Craighalbert Centre
1 Craighalbert Way
Cumbernauld
Scotland
G68 0LS

Craighalbert Centre

Educational & Therapeutic Provision

Education in the SCCMI

All children educated at the SCCMI have access to a broad, balanced curriculum with learning and teaching directed towards developing children’s abilities within the context of Curriculum for Excellence (CfE) capacities which are long-term aspirations enabling children to become: Successful Learners, Confident Individuals, Responsible Citizens, and Effective Contributors to Society.  


Teaching and learning are focused on addressing children’s needs and aims to:

  • develop cognitive and communicative abilities,

  • promote confidence, self-reliance and independence.

 

The SCCMI’s Educational Tenets 

 

We hold the view that for education to be effective, the environment requires to be conducive to learning, allowing pupils space, time and opportunity to interact within learning and teaching processes.   SCCMI has a comprehensive range of educational tenets which inform the SCCMI’s educational provision with key elements including:

  • all individuals are of equal worth, have equal rights to have their needs addressed and their potential realised,

  • education is concerned with the development of the whole person,

  • each child, irrespective of cognitive levels and physical abilities is entitled to equity of access to a curriculum which offers breadth, depth and a balance of relevant learning opportunities, combined with motivating, active learning experiences.


The SCCMI Curriculum: Meeting the Individual Child’s Needs and Developing His/Her Abilities


The SCCMI’s Curriculum provides the scaffolding and framework which supports the information, materials and processes associated with SCCMI’s educational provision and articulates the way educational elements are structured and organised, to provide a broad general education.   Children attending the SCCMI require a differentiated curriculum for each child, with such differentiation ensuring that the curriculum is appropriate and accessible to all learners with curriculum components modified to take account of the individual child’s abilities and needs. 


Learning and Teaching

Teaching and learning approaches are engaging, motivating and challenging, enabling the child to participate to their maximum availability.  In addition, all learning is age, aptitude and interest appropriate, include individual and group sessions and include opportunities for children to make meaningful choices between activities offered.   The use of play is a key element of learning experiences.

In all learning, effective engagement between the teacher and the child is important, however in the case of the child who has cognitive, expressive communication, receptive communication and dexterous deficits, a strong positive personal connection assumes a greater degree of importance.   The Centre’s teaching and learning approaches therefore involve the engagement of staff with pupils in demonstrating, questioning, and modelling, suggesting alternatives, prompting reflection and engaging in systematic observation of children's learning and behaviour.


Therapeutic Provision

SCCMI’s team of highly trained therapists ensure each child receives the best and most appropriate advanced child-centred, integrated therapeutic programmes which are tailored to each individual’s specific requirements.

SCCMI provides educational and therapeutic provisions for children with cerebral palsy and related conditions, with such children and young people being affected by:

- disorders of movement and posture, 

- activity limitation, 

- disturbances of sensation, perception, cognition, communication and behavior,

- functional disabilities (variously described as life skills, activities of daily living and activities related to independence), 

- learning difficulties,

- secondary musculoskeletal problems.

SCCMI therefore engages with children who have a considerable array of physical, functional and communication disorders, with these disorders having a range of severity and complexity including some with complex and exceptional healthcare needs. 

The National Institute of Clinical Excellence (NICE) states that the needs of children and young people affected by cerebral palsy should be addressed by a management regimen which is individualised and goal-focused. The view published by NICE is consistent with that of SCCMI which considers that a range of therapeutic approaches are required to address the needs of children affected by cerebral palsy in general, and to address the individual needs of each child. 

The difficulties experienced by children require the attentions of a range of professional staff including a number of highly specialists, well-educated and trained health care professionals including occupational therapists, speech and language therapist and physiotherapists.  Therefore in order to address children’s needs associated with movement, posture, activity, function, sensation, perception, communication and related secondary musculoskeletal problems, SCCMI has established a team of therapists who work in a closely integrated manner to address children’s needs. 

SCCMI’s team of highly trained therapists strives to ensure each child receives the best and most appropriate advanced child-centred, integrated therapeutic programmes. which are tailored to each individual’s specific requirements. The therapists assess each child to determine each child’s needs in order to compile an individual therapeutic plan which is then implemented to address the child’s needs. SCCMI therapeutic approaches reflect contemporary practice and are informed by information published in research, professional and scientific literature. 


Providing Information for Children/Young People and Their Parents

SCCMI holds the view that organisations which offer services to children and young people affected by cerebral palsy should publicly articulate the nature of their physiotherapeutic approaches and the frequency and duration of the physiotherapy programme which children/young people will receive. This information will ensure that children/young people and their parents/carers are able to make informed decisions regarding the nature of the therapy a child/young person will receive and which organisation they wish to provide this therapy. 

SCCMI’s view is supported by NICE which states that information should be provided for parents of those affected by cerebral palsy and that this information should:

- be tailored to the needs of the child/young person and their parents/carers, be relevant, age appropriate and educational;

- include advice on their child’s developmental potential and how different treatment options may affect this.

It should be noted that many organisations do not place the nature, frequency and duration of the therapeutic approaches which are employed in the public domain and it is considered that SCCMI provides more information on its therapeutic approaches than any other organisation in Scotland.


SCCMI’s Therapeutic Services

Physiotherapy

Overview of Published Information Related to Physiotherapeutic Approaches

Many therapies are used to enhance the development of children/young people affected by cerebral palsy and to assist them to challenge their difficulties, with physiotherapy being a major contributor.   Several approaches or techniques are employed by physiotherapists to address the needs of children/young people affected by cerebral palsy, including eg the Boboath/Neurodevelopment (NDT) approach and Conductive Education.  Analyses by the American Academy for Cerebral Palsy and Developmental Medicine (AACPDM) and published in Evidence Reports, state that neither Bobath/NDT nor Conductive Education appear to have advantages over alternative methods (therefore each other), therefore no discernible advantage is identified regarding the effectiveness of one approach compared with the other.  

The AACPDM analyses are supported by authors in the field including Margaret Mayston, Amanda Connell, and Diane Damiano and NICE who variously state that:

- there is no singular ‘right way’ to provide physical therapy,

- various treatment paradigms have not been shown to be more effective than any other, 

- therapy requires to be tailored to the individual’s needs and abilities and be consistent with developmental and functional goals,

- therapy should be individualised and goal focused,

- therapy should be developed and implemented in partnership with the child/young person and their parents or carers.


SCCMI’s Physiotherapy Approach - Overview

SCCMI’s therapeutic responsibilities include addressing the needs which result from a child’s neurological condition and other elements which may either be concomitant with, or in addition to the neurological condition including respiratory and musculoskeletal disorders. 

SCCMI’s physiotherapy approach is informed by an analysis undertaken by SCCMI of the main approaches employed by physiotherapists to address the needs of children/young people with cerebral palsy.  This analysis suggests that all therapeutic methods have merits, however no single therapeutic method is identified as being capable of addressing the needs of all children, and the use of a single approach would not address the needs of the population of children/young people who might possibly engage with SCCMI.  A key element of this analysis is that each child’s needs are individual and unique and therefore therapy requires to be bespoke, rather than the child being required to engage in any pre-determined approach.

In addition to meeting the needs of the individual child at any particular time, it is SCCMI’S view that children affected by cerebral palsy in Scotland should be able to access as wide a range of therapeutic interventions as is possible, in order that parents are able to make informed decisions on the therapeutic intervention(s) they consider to be most appropriate for their child.  SCCMI’s analysis and conclusions are endorsed by Dr Margaret Mayston in the Journal of Developmental Medicine and Child Neurology November 2011 editorial, who stated “there is no singular ‘right way’ to provide physical therapy [for those affected by cerebral palsy] …therapy needs to be tailored to the individual’s needs and abilities”.

The various physiotherapeutic approaches employed by physiotherapists each have characteristics which can be applied to children/young people to provide a comprehensive programme for the individual child, with many of these approaches informed by the underpinning principles  associated with motor learning. 

SCCMI’s physiotherapy approaches reflect the analysis that there is no singular ‘right way’ to provide physiotherapy and therapy requires to be tailored to the individual’s needs and abilities.  SCCMI’s therapeutic approach will therefore:

- Not be pre-determined, and not constrained by using any single, restricted physiotherapeutic approach.

- Draw upon the range of approaches used within physiotherapy and be focused on meeting the specific needs of the individual child, both in terms of the whole-person approach and of addressing focused and detailed issues.

- Strive to be evidenced-based, progressive, capable of development, up-to-date, subject to possible adaptation, improvement and expansion to meet the child’s needs, constantly re-examined against external quality and improvements sought. 

- Reflect developments in neuroplasticity, pathology, recovery and adaptation.

- Include two underpinning principles ie:

1. aim to enhance children’s development including eg psychomotor abilities, (including limb and trunk movements, manual abilities balance and posture) and functional activities; 

2. enable children to learn how to do things differently when psychomotor and functional abilities cannot be further developed at a significant level.


Articulating SCCMI’s Physiotherapeutic Approach – Applied to the Individual Child

In addressing the needs of all children who can benefit from its services, the SCCMI physiotherapy approach is based upon a detailed and objective professional assessment of each child’s abilities and from the individual child’s perspective will aim to:

§    fulfil the child’s  potential,

§    focus on achievement and progress,

§    maximise independence levels, and

§ incorporate methods to address primary and secondary  musculoskeletal conditions.


Articulating SCCMI’s Therapeutic Approach - Professional Perspective 

SCCMI’s physiotherapy approach is informed by information included in published materials, including eg the views of Professor Diane Damiano (2004) who states: “many clinicians now use a combined or eclectic approach by selecting ….. components as treatment options”.  However Professor Damiano advocates a more radical approach by therapists and that adherence to the various 'named' approaches  should be eliminated with a focus simply being on addressing the child’s needs from an analysis of their abilities and deficits.

Professor Damiano (2006) also states that the physiotherapy management of cerebral palsy requires to shift from “packaged” approaches to a more proactive approach of promoting activity, with increased motor activity being shown to lead to better physical and mental health and to promote neural and functional recovery”.   Damiano also states that “clinical dogma, unsubstantiated by research, once held that movement quality be emphazised over movement quantity or functionality ….. in contrast, current thinking is shifting toward a view that children need to be as mobile as possible”

The views of Professor Damiano are supported by Dr Margaret Mayston who stated, “there is an urgent need for an integrated approach to neurorehabilitation that is not based on approaches, but rather is client based with a sound theoretical, and where possible, evidence base”.

Within SCCMI, the most appropriate elements of the approaches described will be incorporated into addressing the needs of children in general, and addressing the individual needs of each child/young person.  SCCMI therefore aims to provide a physiotherapeutic programme which is tailored to each child’s individual needs and abilities, and which:

- is consistent with developmental and functional goals, and;

- involves as much activity as each child has the physiological capacity to engage;

- incorporates the principles of motor learning;

- employs the elements described below as appropriate for each child.


Summary of Therapeutic Approaches Employed

The various physiotherapeutic approaches which may be employed by SCCMI staff each have characteristics which will provide a comprehensive programme for the individual child and are summarised below.

Motor Learning Programme

Motor learning is based on structured practice of goal-oriented motor function tasks, with specific feedback matched to the learner’s abilities. The principles which underpin motor learning programmes will be incorporated into the SCCMI physiotherapeutic portfolio.

Conductive Education 

Elements of Conductive Education will be employed for  those children placed towards the ‘more able’ and ‘less complex’ aspects of the disability spectra, as CE is not designed for the less able child and may include eg the promotion of independence, a function-focused approach, and group-based activities. 

NDT/Bobath 

The NDT/Bobath approach will be used in two contexts. 

(i)            Examination and Assessment

In conjunction with other methods and measurement tools (eg Gross Motor Function ClassificationScale and  Gross Motor Function Measure) NDT/Bobath approaches will be used to assess a child's abilities.

(ii)          Direct Intervention

In terms of direct therapeutic intervention with the individual child, the NDT/Bobath approach would also be used to address:

-     the specific focused needs of individual children;

-    the needs of children who are towards the more severe side of  the disability spectrum and for whom CE has been identified as  not being appropriate.

Rebound Therapy

Rebound Therapy is used increasingly within paediatric therapeutic environments and involves the use of a trampoline to provide therapeutic exercise for those with a wide range of special needs, including cerebral palsy.  This approach aims to facilitate movement, promote balance, affect muscle tone, promote relaxation and promote sensory integration. Physiotherapists use close handling of the child/young people in a Rebound Therapy session with benefits potentially gained by using the rate, depth and rhythm of the bounce to harness improvements in body awareness, reductions in muscle tone and improvements in postural mechanisms.

Strengthening and Mobility Exercises

‘Normal’ exercise activities are employed where appropriate for those children who would benefit from such activities through the use of tricycles and other equipment.  Such activities will also be used, where appropriate to address orthopaedic-related elements to address specific musculoskeletal needs, including following Botulinum toxin type A injection into a muscle to reduce spasticity.

Functional Electrical Stimulation

Functional Electrical Stimulation (TES) will be used as deemed appropriate to meet the specific individual needs. TES is normally applied to antagonists of spastic leg muscles in children with spastic cerebral palsy and is used to improve joint range, facilitate motor control and muscle re-education, and assist in gait training. Research studies undertaken in Scotland have indicated that stimulation of the anterior tibial muscles of children with hemiplegic cerebral palsy showed significant increase in passive joint range.


Therapy Duration and Frequency

The duration and frequency of therapeutic applications are crucial elements of the SCCMI physiotherapeutic approach.  SCCMI holds the view that children/young people affected by cerebral palsy should receive physiotherapy at the frequency and duration they require and that this should be received from qualified physiotherapists and that the quantity of therapy a child receives is an element in the effectiveness of therapeutic intervention. 

It is also noted that a 2013 NHS Scotland report has stated that in terms of the provision of therapy services related to children affected by cerebral palsy in Scotland:

- the level of physiotherapy input in most cases is determined by local availability of services as much as by the assessment of need,

- there is no coordinated development of services, 

- there is not equity of access to physiotherapy services across Scotland

- physiotherapy services are under significant pressure.

SCCMI's view regarding the frequency and duration of therapeutic intervention is informed by evidence from Gordon (2011) who states “treatment intensity with sufficient repetitions over many hours of training …. may well be the key to successful training protocols especially for older children”.   

A crucial element of the SCCMI approach will therefore include each child receiving the quantity and frequency of therapy each requires as determined by therapists, the nature of which is therefore:

- determined by the child’s individual needs, 

- balanced with ensuring an appropriate educational input, and 

- within the child’s physical and physiological capabilities.

Within the parameters identified, the quantity and frequency of therapy received by each child is relatively unlimited.  Therefore, a child will receive either personal therapy or be under the direct supervision of a physiotherapist at all times, with the SCCMI staffing framework ensuring this situation.


Occupational Therapy

SCCMI’s Highly Specialist Paediatric Occupational Therapists work directly with children/young children who have difficulties with the practical, functional and social skills necessary for their everyday life, in order to maximise their participation and independence in daily activities within the Centre’s environs and in the home environment. In addition to working with directly with children/young people the occupational therapists work in partnership with parents and this partnership is essential in fulfilling the child/young person’s potential.

The Occupational Therapists assess each child/young person using standardised and non-standardised assessments and outcome measurement tools in order to determine appropriate therapy intervention, gathering information from parents and others involved in the child's life to establish an information base related to:

- functional difficulties such as dressing, eating, toileting and other activities of daily living, both personal and social

- sensory abilities such as touch and perception

- fine motor skills, gross motor function and movement disorders

- social skills

- behavioural responses during the child's day.

In order to enable each child/young person to be as physically, psychologically and socially independent as possible, the Occupational Therapists engage with parents/carers to identify appropriate strategies in order to enable the child to maximise his/her potential when carrying out activities of daily living. These activities include the following functional areas:

- self-care tasks, such as feeding, washing, dressing, grooming;

- equipment use (such as writing materials, specialist cutlery and self-care aids)play and leisure activities

- recording written information

SCCMI’s Occupational Therapists employ a range of methods to address each child’s needs including the recommendation of specialist equipment to support functional skills and learning, direct therapeutic intervention with the child both individually and in a group and through the use of evidence-based practice, establish individualised management plans that will supply families with strategies and interventions for use within the home environment. Where appropriate, occupational therapists will assess and advise for appropriate equipment to assist in moving and handling as well as to support a child in their 24 hour postural management programme.


Speech and Language Therapy

Motor disorders associated with cerebral palsy are frequently accompanied by disturbances of sensation, perception, cognition, communication and behaviour.  Individuals with a movement disorder, where abnormal neuromuscular function disrupts muscular control, can experience dysarthria (difficulty in controlling muscles for speech); dysphagia (difficulty in controlling muscles for swallowing); and language impairment (difficulties in understanding and expressing themselves).

SCCMI is committed to assisting each child to communicate to the best of his/her ability in order to access education and participate in activities of daily living.   

SCCMI’s Highly Specialist Paediatric Speech and Language Therapists aim to provide high quality speech and language therapy input to all SCCMI programmes through the application of evidence-based practice to assess, plan, implement and evaluate interventions to the children and young people who have communication and/or swallowing difficulties.  Where appropriate, discrete therapy interventions and complete therapeutic programmes are integrated with the academic curriculum for children/young people individually and in collective groups.   

Speech and Language Therapy aims to address difficulties with:

- understanding spoken and written information

- being understood (spoken, written, sign and gestures) 

- developing intentional communication behavior

- intelligibility 

- chewing and swallowing disorders.

SCCMI’s Speech and Language Therapists undertake a comprehensive assessment of children/young people, using standardised and non-standardised assessment and outcome measurement tools related to eg communication, language, speech, fluency and eating and drinking to determine appropriate therapy intervention.  They use evidence-based practice and client-centred principles to assess, plan, implement and evaluate interventions both within the SCCMI environment and in the child’s home.

The Speech and Language Therapist working with other team members, takes a lead role in developing and implementing strategies and interventions which address the functions identified.

§  Oral Motor Skills

With children who possess the ability for oral communication, the speech and language therapist will establish an appropriate oral motor programme aiming to increase comprehensibility and function within conversation.

§  Dysphagia Management

Dysphagia in neurologically impaired children is associated with difficulty in controlling the muscles controlling the feeding and swallowing process and is characterised by dysfunction in the sequential phases of the swallowing process. Children with dysphagia can experience difficulties in tongue control and bolus manipulation, problems with movement of food from the mouth to the pharynx and/or delayed pharyngeal swallow, resulting in increased risk of aspiration of food into the airway. Dysphagia can be mild, moderate or severe.  The Speech and Language Therapist is responsible for the management of children with dysphagia and oral-motor deficits, which includes devising feeding protocols and providing specialist training to other staff in this area.  This involves the assessment of the child’s abilities related to oral function, behavioral state, the positioning and dynamic handling required, utensil selection, bolus modification and oral/non oral feeding. The involvement of the parents is a critical part of identifying the most appropriate protocol for each child.

§  Individualised Augmentative and Alternative Communication (AAC)

Augmentative and Alternative Communication (AAC) describes a variety of methods through which individuals can communicate if they have limited or impaired speech.  The speech and language therapist works closely alongside parents and within the inter-disciplinary team to establish the most accessible communication system for that child, with the modes of communication including:

- low-tech communication equipment including communication charts and symbol boards;

- mid-tech and high-tech communication equipment which provides electronic or pre-recorded voice;

- sign-supported speech including a wide range of signing; gesture and symbol-based languages.

Thu 29 Jun
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