Unit 1: Concept and understanding of clinical therapies

1.1.  Definition, need and importance of therapies for children with developmental disabilities

1.2.  Behavioural therapy- management of problem behaviours, cognitive behavioural therapy, (CBT), Positive behavioural intervention supports (PBIS).

1.3.  Occupational therapy – definition, aim, scope and techniques in class room setting.

1.4.  Physio therapy - definition, aim, scope and techniques in class room setting.

1.5.  Speech therapy - definition, aim, scope and techniques in class room setting.

 

 

 

 

 

 

 

 

 

 

 

1.1                Definition, need and importance of therapies for children with developmental disabilities

 

 

When people think of therapy, they often think there has to be a “big” issue before they seek out support and advice. That simply isn’t the case. Therapy is about learning – for kids and for parents. It is about finding the best tools to support your child’s ability to thrive and be happy at home and school. Special needs children, whether it is ADHD, ASD, Dyslexia, behavioral issues, health issues, anxiety, or depression, need as much pro-active support as they can to be ready for the increased challenges they may face. There are many therapies for learning disabilities and ADHD and traditional counseling is one of them. Here are nine reasons why counseling helps the special needs child.

A therapeutic intervention is an effort made by individuals or groups to improve the well-being of someone else who either is in need of help but refusing it or is otherwise unable to initiate or accept help. The intervention, which can be psychological, physical, or even pharmacological, may be led or guided by a professional interventionist or by friends or family members, with or without the help of a professional, depending on the circumstances. In some cases, an intervention takes the form of a confrontation or meeting between a person who is engaged in self-destructive behavior—and is resistant to help—and concerned friends or family members. In other cases, where individuals are not able to make decisions for themselves, an intervention is a decision to take action on their behalf. This method may not work for every person in need.

Gain Coping Skills

Probably the single most important thing any parent can do is to teach their child how to cope with stress. In our fast-paced, intense world, we are living with high-stress levels with little downtime. Today, there is little tolerance for the uncomfortableness that comes with stress and giving kids the tools to self-manage uncomfortable feelings is a gift for today and tomorrow. Building frustration tolerance is different for every child. Some who have a natural stress tolerance have a  more “sunny” disposition whereas other children need to develop that skill. Whatever the disposition or skill set, a child can learn healthy coping skills assisted by counseling.

Make a Mind-Body Connection

One of the most critical ways to learn how to manage stress is to have the ability to make a mind-body connection. We all hold stress in our body, and some of us are better at noticing the alerts our bodies give us when our brain is stressed.  When we learn to recognize that chest tightening, sweating, or increased heart rate, we need to take a moment and get back in balance. Therapists instruct children and adults on how to make a mind-body connection with a type of therapy called Somatic Therapy. This therapy emphasizes tracking sensations through the body and directly teaching how to recognize them, as well as breath work, mindfulness, movement, and sometimes healing touch.

Gain Self- Regulation

Many learning disability symptoms result from dysregulation of the Central Nervous System (CNS) thus impacting behavioral and emotional regulation. When children or teens get into a pattern of overreacting to situations, people, or stimuli, they find breaking that pattern very hard without direct therapeutic support. Neurobiological reasons for self-regulations difficulties are often confused with learning disability symptoms. Therapists who work with special needs children are trained to not only support the children and teens but teach parents how to manage the behaviors that come along with self-regulation issues. A therapist can help children and parents gain the needed tools to change family dynamics and create healthy behaviors.

Teach Executive Functioning

Most often, a diagnosis such as ADHD or a learning disability arises out of executive function issues. Some individuals have a natural ability to focus and organize easily, and others do not. The brain’s frontal lobe controls executive functioning skills giving organization and order to our actions and behavior. Executive functions involve planning for the future, strategic thinking, ability to inhibit or delay responding, self-regulation, initiating behavior, and shifting between activities flexibly. When kids have issues with executive functioning, any task that requires these skills becomes a challenge. Although often considered characteristics of a learning disability, these challenges can be overcome with therapeutic executive function coaching giving people the ability to manage and juggle multiple tasks, orient to their environment differently, and attend better with direct skill set instruction.

Learn Social Skills and Social Thinking

For most, developing and maintaining friendships is a natural process. However,  for some special needs children and teens can have developmental delays or clinical issues that interfere with their social skills. Developmental lags can occur in all areas, including social thinking and social functioning, such as initiating social interactions, maintaining social interactions, or understanding social pragmatics.  Whether it is a clinical issue or a developmental lag, these issues can interfere with their ability to relate to others by inhibiting impulse control with peers that make getting along with others or keep friendships difficult. Direct instruction in the social realm teaches how to manage the different components of social interactions and pragmatic language communication.  Social thinking skills can be learned with direct guidance and support from a highly trained and skilled therapist in a one-to-one session or group setting.

Improve Self-Esteem

Children with special needs often aren’t successful in their job as a student. They may have difficulty with paying attention, reading, socializing or a combination of issues which all lower their self-esteem.  Working with a therapist to find ways to improve feelings of self-worth can make a huge difference and prevent later high-risk behaviors. Ultimately, for parents, it is about ensuring that your child’s or teen’s emotional core is secure.

Understand Strengths and Weaknesses

Because so many tasks can be a challenge for the special needs child, they only see what they can’t do. Counseling is all about understanding all the parts of oneself. For the special needs child, identifying strengths and weaknesses can help them adapt and learn more comfortably. Validating and explaining the hardships empowers kids. They often know something is wrong, and instead of feeling ashamed, they can feel better by understanding why they struggle.  A skilled therapist can help parents and children harness the child’s strengths and lead with them.

Connect with Emotions

Special needs children and teens can have a hard time connecting with their emotions due to stress and anxiety. Therapists help kids put words to emotions so that can connect with their feelings rather than being overwhelmed by stress. For parents, learning how to support their children with emotional language in a positive manner may not come naturally. While neurotypical children may be able to pick up emotional language, sometimes special needs children need to be explicitly taught this skill. Counseling can help parents and children learn the language tools necessary to discuss emotions in a way the lessens behavioral responses to stress.

Parenting Support

Finding the right guidance from a trained therapist to support your special needs child can be invaluable. For some parents, counseling means getting coaching through a tough parenting moment. For others, it means getting regular help that addresses your child’s clinical issues. Therapists can help parents navigate the hurdles of childhood and adolescence that are often more challenging for the special needs child.

Whether your child has ADHD, a learning disability, or requires educational aids for dyslexia treatment, therapy for families and children can help address the underlying causes of a learning disability, executive functioning issue, attentional problem, or the external stressors the special needs child faces.

 

 

1.2                Behavioural therapy- management of problem behaviours, cognitive behavioural therapy, (CBT), Positive behavioural intervention supports (PBIS).

 

Problem Behaviours — like all behavior — serves a function, usually one of these:

Your child’s difficult behaviour might also have specific triggers, like the following.

·      Routines and rituals
Children with ASD often like predictable environments, and they can get very upset if their familiar routines are broken. For example, your child might be upset if you change the route you usually take home from school.

·      Transitions
Your child might not understand it’s time to move on from one activity to another. Or like typically developing children, your child just might not want to.

·      Sensory sensitivities
Children with ASD often have sensory sensitivities and might like feeling or touching particular surfaces or objects. Your child might get upset if they aren’t allowed to touch.

·      Sensory overload
Your child might get upset if too much is happening around them, if they find a particular noise overwhelming, or if the light is too bright.

·      Unrealistic expectations
Like all children, your child with ASD can get frustrated if they’re expected to do something they don’t have the skills for, like getting dressed independently.

·      Tiredness
Children with ASD can have sleep problems. If your child isn’t getting enough good-quality sleep, this can cause difficult daytime behaviour.

·      Discomfort
This could include things like the feeling of clothes against skin, a prickly label, wet pants, a bump or pain. Check with your GP if you suspect there could be a medical condition causing your child’s behaviour.

·      Other conditions
Your child might have other conditions as well as ASD, like epilepsy, mood disorder or ADHD. These can all cause difficult behaviour. A medical assessment will help you to identify and manage these conditions.

Behavioral interventions are now considered an “established” treatment for ASD children, although they should not be expected to lead to normal functioning. They may improve the core symptoms of ASD, mainly in the first 12 months of treatment. Behavioral interventions are those in which instrumental learning techniques constitute the predominant feature of the intervention approach, based on the principles of behavior modification.

Ivar Lovaas and colleagues pioneered one of these intensive behavioral interventions, Applied Behavioral Analysis (ABA) in the 1960s. It seeks to reinforce desirable behaviors and decrease undesirable behaviors, teaching new skills and generalizing them through repeated reward-based trials. It requires a low student-to-therapist ratio and very intensive intervention (at least 25 hours a week). At this time, this is the only evidence-based approach to intensive early intervention for children with autism.

COGNITIVE BEHAVIOR TECHNIQUES

v Cognitive behavioral therapy (CBT) is a talking therapy that can help you manage your problems by changing the way you think and behave.

v Therapists or computer-based programs use CBT techniques to help individuals challenge their patterns and beliefs and replace "errors in thinking such as over generalizing, magnifying negatives, minimizing positives "with "more realistic and effective thoughts, thus decreasing emotional distress and self-defeating behavior.

v The origins of Cognitive Behavioral Therapy (CBT) dates back to the Behavioral Therapies and their development in the early 20th century, and correlate with the development of Cognitive therapy in 1960, and consequently resulted in their fusion. Their effectiveness has been demonstrated by numerous clinical studies in the treatment of various psychiatric disorders. Aaron Beck is considered to be the father of Cognitive Therapy, and his focus was initially on targeted treatment of depression. He thought that in depression there is a distortion of thoughts that is mainly focused on the negative perception of themselves, negative interpretation of the environment and the negative expectations in the future [1]. High efficacy of Cognitive Bihevioral Therapy is demostrated in the treatment of depression, generalized anxiety disorder, social phobia, posttraumatic stress disorder, and depressive and anxiety disorders in children.

v Basic principles of Cognitive Behavioral Therapy include cognitive restructuring, in which therapist and patient work together to change disruptive thinking patterns. It includes behavioral activation, in which patients learn to overcome obstacles to participating in enjoyable activities. Also, it focuses on specific, present problems and it is time-limited, economic and goal oriented. In individual or group sessions, problems (in terms of behaviors, emotions and thinking) are identified. Approach is educational. The therapist uses structured learning experiences that teach patients to monitor and write down their negative thoughts and mental images. The goal is to recognize how those ideas affect their mood, behavior, and physical condition. Therapists also teach important coping skills, such as problem solving and scheduling pleasurable experiences. Patients are expected to take an active role in their learning, and that is why they are given homework assignments at each session which is one of the main basics in cognitive-bihevioral therapy. If you had learned in school multiplication table for only an hour a week, you would probably still wondering how much is 6x7. Same is with psychotherapy; achieving the goal would take a very long time if all what person is doing is thinking about techniques and topics taught only one hour a week. Therefore, Cognitive Behavioral therapists assign patients homework and encourage them to practice techniques that they are taught.

STEPS IN CBT

Step 1: Identify critical behaviors

Step 2: Determine whether critical behaviors are excesses or deficits

Step 3: Evaluate critical behaviors for frequency, duration, or intensity (obtain a baseline)

Step 4: If excess, attempt to decrease frequency, duration, or intensity of behaviors; if deficits, attempt to increase behaviors.

HOW CBT WORKS?

v CBT is based on the concept that your thoughts, feelings, physical sensations and actions are interconnected, and that negative thoughts and feelings can trap you in a vicious cycle

In CBT, problems are broken down into five main areas:

Situations, thoughts, emotions, physical feelings, actions.

v CBT is based on the concept of these five areas being interconnected and affecting each other. For example, your thoughts about a certain situation can often affect how you feel both physically and emotionally, as well as how you act in response

WHAT HAPPENS DURING CBT SESSIONS

v If CBT is recommended, you'll usually have a session with a therapist once a week or once every two weeks. The course of treatment usually lasts for between five and 20 sessions, with each session lasting 30-60 minutes.

v During the sessions, you'll work with your therapist to break down your problems into their separate parts – such as your thoughts, physical feelings and actions

v You and your therapist will analyse these areas to work out if they're unrealistic or unhelpful and to determine the effect they have on each other and on you. Your therapist will then be able to help you work out how to change unhelpful thoughts and behaviors.

v After working out what you can change, your therapist will ask you to practice these changes.

v This should help you manage your problems and stop them having a negative impact on your life.

HOW CBT IS DIFFERENT?

v Pragmatic – it helps identify specific problems and tries to solve them

v Highly structured – rather than talking freely about your life, you and your therapist discuss specific problems and set goals for you to achieve

v Focused on current problems – it's mainly concerned with how you think and act now rather than attempting to resolve past issues

v Collaborative – your therapist won't tell you what to do; they'll work with you to find solutions to your current difficulties

USES OF CBT

CBT has been shown to be an effective way of treating a number of different mental health conditions. In addition to depression or anxiety disorders, CBT can also help people with:

v obsessive compulsive disorder (OCD) 

v panic disorder

v post-traumatic stress disorder (PTSD)

v phobias

v eating disorders – such       as anorexia and bulimia

v sleep problems – such as insomnia problems related to alcohol misuse

PRONS AND CONS OF CBT

v It may be helpful in cases where medication alone hasn't worked

v it can be completed in a relatively short period of time compared to other talking therapies

v The highly structured nature of CBT means it can be provided in different formats, including in groups, self-help books and computer programs

v It teaches you useful and practical strategies that can be used in everyday life – even after the treatment has finished

DISADVANTAGES

v You need to commit yourself to the process to get the most from it

v Attending regular CBT sessions and carrying out any extra work between sessions can take up a lot of your time

v It may not be suitable for people with more complex mental health needs or learning difficulties – as it requires structured sessions

v It involves confronting your emotions and anxieties – you may experience initial periods where you're anxious or emotionally uncomfortable

v It focuses on the individual’s capacity to change themselves (their thoughts, feelings and behaviors) – which doesn't address any wider problems in systems or families that often have a significant impact on an individual’s health and wellbeing

v Some critics also argue that because CBT only addresses current problems and focuses on specific issues, it doesn't address the possible underlying causes of mental health conditions, such as an unhappy childhood

 

POSITIVE BEHAVIOURAL INTERVENTION STRATEGIES

PBIS is a proactive approach schools use to improve school safety and promote positive behavior. The focus of PBIS is prevention, not punishment.

At its heart, PBIS calls on schools to teach students positive behavior strategies , just as they would teach about any other subject — like reading or math. In schools that use PBIS, all students learn about positive behavior. This includes kids with IEPs and 504 plans.

PBIS recognizes that students can only meet behavior expectations if they know what the expectations are. Everyone learns what’s considered appropriate behavior. And they use a common language to talk about it. Throughout the school day — in class, at lunch, and on the bus — students understand what’s expected of them.

According to research, PBIS leads to better student behavior. In many schools that use PBIS, students get fewer detentions and suspensions. They also earn better grades. There’s also some evidence that PBIS may lead to less bullying.

PBIS has several important guiding principles: 

·      Students can learn behavior expectations for different situations.

·      Schools teach expected behaviors through explicit instruction, with opportunities for students to practice behavior and get feedback.  

·      Stepping in early can prevent more serious behavior problems.

·      Each student is different, so schools need to give many kinds of behavior support.

·      How schools teach behavior should be based on research and science.

·      Tracking a student’s behavior progress is important.

·      Schools gather and use data to make decisions about behavior interventions.

·      School staff members are consistent in how they encourage expected behavior and discourage misbehavior.

Most PBIS programs set up three tiers of support for students and school staff.

·      Tier 1: Universal, schoolwide system for everyone. All students at the school learn basic behavior expectations, like respect and kindness. School staff recognize and praise students  for good behavior. Sometimes, they use small rewards, like tokens or prizes, to recognize kids.

·      Tier 2: Extra, targeted support for struggling students. Some kids have a harder time with behavior expectations. The school gives these kids evidence-based interventions and instruction. For example, some students may struggle with social interactions. A Tier 2 strategy might be providing Social Thinking support  to help them learn how to read and react to situations.

·      Tier 3: Intensive support for individual students. The third tier of PBIS is the most intensive. It’s for students who need individualized supports and services because of ongoing behavioral concerns.

Students with IEPs or 504 plans can be in any of the tiers. Schools that use PBIS must make sure that IEP teams are clear on how the tiers of PBIS overlap with IEPs and 504 plans. PBIS uses increasing levels of support for students. This is similar to other tiered approaches like response to intervention (RTI). 

 

 

 

1.3                Occupational therapy – definition, aim, scope and techniques in class room setting.

 

Occupational therapy (OT) treatment focuses on helping people with a physical, sensory, or cognitive disability be as independent as possible in all areas of their lives.

In OT, occupations refer to the everyday activities that people do as individuals, in families and with communities to occupy time and bring meaning and purpose to life.

The primary goal of OT is to enable people to participate in the activities of everyday life.

Occupational therapy interventions focus on adapting the environment, modifying the task, teaching the skill, and educating the person in order to increase participation in and performance of daily activities, particularly those that are meaningful to the person.

Occupational therapists often work closely with professionals in physical therapy, speech therapy, nursing, social work, and the community.

Children who need OT

According to the AOTA, children with the following medical problems benefit from OT:

-         birth injuries or birth defects                               

-         sensory processing disorders

-         traumatic injuries (brain or spinal cord)              

-         learning problems

-         autism/pervasive developmental disorders       

-         juvenile rheumatoid arthritis

-         mental health or behavioral problems                

-         broken bones or other orthopedic injuries

-         developmental delays                                        

-         post-surgical conditions

-         burns                                                                  

-         spina bifida

-         traumatic amputations                                         

-         cancer

-         severe hand injuries

-         multiple sclerosis, cerebral palsy, and other chronic illnesses

Objectives of Occupational Therapy

Through the years, three general objectives of occupational therapy have evolved:

§  Diversion: The primary objective is to divert or distract attention away from the disease or disorder toward more healthful ideas and positive thinking i.e. toward useful tasks or occupations such as painting, weaving, pottery, sewing, or woodworking and amusements which included playing games, listening to music, playing music, watching or performing plays, participating in playful exercises and sports, as well as doing a variety of arts and crafts.

§  Emotional Expression: Emotional expression, also called creative expression, became important to occupational therapy as through the use of the creative arts and crafts patients can express attitudes, feelings, and ideation, express hostility, dependency, and infantile oral and anal needs.Develop better self-concepts, improve personal identities, and build more healthy egos.

Creative arts and crafts provide opportunities of reality testing as well. The objects and processes offer sensory contact, shared values, and consensual validation.

The use of expression dominated occupational therapy in psychiatry in the 1960s and 1970s.

§  Skill building: Skill building has been a part of occupational therapy from the beginning, but its purpose has expanded in recent years. Initially, skills were primarily honed in relation to work situations.

During the 1950s, the concept of activities of daily living (ADLs) was added to the objective of skill building. Activities of daily living, also called self-care, included such tasks as dressing, grooming, walking, and eating.

In the 1970s, skill building began to be described in three or four areas called self-care or daily living skills, work or productivity, and play-leisure or recreation and three to five components called physical, motor, sensory, sensorimotor, cognitive, intrapersonal, psychological, interpersonal, social, psychosocial, or cultural. Gradually, the term ‘performance’ became a key concept.

These objectives provide the framework for more specific and more individualized goals and objectives.

Objectives of OT for Children/ Persons with Special Needs

The objectives of occupational therapy for children/persons with special needs are to:

§  help children work on fine motor skills so they can grasp and release toys and develop good handwriting skills

§  address hand-eye coordination to improve child's play and school skills (hitting a target, batting a ball, copying from a blackboard, etc.)

§  help children with severe developmental delays learn basic tasks (such as bathing, getting dressed, brushing their teeth, and feeding themselves)

§  help children and adults with behavioral disorders maintain positive behaviors in all environments (e.g., instead of hitting others or acting out, using positive ways to deal with anger, such as writing about feelings or participating in a physical activity)

§  teach children and adults with physical disabilities the coordination skills needed to feed themselves, use a computer, or increase the speed and legibility of their handwriting

§  evaluate a child's need for specialized equipment, such as wheelchairs, splints, bathing equipment, dressing devices, or communication aids

§  work with children and adults who have sensory and attentional issues to improve focus and social skills.

Modalities of Occupational Therapy in classroom setting

Occupational therapists use a variety of modalities to help with treatment.
A modality is the employment of therapeutic agents such as whirlpools, hot packs, cold packs, paraffin, and fluidotherapy. The modalities either produce heat or cold and are used for a variety of reasons.
Heat modalities are generally used as a preliminary to a prescribed exercise or activity. Heat helps to increase circulation to the affected area, decrease pain, improve elasticity of soft tissue prior to stretching or exercise, and improve joint mobility. Cold modalities assist in reducing swelling, inflammation, and pain. Generally, cold modalities are utilized after a treatment session, activity,
or exercise.

Cold Packs
Cold packs are generally kept in a freezer or some type of cooling device to maintain the packs at or below freezing. Another form of cold treatment is referred to as a cryocuff. This device consists of a small
cooling unit attached to an inflatable cuff. The cuff is applied to a specific body part such as an ankle, wrist, or shoulder. Cold water runs from the cooling unit through the cuff and back to the unit through
rubber tubing. The patient’s skin should be checked during and following a cold treatment to ensure that the patient’s skin is having no adverse reaction to the cold nor sustaining a cold burn.

Individual Work

Individual therapy sessions address occupational performance areas of concern. Areas of intervention can address:

•        Organisation skills

•        Sensory regulation strategies

•        Handwriting

•        Balance & coordination

•        Anxiety management

•        Self care issues

Group Work

The aim of group work is to develop a positive peer culture through a supportive group environment, which fosters engagement and participation and enables the students to develop and practice positive interpersonal skills such as:

•        Listening

•        Turn taking

•        Problem solving

•        Team work

•        Respect & responsibility

•        Choice

•        Equality

•        Positive self image

 

 

 

1.4                Physio therapy - definition, aim, scope and techniques in class room setting.

 

According to the definition adopted by WHO, physiotherapy is "the art and science of treatment using therapeutic exercise and physical agents such as heat, cold, light, water, massage, electricity, etc. In addition, physiotherapy includes the execution of manual and electrical tests to determine the level of intervention required to recover muscle strength, joint movement and the range of vital capacity, as well as diagnostic aids for monitoring recovery. Physiotherapy aims to develop, maintain and restore the maximum degree of functional capacity in people with somatic, psychosomatic and organic disorders, or in those whose health or quality of life has been negatively affected.

Objectives  of Physiotherapy

Physical therapy (PT) is care that aims to ease pain and help you function, move, and live better. Specifically, physical therapy looks to achieve these objectives for their patients:

Physical Therapy: Methods And Treatments

At the first physical therapy session, the physical therapist assesses your needs. A history of your pain, symptoms, ability to move and your medical history will be taken.

Tests will measure:

Treatments can include the following:

Physical Therapy Benefits: Physical therapy is the conservative approach to managing health problems, and in many cases the first resort advocated by doctors and health professionals.  Indeed, it may help people of all ages who have medical conditions, illnesses, or injuries that limit their regular ability to move and function.

Physical therapy can be a benefit for the following conditions:

Modalities used in physiotherapy

Physiotherapy is a discipline that works to develop, maintain or restore the functional ability of a person. Where a person has had their normal body function compromised through a health and/or disability condition, injury or other trauma, physiotherapists apply therapeutic treatments to ease discomfort or increase the person’s abilities to move and perform activities of daily living. A health assistant in physiotherapy is a person employed to assist a physiotherapist to provide physiotherapy services in a safe, effective and efficient manner.

Therapeutic treatment can include the use of modalities.

 A modality (treatment) is a therapeutic agent or method used to treat an injury, disability or disorder and to promote, maintain or restore a person’s physical and psychological wellbeing.

The use of therapeutic modalities may help to:

·       reduce pain or discomfort.

·       improve physical function and the person’s ability to complete activities of daily living and participate in life roles.

·       facilitate independence.

·       help the person adapt or adjust to the effects of an injury or health and/or disability condition so that they can have maximum wellbeing and achieve their goals.

Physiotherapy modalities include:

·       standardised treatment programmes

·       thermal treatment (hot and cold).

·       application of orthoses (splints and braces).

·       TENS (Transcutaneous Electrical Nerve Stimulation).

·       electrotherapy agents.

·       paraffin wax baths.

·       laser therapy.

·       ultrasonic therapy.

An agent is the particular equipment or activity that is used with the person you are supporting. The method is how that equipment or activity is used with the person to bring about the desired therapeutic effect.

As health care providers, physiotherapists are also involved in the prevention and promotion of health, including mental health. It is their responsibility to inform individuals adequately about mental health, eliminate misconceptions about mental illness and refer them when necessary to specialized professionals in mental health and psychiatry.

 

‘Physical health‐related’ approach

The physical health‐related approach aims to improve the global physical health of the person with mental health problems. Studies have shown that people with mental health problems are more susceptible to inactivity and are at risk of a sedentary lifestyle. In addition, the use of psychotropic drugs can result in the development of metabolic syndrome, obesity, osteoporosis and cardiovascular disease. The physical health‐related approach is consistent with the recent recommendations of the World Health Organization (WHO) about the relationship between individuals’ ‘physical inactivity’ and poor health and a serious threat to their quality of life 

Psychosocial‐related and psychophysiological approaches

The psychosocial‐related approach emphasizes the acquisition of mental and physical skills related to the ‘moving body’ and support of people's ability to function independently in society and to improve their quality of life. The activities aim at learning, acquiring and training psychomotor, sensomotor, perceptual, cognitive, social and emotional proficiencies. Other elementary proficiencies are stressed, such as relaxation education, relaxation skills, stress management, breathing techniques, psychomotor and sensory skills and also cognitive, expression and social skills. Through exercises, patients acquire a broader perspective and can experience their own abilities. Moreover, the learning of the basic rules of communication is integrated. The psychophysiological approach involves the use of physical activity to influence mental health problems such as in the treatment of depression and anxiety disorders. In the literature, the benefits of physical activity for mental health are well accepted. Physical activity has a positive influence on mental well‐being, self‐esteem, mood and executive functioning. Through these effects, a downward spiral that leads to dejection can be stopped. Well‐balanced and regularly executed endurance activities (walking, biking, jogging and swimming) power training (fitness training) and mindfulness‐derived exercises) augment physical and mental resilience; improve the quality of sleep; enhance self‐confidence, energy, endurance and relaxation; and, in general, decrease physical complaints.

Psychotherapeutic‐oriented physiotherapy approach

The psychotherapeutic‐oriented physiotherapy approach uses the motor domain as a gateway to ameliorate social affective functioning. This approach puts less emphasis on the acquisition of skills but more on the awareness of psychosocial functioning and facilitating a process of change. Using movement activities, the physiotherapist creates a setting that favours the initiation and development of a process aimed at helping patients to gain greater insight into their own functioning. During these activities, patients are invited to venture outside their comfort zone, think outside the box, experience new things, become more in touch with their inner self and cope with numerous emotions (depressive feelings, fear, guilt, anger, stress, feelings of unease, estrangement and dissatisfaction) and negative thoughts (intrusion, obsession, morbid preoccupations and worrying). Moreover, they are confronted with their behaviour (i.e. impulses and lack of abilities) or cognitive symptoms (i.e. derealisation and lack of concentration). Through psychomotor therapy, an alternative perspective on experiences can be proposed. Experiencing the possibility that an alternative may exist triggers new emotions and experiences, and a discrepancy between reality and the patient's perception of reality emerges. Consequently, it is important to note that it is not the physical activity itself but the patient's experiences and inner perception that play the central role. The careful guidance and encouragement of the physiotherapist and the opportunity to experience feelings in a safe environment allow the patient to develop behaviour, which would not have developed otherwise. Although the underlying problems are not necessarily resolved, the therapist tries to improve problem management of the patient. The patient shares his behaviour, feelings, and thoughts with the therapist initially and, eventually, with his peers. More emphasis is placed on experiences and how reactions to these experiences function as a dynamic source of power

 

 

1.5                Speech therapy - definition, aim, scope and techniques in class room setting.

 

DEFINITION OF SPEECH THERAPY:

treatment to improve the speech of children who have difficulty in learning to speak, for example because of partial deafness or brain damage, or to help restore the power of speech to adults who have lost it or partly lost it through accident or illness

 

What is Speech Therapy?

Speech therapy, also called speech and language therapy, is used to treat a variety of disorders related to producing speech and other oral motor functions. A person who provides speech therapy is called a speech-language pathologist (SLP). SLPs may help young students learn to overcome a stutter, or they might help geriatric patients re-learn how to swallow properly. People who receive speech therapy are generally referred to as clients (not patients), as an SLP is typically not a medical doctor.

An SLP works in a many different environments helping people with a variety of disabilities. They also sometimes have speech-language pathology assistants who work under them and provide basic services. SLPs can work in public schools, private schools, schools for the deaf, hospitals, private clinics, university clinics, nursing homes, and audiologist offices, or they can have their own private practices.

 

Online Speech Therapy or Telepractice is the use of technology to provide speech therapy via high speed internet, webcam, headset with microphone or any other form of communication. Online therapy is a clinical arrangement where the patient and a speech-language certified pathologist communicate and interact face-to-face over the Internet.The session involves a suite of therapeutic exercises including listening, speaking, reading and writing. The recorded videos are assessed by the pathologist to generate an activity report for evaluating progress and usage.

 

GOALS AND OBJECTIVES OF SPEECH THERAPY:

The main goal of speech therapy is to improve communication. Some of the goals of speech therapy might include:

•     Improving coordination of speech muscles through strengthening and coordination exercises, sound repetition and imitation.

•     Improving communication between the brain and the body through visual and auditory aids such as mirrors and tape recorders.

•     Improving fluency through breathing exercises.

•     Enhancing the learning of language through language stimulation and the use of language through positive reinforcement.

•     Improving communication by helping a child learn alternative way to communicate. This might include gestures, signing or augmentative communication devices.

The benefits are of Speech Therapy are immense, these may include:

•     Improvement in the ability to understand and express thoughts, ideas and feelings

•     Clear speech so your child is understood by others

•     Improved swallowing function and safety

•     Achievement of school readiness skills

•     Development of pre-literacy skills

•     Improved vocal quality

•     Fluent speech

•     Greater self-esteem

•     Increased independence

TYPES OF SPEECH:

·      INFORMATIVE SPEECH

·      PERSUASIVE SPEECH

·      SPECIAL OCCASION

INFORMATIVE SPEECH:
This kind of speech is delivered mostly to convey information to the audience about something they don't already know.There are a few types of informational speeches:

•     Speeches about objects

•     Speeches about events

•     Speeches about processes

•     Speeches about concepts

1) When a public speaker talks about things that can inspire your senses, like touch, smell or feel, it is a speech about objects and involves talking about things in the sensory and physical world.

2) Some speeches are written to inform people of a current or past happening. This is a speech about an event, and it is meant to bring people up to speed on things that have, are or will be going on in the world.

3) A cooking demonstration is a good example of a speech about processes because it instructs the audience on how to do something through a process.

4) There are speeches that are a bit more abstract than a current event or even a how-to talk. Some are speeches about concepts, written about theoretical ideas and notions, like world peace, freedom or love. Unlike the other types of informative speeches, this type of speech is intangible.

PERSUASIVE SPEECH:

A persuasive speech is intended to persuade an audience that the personal opinion expressed by the speaker is correct.

OCCASIONAL SPEECH:

special occasion speeches are speeches that are given on special occasions. There are many examples of special occasions where it might be appropriate to deliver a speech. For example, an individual might give a speech at a wake or memorial for an audience of friends and families who knew the person being memorialized.

LANGUAGE AND HEARING DISORDERS:

When a person is unable to produce speech sounds correctly or fluently, or has problems with his or her voice, then he or she has a speech disorder. Difficulties pronouncing sounds, or articulation disorders, and stuttering are examples of speech disorders.

When a person has trouble understanding others (receptive language), or sharing thoughts, ideas, and feelings completely (expressive language), then he or she has a language disorder. A stroke can result in aphasia, or a language disorder.

Both children and adults can have speech and language disorders. They can occur as a result of a medical problem or have no known cause.