and social performance, provide parents and people in the nvironment with counselling, including instructions on developmental stimulation and education.
Team’s tasks shall comprise:
As far as children and adolescents are concerned, their participation in rehabilitation sessions, including frequency, shall be strictly dependent on their general medical condition and the ability to participate in the rehabilitation programme.
- making multidisciplinary medical diagnoses, including psychological diagnoses and speech pathology diagnoses, as well as evaluating psychomotor development and the condition of the locomotor system;
- establishing procedures to support physical and psychosocial development of children;
- monitoring children’s development through repeated diagnoses and programmes adjusted to changing developmental needs;
- running individual and group rehabilitation programmes, therapies and stimulation sessions;
- providing disabled children’s families with psychological support; specialised counselling from geneticist, dietician, social worker and nurse shall be included within the scope.
Equipment for treatment and rehabilitation
As part of the project, we will supply the facility with modern equipment for treatment and rehabilitation. This way we shall be able to offer physicotherapeutic services, which have so far been only provided on a much smaller scale.
We expect to stock up — among others — the following devices and systems:
- Liquid nitrogen cryotherapy system.
- High frequency device for pulsed electromagnetic field therapy.
- Ultrasound system.
- Swirl bathtub for upper and lower limbs.
- Hydrotherapy bathtub.
- Electrotherapy system.
- Treadmills and stopwatches.
- Multimedia kits for communication.
- TheraTogs suits.
- Messengers, switches and specialised switches used in nonverbal communication
(augmentative and alternative communication).
- Rotors for exercising upper and lower limbs.
- . Universal exercise unit, 8 segments.
- Manual exercise table or boards with resistance.
- Video training camera.
- Resistance chair.
- Augmentative and alternative communication systems, including PCS.
Methods used in rehabilitation of a disabled person
A comprehensive rehabilitation programme of a chronically diseased and dependent person is based on multiprofile neurodevelopmental stimulation.
- Bobath approach (NDT)
Bobath method is applied to persons with a damage or disorder of the central nervous system that affects muscle tone and motor skills. It is entirely safe and noninvasive for a patient. It is employed by a qualified therapist and consists in triggering movements that approximate to correct movements, which is accomplished by providing support to and initiating movements at
key points, that is, following points used to control movements: head, shoulder girdle, pelvis and other parts of the body, as well as by applying and consolidating the acquired skills in daily activities. Exercises are accompanied by statements about what is being done, which helps to acquire speech/language. The method also includes additional techniques for the regulation of the unsteady muscle tone:
- using pressure and tension, and load and resistance, similarly to PNF;
- stopping motion in a chosen phase and maintaining the position reached (freezing);
- clapping a part of the body, which can have a stimulating or inhibiting effect;
- relaxing a spastic child as a way of preparing them for exercises and possibly also as a break between different series of exercises. Relaxation can be accomplished by stroking, shaking the limbs and swinging the trunk and limbs.
- Proprioceptive neuromuscular facilitation (PNF) stretching
Proprioceptive neuromuscular facilitation is a comprehensive neurophysiological approach based on newest scientific achievements whose functioning is explained in its name itself: proprioceptive (related to the body’s receptors) neuromuscular facilitation of movement. Theoretical foundations for this concept are the physiological aspects of motor skill development, including stages of motor control development, which consists in reaching new positions and being able to move around when these positions are assumed. The process of teaching movement, as it is understood in PNF, is supported in the therapy by both previous experience of child’s motor skill development schemas and multisensory stimulation that rests on temporal and spatial organisation of impulses of different kinds that come to the central nervous system from the outside of the body (tactile, visual, aural, vestibular, proprioceptive and other stimuli).
- Medical taping
Kinesio taping is an auxiliary therapeutic method used in the treatment of orthopaedic, neurological and musculoskeletal conditions. It consists in evaluating disorders of the musculoskeletal system and then applying the Kinesio Tex tape. The method impacts muscles, fasciae, joints, lymphatic system and nervous system. Kinesio taping contributes to pain relief in muscles and joints, lymphoedema reduction, muscular activity and adjustment of incorrect joint positions.
- Myofascial stretching: soft tissues, fascial stripes and trigger points; deep tissue massage
Patients with disrupted locomotive functions very frequently choose schematic locomotive strategies to achieve their goals. As a result, lesion formation occurs in soft tissues, which therefore become functionally or structurally restricted. The therapy is geared toward lifting the restrictions by “unlocking” the fasciae, applying post isometric relaxation and impacting trigger points, and it is a significant supplement to the neurodevelopmental approach, as it prepares the broadly defined locomotor system for the acquisition of new skills. Soft tissue therapy includes both diagnostic tools and therapeutic solutions.
- Positive reinforcement
It consists in promoting desired behaviour by praising and rewarding proper conduct.
Modelling consists in learning through imitation. It is one of the most effective methods used in upbringing. Modelling is sometimes also called cognitive imitation or mimicry.
Elements of tale therapy
Tale therapy is one of the effective methods of cooperation with intellectually disabled individuals. It is based mainly on the therapeutic influence of literature, and its major goal is to help participants feel comfortable in unfamiliar, difficult circumstances.
- Multisensory stimulation
The purpose of multisensory stimulation is learning about the environment by experiencing varied stimuli that are interpreted by different senses.
- Sensory integration therapy
Sensory integration is a system of exercises that are designed to teach the brain how to react properly to external stimuli. This method is suitable for people with learning difficulties, autistic children and children with cerebral palsy, Down syndrome, hyperkinetic disorder, deafness or blindness. Sensory integration is classified as one of the neurodevelopmental approaches, because it focuses on the developing nervous system. The overriding principle in all of the exercises is providing the brain with enough different stimuli to be interpreted by different senses (especially touch, balance and proprioception) in a way that facilitates their integration and the reaction of the whole body to the stimuli. Therapeutic sessions take place in a room that is adjusted to host sensory integration therapy. A lot of different devices and constructions
are used in SI therapy, including slides, swinging platforms, climbing ropes, scooter boards, weighted vests, hammocks, obstacle courses or trapezes. Such environment involves children more in what they are doing, and accelerates their development.
- Hand therapy
Hand therapy aims at improving the socalled fine motor skills, i.e. precise movements of hands and fingers. It includes delivering various tactile sensations, teaching about how to recognise shapes and textures, and drawing attention to objects' weights and sizes. It is designed to encompass better eyehand coordination and concentration, resulting in increased independence and selfreliance in managing simple everyday tasks.
- Elements of behaviour therapy
Here, patient’s diagnosis is based solely on their behaviour, i.e. natural reaction to the influence from the outside world. Therapist is supposed to remain active and to direct patient’s conduct by explaining, suggesting, giving advice, encouraging, motivating and setting tasks. In order to improve patient’s emotional, physical and psychological condition, elements of music therapy can be applied.
- Learning through play
Learning through play is a special — natural and inborn — method of acquiring knowledge by humans. In all of its diverse forms, it provides for development in the atmosphere of trust and mutual acceptance, fosters creative activity, improves communication, promotes cooperation within a group, enhances confidence, and alleviates anxiety as well as psychological and muscular tension.
- Le Bon Départ method (Polish version by M. Bogdanowicz)
This method is used for treatment and prevention of disturbed child development. It is a form of psychomotor rehabilitation and stimulation of psychomotor development. Apart from enhancing perception, motor skills and perceptualmotor integration, Le Bon Départ method also helps to understand and apply abstract symbols, which is especially important for children who start formal education. It constitutes introduction to literacy acquisition. A group model of workshops facilitates establishing contacts (social interactions) and hones cooperative skills in children who find it difficult to adapt or are emotionally disturbed.
- Knills’ method
Knills’ programmes are used for the rehabilitation of individuals who exhibit different levels of intellectual disability and different kinds of physical disabilities. Carefully selected exercises help establish contact, while at the same time providing entertainment for participants. Within these programmes, tactile stimuli and elements of music therapy are applied to improve body
awareness and control, which enhances communication with the environment in an aura of trust and security.
- Educational therapy
Educational therapy influences all aspects of life, particularly the cognitive and emotional ones, as well as graphomotor skills, and is applied in the case of children with psychomotor disorders. Educational therapy is also considered a supplement to psychotherapy. It is focused on stimulation that advances children’s and adolescents’ psychomotor development, as well as on compensation for inadequate education, elimination of educational failures by using different techniques, and elimination of emotional and social failures and their consequences.
- Verbotonal method
Verbotonal method enables aural, vocal and locomotive stimulation. Carefully selected exercises that accompany rhythmic music help sensitise auditory perception and enhance patient’s linguistic communication. Appropriate bodily movements, while manipulating props that are assigned to phonemes, impact simultaneously motor skills, balancing and coordination, which helps children progress.
- Feeding training in Bobath concept (NDT)
Feeding training is an example of intensive stimulation of the oral area, indispensable for the development of articulation. Children deprived of experiences connected with texture and consistency (hard or soft, raw or cooked foods), temperature, taste (sour, sweet or salty foods), who had no opportunity to chew or grind, are disadvantaged in language acquisition. The training is connected with delivering an optimal amount of tactile, gustatory and olfactory stimuli, required to develop efficient tongue, lips and palate, and it is a way to increase tolerance of tactile stimuli.
- Speech therapy massage
The aims of speech therapy massage are improved motor skills of speech organs, decreased oversensitivity of the oral area and the mucosa, and prevented excessive salivation. It also helps with proper breathing and eating, including sucking, biting, chewing, grinding and swallowing food. There shall be several forms of massage used: classic, speech therapy, CastilloMorales’ and Shantala.
- Speech therapy and alternative communication
Most of children and adolescents with linked disabilities have significant deficiencies in their communicative functions. Although in some cases their executive potential is large, their independence is limited due to the deficits in the area of communication. These difficulties can lead to diminished sense of agency, lower selfesteem and social withdrawal. Areas of speech therapy include:
- instilling the need of communication;
- improving the efficiency of speech organs (starting with basic functions, such as strengthening of the muscular apparatus which is responsible for speech production and appropriate breathing or eating);
- practising and perfecting proper articulation of distorted phonemes or series of isolated phonemes;
- practising and perfecting proper articulation of distorted phonemes or series of isolated phonemes in spontaneous talk; alternative communication in the case of nonspeaking children;
- augmentative and alternative communication systems, including pictograms or picture communication symbols (PCS);
- Makaton, a language programme integrating speech, gestures and graphic symbols.
Augmentative and alternative communication helps patients with communicative impairments to exchange information with other people and to expand their language skills. Appending gestures or symbols to verbal messages facilitates comprehension and enables patients to use a communication system independently, which significantly adds to their socioemotional and cognitive development. Also, implementation of such a system promotes agency and competence, and encourages one to take initiative and interact with the environment. Patients who use several communication systems are more and more motivated to generate speech.
As for nonspeaking individuals, alternative means of communication might be their only chance to interact with others.
A TheraTogs suit is a comprehensive tool designed for cooperation with a neurology patient, as it allows to improve posture and gain more independence. It works on the principle of increased proprioceptive stimulation that provides for the additional use of tapes for better distribution of muscle tone and linearity of body segments.
This therapeutic method consists in encouraging disabled individuals to take an active part in their social lives, as well as in proving that they are able to cope with their daily tasks by themselves, by dealing with adversities on their own (being independent and selfreliant instead of having to ask for help). Such a way to independence raises a disabled person’s self-esteem to a great measure. They stop being afraid to go out, meet their friends or have a hobby. They stop feeling isolated and left alone with their problems. Occupational therapist’s tasks include providing a patient with all of the accessories and pieces of advice that could
become useful in their everyday life. This could be, for instance, advice on how to adjust a room to enable it to accommodate a disabled person, or on how to get up in the morning and get dressed (or undressed in the evening). The therapist should also provide the patient with individually established set of aids and devices that are useful for selfcare (activities of daily living, ADLs), that is getting dressed and undressed, maintaining personal hygiene and grooming, selffeeding, and remaining functionally mobile both at home and outside. Occupational therapy also includes improving patient’s physical condition. The offer of
rehabilitating exercises is profuse. Occupational therapy is focused on improving mobility and coordination of movements, but also on enhancing memory and ability to concentrate, which translates into selfreliance. The aim of this approach is to teach an individual to cope with their disability and to accept their situation.