Index

Introduction
. Terapias

ABR technique

1.1. Concept
1.2. Objective
1.3. Destinatarios
1.4. What does the method consist of?
1.5. Centers

Doman Method

2.1. Neurological Development Profile

2.2. Theories on which it is based
2.3. Methodology
2.4. Why is it questioned?
2.5. Centers

3. Therasuit - Intensive pediatric therapy

3.1. Background
3.2. The therasuit method
3.3. Objectives
3.4. Recipients
3.5. What does it consist of?
3.6. Typical intensive exercise program
3.7. Effects
3.8. Centers

4. Nazarov - Tenotomies

4.1. Background
4.2. Recipients
4.3. What does it consist of?
4.4. Centers

5. Tomatis Technician (Psychoaud phonology)

5.1. What is it?

5.2. Target population
5.3. What does it consist of?

2
6. Vojta Method

6.1. Recipients
6.2. What does it consist of?
6.3. Advantages
6.4. Differences with other methods
6.5. Contraindications
6.6. Centers and addresses

7. The walker / bipedal walker NF- Walker

7.1. What is it?

7.2. Results
7.3. Contacts

8. Ulzibat fibrotomy

8.1. Background
8.2. What does it consist of?
8.3. Recipients
8.4. Treatable pathologies
8.5. Contacts

9. Bobath

9.1. Background
9.2. Concept
9.3. What does it consist of?
9.4. Centers

10. Katona therapy

10.1. Introduction
10.2. What does it consist of?
10.3. Results
10.4. Centers

11. Hippotherapy

11.1. Background
11.2. What does it consist of?
11.3. Operation of hippotherapy
11.4. Benefits of the horse
11.5. Centers

12. Dolphin therapy.

12.1. Background
12.2. What does it consist of?
12.3. The Cyberdolphin.
12.4. Dog-assisted therapy

3
13. Peto Method - Conductive Education

13.1. Background
13.2. What is it?
13.3. Operation
13.4. Recipients
13.5. Pillars of conductive education

14. Padovan Method

14.1. Background
14.2. What does it consist of?
14.3. Main novelties of the method
14.4. Centers

Craniosacral therapy

15.1. Background
15.2. What is it?
15.3. How does it work?
15.4. Benefits
15.5. Contact

16. Foltra Method

16.1. Background
16.2. Objectives
16.3. Information

17. Sensory stimulation rooms

17.1. What is it?

17.2. Objective
17.3. What does it consist of?
17.4. Advantages
17.5. Other utilities
17.6. Elements of the room

18. Subthreshold therapeutic electrical stimulation, threshold and therapy of

hyperbaric oxygenation

19. Selective dorsal rhizotomy

19.1. What does it consist of?

19.2. Who benefits from the RDS?
19.3. Results that can be expected
19.4. Ideal candidate for rhizotomy

20. Therapy of rhythmic movements and primitive reflexes

20.1. Background

4
20.2. What is rhythmic movement therapy?
20.3. What is it based on?
20.4. Benefits
20.5. Information

21. Cognitive–neuro therapy

22. Neurofeedback and Biofeedback

23. Kabat Method

23.1. What does it consist of?

24. Hydrotherapy

24.1. Recipients
24.2 Benefits
24.3. Thalassotherapy
24.4. Therapeutic effects of thalassotherapy
24.5. Indications for thalassotherapy
24.6. Halliwick Therapy

25. X-cell-Center treatment for Cerebral Palsy

25.1. Introduction
25.2. What is it about?
25.3. Results
25.4. Center

26. Application of botulinum toxin type A in Spastic Infantile Paralysis

(Botox)

26.1. Background
26.2. Application of Botulinum Toxin in Cerebral Palsy.
26.3. General guidelines for the effectiveness of the treatment with
TBA
26.4. Recipients
26.5. Contraindications
26.6. Conclusions

27. Homeopathy

27.1. What does it consist of?

27.2. Cerebral palsy and homeopathy

28. Israel's Shoes (Step of Mind)

28.1. Background
28.2. What is it?
28.3. Who can benefit from Re-Step?
28.4. How does it work?

5
29. Functional myotherapy

29.1. Introduction
29.2. What does it consist of?
29.3. Conclusions

Cinesitherapy

30.1. What is it?

30.2. Benefits

31. Pharmacotherapy

31.1. Medication to control seizures

31.2. Drug to control spasticity
31.3. Drug to control athetoid movements and drooling.

32. Music Therapy

32.1. Definition
32.2. Objectives
32.3. Types of therapy
32.4. Music therapy and cerebral palsy
32.5. Effects

33. Acupuncture

33.1. What is it?

33.2. Effects
33.3. Acupuncture and cerebral palsy

34. Swimming

35. Method of Le Métayer

35.1. Techniques

36. Schwartz Method

37. MOVE Program

38. Physical Therapy

38.1. Facilitate psychomotor development

38.2. Reduce spasticity
38.3. Prevent muscle hypoextensibility
38.4. Transition from sitting to standing
38.5. Reduce functional limitations

39. Pohl Method

40. Collis Method

6
41. Phelps Method

41.1. Background
41.2. Basis of the method
41.3 15 Treatment Modalities

42. Temple Fay Method

43. Deaver Method

[Link] stroke technique –Rood Method

44.1. Introduction
44.2. What does it consist of?

45. Castillo Morales Method

46. Guy Bérard Method

46.1. Background
46.2. What does it consist of?

47. Speech therapy treatments

47.1. Objectives

Occupational therapy

49. Conductive education

49.1. Introduction
49.2. Main objectives

50. Artistic therapies: dance, theater, etc.

50.1. Example of artistic therapy: Dance Ability method

50.1.1. Background
50.1.2. Objectives
50.1.3. Contact

51. Jacobson Method

52. Perfetti Method

53. Electrotherapy

54. Vestibular stimulation

55. Orofacial therapy

56. Tardieu Method

7
57. DEMEK Method (dynamic method of Kinesiological stimulation)

58. The Carolina Curriculum (Early Intervention)

59. Chromotherapy or Color Therapy

59.1. Application of colors.

59.2. Therapeutic actions of colors
59.3. Treatment methods

60. Spider Therapy

60.1. What is it?

60.2 Who is it intended for?
60.3. Centers

61. ABA Method

61.1. Background
61.2. What does it consist of?

62. PROMPT Method

62.1. Introduction
62.2. Definition

63. Sensory Integration Therapy

63.1. Introduction
63.2. Objective
63.3. Contact

64. Treatment of auditory disorder

65. Treatment of visual disorder

66. Neuromuscular tape or Kinesiotape

66.1. Introduction
66.2. What does it consist of?

67. Yoga

68. Ozone Therapy

68.1. Introduction
68.2. Ways of application

69. Frenkel Method

69.1. Introduction
69.2. Progression

8
69.3. Techniques

70. Theratogs

70.1. Información y centros

71. DAFOS

71.1. What are they?

71.2. How can SWOTs help?
71.3. What conditions are they suitable for?
71.4. Information and centers

72. Art Therapy

72.1. Therapeutic art objectives with people with CP

72.2. The concept of resilience
72.3. Factors

73. Feldenkrais Method

73.1. Anat Baniel Method (ABM)

Pilates Method

75. Constraint-Induced Movement Therapy (CIMT)

76. Reflexology

76.1. Introduction
76.2. What is the purpose?

77. Therapeutic Esferodynamics (Vogelbach Technique)

77.1. Introduction
77.2. What are they?
77.3. Educate the body
77.4. Results

78. Brunkow Method

79. Sensory integration

79.1. What is sensory integration?

79.2. The process of sensory integration

80. Mechanical therapy

80.1. What is it?

80.2. Effects

9
Magnetotherapy

81.1. What does it consist of?

81.2 Fundamentals
81.3. Instructions

82. Quantum ScIo Feedback

83. Intrathecal baclofen therapy

83.1. What is it?

83.2. Components of therapy
83.3. Benefits and risks
83.4. Contact

Bach Flowers

84.1. Introduction
84.2. Who can take Bach flowers?

85. Deep muscle therapy (DMT)

85.1. Introduction
85.2. Objectives

86. Therapeutic touch (pranotherapy). Alternative to mobilizations

86.1. Introduction
86.2. Method
86.3. Objective of the mobilizations

87. Crioterapia

87.1. Introduction
87.2. Recipients
87.3. What does it consist of?
87.4. Centers

88. Taichi

88.1. Origin and philosophy of Tai Chi

88.2. The movement
88.3. Tai Chi and its therapeutic effects

89. Shantala. The Ayurvedic massage for babies and children

89.1. Who can it help?

89.2. What are its benefits?
89.3. How is it worked?

10
 90. Essentis Method

90.1. Workshops and therapies of the method

90.2. Center and contacts

91. Treatment with Tizanidine

Cerebral palsy and Scoliosis (Treatment)

92.1 Niederhöffer Method

92.2 Asymmetrical Method Rudolf Klapp

93. Other therapies

93.1. Treatment of drooling

93.2 Treatment of bladder incontinence
93.3. Treatment of feeding problems
93.4. Pattern therapy
93.5. Surgery to lengthen the muscles
93.6. Behavior therapy
93.7. Método de Brunnstrom
93.8. Hipps Method
93.9. Fraenkel Method
93.10. Montessori
93.11. Lunning, Plum
93.12. Steiner, King
93.13. Beaman and Obholzer Method
93.14. Dane Method and Neumann-Neurode
93.15. Myoelectric feedback
93.16 Plum
93.17. Counter-stimulus technique
93.18. Carlsson Method
93.19. Spinal cord stimulation
93.20. REIKI Therapy
93.21. RPG (Global Postural Re-education)
93.22. Maternity gymnastics
93.23. Treatment with Ex N'Flex devices
93.24 The Neuralter
93.25. Balance Polar Electromagnético
93.26 Gindler Method

News

Annexes

Bibliography of interest

11
12
INTRODUCTION

Cerebral palsy cannot be cured. But if the affected person receives care
adequate to help improve their movements, that stimulates their intellectual development,
that allows them to develop the best level of communication possible and stimulates their relationship
social, they will be able to lead a full life.

It is traditionally accepted that there are four pillars of treatment for cerebral palsy: the
physiotherapy, occupational therapy, compensatory education, and speech therapy. There are different
techniques and approaches in their treatment, as long as they are applied by professionals
qualified individuals may be effective.

With the goal of achieving comprehensive care for the person with cerebral palsy and taking into account
it accounts for the specificity of this type of disability (due to the global nature of the disorder, to
the diversity of areas in which it manifests and the variety of consequences that can
appearing in each of them), from ASPACE the work with people with cerebral palsy is proposed
and related as a construction process in which both the person, the family and the
professionals must have an active attitude that contributes to achieving the maximum
development of the person.

In this process, we take into account the different needs of the person: health-related,
educational, social, labor; and the possible responses regarding more specific services
that they may need (in addition to the usual health, educational, and social services): Centers of
Treatments (early intervention, physiotherapy, communication, language, speech, and nutrition)
psychopedagogical, neuropsychological rehabilitation, psychotherapy, social intervention), Centers of
Adults, Occupational Centers, Special Employment Centers, Residences, Supported Housing.

For this reason, the methodology used is that of meaningful learning in which the person is the
active subject of the process. From him and with him, the objectives will be designed and the planning will be done.
contents in a way that adapts to the individual development level, to previous experiences
and the different contexts in which their life takes place or will take place, in order to
garantizar la habilitación funcional. Para esto se utiliza el repertorio de conductas útiles de cada
person, who are the ones directing their activity, to promote the gradual development of the
both personal and social autonomy.
14
 01
Therapy
ABR

ABR is the acronym translated into Spanish for: Biomechanical Rehabilitation

Advanced is the only rehabilitation method based on biomechanics that
provides a recovery of the musculoskeletal structure and functions
motor skills to children and young adults with brain damage.

It is a method of structural correction of muscle deformities.

skeletal, this is a method carried out by the parents, who learn the
technique and the individual application of ABR by the professionals of the same.

ABR improves the musculoskeletal structure in such a way that the functions
motors recover spontaneously, making equipment unnecessary
special treatments for "motor disabilities".

No drugs, electrical instruments or surgeries are used. ABR is a method of

manual application on the child's body, based only on the principles
biomechanics.

The results are visible, due to the number of hours invested in each exercise,
as well as changes in alignment, mobility, size, tone, and strength of
body of the child (thorax, abdomen, and size of the pelvis). Each application of ABR
about the body, it is calculated for each individual.

1.1 Concept

Everyone believes that children with cerebral palsy (CP) have deficient functions.
because his brain is too damaged to control movements
normal. Children with CP are considered incurable because the damage to
The brain is irreversible.

15
ABR has a different philosophy. They believe that even severely damaged brains...
damaged, have enough electrical plasticity to control motor functions
normal, however, for this plasticity to occur, the muscle structure
the child's skeletal system needs to improve to a certain level; to the threshold of the
plasticity.

1.2 Objectives

It restores the motor functions of people with brain damage, of a

spontaneously through the reconstruction of the muscle structure–
skeletal, and the restoration of the bioelectric signals that flow between the
muscles and the brain.

ABR stands out from other methods due to a critical factor: while all
they focus on the functional learning of the person with brain damage,
ABR poses another question: - How to normalize the muscle system?
skeletal?

While it is common to believe that people with a brain injury need a

special treatment for their motor functions making "better use" of their
deficient musculoskeletal system, ABR demonstrates that the true
biomechanical structural improvement of the musculoskeletal system becomes
automatically in a progress of motor functions, eliminating any
need for a specific treatment to perform motor tasks. The
motor functions are developed as a result of "spontaneous"
structural normalization.

1.3 Recipients

A wide range of children and people with brain damage, such as paralysis
cerebral, microcephaly, flaccidity, developmental delay, seizures, accident
cerebral vascular, vaccination damage, dyspraxia, scoliosis, head injury
Down syndrome, Angelman syndrome, West syndrome, Rett syndrome, and many others.

1.4 What does the method consist of?

The technique targets the inner layers instead of the outer ones, making it
the internal muscles react automatically. The child is a receiver
passive.

The rehabilitation program is based on a series of exercises that

they transfer kinetic energy through a nearly-static movement towards the

16
membranes (tissues and cells). It is a pumping, with hand and arm movement
(piston) that reaches the deepest layers of involuntary muscles.

This imitates the shape of the movement of the lungs, rhythmically pushing air.
inside the chest and abdomen against the internal muscles. This maintains
firmly the electrical activity when developing and maintaining the supply of
blood. Likewise, it accumulates a normal volume that gives control to the head and
neck creating a cascading effect down through the body
whole.

The towels are used as "air cushions" to ensure that there is no pressure on
the superficial tissues (skin and superficial muscles) and allows energy
pass through the barriers of skeletal muscles penetrating into the
internal layers (smooth muscle). The gentleness of the method is very relaxing for
the patient is extremely confident.

The target muscles are the intrinsic involuntary muscles of the

neck and trunk (thoracic cavity, abdominal cavity, and the floor of the pelvis). The
group of strong muscles, (which is associated with the most pronounced effects
from PC, spasticity and contractures) is never worked directly through
these exercises. Improvement is achieved through the strengthening of the group of
the opposing muscles (smooth muscle).

Once the quality of the musculoskeletal elements is improved, the

brain improves the quality of the "matrix" of the musculoskeletal system
incorporating these positive changes, then the child begins to perform
spontaneous motor functions.

1.5 Centers

In Spain, there is no center where they are carried out during the year 2009-2010.
They gave talks about the therapy in Madrid, but to contact this therapy we
refer to the Denmark website whose email is:info@[Link] or in their
[Link].

We also found information about this technique on the page

[Link], where it can also be obtained for free a
video or DVD about ABR, filling out a form. The blog in Spanish is
[Link]

17
 02
Method
DOMAIN

Dr. Glenn Doman, an American physician, began to dedicate himself to

treatment of children with brain injuries with neurologist Temple Fay.
He used his methods, based on progressive movements, which were very effective both
in motor areas as well as in more intellectual areas. They focused on work
with the reflexes, fundamentally with children with cerebral palsy.

Upon observing the progress being made by these children, Doman decides
to pass on their knowledge to the rest of the children, so that it would be enhanced
its learning capacity. He develops his theory about brain development,
a Profile of Neurological Development and systematizes an educational work,
structured through sequenced programs, with precise methods and
effective.

Founded in the late 1950s, the Institutes for the Development of Potential
Human in Philadelphia (USA), starting what Doman and his disciples have
called a "Peaceful Revolution."

2.1 What is your Neurological Development Profile?

After studying the neurological development process of children from various

societies create a scale of neurological development.

This scale allows to 'measure' the degree of development of the child, to set the
objectives. They are based on the premise that the differences between some children and others are
are fundamentally due to the environment, since at birth all children have the
same potential.

The Neurological Development Profile measures, on one hand, the development of the
cerebral strata, that is to say, it points out the specific functions of the spinal cord,
the brain stem, the midbrain, and the cerebral cortex. Thus, it is

18
It is possible to work in a systematic and orderly manner and to know the child’s objectives.
in each of the developmental areas based on the level achieved. Additionally,
differentiate the sensory areas and functions from those of a motor nature, since the
first are afferent pathways (traveled by the stimulus to carry information to
brain) and the second are efferent, that is to say, they leave the brain to provide the
movement order to the body.

According to this profile, the motor areas are mobility, language, and dexterity.
mobility is the key or the engine of intelligence development in
all its expressions, and it significantly affects other areas, just like
What happened in the evolution of species towards structures and functions
more and more complex and refined cerebral.

According to this theory, the level of perfection achieved largely depends on

that these basic functions are achieved as soon as possible, the greater the
brain plasticity

2.2 Theories on which their teaching method is based

All pathologies, including Down syndrome or Autism, entail

a brain injury, as occurs in cerebral palsy.
Children with brain injuries should not be classified by their severity,
but for its potential for development.
The learning and maturation of children come as a consequence of
the spontaneous experimentation of a series of schemes. Its repetition
it makes these patterns of movement and action consolidate in the end.
The children who do not experience this spontaneously must be
guided and exposed to the same stimuli so that they develop
adequately.

2.3 Methodology

Their intervention methodology is based on maximizing the

individual possibilities, with the early moment being fundamental in which
Start, as more goals will not be achieved later on.

Parents become 'professional parents,' as they are the ones who

they must apply the method to their child, with the guidance of the professional. This
method requires the repetition of various activities several times a
day, which translates into daily intervention hours. Moreover, it is very strict
regarding the compliance with these routines. Therefore, the father or mother who decides
to apply the method, one must commit seriously to it.

19
In the motor aspect, it uses what he calls the basic movement patterns:

Homolateral pattern
Cross pattern
Relaxation techniques for limbs
Crawling and dragging exercises
Brachiation and walking exercises.

In addition to the motor area, it has its own methods of teaching reading.
(global), from the calculation, and from other areas. Thus, almost all of their learning is
developed using the method of intelligence bits (like in computers or
computers, the bit of intelligence is the maximum amount of information that
can be processed at the same time in a second). The words, the numbers, the
animal sheets... are taught to children in groups of 10, several times
a day (3 or 4 times) and each sheet is shown for one second. The child at
finally ends up recognizing the sheet, whether it is a drawing, a word, a painting or
a set of points.

While the results they present can be spectacular, both in children

with Down syndrome as in children without impairments (children of months who
they recognize words or they recognize the number of points on a sheet), their
methodology may not be entirely functional, especially in children with syndrome
There is a risk that they may not develop meaningful learning.
even more so with the difficulties of abstraction and generalization that they have.

2.4 Why is this method questioned?

Although some of the aforementioned postulates are accepted by everyone

scientific community, there are important aspects that are strongly
questioned as they are: the excessive simplification and generalization of their
scientific proposals, their attempt to encompass the entire complex pathology of
development within rigid coordinates, and the excessive rigidity of its
methodology that imposes unjustified efforts.

Thus, the Doman method was rejected by the American Academy of Pediatrics.
in 1968, 1982, and 1999, mainly for 3 reasons:

1.- His theory about the nervous system seems very simple and not well-supported.
in scientific studies.

2.-No serious studies have been published on the outcomes and merits.
achieved, but their guarantees are based only on testimonies
of parents.

20
3.- A huge dedication from parents is required, both in terms of
time is like money.

In addition, the American Academy of Pediatrics comments that after various

comparative studies have not observed significant differences in the
progress achieved by the children who followed this or another method of
stimulation.

On the other hand, the Down Syndrome Association of the United Kingdom warned in 1997
that the Doman method was developed for children with brain damage and not for
children with chromosomal alterations, for whom there is no evidence of their efficacy and
that children with Down syndrome learn to read, write, walk, and
to communicate through other types of programs that do not require so much effort and
neither dedication on their part nor on the part of their parents. Furthermore, this Association is
worried about the daily time required for treatment, as well as about the
consequences it can have on family life.

2.5 Centers

Fay Institute, in Madrid. [Link].

There are numerous links on the internet to download the bits of the method.
Doman, as well as in paper-cardboard published by Bruño, Edebé and Edelvives among
Others. There are numerous videos on YouTube about it, both its explanation as well as
cases in which it applies.

There is also a website by some parents sharing their experience.

with this method, showing with videos and photos all the activities they carry out
in the daily life of your son, [Link] with an explanation
about it.

ANNEXES

The family of a child with cerebral palsy plans to hold an auction with
Andrés Iniesta's boots

[Link]

Bertín's crusade

[Link]

The blog of hope

21
[Link]

Walks through Andalusia raising money for a girl with paralysis

cerebral

[Link]

The Philadelphia Institute on cerebral palsy meets in Valencia.

[Link]
ralisis/cerebral/[Link]

Puçol celebra hoy un mercadillo solidario para ayudar con los beneficios a
a 6-year-old neighbor with cerebral palsy

Puçol celebrates market today.

solidarity-to-help-with-neighbor-benefits-6-/1456

22
 03
THERASUIT
Pediatric intensive therapy

3.1 Background

Invented in Russia during the space age and designed to combat the effects
negatives (muscle atrophy, osteoporosis) that astronauts suffered (lack
of gravity) during long space travel.

In the 90s, the suit was used to treat children with muscular disorders.
In 1997, it begins to be used in North American children and in 2002, it is designed the
TheraSuit was registered with the FDA (Food and Drug Administration).
USA

3.2 The Therasuit method

Combine an intensive and personalized strengthening program for

children with cerebral palsy through TheraSuit and the Exercise Unit
Universal.

Combat the effects of loss of conditions and immobilization.

Recognize that standardized therapeutic approaches are less

effective.

Based on the principles of intensive therapy and strength development.

Educate the body of the disabled child as you would that of a child without disabilities.

New approach by which the field of physical therapy learns from the field of
health and physical fitness.

23
 Structured program that enhances growth and development of the
person.

3.3 Objectives

Normalize the child's muscle tone.

Increase active joint excursion.

Increase strength and endurance.

Control over the newly strengthened muscle groups for children

they can improve their functional skills in order to gain independence.

3.4 Recipients

Children with cerebral palsy

Patients with stroke (accident

cerebrovascular

Cerebral contusions

Spinal cord injuries

Neuromuscular disorders

3.5 What is the Therasuit?

TheraSuit is a soft, dynamic, and proprioceptive orthosis that consists of

a hood, a two-piece suit, knee pads, and straps for the
shoes held together by a system of elastic bands. It is a tool.
effective and safe that we use in combination with our intensive program
of exercises to accelerate the child's progress.

Among other benefits:

Improves proprioception

Reduce pathological reflexes

Recover postural and movement patterns

Provides external stabilization and strengthens weak muscles

24
 Correct the body alignment.

Improve the vestibular system.

3.6 Typical intensive exercise program

3 to 4 hours daily, 5 days a week, for 3 or 4 weeks:

1st week: work to reduce muscle tone, decrease the patterns of

pathological movements, increase active movement patterns
correct and the general development of strength.

2nd week: work to strengthen specific muscle groups

responsible for the movement.

3rd week: use the gain in strength and endurance to improve the level
of child functionality (sitting, crawling, walking).

3.7 Effects

Reduce pathological movement patterns

Increases strength and endurance

Increases muscle control and coordination

Increases functional activities (sitting, crawling, walking, etc.)

25
3.8 Centers

Nipace Foundation, in [Link].

Center GROW, en Palm of Mallorca. [Link] ó

therasuitcreix@[Link].

Neusens Clinic in [Link] phone: 979.710607,

emailcomercial@[Link].

ANNEXES

Ibercaja provides funding for a 'miraculous' suit against cerebral palsy

infantile

[Link]

Nipace, the perpetual dream of a father of a girl with cerebral palsy

The link provided appears to be a news article. Please provide the text you would like to have translated.

If kisses could heal...

[Link]

26
 04
NAZAROV-TENOTOMIES

4.1 Background

The treatment has been practiced and developed since 1992 and continues to be.
currently practicing, it can be defined as a myotenofasciotomy
selective and closed.

4.2 Recipients

Muscular problems of patients with sequelae can be treated

cerebral palsy and also with sequelae from cranioencephalic trauma
(forms of hemiparesis, diparesis, tetraparesis, etc.). In addition to patients with
foot deformities (clubfoot, equinus, etc.), deformities of the
arms (obstetric brachial plexus palsy), from the neck (congenital torticollis) and others
deformities.

The main problem of these pathologies are the contractions that may occur.
to train practically in all the motor segments of the human body.
A retraction is caused by a shortening in a soft tissue, whether in
a muscle or in an aponeurosis that maintain the respective part of the apparatus
motor en posición viciosa, difícil o imposible de corregir por movimientos pasivos.

4.3 What does it consist of?

Myotenofasciotomy consists of performing percutaneous operations.

(closed), which are performed with a fine scalpel, only severing the
shortened fibers that limit movements.

When the pathological fiber is sectioned in a tissue structure

soft, it has no other fixing point and can no longer prevent stretching and the
correct function of this structure; and in this way, it is possible to eliminate all

27
the shortened fibers that exist in all areas of soft tissues, saving the
maximum the healthy structures and without interrupting the continuity of the muscle. Do not
uses post-operative immobilization.

The basis of this technique are the operations: fasciotomy, tenotomy, myotomy,
aponeurotomy, ligament surgery (e.g. Myotenotomy: Surgical section
of a muscle tendon or section of muscle and tendon) that were used until
now all over the world, to treat different diseases as well as the
muscular and derived from cerebral palsy.

The growth of the affected limb is limited and if the contractions are very
dysplasias, dislocations, and deformities appear. At the same time,
during the growth of children, joint contractures can form, such as
result of the limitation of movement (generally from 13 to 15 years of
edad). Para tratar y eliminar las retracciones de los tejidos blandos en pacientes
with cerebral palsy, currently different surgical methods are used,
starting with tenotomies and ending with very reconstructive operations
complicated in the musculoskeletal system. The results of these operations
they are not always efficient since they are:

Quite invasive.

Not all retractions are operated on, for example, often in

the lower limbs, only the adductors and the
Achilles tendons.

The immobilization that takes place after these operations weakens more.
the musculature and other structures of the motor system that already suffer by themselves
weakness.

Sometimes, after open surgeries, scars remain.

important ones that lack the capacity for growth adaptation
the posterior of the child's operated area and also hinders the repetition of the
surgical method used in case of relapse

4.4 Centers

Insmicort Medical Institute of Barcelona:[Link]

28
 05
TOMATIS TECHNIQUE
Psychoaudiofonology

5.1 What is it?

The Tomatis technique is an auditory stimulation technique created by Dr. A.

Tomatis, who emphasized the close relationship between the ear and the nervous system, and
he explained that we could have excellent hearing and yet not know how to listen.
A poor listener can seriously affect the ability to communicate and
relationship with others, with life, with oneself and with the universe that we
surrounds.

5.2 Target population

It is aimed at people of all ages (children, teenagers, and adults) who

deseen:

Harmonize the inner state. Indicated in cases of stress, anxiety, distress.

depression hyperactivity insomnia problems affective low
self-esteem, etc.

Improve oral and written expression and comprehension (poor language,

articulation of sound, intonation, dyslexia, etc.

Improve communication and relationships in general.

Improve thinking and reflection.

Improve memory, attention, and concentration.

Improve memory, attention, and concentration

Improve organizational and planning skills.

29
 Improve performance in school or at work. Increase interest in
learn.

Improve balance, body image, posture, psychomotor skills,

coordination and temporal and spatial orientation.

Enhance development and maturity.

Stimulate creativity and artistic expression in general.

Improve and facilitate language learning.

As personal growth, it helps to expand awareness. It stimulates both the

body awareness like mental, emotional, and spiritual.

It is also indicated for:

Pregnancy and childbirth preparation. Helps the future mom experience her pregnancy.
and I give birth in fullness. To overcome fears, improve uterine dynamics and
facilitate muscle work, improve mother-child communication, etc.

Adopted children.

Children who have experienced difficult circumstances during pregnancy and childbirth.
or the first years of life.

Third age. Helps to be more dynamic, stimulates hearing and the system.
nervous, etc.

5.3 What does it consist of?

It consists of listening to music or sound through the electronic ear (complex

simulator of the human ear). The muscles of the middle ear are retrained,
lost frequencies are restored and the proper functioning of the
nervous system. In this way, we can regain the ability to listen and
provide energy to the brain and the body.

Listening is the open door to awareness.

5.4 Centers

Please wait. Therapy of the listen. Cinty Martinez Villar.

celattendere@[Link]( A Coruña )

Ester Viña Gundin, estervg@[Link]. (Lugo).

30
 Angel Centerlinfo@[Link].

To contact therapists who perform the Tomatis Technique in different

Points in Spain can be obtained through the Student Association of
Taketis: [Link].

31
 06
Method
VOJTA

6.1 Recipients

Although Vöjta therapy can be applied up to adulthood, it is

particularly suitable for children:

Infants, in whom movements have not yet been established

abnormal (substitutive patterns). These movements appear as
consequence of the infant's repeated attempt to contact the environment, of
to straighten up or move in a pathological manner.

Young school-age children or young people with psychomotor delays,

secondary motor disorders, peripheral paralysis, diseases
muscular or other ones in order to improve their maturation process and
growth.

6.2 What is it about?

It is an activating principle of the Central Nervous System, which consists of evoking

the normal patterns of posture and movement activated through the two
Locomotion patterns Reflect: reflective crawling (prone position) and rolling
reflection (supine and lateral position).

Reflex respiration (prone position)

32
 Reflexive turning (supine and lateral position)

The treatment focuses on positioning the child in different postures, stimulating

specific points and opposing resistance to the movement that is triggered.
This resistance facilitates the emergence of innate functions that develop in a
Throughout the first year of life, such as crawling, rolling over, and walking.

6.3 Advantages

Early diagnosis and treatment through Vojta therapy allows for the
the patient's alterations do not evolve into a definitive pathological situation,
therefore assuming a significant qualitative improvement in their quality of life.
Some of these improvements are:

Postural control or automatic maintenance of balance during the

movement.
The straightening of the body against gravity.
Phasic mobility or purposeful movements of grasping or passing of the
extremities.
Development of innate functions such as crawling, rolling over, walking and the
support and pressure functions.
More relaxed movements, decrease in stiffness, and improvements in
motor skills. More intelligible language and speech.
More complete defecation and urination thus helping with sphincter control.
Improvements in suction, swallowing, and chewing.

6.4 Differences with other methods

It works directly on the Central Nervous System.

The movement is active on the part of the patient.
The family can (and should) work with the child at home. This role they have
the parents or guardians in this therapy are crucial, since they will be the ones who
they should do the exercises with your little one up to a maximum of 4 times a
day. Not all families can do it, as it requires a great effort
for their part. They must learn the exercises well and understand that they are done with
the end of helping his son.

33
 There must be perfect coordination between the child's parents or guardians and the
therapist who will be available to resolve any questions that may arise
about therapy.
This participation by the parents calms their anxiety. Feeling
assets in the rehabilitation of your son, helps them make disappear the
"guilt" that they often feel because they sense that they are a key piece and
essential in therapy.

6.5 Contraindications

It is not indicated in the following cases:

Children with osteogenesis imperfecta

Children with serious metabolic problems
Patients with brain tumors
In outbreaks in patients with multiple sclerosis
Patients with asthma attacks in the outbreak.
Cases of fever.

6.6 Centers and addresses

Vöjta Association Spain: [Link] / e-mail:info@vojta.e

ANNEXES

One in a thousand

[Link]

When evoking pain, bits of joy are also attached.

When evoking pain

[Link]

34
 07
WALKER/BIPEDAL SUPPORT
NF-WALKER

7.1 What is it?

It is a medically recognized device in Germany that has passed the

technical inspection and complies with the current European regulations, is included in
the catalog of medical procedures.

The allocation of this device to a child with motor deficiencies requires an analysis.
specialized in the child's ability. There is a first contact that has as
purpose of presenting the product, understanding the child and becoming aware of the
personal situation of the child. During the appointment, the
possibilities and the objectives of using the walker with parents, doctors and
therapists.

The walker has shoes that act as stirrups supporting an 80-

90% of the child's weight (not 100%). In this way, the child is to some extent
deprived and has more chances of being able to take the step.

Some straps facilitate the reciprocal walk, without it being possible for both feet
advance at the same time (as one knee flexes, the other extends).

The child is aligned and secured by one strap at the pelvic level and another at the thoracic level.
they do not allow him to sit in any case, moreover it has other
head accessories, if they were necessary to control a possible pattern
extensor

7.2 Results

In many cases, it is effective as a walker, in others just as

bipedestator. There are certain contraindications such as: knee flexor, ankle and
hip of more than 20º, spina bifida.

35
A perfect walking pattern is not generated, but the child, after a while
of adaptation, is able to strengthen the posture, to use the hands that are
free and little by little they regulate the tone (the same happens with the head) and of
to move

7.3 Contacts

[Link]

In Spain, the contact person is Leandro González 629.096.006

ANNEXES

Children with reduced mobility can move independently.

using the NF-Walker

[Link]

36
 08
ULZIBAT FIBROCTOMY

People and children suffering from cerebral palsy live incapacitated by the
muscle spasms and the pain caused by their illness. But for some time now
For 20 years, the Russian surgeon Dr. Valeri Borisovich Ulzibat has been successfully applying
a technique, fibrotomy, that manages to eliminate pain to a certain extent and
recover part of the mobility for these people.

8.1 Background

Valeri Borisovich Ulzibat is the name of the surgical researcher and pioneer of the
technique called gradual fibrotomy by stages. It was born in 1946 within the
a family of military members and studies medicine at the university of
Kemerova. She works as an orthopedic traumatologist and a professor in traumatology and
orthopedics developing its activity in various universities and hospitals. In
In 1990, the Ministry of Health of the USSR admitted a whole series of
recommendations on the methodology for pain management.

In 1985, while trying to relieve the muscle pains that a patient was suffering from
close relative, began to conduct a series of investigations e
surgical interventions that result in a surgical technique that today
it is called gradual stepwise fibrotomy. For the practice of the
surgical interventions, design and patent a series of medical instruments
specifically that although they were initially made almost artisanally, today
Its manufacturing has a whole complex system.

In December 1996, he defends his doctoral thesis in medical sciences.

the excellent results of his methodology; in 1998 V. B. Ulzibat was
grants the title of emeritus researcher of the Russian Federation and in December of
1999 the title of professor.

The technique began to be applied to a whole series of patients with ailments.

muscular or myofascial and with excellent results in pathologies that

37
they involve Spasticity (cerebral palsy, diplegias, hemiparesis...) Starting from the
1992 and under the name of the Tula Clinical Rehabilitation Institute, a team of
surgeons, anesthetists, neurologist, and specialized nursing, have gone
developing and perfecting gradual fibrotomy to become what it is today
Patients with cerebral palsy from all over the world have moved from
so that they can be treated at the clinic. By the doctors of the institute they have
I have defended eight theses and more than 165 scientific articles have been published that
they warn the Russian medical community about fibrotomy. A whole series of
lectures and interventions at various medical conferences in different countries
from around the world, help to extend the knowledge of the technique to other countries.
Unfortunately, the professor passed away suddenly in 2003 and many of the
Extension plans are cut short. Their legacy is in the hands of the Institute.
of the Clinical Rehabilitation of Tula that he himself founded in 1992 and its
components are developing new concepts and various modifications of
the technique, which is applied to this day.

Although the technique has been refined and perfected in various aspects
for his pupils, the lack of this entrepreneurial character of Dr. Ulzibat, the
language problems and some other factors hinder, to a certain extent, the
expansion of gradual fibrotomy in stages outside the Russian Federation after its
death, although among patients with cerebral palsy and due to its frequent
associationism is quite well known.

8.2 What does it consist of?

Fibrotomy consists of making small incisions in fibrous areas of

the muscles that keep them permanently contracted. With this, they
They achieve two things: to regain mobility and to suppress pain. This technique
surgical procedure that takes only 15 minutes prevents spasms
muscular typical of cerebral palsy cause a compression on the
arteries that nourish the muscle, thus eliminating the pain, as the flow
sanguineous is restored.

Between a few and 20 cuts are made. In simple cases, it can be done in
outpatient regimen. In more complex cases, admission to a
hospital and the assistance of an anesthetist.

The gradual stage fibrotomy is a surgical technique that is practiced

generally, although not always, under general anesthesia with some scalpels
specially designed for this purpose called microfibrolotomo.

1. Basically consists of the percutaneous removal of those

muscle contractures that prevent or hinder proper functioning or

38
 appropriate angle of a joint. It also seeks the elimination of
myofascial pain syndrome.

2. Gradual fibrotomy can be considered as microsurgery with a

minimum trauma level in the absence of cuts on the skin, scars and
bleeding. Since no complete section or transposition is performed
muscles do not require to affect bone structures or tendon tissues
immobilization or plastering of the patient, contributing to the early
reincorporation of the patient to their activities.

3. It has a character of universality because regardless of the

Etiology offers high functionality by being able to intervene in various areas at the same time.
muscles or muscle groups considering their synergism or antagonism
increasing the effect of the intervention.

They allow for significant progress in other types of therapies by facilitating the
active or passive mobility of the patient.

8.3 Recipients

It is indicated for patients with muscle contractures and/or pain syndrome.

myofascial. This pathology is very evident in patients who suffer
{"espasticidad":"spasticity","parálisis cerebral":"cerebral palsy","hemiplejias":"hemiplegias","paraparesia":"paraplegia","displejias":"diplopia","hemiparesia":"hemiparesis"}

sequelae in accident victims with trauma, fibromyalgia, plantar fasciitis...

This method, in the case of cerebral palsy, is usually recommended to be performed at

from two years old, although each case is particular, especially in cases of
cerebral palsy, the prevailing criterion is always that of the surgeon.

8.4 Pathologies treatable with the Ulzibat method

In general, all those where muscle contractures or pain appear.

muscular and myofascial. The goal is to eliminate or reduce pain and increase
joint movement. In the case of cerebral palsy and similar conditions, the results
they facilitate the application of the rest of the therapies (physio, pool, postural education...)
with a good risk-benefit relationship, especially when compared to
much more aggressive techniques such as tenotomy. In cases of an affection
severe pain reduction and assistance in patient management (hygiene,
postural control, drooling...) turn the technique into the only truly effective aid.
effective. In the case of fibromyalgia, fasciitis, carpal tunnel, and other diseases
those who experience muscle pain or myofascial pain show remarkable improvements and
in many total cases.

39
8.5 Contacts

Clinical Rehabilitation Institute of Tula (Russia)

Hospital los Madroños (Madrid)). info@[Link]

ANNEXES

We improve the patient's quality of life, allowing them to perform

basic things, with less effort

[Link]
[Link]

Half the world for a step

Half the world

step/[Link]

40
 09
BOBATH

9.1 Background

Berta Busse was born in Berlin in 1907, initially studied at the school of
gymnastics and dance ―Anna Hermann‖, once her training is completed, remains
in this school as an instructor until the year 1933. During this period
they get married, which lasts approximately one year. In February 1933
his son named Peter is born. Karel Bobath was born in the same district of Berlin as
Berta, they both meet during adolescence. Karel Bobath ...
graduated as a Doctor from the University of Berlin in 1932 and subsequently in
Czechoslovakia graduates for the second time in Medicine in 1936. In the year 1939
migrate to London.

Later, and due to the Second World War, Berta also

she emigrates to London, where she reunites with Karel Bobath and gets married in
second marriage in 1941. Berta, in 1943 is called to attend to a famous
painter - Simon Ewes, with whom he begins to apply his different way of
manage spasticity, an approach that will continue to be developed not only
for the treatment of adults with hemiparesis, but also in children
with a sequel of Cerebral Palsy.

Together; Berta from the clinical aspect and Karel from the available neuroscience
At that time, they developed the Bobath Concept for the treatment of children.
and adults with neuromotor disorders. Both from their place of residence as
also traveling to different parts of the world, they taught and trained
different professionals in the Concept, who continued and continue today
in the day with the development of this - Living Concept.

The impact of his Concept was so great that it motivated many forms of
recognition throughout the entire world. Just as they developed their life together
Both professionally and personally, they decided to leave on January 20, 1991.

41
9.2 Concept

The Bobath approach is a specialized therapy applied to treat disorders.

of movement and posture resulting from central neurological injuries. It was
started in London in the 1940s by physiotherapist Berta Bobath and the
Dr. Karel Bobath, who studied normal development, what effect did they produce?
the injuries of the Central Nervous System (CNS), and how to help patients in
these situations. His hypothesis was based on the work of several neurophysiologists,
among them Sherrington2 and Magnus, who produced lesions in the CNS of
animals and then observed the resulting effects.

They studied the motor unit, the basis of motor function (a motor neuron and
the group of muscle fibers that it innervates.

The Bobath Concept is an important concept in therehabilitationof people

withbrain injuries [Link] owes its name to its creators,
thephysiotherapistBerta Bobathand her husband, theneurologistKarel Bobath.

9.3 What does it consist of?

It is based on the brain's ability to reorganize; which means that the

healthy parts of the brainthey learnunder certain circumstances they can compensate
the functions that were previously performed by the damaged regions of
brain. The prerequisite for this is, however, a support and
astimulusapplied to the patient by [Link] concept has
achieved good success in rehabilitation, particularly in the case of the
sick people who sufferparesison one side of the bodyhemiparesisafter a
stroke

The person affected by hemiparesis often tends to neglect their side.

paralytic, and therefore its limitations, to compensate with its less
affected. These movements carried out with only one side of the body, without
embargo, only helps the patient in a basic way, since the
the affected side does not have the ability to receive and work with the new one
information. Thebrainpor lo tanto no tiene la oportunidad de reestructurarse.
Even due to a the movementasymmetricalthere is a danger of
developspasmspainful in the affected area.

The main value of the Bobath Concept is, on the other hand, to support the affected side.
of the body as much as necessary to adapt its movements accordingly
according to the least affected side of the body. It is, definitely, a way of
balance the body in terms of functionality and mobility.

Another key aspect of the Bobath concept is to modify the patterns.

abnormalities that result from the injury itself and facilitate movement for

42
achieving it in the most functional way, always following the milestones obtained
in theneurodevelopment neurophysiologicalhuman.

The 'Bobath Therapy is a 'concept of life', not a method. It does not offer
strict treatment regimens that must be followed to the letter;
It provides elements to apply according to individual needs and responses; it is
an approach that solves problems involving treatment and management of
patients with movement dysfunction. It describes both the problems of
motor coordination in relation to normal postural reactions of
central mechanism of it, like the characteristics of motor development
Normal. It is observed what children do at different stages or milestones of
maturation and how they do it. Development is considered as a great
variety of movements and the sequences overlap, enriching each other
to others; it explains why babies engage in certain activities in
At a determined moment. Those that are mandatory are called 'primitive reflexes'.
(osteo-tendinous, etc.); on the other hand, those observed in young children, such as
like the Moro, the prension, etc., and that are not mandatory, they are called
―primary responses, primary motor patterns, temporary or primitive‖, and
the variability of the responses and their modification over time is taken into account
As the CNS matures, it remains until 4 months. If these patterns in
Primitive masses are maintained beyond 6 months, we talk about - patterns
primitive in appearance. The abnormal or pathological motor patterns are the
that are not observed at any stage of normal development. The concept of
Therapy of

Neurodevelopment (TND) is based on the recognition of the importance of two

factors: a) Interference of the normal maturation of the brain due to an injury that
leads to the delay or halt of some or all areas of development. b)
Presence of abnormal patterns of posture and movement, due to the release of the
abnormal postural reflex activity or an interruption of normal control of the
postural and movement reflexes. Its main objective is the control of tone.
postural, inhibiting the patterns of abnormal reflex activity by facilitating
most normal motor patterns (that are obtained
like automated responses to manipulations
specific, achieving a more functional control
cash), and preparing for a greater variety of
functional skills, which increase capacity
of children to move and function in the way
as normal as possible. The Bobath spouses
it was shown that the quality could be varied of
postures and movements, achieving more activities
fine and selective (such as vision, mechanisms
respiratory, nutrition and speech). This management of
TND applies in daily life and includes the family

43
in activities incorporated into daily tasks and transform them into
therapeutic: how to feed, dress, mobilize, position; adjustment of
furniture; etc. Parents are active participants in them, extending them
thus during the 24 hours of the day, from where the concept of functionality arises.

9.4 Centers

Aifis physiotherapy. Coruña. 981.174829

Madrid. Aleka Center. info@[Link]

ANNEXES

Bobath Foundation

[Link]
[Link]

44
 10
Therapy of
SOLDIER

10.1 Introduction

The early diagnosis of brain damage in

newborn babies make a difference for
that the little ones can develop a life
normal.

The technique called Katona neurorehabilitation,

allows for early diagnosis, if the
baby suffers from some disability such as
cerebral palsy, psychomotor problems,
hearing loss or attention disorders, language or
learning that is detected after the
three years.

10.2 What is it about?

The method consists of placing the child in certain positions and analyzing.
If you respond like a normal child. These positions are unique to beings.
humans, because other animals do not present them.

The positions consist of laying the child down and holding their hands so that they
a child can stand up straight and will directly see
the eyes of the mother or of whoever practices the technique.

Another position is to hold him by the thighs without any support, in the air and that
he/she can lift his/her back vertically.

45
Putting him on all fours is the last position, if the child moves as if crawling and
being able to perform the other poses means that it is okay. If on the contrary, it is not.
shows the expected movements it is likely to suffer some brain damage,
what will prevent you from developing a normal life.

The most effective way to prevent the little one from worsening his injury is to take advantage of
when the plasticity of the brain is high, this happens when the child is newborn
born. In such a way that the nervous system is taught to learn the
correct behaviors before the injury worsens over time and
when the treatment is already too late.

At first, therapy can be very tough, but over time it

will be carried out automatically.

The exercises should be repeated five times a day and last for 45
minutes, leaving four to five hours to rest. It consists of forcing
a los bebés a que realicen posturas que deberían de hacer de forma natural.

10.3 Results

Recovery is sometimes not total, but partial. Some members like the
arms may not be able to move 100% naturally, but they do have a
high degree of action.

The results affirm that after 24 months with neurorehabilitation of

Katona, 159 out of 188 babies showed significant progress and will be able to
develop a normal life.

The family's participation in therapy is very important. Furthermore, the

small ones are studied and monitored all the time; prior to the
implementation of neurorehabilitation, a series of tests are applied to them
doctors who evaluate brain damage.

10.4 Centers

Dr. Roberto Jorge Ortega Ávila, Katona neurotherapist, recognized for the
Professor Ferenc Katona as qualified to teach and apply the method in
our country. [Link]

46
ANNEXES

Katona therapy, an alternative for brain damage

[Link]

47
 11
Hippotherapy

11.1 Background
This therapy is used systematically.
since the 50s - 60s, although its advantages are
They have been known since ancient times. The
ancient Greeks, among them Hippocrates,
they recommended the practice of horseback riding for
improving the mood of people with
incurable diseases and later, in the
17th century, some doctors recommended
to ride a horse daily to combat gout.

From the Greek "Hippos" (horse), hippotherapy is a therapeutic alternative that

take advantage of the horse's movements to treat different types of ailments.
It is a treatment that uses the multidimensional movement of the horse. It is a
special physical training, which can be used therapeutically as
medical treatment for patients with movement dysfunctions and others
diseases.

Historically, the therapeutic benefits of horses were already recognized.

hacia el año 460 a.c. Hipócrates, ya hablaba del saludable ritmo del caballo y a
Throughout history, we can find many references to the benefits.
physical and emotional aspects of riding since the year 1600.

Classical hippotherapy in Europe reflects the widely adopted German model since
1.960, where fundamentally, is the movement of the horse and the response of
patient, what constitutes the treatment. By its nature, horseback riding
therapeutic, influences the person as a whole and the effect on the entire body,
it can be deep. Therefore, a natural progression was developing by
everyone, in the application of the horse medically.

48
11.2 What does it consist of?

It is therapeutic riding; it is a rehabilitative activity, recognized throughout the

world.
It consists of taking advantage of the three-dimensional movements of the horse to
stimulate the muscles and joints. In addition, the contact with the horse,
it contributes therapeutic facets at cognitive, communicative, and
personality.

An occupational therapy with a suitable horse requires a consultation.

to establish the program, specifically direct the sessions to the areas of
motor planning and sensory integration of the patient. The horse,
selects for patients carefully based on their movements and their
behavior. The patient, based on the therapist's instructions,
You can adopt different positions on the horse in different sessions.

11.3 Operation of hippotherapy

Hippotherapy involves individuals affected by diseases or

chronic disorders, horseback riding. This causes the patient to receive a
physical stimulation throughout your body, causing areas that have never been
physically stimulated, receive stimuli, which may cause effects
incredible.

In order to ride the horse, any patient must follow certain steps.
the first sessions and depending on the type of condition, will begin
making some initial contacts with the horse from below. Get to know a
a little to the animal and establish a certain relationship of contact. This usually happens during
the first or the first two sessions.

The patient should be explained what their treatment consists of, what it is that...
you have to do on the horse and what risks you may run. In the
in the case of children, these explanations must be understandable to them. Before
To ride for the first time, the patient must undergo an assessment by the
health personnel of the center, who will assess the degree of impairment based on
his examination and the medical information that the patient may or must provide
and will establish:

whether the patient can ride a horse or not

what kind of side effects it could have and therefore, establish a plan
prevention
establish a work plan (which horse the patient should ride and the
work program that must be carried out on it.

49
Before each session, the patient must warm up in the
gym, so that your muscles and joints are ready to
The exercise you will have on the horse can last between 15 and 20 minutes.
Then, the patient will move on to the horse, where they will carry out the planned program.
always assisted by the riding monkey and the assistants who will be present
pending on him during the ride. The working time on the horse is variable,
but initially, it usually lasts between 15 and 30 minutes. Once the work is done on
the horse, the patient will return to the gym, where for about 20
minutes, you must perform a relaxation process before leaving the center. Great
some of the patients receiving treatment with horses must travel
in a wheelchair, as they suffer from mobility problems that prevent them
walking. This is not a problem for accessing the horse, since in these
cases, such as those where crutches, walkers, or other types of
support elements, an access ramp is used to elevate the patient to
an appropriate height, so that I can ride the horse comfortably, with the
help from an assistant.

El caballo siempre es conducido por un auxiliar; solamente los pacientes que

they have considerable practice and demonstrate that they have acquired a certain level
en la equitación, se les permite montar en ausencia de un auxiliar, aunque éste,
he is a few meters away observing.

11.4 Benefits of the horse

The horseback ride provides a sensory entrance through movement.

variable, rhythmic and repetitive. The response of the resulting movement in the
the patient is similar to the human pelvic movements when walking.

The variability of the horse's gait allows for therapeutic gradation.

degree of sensations that the patient receives. They respond enthusiastically
a esta experiencia de aprendizaje divertida, en un medio natural. Físicamente, la
hippotherapy can improve balance and mobility, although it can also
positively affect communication and behavior functions
for patients of all ages.

The horse is a great equalizer that allows disabled people to

compete with their healthy peers. It is known that the physical act of riding
horse, breaks the isolation of the sick and puts him on equal footing
conditions with the undiminished rider.

This is why equestrian activity helps overcome fear, improving the

trust and the ability to concentrate and loses tensions and
physical and emotional inhibitions.

50
The first research studies to demonstrate the therapeutic value of horseback riding.
they notice in 1875. The opinion of various psychiatrists is that the horse, for children
who live in wheelchairs, allows them to look, for once in their lives, at
above their peers, which greatly stimulates their self-esteem.

11.5 Hippotherapy Centers

This therapy is carried out in numerous centers both at the community level.
Galician Autonomous as well as National.

11.6 HORSE THERAPY SIMULATOR

It is a project called 'Development of an advanced platform

of hippotherapy and the study of its therapeutic benefit in children with paralysis
"cerebral" is a research work carried out jointly by
researchers from the Tecnodiscap group (University of Zaragoza) and AIDIMO
(Association for Research in Motor Disability). This project is
funded by the Department of Science, Technology and University of
Aragon Government aims to study the therapeutic benefits of
a hippotherapy emulator for children with cerebral palsy.

The Tecnodiscap group (technology for people with disabilities) is a group

multidisciplinary composed mostly of engineers, although it includes
physiotherapists and occupational therapists, among other professionals. AIDIMO is
a non-profit organization made up mostly of physiotherapists,
some of whom are currently dedicated to research resulting from
collaboration agreement signed with Entities such as the University of
Zaragoza.

51
In this project, each child is classified according to their level before starting.
motor development according to a scale called GMFCS, which distinguishes 5
levels. Each child receives 10 physiotherapy sessions for free about the
emulator that reproduces the movements of the horse, at a rate of one per week.
The study is a randomized clinical trial involving children
participants are divided into two groups when determining what type of
treatment received during the 10 sessions: intervention group (emulator +
physical therapy) and control group (physical therapy). Every day a physiotherapist from
AIDIMO attached to this research project in addition to giving it its
The corresponding physiotherapy treatment is responsible for performing various
measurements before and after to carry out individual tracking. These
measurements focus on:

Record the muscular activity of the adductors with an electromyograph.

Measure the separation of both legs with the hip and knee flexed with
an electronic inclinometer.

Measure the hip abduction in extension with a goniometer.

These measurements will allow us to assess at the end of the 10 treatment sessions whether
there have been changes regarding the muscle relaxation of the adductors and the
degree of separation of the hips.

In addition to the data provided by all these measurements, each child before
being included in the project has been assessed with two scales (GMFM and SAS) with
those that are reassessed after the 10 sessions and 3 months later
to have concluded in order to objectively determine whether there has been
changes in their postural control and motor development.

ANNEXES

It is reported that some equine therapy centers operate without the necessary licenses.
rigor

[Link]

Elegancia hasta para ayudar

[Link]
A3CBD74B-CDC3-25A6-E5AA0FA70AD04D4E

52
Horses that heal in Alda

[Link]
[Link]

The 'asnoterapia' stimulates more than 220 disabled people from Córdoba

[Link]
stimulates-disabled-people-from-Cordoba_201009011324.html

The cerebral palsy center in Sada begins therapy with

pets

[Link]

A boy with paralysis learns to walk thanks to a little duckling.

A child with paralysis manages to walk thanks to

duckling_2010021200052.html

They create an equine simulator with heat as a substitute for equine therapy.
children with autism, cerebral palsy, and spina bifida

[Link]

Effective therapy on a virtual horse

[Link]
[Link]

53
 12
Dolphin Therapy

12.1 Background

The pioneers of what is known as 'Dolphin Therapy' were Horace Dobbs.

in Scotland and Dr. David Nathason in Florida. In Spain, the first in
to use dolphins in the treatment of patients with Down syndrome,
Depressions and autism were the members of the Dolphin Foundation.
Mediterranean. His work at the dolphinarium on the Costa Brava in Girona
They achieved truly spectacular results. A novel therapy is emerging.
step in the treatment of autism, psychomotor delay, cerebral palsy, etc.

12.2 What does it consist of?

It is the combination of Biosonics and Craniosacral Therapy that use the

acoustic emissions of dolphins in favor of unblocking and rebalancing for
certain cases where other more conventional treatments do not work
appropriate.

The skin, as a support for the receptors of nerve endings, receives the
waves emitted by dolphins, and through the transmitting channels they reach the ear and the
cerebro, realizando una estimulación selectiva, pues dentro de las emisiones
acoustics of dolphins we find sounds as audible to humans as
infrasound. All this without overlooking the powerful importance of the aquatic environment.
and the particular weightlessness that it offers us.

We could define these therapies as aimed at awakening certain areas.

of the brain and to rebalance the cerebral hemispheres reaching states of
mayor coherencia y sincronía. Esto ha sido comprobado al realizar pruebas
electroencephalograms and other computer-assisted measurements.

54
12.3 THE CYBERDOLPHIN

In cases where therapy cannot be afforded, there are other alternatives.

like the "Cyberdolphin," which is virtual dolphin therapy.

In this modality, the patient lies down on a water mattress and begins
listening to dolphin sounds through speakers, while through their
virtual reality glasses see themselves surrounded by dolphins. The patients who have been
those subjected to this virtual treatment claim to end up tired as if
they would really have been swimming with the dolphins.

12.4 DOG ASSISTED THERAPY

These therapies aim to encourage the participation of dogs in the

therapeutic interventions to promote human health and well-being,
taking advantage of the intrinsic values of the animal, such as its loyalty or its
inability to judge. In this way, they manage to facilitate the work of the faculty of
educator or therapist in education, rehabilitation, recovery,
treatment or improvement of the quality of life for people with needs
specials.

ANNEXES

They seek help to assist people with disabilities using pets as therapy.

[Link]

Dolphin therapy, therapeutic technique

[Link]
127/13826-the-dolphin-therapy-therapeutic-technique

55
 13
Method
PETO - Conductive Education

13.1 Background

Its origins date back to 1945 in Budapest. Its creator and promoter, Àndras
Peto launched a care program for disabled children, which
until that moment, it was not considered that they were susceptible to receiving
teaching. This is how the first specific motor therapy center for children was born.
in educational system. In 1950, the first Education Institute was built.
Conductive in Budapest and in 1965 the establishment is officially approved
specific to "conductor", the professional who provides the treatment of
integrated rehabilitation in a school learning. Currently, this training
It has a duration of 4 years and is considered a bachelor's degree university cycle.
medium.

In 1970, the Institute opens its doors to the treatment of children from
other countries.

13.2 What is it?

I grant education a fundamental role in the rehabilitation of the child.

Understand that altered or undeveloped functions, while not always...
"Recover them" is possible, thanks to neural plasticity, they can be restructured.
and reorganizing itself, and this is achieved through learning, that is, the system
nervous has the ability to readapt and compensate for altered functions, and for
Hello, learning programs must be established in which there is a
purpose and at the same time integrate into the patient's daily routine and activities.

What started as a method of neurorehabilitation applicable to children with

perinatal injuries, soon applied to other brain injuries originating from

56
adult life. Since the budgets for brain reorganization are similar
in these cases. Today we know that neuronal plasticity does not end in the period
perinatal, and that the adult brain has the capacity for functional reorganization.

Thethe rehabilitative approach that this method involved differs from others not only
not in the form but in the very concept of rehabilitation. While in others
methods, importance is given to the specific motor exercise in a passive way and
disaggregated, the Petö method proposes the global stimulation of functions in
order to achieve practical functional objectives, with the active participation of
own patient in their recovery process.

13.3 Operation

A first consultation is held, during which information related to the

medical history of the child or adult. Along with the initial examination performed, it was
assign the most suitable treatment group and proceed with the planning of the
rehabilitation program.

When the child begins rehabilitation treatment, an evaluation is conducted.

of the motor, functional, cognitive, affective, and behavioral state by the team
of Drivers-rehabilitators.

At the end of the treatment period, the team of rehabilitation drivers

prepare a report that gathers the most relevant aspects of the process
rehabilitator followed by the child. An interview is conducted with the parents and/or
relatives in order to convey this process and the future guidelines to follow.
Likewise, and as a complement to our rehabilitation work, it is given to the
parents or relatives the instructions that we consider most appropriate with
regarding orthopedic follow-up, speech therapy care, trying to do so
establish collaboration with the centers and specialists that care for the child in
his/her usual place of residence.

13.4 Recipients

Cerebral palsy.

Cerebrovascular accidents

Consequences of brain injuries

Traumatic brain injury

Spinal injuries: Spina Bifida and paraplegia.

57
13.5 Pillars of conductive education

To achieve its objectives, the Conductive Education method has

a series of essential and in some cases distinctive elements of this
working method:

The group

It is one of the essential elements of the method, which makes it different from
other neurorehabilitation systems. Group work, both in children as well as
in adults, it provides an ideal framework to enhance motivation, interrelation and
the own acceptance of the situation. The fact that one works in a group does not
means that all patients do the same programs: the tasks are
they adapt to the situation and to the individual needs of each person.
There are differences in how the exercises are performed, the
required time, the degree of help provided, the level of skill achieved
etc.

The driver-rehabilitator

In Conductive Education, the professional who works with the patients in the
group is called "conductor". Petö conceived this profession as specific,
hence it requires a training period of four years, during which
they integrate knowledge of anatomy, physiology, neurology, orthopedics,
pedagogy, psychology, etc. This specific training is backed by the
Hungarian Ministry of Education, and it is what our drivers have received.
Spaniards.

The rhythmic intention

András Petö argues that the use of language (verbal or non-verbal) with a certain rhythm and
cadence facilitates action (intention), achieving an internalization of
movement.

In Conductive Education, all movement is directed towards a purpose and

involves a certain motor task. At the level of instinctual behavior, with its
elementary structures, these motor tasks are dictated by programs
innate; during life, at the level of complex conscious actions, these
tasks are dictated by intentions that are formed with participation
"narrowing of language, regulating human behavior" (Luria, 1961).

58
The facilitations

Facilitation is a pedagogical element that implies a way of guiding.

through methods and techniques to achieve a goal. The facilitations are
all those aids that are offered to the individual so that they can achieve their
objetivos: instrucciones verbales, ayudas manuales, ayudas instrumentales,
techniques, etc. The driver-rehabilitator himself assesses the possibilities of
recovery from a specific dysfunction, and throughout the entire process
therapeutic proposals are being made for the appropriate facilitations, being the desirable
that, over time, the patient needs fewer facilitations (assistance) to
achieve their objectives. Depending on the different types of dysfunction, they will be
different facilitations are necessary and these will be different for each individual.

The programs

The Conductive Education system has its own motor tasks,

cognitive, etc,... integrated into programs that are being structured and
occurring throughout the rehabilitation process. These programs are designed to
according to the needs of each patient and are developed in the group. They
follow a certain routine in terms of the type of tasks in various positions, in
lying down, in a sitting position, standing, walking...

13.6 Centers

In Budapest is the Peto method institute, but in Spain there are several.
centers that carry out this method, such as the Fay Institute in
Madrid and also since the year 2000, ASPACE Navarra started the program of
Neurorehabilitation based on the Peto method.

ANNEXES

The assistance for 32 children undergoing rehabilitation has been cut.

[Link]
van
[Link]?not=2010110601135908&idnot=2010110601135908&day=20
101106&section=navarra&section2=society&channel=10

59
 14
Method
PADOVAN

The Padovan method is a therapy primarily used by speech therapists that

they seek to solve language problems in children.

14.1 Background

Beatriz Padovan is an educator and speech therapist who, after learning the principles
Steiner, de Fay and their followers Doman and Delacato, among others, focused on
the world of neurology, studying and researching everything related to it
neurological and functional development of the child and its implications in all
fields, mainly in the field of language development.

In this way, he came to the conclusion on which the method and everything is based.
the philosophy that comes from the great masters like Temple Fay: just like the
the rest of the functions of the human being, language cannot develop
adequately if there has not been good and proper organization beforehand
neurological.

The neurological organization is a natural process that occurs within the

normal evolution of the child. It consists of the different phases that the child goes through
baby, from birth until it has completed and acquired the functions
basic human beings. These phases have a natural order and must be maintained
within this sequence, that is to say, it is necessary to mature each of the
stages to be able to advance to the next one without encountering problems.

Babies roll to both sides, crawl, creep, stand up,

they walk and begin to use language, finally at the age of six,

60
having been lateralized as right-handed or left-handed and being perfectly prepared
to read and write without difficulty.

14.2 What does it consist of?

The Padovan method works on traditional exercises that come from

Doman method of Neurofunctional Reorganization, these help the child in their
set, improving many of the problems faced by children with
language difficulties, as these difficulties are often associated with
others and to cases of autism, brain injury, trisomy, attention deficit with or without
hyperactivity, dyslexia, etc.

These exercises aim to imitate nature in the evolution of development.

child, so that movements the baby makes naturally are worked on,
continuously and intensively carrying them out to overcome possible gaps or
mismatches arose during development.

They are not the only activities worked on in the method; they are the foundation for the
other specific exercises for each child according to their needs,
neurological reorganization of all children regardless of
problems that arise, in addition to being worked on. Beatriz Padovan, instead of
work the word and the articulation opts to begin working on the functions
known as prelinguistic, that is: breathing, sucking,
chewing and swallowing.

14.3 Main innovations brought by the method

Children go through all stages of development in their reorganization.
neurological, unlike the Doman method, where each child is evaluated to
determine the stage of development in which it is and work from this
stadium onwards.

Vary the intensity and frequency of the sessions, as in the Padovan method.
these are not daily, but are done twice a week for 45
minutes, less in the most severe cases. The intensity with which it is repeated
each exercise depends on the possibilities and needs of each patient.
While in the Doman program it is the parents who carry out the
activities in their homes, in the

Padovan, these are carried out by therapists, with the parents present to
to transmit calmness to children and to help in certain cases. During
the performance of the exercises, poems and songs are recited with what is

61
it also works on the rhythm and synchronization of movements alongside hearing and
the imagination. This also brings a playful element to the treatment.

The Padovan method is a very comprehensive therapy that not only solves and improves
difficulties in language, but as has already been said, it affects maturity of
all the skills and abilities of the child reorganizing their nervous system from
global form.

14.4 Centers

INPA in Madrid, information:[Link]

62
 15
Therapy
CRANIOSACRAL

15.1 Background
Dr. Sutherland (1873-1954) discovered, in the early 1900s, that the
head bones had some mobility, based on the idea that the
the bones of the skull are not firmly fused, but there are
micromovement or flexibility through the bone sutures where they separate
the bones. For the next 50 years, he dedicated his life and clinical work to
demonstrate and find the implications that this mobility had for the body
human.

15.2 What is it?

Craniosacral Therapy is based on the principle that there is a subtle pulsation.

that emerges in the tissues and fluids of the core of the body. This pulsation is a
expression of the individual's basic life force. The nature of this
pulsation is rhythmic; it has a phase of expansion and another of relaxation; and it
expressed in all fluids, bones, tissues, membranes, and inside and around
from the central nervous system, although it is also possible to feel it throughout the rest
of the body. This pulse is called 'Primary Respiratory Drive', and
plays a fundamental role in maintaining order and integration
body/mind.

15.3 How does it work?

Our body, as a living organism, is immersed in a continuous movement.

of all and each of its structures. This mobility represents being life in

63
herself, who is often disturbed by agents, both internal and
externals, which represent the setbacks that the course of life brings us
These alter the body rhythms and the mobility of our
structures. The cessation of this movement will result in illness,
pain and suffering

With the technique of Craniosacral Therapy, the therapist, properly

trained, will drive, through small pressures applied on
different structures, the recovery of that lost movement, as
consequence of both physical and psychological trauma.

15.4 Beneficios

The effects occur at a deep level. The person on the stretcher can
to feel a great relaxation. After a session, the body may need
rest or, on the contrary, feel a great energy. The work begins in the
session, but based on the natural mechanisms of self-correction,
continues far beyond leaving the consultation. Each session is built
About the previous one, in this way each time deeper physical layers are reached.

As an integrative therapy, the treatment can help with almost any condition,
increasing vitality and allowing the body to use its processes of
self-healing.

Carried out with specialized physiotherapists.

15.5 Contact

[Link]

64
 16
Method
FOLTRA

16.1 Background

A method based on the comprehensive treatment of the patient with the application of
factors of growth to functions beyond the usual ones as a key piece,
turn the center into a pioneering project in Europe and an international reference,
to which patients from all over the world arrive.

Foltra was born in 2005 as a Foundation aiming to alleviate part of the

shortcomings of the public system in the field of acquired brain injury. Since
then it proposes a new perspective in treatment based on a vision
integral of the necessary aspects for healing: diagnosis, treatment,
rehabilitation and reintegration into everyday life.

From a medical standpoint, the key to treatment is the application of

growth factors that facilitate the release of stem cells and their
transformation to neurons. This is an innovative approach that still does not
It is carried out in the public health system. Furthermore, Dr. Devesa himself will be the
in charge of directing the clinical trial that will take place before the end of the year in the
National Paraplegic Center of Toledo.

16.2 Objectives

Carry out a specific rehabilitation treatment for each case, medical,

physiotherapeutic, psychological, and speech therapy, until achieving the maximum possible in
the recovery of the patient with acquired neurological damage, central or
peripheral and its reintegration into society, without the treatment time and
daily dedication to this or individual economic availability is a
limiting or conditioning factor.

65
Devesa: 'The growth hormone opens a pathway in repair'
cerebral

[Link]
hope/[Link]

In the CRE in September 2010, a presentation day took place

of the first clinical trial with growth hormone in injured patients
medullary. This information regarding it is available at:

[Link]
ion/m_audiovisual/devesa/[Link]

67
 17
STIMULATION ROOMS
MULTISENSORIAL

17.1 What is a multisensory stimulation classroom?

The concept of Snoezelen Room originated in the Netherlands as an initiative to stimulate

to people with disabilities, especially children.

The multisensory stimulation classrooms or 'snoezelen environments' are spaces

where people who have certain sensory doors closed reinforce
the expression of sensations, feelings or desires. At the same time, they improve their
self-control and relaxation. All of this in a space of
multisensory experimentation, that is to say, one in which stimuli are
they perceive through a combination of senses: touch, hearing, sight, smell,
vestibular, proprioceptive, etc. These spaces aim to broaden the experience to
all the senses.

The multisensory experience is achieved by creating specially designed spaces.

prepared and equipped with multiple sensory elements that open the door to
the different senses: visual, auditory, tactile, olfactory, gustatory
and mobility. Elements distributed in an environment where relaxing music and
the dim light creates an atmosphere of relaxation, safety, and protection.

17.2 Objective

"Snoezelen" is a contraction of two words that mean "to immerse oneself" and
"to dream" and even today they name spaces where we invite to let loose to
the imagination to capture the environment.

The objective of multisensory stimulation spaces or Snoezelen Rooms is

improve the physical and emotional well-being of the person with a disability, in this
case of the person with Cerebral Palsy, as well as their relationship with the environment.

68
From the feeling of calm and security that the environment provides,
we promote the relaxation of the person and improve their muscle tone
postural.

Relaxation with the environment is achieved by providing information.

coming from various sensory channels.

In this way, we teach the person to integrate different stimuli with the.
to enrich their sensory experiences and expand their knowledge of
world.

With all this, we open the door for the person with disabilities to incorporate and
organize the received information, have an awareness of yourself and your body,
make decisions, gain autonomy and independence, and express your
needs and feelings. Always respecting the rhythm and motivation of
each person.

17.3 What does it consist of?

During the work carried out in these spaces, two relationships are created:

Therapist–person
Person–environment

In the case of contact with the therapist, when generating an individualized relationship,
a mutual climate of trust is created. If we reinforce this climate, the whole team
educational, including his family, participates in the new sensations of the person
and get to know more about their reactions in daily life.

In relation to the environment, the person 'plays' in this space from their own
level and, based on its sensory dominance, we generate a motor reaction.

17.4 Sensory advantages for people with cerebral palsy

In the case of people with cerebral palsy, stimulation classrooms

multisensory offer the possibility of treating and rehabilitating each individual
child from a holistic perspective.

In most cases, we encounter people with

pluridisability that, thanks to the "snoezelen" environments, open the doors of
his five senses.

Thus, through these spaces, people with cerebral palsy relax their
muscle tone, better understand their body, improve their mobility and posture.
All this through contact with different elements of the classroom such as the
mattresses or through therapeutic and rehabilitation exercises.

69
Touching, grabbing, holding is a great challenge for some people with paralysis.
cerebral. Therefore, when using balls or surfaces of different sizes and
textures we get the child to be aware of their hands, learn to
to hold objects, to pick them up or to drop them voluntarily.

Additionally, the person improves their visual effectiveness, visual control, and posture.
visual organs (some children have strabismus, for example). At the same
time, we promote the capacity for muscular imitation and response. The
bubble columns, mirrors, projectors, lighting systems
especially will help the person with cerebral palsy open their eyes to the world.

On the other hand, the possibilities that the sense of hearing offers are infinite.
through relaxing music, sounds of nature, different rhythms and levels,
we managed for the person to not only relax, but also to be motivated and promote their
listening ability.

In the classroom, we can also create a space for the person to know the
smells its sensations. We apply massage oils to the child's skin that
will feel the stimulation on their skin and in the brain

Some children with cerebral palsy have difficulties chewing and swallowing.
We enhance the child's taste experience by using different flavors and
textures within the classroom. The little one will not only show his preferences but
which will expand its capacity for swallowing and chewing.

17.5 Other utilities

The multisensory stimulation classroom, in addition to generating new sensations and

experiences in the child prepare him to relate effectively with his
environment.

Therefore, multisensory spaces combine two aspects of the

person: the relationship with oneself and the relationship with the environment. With all of that,
we will enhance the child's physical, emotional, and social well-being.

In addition, classrooms provide the opportunity to generate various utilities: educational,

rehabilitator and socializer. The educator or therapist accompanies the child in
learning tasks, generating a climate of mutual trust through
a comprehensive and harmonious system. On the other hand, the physiotherapist or rehabilitation specialist
enhances the 'atrophied' physical abilities. Additionally, the professional guides
to the little one towards socialization and integration into their environment, through the
generation of responses, relaxation or active communication.

The entire learning process of the child is supported by a prior study of their
needs and motivations in such a way that we create a program
individualized. The child's responses and progress, in turn, give us clues
for future interventions. Therefore, we teach and learn at the same
time.

70
17.6 The elements of the room

Mats, poufs, and foam sofas: Located on the floor or covered

the walls stimulate the sense of touch and create an atmosphere of
comfort and protection.
Microballoon puff: Covered with the same material as the mats and
polystyrene ball filling helps children adopt a posture
determined.
Touch panels: Made with materials of different textures and colors,
They stimulate the sense of touch and sight.
Ball pool: That caress the body, generate relaxation and encourage to
the little game, choose, move effortlessly.
Vestibulator: Allows oscillations in all directions and turns. Thanks to
with their accessories, we can vary the degree of difficulty.
Mirror podium: A set of shatterproof mirrors in front of which
we place the child in different positions, we bring them closer or move them away so that
touch your image and become aware of your gestures, your postures and, in
definitive, your body.
Bubble columns: Acrylic tube through which bubbles ascend
different colors while vibrating, stimulating the sense of sight, the
touch and hearing.
Optical fiber bundle: A bundle of 100 glass fibers to which a source is connected.
luminous, which generates points of light that change color. Such variations
They generate a relaxing effect on those who look at them.
Bright heart and ultraviolet light: They have tubes as accessories.
different colors that shine when placed under light. We stimulate this
mode, the sense of sight.
Musical water mattress: It features a heater and speakers in such a way that
the sound transmitted through water produces a relaxing vibration with the help
of the heat.
Color ladder: Ladder with steps of light and colors that illuminate.
while there is intensity of voice and low when such intensity is turned off. Another
possibility is that the colors rise while there is a loud voice and when there is voice
weak, the colors fade little by little.
Light and sound panel: A screen that responds to any noise by changing color
and a bright aspect. We can use it with ambient music or talking through
from the micro.
Bola reflectante:Bola de espejos con un foco en el interior que hacen que multitud
colorful lights spin slowly around the room.
Image projector: Several rotating discs generate different images that
they stimulate the child visually.
Rainbow of aromas: A system that relates aromas to colors.

71
These rooms are held by associations such as Amencer - Aspace (Pontevedra) or
Aspace Coruña.

ANNEXES

Sensorial disco in a center for disabled people in Majadahonda

[Link]
[Link]

10 capons are auctioned to create a garden for people with paralysis

cerebral

[Link]

72
 18
ELECTRICAL STIMULATION
SUBTHRESHOLD THERAPY,
THRESHOLD AND THERAPY OF
OXYGENATION
HYPERBARIC

Therapeutic electrical stimulation (subthreshold), also called stimulation

neuromuscular electric stimulation (NMES), pulses electricity to the
motor nerves to stimulate contraction in muscle groups
chosen. Many studies have shown that NES seems to increase the
range of motion and muscular strength.
Electrical stimulation with threshold, which involves the application of stimulation
electric at an intensity too low to stimulate contraction
muscular, it is a controversial therapy. Studies have not been able to
demonstrate its effectiveness or any significant improvement with its use.
Hyperbaric oxygen therapy. Some children have cerebral palsy.
as a result of brain damage due to lack of oxygen. Those who
they propose hyperbaric oxygen therapy, they believe that the tissues
Cerebral areas around the damaged area can "wake up" by forcing high levels.
oxygen concentrations in the body under more pressure than the
Atmospheric. Hyperbaric Oxygenation (HBO) is a treatment method
from orthodox medicine, which consists of making the patient breathe oxygen
at 100% under pressure, between 1.5 to 3 absolute atmospheres (ATA). What
equivalent to the pressure experienced in water at a depth of between 5
and 20 meters. Oxygen is supplied in handling equipment.
specialized, known as hyperbaric chambers.

73
A recent study compared a group of children who did not receive treatment
hyperbaric with a group that received 40 treatments in 8 weeks. In each
measure of function (gross motor, cognitive, communication and memory) to
end of 2 months of treatment and then 3 more months of follow-up, both
groups had identical results. There is no added benefit with the therapy
of hyperbaric oxygenation.

ANNEXES

Electrical stimulation could restore voice to the mute.

Electrical stimulation could restore voice to

the-mutes_a5900.html

74
 19
Dorsal Rhizotomy
SELECTIVE

19.1 What does it consist of?

It is a surgical intervention that is performed on the roots.

posterior of the spinal nerves that run in the cauda equina, in the
lowest part of the spinal canal.

Through intraoperative electromyographic monitoring performed by a physician

neurophysiology specialist, the nerve roots are determined
that are part of "abnormal circuits" that produce and maintain the
spasticity.

The identification of these roots is carried out through individual stimulation of

each of the little roots that form the posterior roots of the segments
lumbosacral intended for the lower limbs. The "normal" clinical response
to the stimulation of a posterior root (sensory), it is a muscle contraction
at the same level as the stimulated. An 'abnormal' clinical response is one that
which results in a diffusion of the stimulus to other levels of the stimulated.

75
This diffusion of the stimulus and the persistence of muscle contraction, added to
The "incremental" electromyographic pattern shows that the stimulated root forms
part of an 'excessively facilitated circuit' by it, as well as the others
roots with "abnormal" responses are selectively sectioned under
microsurgery interrupting the abnormal circuits causing the
spasticity.

The roots that show 'normal' responses are not interrupted and, for
Therefore, there is no possibility of sensory alterations occurring.
The previous motor roots are also not interrupted, which prevents any
possibility of postoperative muscle paralysis. The basis of Rhizotomy
Selective dorsal refers to the fact that, under normal conditions, muscle tone
It results from a balance between the inhibitory or 'braking' action that affects it.
muscle tone exerts the pyramidal life, and the excitatory or 'facilitatory' action
transmitted by the posterior roots of the spinal nerves from the
muscles to the spinal cord.

The pyramidal lesion, which exists in patients with brain injuries or

medullary, like the ones mentioned, breaks that balance, which is restored
through Selective Dorsal Rhizotomy, by selectively interrupting the action
from the posterior roots of the spinal nerves.

19.2 Who benefits from the RDS?

An important group of patients who benefit from dorsal rhizotomy

selective, is made up of those who present a spastic form of
cerebral palsy. It is indicated in cases where the
spasticity prevents them from maintaining an upright posture (walking posture of
scissors with clubfoot.

19.3 Expected results.

In patients who walk, although in an abnormal way, it is possible to improve.

the appearance, performance, and effectiveness of their gait; as spasticity decreases the
the patient can stand up and walk more straight; also, there is an increase in the
amplitude of hip and knee movements achieving that the steps are
longer and the march faster.

In patients who walk abnormally and with the help of aids

(walking sticks, crutches, etc.), it is possible to improve the quality of their walking and
reduce the dependence they have on those elements.

76
In those who crawl or move by dragging themselves on their chest and abdomen and
that remain standing with help even without advancing or walking, is obtained
a better maintenance of the standing position, opening up the possibility,
neurorehabilitation through achieving assisted ambulation with the help
of sticks or crutches, It is important to note that to achieve goals the
patients must undergo intensive work before the operation
neurorehabilitation, with the aim of achieving the best possible results,
it is not expected that a patient without prior neurorehabilitation preparation
I can obtain results.

19.4 Who is the ideal candidate for rhizotomy?

It is between 4 and 6 years old

He has pure spasticity without other types of muscle tone problems.

(dystonias) nor disturbances in balance (ataxias).

Have undergone neurorehabilitation treatment prior to surgery no

under 6 months with stabilization in the results.

Have control over movement (can move the muscle but its tone prevents it
use it effectively)

He has spastic muscles, especially in the legs (spastic diplegia),

spasticity in the legs and arms with the legs being more affected
(spastic quadriplegia), or spasticity that affects one arm and one leg of the
same side of the body (spastic hemiplegia).

They do not have severe scoliosis (deforming curve of the spine) or have not
I have had a spinal fusion in the lumbar area (lower back) due to scoliosis.

He is well motivated and has the ability to cooperate in the program.

long-term therapy.

He has a family that understands the long-term commitment to therapy.

intensive physics.

77
ANNEXES

A procedure reduces stiffness in the legs of children with paralysis

cerebral

[Link]
[Link]

78
 20
Therapy of
RHYTHMIC MOVEMENTS AND
PRIMITIVE REFLECTIONS

20.1 Background

Harald Blomberg, Swedish specialist in psychiatry, is the creator of the

rhythmic movement therapy or RMT. It has more than fifteen years of experience.
and has helped many children and adults with locomotor problems, ADHD,
learning disabilities and autism.

For the past few years, he has been training many professionals in the field.
of health and early education in our country.

20.2 What is rhythmic movement therapy?

It is an easy therapy to carry out and is usually pleasant for the

majority of patients. It is about the repetitive performance of movements
rhythmic movements that involve the whole body. They are performed on the ground and are based on
mainly in the imitation of the movements themselves made by the
babies naturally during their growth and development.

20.3 What is it based on?

A través de la estimulación sensorial y del movimiento principalmente, las zonas

more basic and primitive parts of the brain (those that receive this stimulation in a
more directly) are activated and developed. They in turn stimulate and
connecting with other more evolved areas. For the brain to be
Maduro, it is not only necessary for all areas to be stimulated and active,

79
but are interconnected with one another, functioning together.
If this interconnection fails and the correct activation of all brain areas,
both physical and cognitive problems, learning issues, may arise
emotional or relationship.

When the stimulation has not been correct and the baby has not performed the
spontaneous movements needed for its development (due to problems in the
pregnancy, childbirth, for not having spent enough time on the ground, for abuse
of little chairs...) and has not adequately fulfilled all the stages of its development.
during the first year of life, developmental delays may occur with
the aforementioned consequent problems.

If the lower parts of the brain have not matured, the upper parts
Those responsible for essential functions for learning will not do it. And no
we can pretend to reach these areas without having passed through the
remedying their dysfunction in order to enable all the
other areas. For this it is necessary to use stimulation techniques
specific such as TMR or Rhythmic Movement Therapy.

20.4 Benefits

When a child's development is slow, we can accelerate it through the

stimulation that rhythmic movements entail. A stimulation of the
most basic and primitive parts of the brain that activate and stimulate
they will in turn activate more evolved and necessary areas for learning and
emotional and behavioral control.

To address the shortcomings or deficits in development, we will make movements.

similar to those made by the baby naturally. This is the goal of the
rhythmic movements that make up TMR (rhythmic movement therapy and
primitive reflexes) and that mimic the repetitive swinging movements with the
what babies experience and evolve in their first year of life.

Thus, the movements that are spontaneous in the baby become

therapeutic in the older child and the adult. Seeking ways to stimulate the
neural connections between different parts of the brain.

Once this is achieved, benefits will be noticed in the capacity of

attention, in impulsivity and hyperactivity, in language or literacy
and all academic tasks in general. It will improve muscle tone, posture,
balance and coordination. Moreover, greater maturity and control will be achieved
emotional.

80
20.5 Information

In Galicia, for example, the Galician Optometry Center COGA,

[Link][Link]

ANNEXES

Rhythmic movement therapy

[Link]

81
 21
Therapy
NEURO COGNITIVE

A new approach to the treatment of cerebral palsy from Snowdrop. It

based on two proven principles:

Neural plasticity. The brain is capable of altering its own structure and
functioning to meet the demands of any environment in
particular. Consequently, if the child has a neurological environment
suitable, will have the best opportunity to advance.

Learning can lead to development. Already in the year 1900, this was
siendo probado por un psicólogo llamado Lev Vygotsky. Propuso que el
children's learning is a social activity, which is achieved through the
interaction with the most qualified members of society. There are many
studies that provide evidence for this statement, however, not yet
There are controlled studies on neuro-cognitive therapy.

82
 22
NEUROFEEDBACK AND
BIOFEEDBACK

NEUROFEEDBACK

Discovered in the 1970s in the U.S., it helps the brain to reorganize.

a better function.

Use of electrodes placed on the skull, the system analyzes the activity
brain electrical activity and then returns information about itself
functioning.

Neuroptimal is a new and special method of neurofeedback. It is different

of the previous one which is basically only interested in the variability of the
brain, that is, the characteristics of its fluctuations, while the others
methods detect differences in the relative levels of a 'normal' brain.

There is no need to make a preliminary diagnosis because the

application of the method in a session is completely independent of the
expected changes. It reports on its own brain function and the brain
reorganizes improving its self-repair and self-control capacity.

83
Neurofeedback:

[Link]

Contact in Spain:

estherdb@[Link]

BIOFEEDBACK

It is an alternative therapy in which people with cerebral palsy learn to

control their affected muscles. Some people learn how to
reduce muscle tension with this technique. Biofeedback does not help everyone.
people with cerebral palsy.

Biofeedback Brucker in Miami:

[Link]

84
 23
Method
BAG

The main characteristic of this method is the use of massive movements,

based on observations between functional activities, such as walking,
eat, and. These models are spiral, rotational, and diagonal with a
synergy of muscle groups. They consist of the following components:

Flexion or extension

Abduction or adduction

Internal or external rotation.

23.1 What does it consist of?

Resistance to movement is used to facilitate the action of the muscles that

they contract against resistance and auditory and visual stimuli.

The Kabat method is a rehabilitative method that employs facilitation techniques.

neuromuscular proprioceptive. Dr. Hernán Kabat and Margaret Knott in the Kabat
Kaise Institute conducted the first practices between the years 1946 and 1951; the
primera comunicación de que se tiene noticia fue suministrada por el Dr. Kabat
at the first World Congress of Physical Therapy in 1953.

In the name of the method: "Neuromuscular Facilitation Techniques"

Proprioceptors are involved in its foundations.

Facilitation: Perfectly studied in physiology, especially by Sherrington and

where sums of stimuli are discussed and the concept is born that when
an afferent pathway is excited, the passage of the produced impulses is facilitated
by a second stimulus arriving at the center through the same route or by a different route

85
convergent. In this method, facilitation would be the prompt obtaining of a
motor response through adequate stimuli.

Neuromuscular: It is in the neuromuscular mechanism, where it is expected that

increase in response.

Proprioceptive: The nerve endings found within the muscles,

joints, ligaments, tendons are what provide knowledge of the
position that the body occupies in space. By stretching, relaxation,
pressures, etc. It generates a complicated series of reflexes (myotatic reflex) that
In a certain way, it governs the action of the agonist and antagonist muscles.
It is the stimulus of this pathway that is used in this technique.

These techniques can be defined as methods of promoting responses.

of the neuromuscular mechanism through the stimulation of the
proprioceptors. To carry out this method, the kinesiologist follows
approximately this scheme: Verbal command, Manual contact, Traction and
pressure, stimulus and stretch reflex, maximum resistance, patterns of
movement, Muscle training and Relaxation technique.

1. Verbal Command: The execution of every movement indicated in this method

must be preceded by a command voice that serves as a stimulus to it. It
give a lot of importance to clarity, precision, tone and timing.

2. Manual Contact: it is used as a proprioceptive stimulus by placing it

hand always opposed to the indicated movement.

3. Pressure and Traction: it can be used for the same purpose of stimulation
proprioceptive.

4. Stretch Reflex and Stimulus: used in cases where there is not

Another technique that leads to voluntary contraction consists of quickly extending
and suddenly in passive form the muscles that are involved in the
movement, before ordering its contraction.

5. Maximum Resistance: it is the application of a force opposed to that of the arch of

movement. A little less than the patient's strength in a contraction
isotonic and slightly greater in the isometric. This also causes a stimulus
a relaxation of the antagonist muscles.

6. Movement Patterns: Kabat adds other techniques that serve to

retrain and strengthen the muscular part, taking advantage of the stimulus of
stretching and maximum resistance. This is achieved with contractions
repeated, hold-relax and active movements; slow investment and
rhythmic stabilization, this is referred to as muscle training.

86
7. Relaxation techniques: all these techniques help to relax muscles.
spastic and contracted. Moreover, the excitation of the muscles is obtained.
antagonists to spasticity or contracture.

In summary, the Kabat Method has proven its effectiveness in the treatment of the
consecutive hemiplegias or cerebrovascular accidents, where it is due to
a central problem cannot be addressed with any peripheral treatment, but rather to the
rational and scientific re-education. The various techniques stated will be
employing in a combined or successive manner as appropriate, achieving
highly satisfactory results.

87
 24
HYDROTHERAPY

It consists of a physical activity that uses water for therapeutic purposes,

good for its thermal effect or for its mechanical properties, such as being a
medium that cushions the impacts of the exercises performed on it. From this
thus counteracts the harmful effect exerted by gravity, which is
it is imposed in most sports commonly practiced on the ground,
this being the main advantage gained in the aquatic environment, marking the great
difference compared to other sports activities.

Hydrotherapy allows exercises to be performed for individuals with physical limitations.

from ailments that affect the spine to diseases
more focused, such as: meniscus injuries, ankle, strains
muscular...

Likewise, it manages to improve psychological pathologies such as anxious states and

depressives, who release endorphins through physical activity,
gaining a feeling of well-being and pleasure that water brings, relaxation
obtained, the music that can accompany them and the integration and social relationship.
This creates an optimal environment that, along with the necessary medications and psychotherapy,
In each case, it improves the patient's health condition.

88
24.1 Recipients

Hydrotherapy is beneficial for both children and adults. In children with paralysis
cerebral helps greatly, improving the control of movements and the
breathing.

24.2 Benefits

About the musculoskeletal system: thanks to the principle of buoyancy, it releases the
skeletal and muscular system, and to the joints a large part of the weight of
body. By reducing the load, it allows for new possibilities of mobilization
active or passive of the damaged joints. Likewise, the greater density
the water in relation to the air represents a hydrodynamic resistance to
certain movements, toning the body.
Circulatory system: blood vasoconstriction due to cooling of
a hot body produces as an immediate reaction, vasodilation, which
increases blood circulation.
At the respiratory level: the higher density of water causes compression of the
thoracic cavity, strengthening the muscles related to inspiration, and
facilitating expiration.
At the neurological level: thermal changes influence the regulation of the system.
sympathetic-parasympathetic, which influences the regulation of the digestive system,
respiratory, cardiovascular, renal...

Depending on the nature of the therapeutic agent; water, hydrotherapy

it is also classified into:

Thalassotherapy: Marine or salt lake water.

Balneotherapy: Mineral-medicinal water.

24.3 Thalassotherapy

It is a treatment whose active ingredient is seawater, a living system in the

that a series of elements are conjugated, whose letter of introduction is conferred by
its composition, since it is a strongly mineralized water, in which
composition predominates chlorine, sodium, iodine, etc., although it also contains
sulfate, magnesium, and other earth minerals, as well as dissolution gases
(nitrogen, oxygen, carbonic). It is therefore about sodium chloride waters.
hypertonic, which act as general stimulants of the organism, in which
improves its responsiveness given the transmineralizing effect through
the skin obtained through bathing techniques, to which there is no doubt

89
that add the physical, mechanical factors (buoyancy, hydrostatic pressure) and
thermal, which makes water an ideal medium in functional recovery of
multiple pathologies.
The use of seawater, from a health perspective, is known
since ancient times.

24.4 Therapeutic effects of thalassotherapy

Seawater acts as a therapeutic agent whose effects

Biological factors will depend on various physicochemical factors:
Mechanical factor.
Thermal factor.
Chemical factor.

24.5 Indications of Talassotherapy

Thalassotherapy becomes an important therapeutic resource, especially

in those chronic processes, mainly degenerative, that
they suffer from pain, joint destruction, or bone lesions, which lead to
great functional disabilities, since the physical-chemical factors of water
from the sea provide necessary elements for the reduction of the component
painful, facilitating the recovery of tone and muscle balance, thus
how functional reeducation through balneokinesitherapy techniques what
it translates into an increase in mobility and an increase in strength.

These benefits are undoubtedly more evident in load-bearing joints.

(hips, knees, spine...) where weight relief, even greater in a
water of such high density extraordinarily favors mobility.

The conditions that can be treated include:

Sequelae of stroke.
Spinal cord injuries.
Cerebral palsy.
Polyneuritis.
Neuralgias.
Parkinson's disease.

90
24.6 HALLIWICK THERAPY

It all began when James McMillan (1913-1994) visited Halliwick school,

where numerous girls with cerebral palsy were housed. During the study
what was carried out on the effects of swimming on this type of pathology discovered
that only those with minor damage were able to enter the
pool (using the traditional system) and consequently enjoy the water. The
the fact that girls with profound brain damage could not benefit
The effects of hydrotherapy moved this hydraulic engineer so much
way that was dedicated to the creation of a specific methodology.

Hacia 1948, McMillan ayudado por su esposa, pusieron en marcha un nuevo

method based on the scientific principles of fluid mechanics and on the
rotations of the human body observed in water. Since then there is no
Why deprive children with severe cerebral palsy or with any other conditions
type of pathology of a combined motor training, at the same time with
the pleasure that gaming produces. Physical activity on earth can be
very difficult, even impossible; however, the aquatic environment makes it easier
notably the possibility of movement and transfer.

Since Halliwick (London), many countries have been interested in this

methodology that they have subsequently adapted according to their needs
its environment for being one of the most important strategies in the field of
hydrotherapy. McMillan and his colleagues continued researching and founded a
association for therapeutic swimming. Since 1963 the impact of
the program became even more evident. Currently, it is not considered as a
method, but as a concept since it encompasses the aspects of swimming
from the physical, psychological, and social point of view.

The human being is terrestrial and therefore will have to learn new patterns of
movement in the water. To achieve this, the following will be trained: head control, the
breathing, coordination, perception, balance, bipedalism,
march, etc.
When the human body moves in the water, it is observed how two act.
forces in opposition and simultaneously; that is, the buoyant force
the upward thrust and the force of gravity or downward thrust. The
physiotherapist will be able to use for aquatic exercises a
additional potential in three dimensions that will offer greater stimulation
towards the perceptual training of the senses of vision, hearing, and touch.
In addition, breathing, balance, and rotational control will be benefited.
Many of the elements of the Halliwick concept can be learned through
games and group activities since motivating the child allows them, while
learn, greater social interaction.

91
The psychological adaptation and the restoration of control over body balance are of
vital importance and occupy the first place in the demands for greater activity
in the water; however, in a proper treatment protocol it can be
obtain many therapeutic effects while these are being developed
attitudes and skills, always taking into account the mind, the body and the
spirit.
These considerations are referenced in the Halliwick principles and in the use
generalized hydrotherapy. There are 10 points that make it up.
methodology divided in turn into four phases:

Phase 1. Adaptation to the aquatic environment:

- Psychological adaptation
- Freedom

Phase 2. Rotations:

- Vertical rotation
- Lateral rotation
- Combined rotation

Phase 3. Control of movements in the water:

- Floating
- Balance
- Transfer due to turbulence

Phase 4. Mobility in water:

- Basic movements
- Fundamental movements

Phase 1: Adaptation to the aquatic environment

Psychological adaptation is essential for both the physiotherapist and the child.
they should know what to expect from the aquatic environment. This is important for this
understand the elements that will intervene, such as, for example: the ability
to adjust to new sensations, the turbulence, the floating, and the weight of
all these effects on the body's balance.

92
As terrestrial beings, we are subconsciously adapted to the effects of
gravity; however, when canceled out in the water, they result in
a great postural confusion. Thus, it will be necessary to teach the child how to
behave in this new environment so that I can carry out the activities
proposals.

Respiratory control is part of the basic preparation of all

activities, as it is not only a prerequisite for cephalic control,
but it is also essential for swimming. The patient must learn to
blow when the water gets close to your face and exhale slowly
when it submerges.

Water is a medium of support in itself, a fact that frequently

it eliminates pain, allowing for increased freedom of movement.
As psychological adaptation increases, the child becomes encouraged towards a
greater activity that demands independence and control over new
acquisitions, in which case it is vital that he be allowed to move by himself
to walk, turn, jump and make postural changes through movement of
the upper and lower limbs.

Phase 2. Rotations

Due to the fact that water reacts concerning shape and density, the
the body is continuously subjected to the force of rotation. The more
the smaller the surface area and mass density of an object, the less
there will be a possibility of flotation.
Vertical rotation consists of a person's ability to recover the
verticality from the supine position. For this, a
strong bending of the trunk, hips, knees, cervical spine, and shoulders, to the
that will maintain a precise balance of the head over the body in order to
maintain the upright position.

Regarding lateral rotation, it should be said that human bodies are

asymmetrical and, consequently, in the lying position there will be a tendency
of the body to rotate around its longitudinal axis. The rotational movement
it occurs when the rising and falling factors are not balanced and
opposites.

The combined rotation is used to prevent the child during treatment

fall into a vertical rotation and end up in a prone position on the water. By means of the
lateral rotation will be able to turn towards the supine position and thus, by combining
the rotation, reaching a position where I can breathe freely.

93
Phase 3. Movement control in water

The lifting force can be used to assist movement in a way

conventional and also as a counterweight taking into account the effects of
gravity. The stillness of the water will initially serve for the child
learn to control your balance.

Later on, however, you will have to be able to maintain that balance in
different positions, but against the deliberate turbulence that occurs
around her. If these turbulence occur directly towards a
part of the body, the water pressure will be lower and an effect will be observed
rotation or dragging. In this case, the child will tend to move in the area of
turbulence that has lower pressure, an effect that can be used to produce
postural compensations according to therapeutic needs.

Phase 4. Mobility in water

Once the rotational control is good, while the child is being 'towed' by
turbulence in the water, you will be able to start making simple movements of
upper and lower limbs. This range of movements can be gradually
increasing gradually, increasing their difficulty and
working more specifically on each muscle group.
Something important to keep in mind is the way to hold the child, as it is not
it is advisable to provide more help than is necessary. On the other hand, the
negative words, such as 'sinking', 'drowning', etc., should be
avoid and replace with positive terms associated with the earth and with the
security.

Every active program must include the use of a wide range of

sensations, movements, postural changes, etc., but it is very
it is advisable to introduce rhythm through songs and music.

The game, besides being fun, in this case serves for the child while
enjoy, forget the fear, and dare to participate in activities such as the
other members of the group, thus achieving the realization of the 10
basic points previously described.

Conclusion
After more than 50 years of development and implementation of the concept of
Halliwick remains one of the most important strategies in therapy.
aquatic, especially in pediatrics. Researchers consider it as a

94
logical learning to move in the aquatic environment, and even many of them
they call it 'Bobath in the water'.

The value of swimming as a therapeutic activity is beyond doubt. If

All training programs are planned taking into account the
recreational activities suitable for the individual diagnosis the child will acquire
multiple advantages both of a physical and psychological nature. For this reason, every time
there are more centers that use the aquatic medium as a complementary part
of the enabling or rehabilitative treatment. Children gain greater confidence
in themselves, they improve their self-esteem and concentration ability,
they experience new sensations and have greater possibilities of
relate to others.

Contact in Spain: [Link]

ANNEXES

The guru of hydrotherapy

[Link]
[Link]

95
 25
Treatment
X-CELL-CENTER FOR
Cerebral Palsy

25.1 Introduction

El tratamiento de la parálisis cerebral de X-cell-Center, difiere de los métodos

standard, as it addresses the fundamental cause of cerebral palsy in the
interior of the brain. Stem cell therapy is a free alternative of
drugs that focus on inducing regenerative or physiological changes in the
brain that can improve the quality of life of affected patients.
Almost 70% of patients with cerebral palsy treated with stem cells
X–cell- Center has shown a clear improvement.

Most patients with cerebral palsy are treated by lumbar puncture.

where stem cells are injected into the cerebrospinal fluid that them
transports through the spinal canal to the brain.

The lumbar puncture is an outpatient procedure that requires that the

patients stay in Germany for 4 or 5 nights.

25.2 What does it consist of?

On the first day, bone marrow is obtained from the patient's iliac crest.
(hip bone) with fine needle mini-puncture under general anesthesia. The
The complete procedure normally lasts about 30 minutes.

Because the bone marrow extraction procedure requires that the

patients do not move, it is performed under general anesthesia in children and patients
of advanced age who for some reason cannot stay still.

96
Once the bone marrow extraction is complete and after a short
recovery period at the clinic patients can return to their hotel and
dedicate themselves to their normal activities.

The next day, the stem cells from the bone marrow are processed by a
novel and high-quality technique in an approved laboratory with permission
governmental. In the laboratory, the quantity and quality of the
stem cells. These cells have the potential to transform into multiple
types of cells and are capable of regenerating or repairing damaged tissue.

On the third day, the stem cells are implanted into the patient through a
lumbar puncture or intravenous (IV) administration of mannitol in cases where
that lumbar puncture is not advisable.

Patients who are treated with a lumbar puncture are required to stay.
in the city the day after the procedure for general safety purposes.
They can return home on the fifth day.

25.3 Results

The reported types of improvements include: reduction of spasticity, a

better coordination, improvement of motor function, greater stability of the
posture, improvement of cognitive abilities especially in communication.
Many have gained the ability to sit, stand, or walk without assistance.
improvement in spoken language and even reported a decrease or even
absence of epileptic seizures after treatment.

The average age of the patients was 8.9 years, while the median was 6.
The oldest patient treated was 44 years old (data from 2009).

25.4 Centers

He has two private clinics in Düsseldorf and Cologne in Germany.

ANNEXES
Joel will be able to undergo surgery on Monday in Germany.

[Link]
surgery-Monday-Germany/[Link]

Joel overcomes the transplant to reduce his paralysis

[Link]
transplant-reduce-paralysis/[Link]

97
Joel starts a new life

[Link]
new-life/[Link]

Viable, treating cerebral palsy with stem cell transplantation

[Link]

They advocate hormone treatment to improve patients with damage

cerebral

[Link]

98
 26
TOXIN Application
BOTULINIC TYPE A
(BOTOX)

26.1 Background

In 1820, a German clinician (Kerner) reported a case of poisoning.

for sausages in 76 patients, whose clinical description was closely approximated.
way to what we currently know as botulism.

This same author proposed the possibility of using the toxin contained in the
sausages as a remedy for some diseases of the nervous system
central.

In the mid-40s, type A botulinum toxin was purified, but it was not until 20
years later when Dr. Scott began to use it in the treatment of
strabismus. In 1989, the U.S. Food and Drug Administration (FDA)
approved its use for the treatment of strabismus, blepharospasm, and the
facial hemispasm. In the following years, clinical studies have
demonstrated its usefulness in numerous pathologies.

26.2 Application of Botulinum Toxin in Cerebral Palsy

The therapeutic options for spasticity in SCI are multiple.

["drugs","physiotherapy","occupational therapy","orthopedic aids","surgery"]
orthopedic, etc.), but most of these procedures aim to alleviate
the repercussions of said spasticity.

It is therefore very important that the treatment of spasticity be carried out.

prematurely, before the progressive shortening of muscles and tendons
be made permanent.

99
Physical therapy and orthotics have traditionally been the procedures of
election in the first stadium, having recently joined the administration
of botulinum toxin.

Koman et al. In 1989, they were the first to report results

preliminary treatment with botulinum toxin in patients with PCI and
dynamic orthopedic deformities checking a decrease in the
spasticity without major side effects. Subsequently, there have been
multiple documented studies have been published that demonstrate the effectiveness of the
botulinum toxin in the treatment of spastic CP.

It is accepted that botulinum toxin improves motor function in some children

with spastic CP but, in addition, other achievements must be attributed to it that in
Occasions can even become more important.

In this regard, it delays the appearance of fixed retractions and therefore the
need for surgery, help with physiotherapy and fitting of orthotics and contributes
to improve the level of well-being in patients with severe impairment by facilitating
their hygiene or reduce the pain. The use of TBA in these children must
be part of a global treatment plan, taking into account that the
reducing muscle tone is not the only objective.

It is necessary to know some aspects to consider before starting the

treatment with TBA in a child with PCI. The objectives of the therapy should be
reviewed prior to each intervention in an individualized manner, being
realistic and clearly presented to the patient or their parents in order to avoid falsehoods
expectations.

It is important to clarify whether the aim is to avoid surgery or just to delay it, if that is intended.
that the child can walk freely or with the help of devices, or if they can only
aim to improve adaptation to daily activities in a wheelchair or the
hygiene. Likewise, a written informed consent must be signed in which
describe the characteristics of the treatment and its possible effects
secondary.

26.3 General indications for the effectiveness of TBA treatment

It must be a dynamic or reversible spasticity, there being no existence

fixed contractures or retractions that prevent reaching the neutral position
of the joint.

Spasticity should be localized. Treatment should be limited to a

small group of muscle groups due to the limitation of the total dose, the
pain and the cost of the process.

100
 The movement disorder must depend on the spasticity of a
muscle group and not of the weakness of the antagonists.

Spasticity must interfere with the function of the limb or the body.

26.4 Recipients

Regarding the age of treatment, although there are authors who inject infants,
In general, it is recommended to start it between the ages of 2 and 6, as that is when one
it develops dynamic motor skills and can alter the course of the disease.

A lesser functional response is described in older patients, without

embargo, the effectiveness on dynamic spasticity continues to exist while
There should be no joint contracture or tendon shortening.

26.5 Contraindications

Most of the contraindications for the administration of toxin are

relatives.

A fixed retraction is an absolute contraindication, although each case should be evaluated.

value individually, as a minimal benefit can be
important in a specific case.

Hypersensitivity to the toxin or infection at the injection site, the false

expectations at the injection point, false expectations, and the lack of
security - collaboration of the patient or their parents may be
contraindications to consider. An imminent intervention requires delaying the
administration of toxin, as well as the placement of a vaccine. The delay
severe mental excludes the functional benefit of the toxin but could be used
as a temporary measure.

Certain drugs interact with the toxin by acting and competing for the
site of action, enhancing its effect like aminoglycosides or
inhibiting it like chloroquine or hydroxychloroquine.

In summary, botulinum toxin type A is well tolerated, safe, and effective in the
treatment of patients with spastic CP. Achieving good
results through its administration require an individualized assessment
that correctly defines the needs of each patient, a selection
careful with them and a multidisciplinary team that complements each other and
make it possible for the comprehensive treatment of these children in order to improve their
quality of life.

101
26.6 Conclusions

Currently, several medications are marketed in our country with

TB, distinguishing: TB-A and TB-B for clinical use and TB-A for cosmetic use;
whose units of power are not equivalent so they cannot be
consider interchangeable.

All medications with TB require a prescription and are classified.

as hospital-use medications that must be administered by
doctors in authorized health centers

The clinical uses of TB are usually reserved for processes (usually

painful or disabling) for which there are no effective alternatives.

The management of TB often requires repetitive injections, having to

respect the minimum time interval indicated in the technical data sheet of the
medication. In case of no response, it is important that the doctor
evaluate the possible appearance of neutralizing antibodies.

The adverse effects associated with TB are usually moderate and transient.
although it can involve serious risks (difficulty swallowing or breathing), which
they can be caused by the spreading to the muscles close to the area
of management. It is important to carefully assess the index
Benefit/risk in each patient and closely monitor the administration.

ANNEXES

Carlos Haya publishes a clinical guide on toxin treatment

botulinic

[Link]

Botox, effective for treating babies with cerebral palsy

[Link]
&id=118602&catid=135&Itemid=217

102
 27
HOMEOPATHY

27.1 What does it consist of?

Homeopathic therapy consists of the administration of microquantities of

a substance of animal, vegetable, or mineral origin, subjected to a process of
successive dilutions.

The laws do not intervene in the preparation of homeopathic medicines.

conventional physics and thermodynamics, their effects are explained by the
phenomenon of resonance, which is the means by which information is
transmits from the molecules of the solute (the mineral, animal, or vegetable essence),
up to the water molecules, in a process renewed indefinitely through
of the successive dilutions and succussions, which lighten the speed of
formation of characteristics of the solute thanks to the plasticity conferred by its
hydrogen bonds, which are capable of acting as resonators of
the information and thus carry it to the last water molecule of the system, which to
final will have the same energy pattern as the matter used in the first
dynamizations.

The effects that are obtained after the administration of the medications
homeopathic remedies are likely the result of the mobilization of

103
neurotransmitters at different levels of the neuroendocrine system and the
consequent neurovegetative responses; if the materia medica is reviewed
many of the main remedies we will find in their characterization a
symptomatic complex that clinically corresponds to an excess or a
deficit of neurotransmitters in the psychic and vegetative sphere.

27.2 Cerebral palsy and homeopathy

Each individual has a particular way of expressing their morbid processes.

there are no diseases, only sick people; for every pathology, acute or chronic, there is
a homeopathic remedy whose pathogenesis accurately reflects that ailment.

The homeopathic doctor must approach the patient with cerebral palsy having
in consideration of each of the symptoms: physical and mental, exhibited by the
little patient, and with this you will be able to choose the indicated medication,
similimum: which responds to the most accurate similarity between the symptoms
produced by the medication in pure experimentation or pathogenesis and the
symptoms that characterize the sick individual; the organic remedy: that one
that has selective action for a localized area, some organ or tissue,
correcting pathological processes, shortening the healing evolution, in this
pathology is the choice for the treatment of associated disorders,
homeopathic remedies: diluted and dynamized organs and tissues that
act on their human counterpart to correct the disturbed activity, their
selection is carried out by taking into account the physiology, pathophysiology, and topography of
the injuries, in this particular case of the central nervous system; these
medications behave like cell regenerators.

The following remedies are some of the most commonly used in therapy.
los pacientes aquejados de PC, la escogencia depende de los signos y síntomas
individuals, there is a "medication for each patient," the potency, the dose and the
the time for prescription is particular, there is no rigid scheme in the
prescription of homeopathic remedies that is common for everyone
sick.

Similimum remedies

Agaricus muscarius: produces spasms, muscle jerks, and tremors that

similar choreic movements, limbs in continuous motion,
clumsy movements of hands and fingers, weak and numb arms, limbs
lower limbs with extreme laxity, paresis that progresses to paralysis.

Causticum:depresor del sistema nervioso y muscular, modifica la nutrición, el

the child for whom this medication is suitable is extremely thin, with

104
delay in psychomotor development and progressive decrease in strength
muscular, paralysis of nerve territories, especially in the face, the larynx and the
sphincters, hemiplegias, paraplegias, rigidity and muscle contractures, retraction
and contracture of the flexors and extensors of hands and feet, joint ankylosis.
Types of petit mal seizures.

Gelsemium sempervirens: selective action medication in the system

central nervous system where it produces a depressant and paralyzing action of the
motor and sensory centers, prostration of the entire muscular system with
total or partial paralysis, inability to transmit nerve impulses
volunteer, tremors when trying to walk or grab an object, difficulty in
to fix attention.

Helleborus niger: selective action in the nervous system causes seizures

tonic-clonic seizures followed by a paralytic state, produce depression of the
sensory activity especially auditory and visual, spasmotic movements
of arms or legs, decrease in sympathetic activity which determines
weight loss and muscle wasting due to alteration of cellular trophism.

Secale cornutum: it acts on striated and smooth muscle, modifies

deeply the muscle fiber, producing disorders of muscle tone,
decrease or absence of contractility and reflexes, paralysis and atrophy.

Organismic

The characteristics of motor deficits, of learning disorders, of the

Intellectual and sensory deficits will depend on the affected brain area.
The selection of organotherapeutic remedies will be determined by the
neurological structure that one wants to regenerate, we have the following:

Motor region, precentral gyrus, frontal lobe, in cerebral palsy

spastic type.

Basal ganglia, globus pallidus, thalamus, will be used in type paralysis

athetosis or dyskinesia.

White matter, myelin, in cases of cerebral palsy due to atrophy

periventricular

Cerebral cortex, hippocampus, temporal lobes, parietal lobes, lobes

occipitalis, for sensory or motor deficits, specific disorders of
learning, memory disorders, decrease in abilities
intellectuals.

105
Buccinator and masseter muscle, orbicularis oris muscle, companions of the
nerves corresponding to articulation and swallowing disorders.

Medullary region, nerve plexuses and muscle groups, whose selection

It will depend on the anatomical region that one wishes to improve.

The homeopathic doctor, with these tools, can be part of the team of
work that supports the young patient with cerebral palsy. The intervention
early and homeopathy produce amazing and unimaginable progress
In these children, the results are maintained over time, the effects of this
Noble medicine will not be suppressed once the process has been completed.
expected dressing.

ANNEXES

Alternative medicine can be dangerous in children

Alternative medicine
[Link]

106
 28
THE SHOES OF ISRAEL

28.1 Background

Step of mind has been launched and has participated in several

high-ranking scientific research in the field of motor rehabilitation
functional evaluations, the transfer of motor achievements and retention.

In its research activities, SOM has collaborated with universities,

industrial centers, private companies and clinics in Europe, United States and
Middle East.

28.2 What is it?

Re–Step is a training system through a sandal that modifies the

environment during the march and aims to improve stability and the
walking in children and adolescents with cerebral palsy at home and the
community.

28.3 Who can benefit from Re-Paso?

The system was initially developed for the needs of children with
cerebral palsy. The company is now working on future models, let's go
for adults to enter and it will also be effective for the motor rehabilitation of the
adults with cerebral palsy, people after the accident
cerebrovascular (hemiplegia) and traumatic brain injury.

107
28.4 ¿Cómo funciona?

The system consists of a pair of formal training sandals that change their
surface and facilitates a person's reaction in real time. The devices
Laptops communicate with a PC in a feedback circuit.

Among other effects, Step of Mind:

Induce the solution to the brain problem

Improves brain plasticity

Provides immediate and accurate clinical results

Programmed for different levels of motor disability

Light and portable

The treatment can be done at home or in the clinic.

Non-invasive rehabilitation

It allows the transfer and preservation of the achievements made in the 'real life' environments.

Contact: info@[Link]

108
 29
FUNCTIONAL MIOTHERAPY

29.1 Introduction

Functional myotherapy includes a set of procedures and techniques.

used in the correction of orofacial muscle imbalance, the normalization
of muscular behavior, the reduction of harmful habits and improvement
of the patient's aesthetics.

Muscle imbalance plays an important role in growth and

development of the stomatognathic system.

The importance of correct muscle balance and its function has been recognized.
for many years now due to abnormal patterns and harmful habits
they contribute to favoring, provoking or recurring dental malocclusions.

The importance of occlusion for good dental health must be recognized.

by pediatric dentists.

The orofacial complex is functionally designed to withstand pressures.

daily caused by chewing, swallowing, resting position, and phonation.

The introduction of abnormal habits can disrupt the normal balance of

stomatognathic system. Due to the importance of the perioral musculature, the
The clinical examination of all patients must include the study of all the
facial and masticatory muscles, especially those mentioned by Garliner cited
by Di Santi form the triangle of forces. Point A of that triangle
is formed by the masseter and buccinator muscles, point B, by the
language and the orbicularis of the lips and finally the chin muscles
they constitute point C. The first muscle point exerts lateral forces, the
group B exerts pressure in the forward direction and C must be inactive. These
forces must cancel each other out to maintain muscular and occlusal balance.

Due to all the negative consequences of muscle imbalance, the

The application of functional myotherapy is gaining more and more strength every day. According to Segovia.

109
(1977), the protocol used must be planned according to the individuality of each
patient, at the age, the needs, and the interest that they express.

29.2 What does it consist of?

Myofunctional therapy consists of three stages: awareness, correction, and

reinforcement and awareness, which have as final goals to achieve the
balance orofacial and prevent, intercept or treat malocclusions and correct
linguistic articulation problems. For all of this, the key to success is the
motivation of the patient and their parents.

The characteristics of the muscles and the patterns of action can be

inherently genetically. However, they also argue that the forces
genetics can be modified by environmental circumstances,
thus modifying growth and development.

Functional myotherapy has been used for several years to improve

muscle dysfunctions, chewing, swallowing, and for control of
feeding in patients with Cerebral Palsy, due to the physiotherapy
conventional and speech therapy have a limited influence on these
problems, Castillo Morales and colleagues developed a therapy based on the
functional diagnosis of dysfunctions of the stomatognathic system, a
muscle stimulation program and the use of functional orthopedic devices,
improving pathologies such as athetosis, hypotonia, and spasticity.

29.3 Conclusiones

Health professionals, particularly specialists in care

The child's caregivers must fully understand the application and use of myofunctional therapy.
and form a multidisciplinary team to address or prevent possible
malocclusions. In many cases, the distortion of the occlusion is not due to its
totality to the habit but to the important aid of the perioral musculature. Furthermore
because of that, muscular dysfunction can bring social consequences and
psychological issues due to the impact on aesthetics, interference in growth and
normal development, associated muscle habits, atypical swallowing, breathing
oral, incorrect chewing and even alterations in phonation.

110
 30
Cinesiotherapy

30.1 What is it?

Kinesitherapy is the set of interventions that utilize movement.

for therapeutic purposes. It can be active if it requires the patient's participation,
or passive, which is carried out without the person making any movement, well of
relaxed or forced form.

Kinesitherapy has positive effects on the cardiovascular system,

respiratory and muscular.

30.2 Beneficios

External resistances that hinder or prevent movement are overcome.

The shortened or contracted fibers are relaxed.

Greater muscular tension is produced, increasing strength and volume.

muscular.

It promotes the functioning and transmission of nerve impulses.

improving balance and movement coordination.

Increasing weight is applied progressively.

The repetitions of the exercise should not be many and must be carried out from
spaced form to achieve good recovery.

It can be done manually or by means of instruments (circuit of

pulleys, springs, coils, etc.

111
Similarly, an enriched and varied environment must be provided for the child with CP.
that stimulates him when he cannot explore the environment by himself.
stimulation programs provide you with learning experiences and the
possibility of relating to the world around him/her.

112
 31
Therapy
PHARMACEUTICAL

Pharmacotherapy is indicated to alleviate and reduce some of the

symptoms associated with cerebral palsy.

It is important to know that medications can only be taken with a prescription.

from the doctor who attends to the person with CP.

31.1 Drugs to control seizures

Various medications are available to prevent and/or control seizures.

associated with the PC. The doctor must determine the specific type of seizure.
to prescribe the most appropriate medication, as no effective one is known
to treat all seizures. Otherwise, in some cases, the most
indicated is the combination of several of them.

31.2 Drugs to control spasticity

In the case of spasticity, medication is especially indicated after

a surgical intervention. Although its long-term efficacy has not been demonstrated.
Deadline, are useful for reducing this symptom in short periods of time. The
most used are diazepam, baclofen, and dantrolene, which are
administered orally.

Diazepam: acts as a sedative muscle relaxant of the nervous system.

Baclofen; it blocks the signals transmitted by the spinal cord so that
contract the muscles.
Dantrolene. It interferes with the muscle contraction process.

113
These medications can produce adverse side effects, such as
numbness. Furthermore, the long-term consequences are still not known.
what they can have on the nervous system.

Alcohol injections are also being used in the muscle to reduce the
spasticity. This technique is especially indicated for contractures
incipient, to correct them while they are still forming and, thus, prevent the
surgery. The technique involves injecting alcohol into the contracted muscle to
weaken it for the time necessary for the doctors to prolong it with
various techniques (orthopedics, therapy, casting).

31.3 Drugs to control athetoid movements and drooling

Athetotic symptoms are characterized by lack of control, lack of coordination.

and the slowness of movements. It mainly affects the hands and arms,
as well as the legs and feet. The medications used in this case are
the so-called 'anticholinergics', whose function is to reduce the activity of the
acetylcholine. This is a chemical substance that facilitates communication between
certain cells in the brain, such as those related to contraction
muscular. Anticholinergic medications are also used to reduce
the drooling, because they reduce the flow of saliva, although, in this case, they can
have side effects, such as dry mouth or cause problems in the
digestion.

114
 32
MUSIC THERAPY

Music with therapeutic purposes has important benefits on the aspects

emotional and motivational aspects, physical health, cognitive functions and
sensorimotor skills, as well as social and communication skills.
music therapy sessions can be received individually or in groups,
depending on the specific needs of the person.

The treatment program consists of very diverse elements and exercises.

musical improvisation, listening and singing songs, lyrical discussion, playing
instruments, etc.) that will be adapted to the characteristics and abilities of each
person.

About music therapy, there are a number of prejudices and myths that need to be addressed.
to uproot, as if it is only suitable for certain types of patients or the
belief that there are musical styles that are more effective for achieving the
fines sought. However, preferences must be taken into account.
personal needs and specific circumstances of each
person at the time of developing the treatment program.

32.1 Definition

Music Therapy can be defined from two perspectives: from the point
from a scientific point of view and from a therapeutic perspective.

From a scientific point of view, Music Therapy is a specialization

scientific field that deals with the study and research of the sound-being complex
human, whether musical sound or not, tends to seek the elements
diagnoses and therapeutic methods of it.

115
From the other point of view. - music therapy is a paramedical discipline that
uses sound, music, and movement to produce regressive effects and
open channels of communication with the aim of embarking through them the
training and recovery process of the patient for society.

32.2 Objectives

Develop orientation and locomotion: body schema and terms

spatial (above, next to, etc.). Activities that include this type are used.
of guidelines, instruments that help identify the location of the
space and rhythm, as a sign of time and movement.

Promote social skills and interpersonal communication; participate in

musical groups and cooperating with others involves social skills,
how to wait for turns or follow instructions, etc.

Expressing and developing sensory emotions: they cannot be seen by themselves.

affected, but the attitudes of the psychics can damage their self-esteem,
so they must be expressed in activities such as composing or writing
song lyrics.

Facilitate the learning of academic behaviors, develop the ear and

reinforce the desired behavior.

Improve affectivity and behavior

Develop auditory discrimination

Acquire skills and means of expression

Develop the speech

Approach to the sound world

Strengthening self-esteem

To know and recognize the place and to adapt to the open space.

Acquire security and confidence and communicate with the therapist in the group

To recognize small musical motifs, or songs

That he/she works individually

That follows simple instructions

Respond in an organized manner to the sensory information

116
 To be integrated into activities that are carried out through music or gestures,
the voice and the word

That it becomes progressively uninhibited

To be familiar with the basic materials of work, whether they are instruments.
musicals or objects in general.

32.3 Types of therapy

Verbal (psychoanalysis): the patient is spoken to. By speaking, work is done on

areas of our personality. Language functions consciously,
We tell what we want or not.

Non-verbal therapies: it includes non-language. Many will be addressed.

tasks through gesture and sound. Place them in situations where they
they can manipulate and manifest. It works before all expression. The gestures
and the sounds we make, and how we make them, manifest our
personality, more closely, real and sincere. Both therapies are
they complement.

32.4 Music therapy and cerebral palsy

Music therapy fundamentally acts as a psychological technique, that is,

that its therapeutic support lies in the modification of problems
emotional, of attitudes, of the dynamic psychic energy that, ultimately
instance, it will be the predominant effort to modify any pathology that
the human being suffers.

In our current society, the largest group of physically disabled individuals is the
of those who suffer from cerebral palsy.

The population with cerebral palsy generally suffers from neuromotor deterioration.
and disturbances in psychological functioning and emotional control.
They present a particularly weak motor control, distraction, hyperactivity,
irritability and disinhibition.

These children present a challenge for rehabilitation therapy and education

general.

Music and musical activities have a beneficial influence on

the level of tension, disturbance, hypersensitivity, and affective tone of many
children with cerebral palsy.

117
Authors such as Bruner, Cass, Frampton, and Rowell point out that music and the
musical activities help to achieve the relaxation needed. Additionally
Music helps to draw attention and increase the level of concentration. Carlson
indicates that music can serve as an agent to minimize the
effects of undesirable environmental stimuli. Suggests that music
stimulates or motivates activity; believes that music provides emotional relief to
children who suffer from cerebral palsy.

When music is used as an environmental stimulus to enhance control

motor or achieving relaxation, must be carefully considered the
different diagnoses of cerebral palsy. Then it should be observed carefully.
attention to determine if the patient responds effectively to the therapeutic goal.

The value of music as an environmental stimulus in group situations where

they find patients with different types of paralysis, depending on the degree of
deficiency, the age of the children, and the degree to which music is stimulating.
For some children and for some activities, it might be valuable to use
more or less soothing or stimulating music with the purpose of establishing a
atmosphere that favored therapy or learning activities. It seems
impossible to establish a musical environment for any group of children with
cerebral palsy that benefits everyone on a certain day. Again
Before planning the extensive use of music in a group setting, it is
It is necessary to observe the group's response to the different types of music.

These considerations indicate that the differential diagnoses of paralysis

They can provide a key to a child's response to different types of music.
but it is not always possible for all diagnosed children to react in the
same way. However, if there is a test, it will indicate that the
Music therapy is valuable and beneficial for children with cerebral palsy.

32.5 Effects

Music has had on man the effects that he expected from its use,
either integrated with various functions or as pure aesthetic experience.

It is difficult to dissociate the physiological effects and the psychological effects of music.
Through the centuries, among philosophers, doctors, and musicians, there have been various
schools of thought that tried to explain the mechanism of responses to
music. They oscillated between two theories: some believed that music affected
primordially the emotions and awakened states of mind that in turn
they acted on the body; others thought that the process was the reverse: from the
physiological to the psychological.

A child music therapist, Louise E. Weir, has expressed: "that sound affects
the autonomic nervous system, which is the basis of our emotional reaction.

118
Throughout history, man's responses to music have been
fundamentally similar influenced by the same factors; that is,
physical receptivity of man to sound, his sensitivity, innate or acquired to the
music and its mental state.

Man can only respond to the music of his civilization that he has.
for him a meaning and an emotion. His culture, or his civilization, is not
only ethnographic, as even within the same society the responses of the
people's artistic experiences vary according to their social background or
educational. In the same society, we can find people who have been
deprived of certain musical contacts or has been forced to go towards the
music; others have discovered music on their own without any guidance. Some
they ignore or accept only a certain kind of music without any prejudices intervening
personal or social. Some good listeners are born, others are made;
it is not necessary to discriminate against them. These factors are among many that can
to help or hinder the task of music therapy, which seeks to offer to its
patients a fun and effective means of communication.

Patients often react normally to the elements of music at their

dynamism and its emotional and intellectual appeal. They normally react to
conventional character of music: cheerful, sad, exciting or soothing.

Some people who suffer from psychological disorders have not developed from
normal way. Many of them cannot act or progress at the pace
current. Some are unable to project themselves into the future: they need a
immediate musical reward.

These two deficiencies can include the response to music. The sessions
musicals based on a normal extension program or development
It is likely that they will fail with them, even though the musical activity has
He/she has been well suited to his/her personality. There has been a distinction between the effects.
emotional and purely physical effects of music on man.

ANNEXES

Music therapy does not cure, but it helps, an expert claims.

Music therapy does not cure but helps.

claims-a-exerta/

119
 33
ACUPUNCTURE

33.1 What is it?

Acupuncture is a therapeutic method of Traditional Chinese Medicine that

it consists of the introduction of metal needles into specific points of the body
for therapeutic purposes, which originated in China about 2500 years ago
years, so he has extensive and deep clinical experience.

It remains fundamental in health systems in countries such as

China, Japan, Korea and Taiwan; and in the West, Acupuncture is among
the most known, accepted, and recommended alternative therapies by the WHO.

33.2 Effects

Numerous studies in animals and humans have shown that acupuncture

it has multiple biological responses such as:

Regulates the body's nerve response

120
 It has analgesic effects, that is, it raises the pain threshold through mechanisms.
body's own modulators.

It has anti-inflammatory effect

It has an anti-stress effect: it increases tolerance to harmful stimuli and factors.

It favors proper emotional management

Improve the sleep pattern

Regulates metabolism and the endocrine system

Regulates the immune system

It favors the restoration mechanisms of the nervous system.

Regulates the digestive system

It favors the regulation of blood pressure

33.3 Acupuncture and cerebral palsy

Some studies have shown that acupuncture improves physical functions.

It provides a remarkable therapeutic effect in patients with cerebral palsy.
Other studies suggested that acupuncture may be effective in management of
pain associated with muscle spasms in athetoid cerebral palsy.

As a result, it improves patient care, emotions, and levels of

hyperactivity, and allow the introduction of communication or cognitive skills. It
what would be really interesting would be to apply a multidisciplinary approach (with
Western and Eastern medicine for the treatment of cerebral palsy.

ANNEXES

Russian children with cerebral palsy receive treatment in China

[Link]

121
 34
SWIMMING

Undoubtedly, one of the most pleasant activities is swimming that can

become not only an exciting distraction but also at the same time
time provides great health benefits.

Swimming, unlike other therapies, offers several advantages such as

for example, the impossibility of the patient getting hurt by falling.
Additionally, using warm or tepid water significantly helps to relax the
stiff muscles or any kind of pain. Likewise, the simple fact of being able to
floating in water relieves stress. Not to mention all the exercise done in
Water helps to reduce weight while gaining muscle mass. One of
the main problems in cerebral palsy are the lack of coordination in
movements and swimming can help improve that lack of coordination.

Contact with water is beneficial for promoting better circulation.

blood and therefore improves the nervous system. Various can be carried out
exercises that are useful for these diseases and the best part is that they do not cause
collateral problems for these patients.

Of course, in special cases of people with very severe paralysis it is

It is necessary for everything to be supervised by experienced people who can
monitor the treatment.

122
 35
Method
The METAYER

Le Métayer bases his method on the fact that education and training are only
possible to the extent that the association areas are able to function.
Starting from the neuromuscular reactions of the normal child, they attempt to provoke in
the child with cerebral palsy has normal neuromotor patterns.

35.1 Technique

The technique can be specified in these points:

Assessment of the neurological development level of the child with motor disease
cerebral, defining, in each child, the pathological neurological schema
predominant.

Factorial analysis as one of the evaluation and motor examination points for
determine stiffnesses, control reactions to external stimuli,
observation at rest and in kinetic period.

Postural maintenance examination, which will report on weaknesses and

defects of motor organization. Execution of mobilization maneuvers that
allow to achieve a state of complete relaxation.

Try to guide the child to navigate the different levels of motor development
essential for the acquisition of normal motor patterns, linked to
the different static reactions, straightening reactions and
balance according to order of difficulty.

Biomedical assessment in search of possible contractures, deformities

installed or possible, as well as the production and installation of systems of

123
adaptation to help the child improve function in activities of the
daily life and to prevent musculoskeletal disorders caused by
the abnormal muscle forces.

Functional examination of locomotion, play, hygiene, feeding, dressing and

sedimentation, which allows determining the level of autonomy in the different
activities.

Assessment of associated disorders: vision, hearing, sensitivity, nutrition

gnostic disorders, organization of gesticulation and grasping, etc.

124
 36
Method of
SCHWARTZ

It is a locomotor learning system for children with paralysis.

cerebral or similar conditions, in which relevance is given to the
psychological, intellectual, and physical stimuli inherent to the child's effort, free
of devices. Thus, children prefer to work and play in groups with other children.
A Hartwell apparatus, a locomotor device, has also been used.
developed in 1951, along with the method, by orthopedic surgeon R. Planto
Schwartz (1892-1965).

He must be encouraged to voluntarily try various activities, this

it depends on the emotional, intellectual, and physical level.

125
 37
Program
MOVE

Linda Blair started in California, in 1980, this children's program with

severe disability that causes a loss of motor skills over time as they
they become adults. Use adapted materials for mobility, seating and
bipedalism.

The program involves the development of a curriculum to integrate learning of

motor skills with MOVE education and training. The material and the
learning provides new opportunities for children to develop
new skills through movement.

The physiotherapist plays an important role in supporting educators and

help children develop mobility in a functional and safe way.

126
 38
Treatment
PHYSICAL MEDICINE

Physiatric treatment can improve or prevent the deterioration of a person's autonomy.

patient with cerebral palsy.

38.1 Facilitate psychomotor development

An important goal in childhood is to facilitate experiences.

sensorimotor activities and promote the learning of psychomotor activities.

In therapy, the focus is on development taking into account alignment and the
postural stability, allowing for the emergence of motor activities
as head control, turning over, sitting, reaching for objects, crawling or creeping,
changes in posture, standing, and walking, which promote development
of spatial perception, knowledge of one's own body, and exploration of
environment.

The movements include trunk rotations, dissociation of the segments of the

body, weight loads and isolated movements that are incorporated into the
different exercises of gross motor skills and in different activities that are
promotes with a proper alignment so that the child can obtain a
sensory feedback mechanism of normal movement patterns.

In children with head control issues, it is necessary to assess the symptoms.

that alters the alignment of the head with and without gravity, and the possible existence
of a visual deficit, and promote those postures in which the child can
better organize their head control, whether in prone, sitting or
bipedalism.

127
The goal for achieving functional seating is determined by the
degree of stability provided by the lower body
(fundamentally the pelvis) to maintain flexibility and free movement in the
upper body (torso, head, and arms).

When the goal is for the child to learn a means of moving around.
soil, it is known that this can be in the form of turning, tracking, crawling or perhaps
slide on the ground while sitting.

While it is essential for tracking that the child has strength in the limbs.
superiors to drag their body, crawling requires coordinating the support of the
arms and legs, ability to shift weight laterally while moving forward
and apply the appropriate force to alternate the limbs diagonally.

It is essential to provide an early experience of standing for the child with

cerebral palsy. The squat to standing activity should be practiced in
very small children, since propulsion, support, and balance are the
most important attributes of the lower limbs and in children with
movement dysfunction it is essential to practice these attributes before it
muscle shortening or atrophy due to disuse occurs.

38.2 Reduce spasticity

The objective is to prevent secondary alterations, provide well-being and

improve positions and functional movement. In preschool ages
decreasing spasticity helps prevent muscle shortening during
growth, and delay or avoid orthopedic surgery.

38.3 Preventing muscle hypoextensibility

Functional exercises:

The maintenance of the extensibility of muscles and soft tissues is

you can achieve through functional exercises that involve stretching
active and muscular activity of the hypoextensible muscles, of the flexors
as extensions at an appropriate length for the function.

The transition from lying down to sitting involves an elongation of the muscles.
oblique, therefore, exercising this change may mean that the child learns to
maintain the extensibility of the muscles necessary for change to be
appropriate and learn to use the body segments that are involved in
this change.

128
Use different materials of different sizes, such as balls or rollers, to
practice various balance exercises in a seated position or to facilitate the
transactions of postures. The exercises and the practice of functional activities
They also need to be designed to encourage the child to apply force.
appropriate muscular.

Proper placement or postural control:

It usually allows for more effective motor activity and avoids changes in length in
the soft tissues associated with misaligned postures. It will be necessary to provide
postural changes throughout the day through positions that help minimize
the shortening of a muscle and maximizing the benefits of a movement
well directed using a bipedal device, a molded pelvic seat, orthotics
dynamic or diverse options of adapted material for postural control.

Passive muscle stretching:

The usefulness of these passive maneuvers is difficult to assess, as children

they also simultaneously carry out active exercises, control programs
postural, etc. However, passive muscle stretching is often a
usual practice to prevent the hypoextensibility of the spastic muscle.

Prolonged stretching:

The effects of prolonged stretching programs have been studied.

by Tardieu (1988). According to his studies, a equine contracture can be
avoid if the plantar flexor muscles are stretched below the threshold
minimum stretching, (length at which the muscle starts to resist the
stretching) for at least 6 hours a day. Lespargot and collaborators (1999)
they suggest that physiotherapy, along with moderate stretching for about 6 hours
daily, prevents muscle contraction but does not prevent tendon shortening.

Nighttime anti-equinus splints may have some effect in prevention of

muscle hyperextensibility in relation to bone growth and splints in extension
to avoid popliteal shortening of the knee, they are also usually applied as
postural control guideline.

Serial splints:

The serial splints over a period of 3 weeks are usually effective if the
hiperextensibility is due to a lack of muscular balance between the triceps

129
sural and the dorsiflexor muscles, but only if the primary dysfunction is a delay
of muscle growth in response to bone growth.

Serial splints are also used on the hamstrings and in the flexors of
elbow.

Dynamic orthoses:

In the lower extremities, they are used to prevent hypoextension of

the muscles of the foot and ankle, to prevent or delay contractures and deformities,
provide correct joint alignment, allow selecting the restriction
from the movement that interferes with the most fundamental step, protect the muscles
weak, facilitate function and protect tissues after surgery.

In a child, it is important not to forget that the foot is the last organ in a chain.
kinetics in formation, function, and information because of the quality of support
planting can often determine the effectiveness of the gesture, the
postural compensations, motor deficiencies, the quality of the
postural information and the possible organization of movement.

The articulated orthoses with a stop for plantar flexion offer the possibility of
that the child uses the available degrees of dorsal flexion and allows for a
tricep stretch during active movement or in the changes of
position.

Electrical stimulation:

Los objetivos de este método son reducir la espasticidad, aumentar la

muscle contractibility, increase the range of joint movement,
providing sensory and proprioceptive knowledge and improving activities
functional.

This stimulation is also used in upper limbs to help

increase strength and coordination, and for that, it is necessary to assess the effects that
it can have in the child's manual activity.

38.4 Transition from sitting to standing

The development of standing up is not only essential for walking but also for
independent behavior in other activities of human beings. The fact that
Getting up requires the ability to extend the joints of the limbs.
lower limbs on a fixed support base (the feet).

130
Propulsion, support, and balance are the most important attributes of the
lower limbs. The action of extending and supporting the body is a part of
the multiple activities of daily life. The practice of extending the limbs
Inferior from the squatting position is a movement pattern.
apparently innate that, if not exercised in early childhood, can be
to lose. The lack of practice of this movement pattern is associated with
shortening of the posterior leg muscles and knee flexors
and hip.

The proper position of the feet, which should be in contact with the ground, already
that if they are not and the child starts the activity in plantar flexion, the activity of
the quadriceps will extend the thigh back.

The knees should be directed forward to ensure sufficient

dorsiflexion of the ankles until the thighs lift off the chair so that the
body mass remains centered above the support base and the knees
do not extend until the end of the movement.

The shoulders and head should move forward in the direction of the
knees.

The way the activity is carried out will depend on the child's age and their level.
of collaboration and of his alert status. If the child has difficulties in the
extensor muscle activity, the movement can be stopped at various points of
the extension phase. To help you develop control of this propulsion,
you can also stop the movement at a certain moment of the
extension, changing the eccentric activity to concentric.

For propulsion, the extension of the legs is maintained by force.

eccentricity of the plantarflexor muscles that contribute to stability of the
knee and ankle.

To move from standing to sitting, eccentric force is generated by the muscles.

dorsal flexors. This activity is crucial for children predisposed to
tricep shortening because it helps to generate adequate strength in some
muscles that tend to generate forces opposite to this functional demand,
since they are spasmodic.

38.5 Reduce functional limitations

Children with cerebral palsy are more capable of understanding and performing
concrete perceptual-motor activities with functional consequences that the
abstract activities. There are many children with cerebral palsy who do not have
an adequate cognitive level or exhibit behavioral alterations; therefore,
The activities must be adapted to their level of behavior and understanding.

131
The activities designed to keep the child motivated and able to
generalizing to other situations are those that may influence their limitations
functional. Thus, the exercises should be integrated for movements
functional.

If the goal is:

The change of position, the child should incorporate it, for example, when
wants to change position in bed.
Increase the strength and coordination of the upper extremities, the child
must incorporate it into their manual activities when reaching and
grabbing objects using shoulder flexion and elbow extension.
Improve balance in standing, the child should maintain the
balance without support.
Improve coordination between the trunk and the lower limbs, the
The child should get up without the help of a chair.
Increase the variety of movements in the trunk, the child should use the
trunk rotation when flipping on the ground and maintaining a pelvis
stable in a sitting position while rotating the trunk to reach objects that
they are by your side.
Improve the protection reactions, the child should use their hands.
as protection in falls and with arms extended.
The independent walking with a posterior walker, the child should
use the walker in its natural environment, home or school.
The exercises aimed at increasing the skill of the activities
functional involve feedforward mechanisms (development of preparations
postures that are learned through the practice of trial and error.

Feedforward is a vital part of functional movement, it involves a

organization of the movement and incorporates different constructions of memory,
scheme and motor program, taking into account that the control of movement
it also involves a cognitive process. The facilitation of movement that it does
a physiotherapist is useful for providing sensory and proprioceptive feedback, and
It is a necessary source of information in physiotherapy practice.

38.6 Load programs in standing position

The standers are used to reduce or avoid secondary alterations.

maintaining the extensibility of the lower limbs, to maintain or
to increase bone mineral density and to promote development
adequate musculoskeletal. The material adapted for bipedalism must
provide a correct anatomical alignment of the trunk and the limbs
inferior. They begin at one year of age, when the child is not able to hold their
body against gravity.

132
Ventral plane:

The ventral plane is often used for children who cannot maintain the
vertical posture in bipedal stance. To do this, the child is placed in a prone position.
with fixation in the trunk, pelvis, and limbs.

Normally, the ventral plane is used in children with neck hyperextension,

retraction of scapulae, trunk asymmetry, lack of muscle balance or
difficulties in aligning the head and torso against
gravity. Generally, the ventral planes incorporate tables for the
the child can play while standing, an aspect that helps him
organize your oculomotor control while maintaining proper alignment
musculoskeletal in the different parts of the body.

Supine bipedal trainer:

It is an alternative to the ventral plane and also allows for adjusting the inclination.
this type of bipedal walker allows the child to perceive the environment and interact with it from
an upright posture. It is important to assess possible compensations that may
make the child use the supine bipedal walker, like kyphosis with prostration of
head or hyperextension of the cervical spine with asymmetry secondary to the
lack of balance and muscle control.

Standing:

The use of standing allows loading 80 to 100% on the limbs.

lower. It is generally used in children who are able to control the
head and trunk against gravity, but with control of the pelvis and the
lower extremities insufficient to be able to maintain a
static bipedalism. It can be used as a therapeutic tool to
prepare ambulation, promote symmetry and musculoskeletal alignment
in verticality, promote acetabular development and growth, and maintain the
flexibility and muscle balance while exercising the Mini standing.

Mini standing:

The mini standing is a variety of standing, in which the support only reaches
up to below the knees. It is designed for children who can maintain
the verticality but are unable to utilize the different muscular synergies
that serve the maintenance of balance and is also useful for those

133
children who cannot control the limits of sufficient stability to
maintain a dynamic bipedal stance and are unable to develop responses
anticipatory postures with their own voluntary movements. It is
especially useful in children with vestibular dysfunction and ataxia.

38.7 Assist mobility

Walkers are mobility aids that provide stability for the

walking. Young children who have a slight delay in acquiring the
Independent march is possible to help you in this process for a period.
short time, using a wooden walker with the ability to brake the
wheels if the child tends to hold on too tightly. For children with
greater difficulties, there are two types of walkers that the physiotherapist
can you recommend:

The walker in front: the child positions themselves in front of it. It is often observed
that the child flexes the hip and torso as he pushes the walker.

The rear walker: the child positions himself in front of it and holds on.
laterally with the hands.

Both types of walkers offer stability, but it has been proven that there is
significant differences between them regarding postural alignment:

With the previous walker, the body's forward movement causes the line
from gravity falls earlier, which does not favor alignment.

The posterior walker allows the child a more upright posture during walking.
The characteristics of the step improve, stability increases, and interaction occurs.
more easily with the environment. The child maintains better alignment of the
vertical posture of the trunk over the feet, and the walker facilitates better the
ability to generate the previous movement, since the line of gravity
it facilitates movement with weight shifting and reduces energy expenditure.

The use of canes allows for gradually reducing reliance on the use of a cane.
the guideline to reduce the pace to a cane is usually dictated by the child as they go
strengthening their security, symmetry, and balance in walking.

The adapted tricycle can be recommended for the child to learn to generate
disassociated force in the legs while advancing. It is necessary to ensure that the
pedals are firmly secured to the feet with a strap and in some
Children require additional support for the torso.

The ability to move helps improve cognitive capacity, encourages

interaction with the environment and improves visual and auditory orientation. Children with

134
important physical limitations are considered to start being used
mobility aids from 17 months onwards.

ANNEXES

Physical therapy helps children with cerebral palsy

[Link]
3/physiotherapy/help/children/cerebral/palsy/914DD24C-EDC3-6566-
D5E660D623434D23

Physiotherapists demand to be part of the Guidance Teams.

Educational of the schools

[Link]

135
 39
Method
POHL

39.1 Introduction

Try to make the brain aware of the movements that the muscles perform and
joints. It is achieved with active (even passive) mobilizations to
beginning of a proximal muscle, then the movement increases
distally until the entire limb is included. It begins with a
first phase of relaxation so that the brain has little information from its
muscles and joints, thus in the second phase contractions are performed and
information reaches the brain more easily.

39.2 What does it consist of?

In this method, the steps in the general treatment plan include the
muscle awareness, muscle function, and coordination, starting from the
three following principles:

1. Achieve muscle relaxation.

2. Teach voluntary muscular control.

3. Build a development pattern.

After relaxation, the patient is alerted to the movement by waking them up.
through the therapist's contacts. He performs three mobilizations and then
The patient is encouraged to make a conscious effort while the therapist guides.
the movement.

The subsequent active efforts are made by the patient. The treatment
develop a certain sequence of evolutions: rotate, elevate the body (over the

136
four members), crawl, stay on your knees, walk on your knees,
bipedestation and walking.

Control of a single joint is obtained before other joints are included.

joints, until finally, the entire body intervenes in the
movement pattern.

When the child has acquired the ability to follow the first two stages.
of the treatment, occupational therapy may be prescribed to assist with the
third phase providing a new incentive.

The dominant hand will be established as soon as possible and the

activities will then begin with her. The less skilled hand will be
trained for assistance. Relaxation will be achieved before starting any
activity maintaining itself throughout it as much as possible.

Straight-backed chairs are used to help achieve a good

posture, which will be sought in all activities. The movements are
they will graduate from the simplest to the most complex, using one hand first,
after the coordination with both and finally all the limbs.

Depending on the patient's age and the required movement, activities can
classify as:

Imaginative: sand, water, phone.

Imitative: house care (cooking).

Games: ball.

Music: tambourine, drum.

Craftsmanship: carpentry, hammer, and sewing.

In all activities, the aim will be to increase muscle control and the
extremities.

137
 40
Method
COLLIS

Use all possible types of external stimuli. They are provided to the brain.
massive information (tactile, auditory, visual) for it to organize.
This is how a motor scheme appropriate to the child's age is acquired by instructing the
parents so that they also carry it out.

Collis tends to consider neuronal activity as a whole, stating that

existence of a combined disorder due to mental development alteration, the
postural reflexes and muscle tone. Look for them from the earliest ages,
a postural security that serves as a base for muscular coordination.

The essential basis of therapeutic efficacy would be the child's mental capacity and,
the second factor, diagnostic accuracy. It resembles the Pohl method, to the
consider that the use of orthopedic devices is completely
counterproductive for interfering with the learning of balance and function
engine.

138
 41
Method
PHELPS

41.1 Background

Wintrop Morgan Phelps, orthopedic surgeon from Baltimore, medical director of

Children's Rehabilitation Institute, Cockeysville, Maryland.

The Phelps method:

Therapeutic progress is assessed in terms of functional improvement of the

individual muscles.

Abbott points out that the physical therapist and the occupational therapist work in
close collaboration.

41.2 Basis of the method

The treatment method aims to educate the motor system to execute the
activities in a correct order, so that the combined movements
practiced for Activities of Daily Living at Home can be
eventually taught.

A total of 15 modalities are used.

41.3 The 15 modalities of Treatment

1. Massage

2. Passive mobilization

139
3. Active-assisted mobilization

4. Resisted mobilization

5. Conditioned movements

6. Active Mobilization

7. Confusing or synergistic movements

8. Combined movements.

9. Rest

10. Relaxation

11. Movement starting from relaxation

12. Balance

13. Reciprocal movements

14. Reach, take, hold, and release objects

15. Skill.

140
 42
Method
TEMPLE FAY

This method studies the origins of human movement, its evolution to

throughout time until the current human form, observing how certain
producer reflections of movement schemes in amphibians, reptiles and
mammals remain to a certain degree in man.

The most advanced movement patterns correspond to higher levels.

of nervous system development in animals, while in humans
skills and knowledge are above the level of the
basal ganglia, as well as coordination, regulation, and movements
associates come from lower levels.

On the PC, it may be possible to use certain reflex responses to obtain

movement schemes.

Temple Fay indicates that the established therapy for brain injuries is
it refers to both integrative reflexes and movement schemes as well as muscles
individuals or muscle groups. In some cases, the cortical areas
Remnants can be stimulated to assist motor patterns.

The method, on the other hand, uses pathological and normal reflexes in such a way that
these reflexes can be inhibited. Similarly, the positions and the movements
from the neck and the extremities that cause muscle hypertonia can be used
as relaxants. It also uses posture, proprioception, and stimuli
peripherals.

As Temple Fay states, 'we can use the neck reflex as a guide of
assistance, turning the head to one side with the limbs
advancing homolaterals, so that the thumb approaches the mouth with the
patient in prone position, then initiating, passively, a series of

141
movements of the advanced limbs downwards and backwards, while the
the head turns towards the advanced extremities on the opposite side.
Alternating these patterns while turning the head at the right time,
we can induce a type of movement similar to that of the amphibian with assistance
or the patient's denial." "The continuous practice of this scheme facilitates, in many
cases of spontaneous form, the type of upper movement found in the
reptiles.

In prone position, the tonic neck reflex after turning the head can
respond with an extension movement and, when the arm is lowered and
the hand placed on the back creates a position of inhibition. The mirrors
they can be used to enhance visual aid when stimulating the child for the
employment of their hands. Sometimes the action of two therapists is necessary. The
the combination of the physiotherapist and the occupational therapist improves the results
of the treatment.

To relax the approach muscle spasm, the Marie reflex is used.

Fox (withdrawal reflex) after obtaining a good position of the child.

The proper posture and the development of movement close to the ground as
it is possible (a slippery surface can be used), as well as the use
of sand and water, are effective for increasing stimuli.

Temple Fay considers the absolute freedom of the limbs to be very important.
superiors, so that there is no restriction on any movement.

In adults, a wide thoracic corset can be used suspended from a trolley.

aircraft that will serve as support and assistance during the march.

The results obtained depend in part on the level of the injury, so that
the spastic with cerebral surface involvement can be taught to
develop the movement patterns of amphibian and reptile types. The true
Atactic with mesencephalon involvement will be unable to develop the scheme.
reptilian (crossed heterolateral), but will indeed develop the amphibian. The ataxic can
being helped to form a better foundation for posture and balance through the
pattern learning and reflex inhibition.

The therapy of the "movement patterns" aims to develop certain

basic reflexes and semi-automatic organized neuromuscular responses
so that skills or abilities can be built upon them
superior and unique to the human species.

Physical treatment cannot be separated from the needs and satisfactions of

sick. Meanwhile, the treatment is aimed at achieving movement,
this acquisition, even if it is slight, will bring great satisfaction to
patient. The functional needs of life for nutrition, the

142
dressing up and the skills will also be taken into consideration and will be
taught.

Temple Fay does not lose sight of the instincts shown by man in the
past and in the present, which express as survival, reproduction
and conquest.

Safety, creativity, physical stimulation, and economic uplift

they will help the patient achieve the best in their scale of life and satisfy their
basic needs.

The method is completed with the inhalation of mixtures of carbon dioxide.

(20%) and oxygen (80%), when there is rigidity with dystonic manifestations.
Reflexes are also used as forms of muscle exercise (the reflex
Patellar stimulated by percussion is used to strengthen the quadriceps.

42.1 Contact

[Link]

institutosfay@[Link]

143
 43
Method of
DEAVER

This therapeutic method primarily aims to achieve four objectives that

considers keys in rehabilitation:

1. functional use of the hands.

2. Maximum acquisition of an appropriate language.

3. Ability to make movements.

4. To achieve a normal appearance or to be normal.

Before applying the method, a prior study of all activities is carried out.
that the child is able to execute, while also maintaining a meticulous balance of the
muscular situation. Then the intention will be to make the child physically so
independent as it corresponds to their mental and chronological age, type of injury,
affected parts and severity of the process.

The exercises will be set to maintain maximum joint mobility and

prepare the child in the execution of voluntary coordinated movements the most
essential in daily life. Spasticity is fought with stretching
liabilities that at the same time prevent contractures and deformities using the
orthopedic correction that is required at the expense of splints and devices. For the
the maximum function of the hands, a progressive teaching of is carried out.
reaching, grabbing, jumping, and placing objects. Training begins with the
larger and simpler joints, before reaching the teaching of the
joints, finer and more discriminative. Considers the use of
orthopedic devices that allow only the execution of two movements
essentials nullifying all the rest.

144
The ability to make movements depends on freedom of
movements of the joints, the trunk, and the lower limbs, as well
like the reciprocal movements. At first, the patient will be taught to
moving in a wheelchair. Later, and with the help of devices
orthopedic, he will be trained in reciprocal movements, balance, the
steps, the turns, the elevations and the descents, etc. The devices
orthopedic will initially be very comprehensive with blocks that annul all the
movements, except for the flexion-extension of the thigh, immobilizing the foot in
90º position. The march will be carried out on the parallel bars with the help of
physiotherapist, then gradually unlocking the different
joints, while parts of the orthopedic device are being suppressed.

A normal appearance is achieved by avoiding contractures and deformities, hygiene

complete, suitable outfits, etc. Patients with PC often maintain
excessive salivation for not swallowing saliva, making it advisable to develop
training sessions to decrease the index of external salivation.
20-minute sessions consist of light stimulations on the midline
from the lips, maintaining pressure around them with stretches,
taps applied to both sides of the larynx, downwards and activities of
sucking

Deaver insists above all on the teachings of daily life.

145
 44
Method
RED
Brushing Technique

44.1 Introduction

Created by Rood, it consists of providing proprioceptive stimuli to establish

most normal motor behavior modalities. It consists, for example, of
pass a brush or the finger on the child's palate. Through stimulation
of the cutaneous receptors of pain, pressure, and temperature located in
Certain reflex zones activate the underlying muscle contraction,
simultaneously carrying out an inhibition of the corresponding
antagonists, facilitating the motor response.

44.2 What does it consist of?

Rood has developed a treatment method based on stimulation of

the cutaneous and musculotendinous receptors for the activation of the
muscle responses both in contraction and in relaxation.

The skin receptors are stimulated by light taps,

brushing or by applying ice to lower the threshold of
the muscular response and produce a reciprocal inhibition between agonists and
antagonists.

Proprioceptive nerve endings are stimulated by stretches or

pressures.

146
Tremblay et al. develop, following these ideas, extended sessions of
muscle stretching, especially in the calf muscle, keeping the child in
the inclined plane for 30 minutes with the foot in dorsiflexion, achieving
you manifest relaxations for a later passive mobilization.

The therapeutic program follows a normal developmental sequence and is based on

the mix and interaction of phasic muscle activity for movement and the
mobility responses with tonic muscle groups to produce
postures and positions. Functional activities are not stimulated until the
treatment of the different body parts indicates that they are
in conditions. The stretching of the contracted parts will be replaced by the
stimulation of the antagonist groups.

147
 45
Method
CASTILLO-MORALES

Dr. Castillo Morales began working with individuals with disorders.

neurological in 1959, in Argentina.

His theory is inspired by philosophy, anthropology, and medical sciences.

neurological. It also takes aspects from Bobath, Vojta, and others. Part of the
the individuality of each individual, and therefore is in favor of the combination of
different methods, depending on the characteristics of each one. According to him, it
it should address disability from what the child can do, leaving aside
what it is not capable of doing, that is, part of a functional assessment.

Their methodology consists of stimulating, through contact, the vibration,

pressure and the sliding of the hands, determined points with massages.

His concepts are two:

Neuromotor development therapy: Through contact, vibration, the

pressure and the sliding of the therapist's hands over the different
stimulation zones of the patient, the skin receptors are activated,
muscular and joint tissue.
The orofacial regulation therapy: It is a treatment concept
Sensory-motor. Dr. Castillo Morales began this technique with children with
Down syndrome, to then apply it to other disorders. This therapy does not
it only improves motor activities, since by improving the motor aspect,
the capacity for perception and communication of a
patient with their environment. It is not a language therapy, but it facilitates
the articulation of the different phonemes. It also positively influences
suction, chewing, feeding, etc.
It is a therapy that primarily stimulates at a sensory level, aimed at
mainly to children with sensory, motor and cognitive disabilities, it is
to say, multideficiencies. However, certain therapies, such as orofacial,

148
it can be beneficial for children with Down syndrome, as they are stimulated
the muscles of the face and mouth.

It is used more and better in hypotonic PCs.

It is based on the stimulation of motor points, where we achieve a

series of motor acts in the child such as standing up, walking, etc. It can
start early, even before 3 years old; comes from a position
facilitator that enables a correct action. The points that mainly are
they stimulate the deltoid, pectoral, bicipital, xiphoid process, adductors and the
big toe

Exercises are carried out in several phases:

Flipping exercises

Crawling exercises

Preparation for crawling.

Quadruped position exercises

Straightening: stimulation of the pectoral point

Sedentary: motor points of the back

Standing up

March: stimulation of the calcaneal motor point

149
 46
Method
GUY-BÉRARD

This method is indicated for some cases of cerebral palsy, not all.

46.1 Background

Guy Berard, a French surgeon and otolaryngologist, invented a long time ago
forty years the auditory reeducation therapy that bears his name.

It is a method that, through listening to adapted music, has the

objective of improving the quality of our hearing.

It is proven that the way we hear determines our state of

mood, our behavior and other important factors such as capacity
of attention...

Despite being a therapy not yet validated by medicine and, in general,

unknown to most professionals of the
otolaryngology, there are numerous studies and publications that support the
benefits of this technique.

Based on his experience with patients over the years, Berard came to
various conclusions: that many of the students with poor performance
they have deficiencies in their auditory quality; that most autistic children
they suffer from hyperacusis that in many cases can become painful;
that almost all depressive children and adults show a pattern
common in their audiogram... These conclusions give an idea of the importance
of the effect of hearing on our behavior and how we feel,
we relate and function in our daily tasks. Dr. Berard
made many more discoveries and devised auditory re-education therapy, which

150
just as if it were an ear gymnastic, it improves many of the
mentioned problems.

46.2 What does it consist of?

The treatment is simple and is done in ten days, with two daily sessions of
half an hour each. During these sessions, the patient listens to music
whose frequencies have been filtered to meet their needs
concrete. To determine the objectives to be achieved with the treatment, it is necessary to
carry out an audiometry that reflects the exact conditions of
the patient's hearing and what the possibilities of improvement are with re-education.
On the fifth day of therapy, an audiometry will be performed again to observe the
changes and the convenience of readapting the modulation of the music for a
greater effectiveness of the treatment. A third audiometry will be done at the end of the
tenth day to check the results. But these will not be final,
since the effect of reeducation will continue to produce changes over time
from the following six months, after which the last of the
auditory tests.

The minimum age at which auditory reeducation can be applied is three.

years, although Bérard advises that one should wait until four or five.
As for the maximum age, there is no limit, and it is a treatment we could
to benefit us all.

151
 47
Treatment
of LOGOPEDIA

When there are problems with communication, swallowing, and drooling,

people with PC should receive speech therapy. These treatments stimulate the
conserved abilities and pursue the development of new skills for
achieve a speech that is as intelligible as possible.

The speech therapist develops and implements the rehabilitation program, following the
therapeutic guidelines marked by the speech therapist, who is the professional
diagnoses speech problems. The speech therapist also
adviser on the use of technical aids that enhance communication,
like computers with voice synthesizers. The speech therapist also teaches
exercises to control drooling.

152
47.1 Objectives

Reduce the factors that obstruct communication and/or swallowing. Posture

inadequate, poor dentition, emotional and behavioral disturbances, etc.

Improve the impaired functions (communication, drooling, and/or swallowing). For

To achieve this objective, techniques that consist of repetition are often used.
task systematics.

Stimulating residual functions. This objective is based on the principle of

neuroplasticity, according to which the functions that are preserved serve to
replace and support those that are deteriorated.

To achieve these goals, speech therapy often includes the following techniques:

Total relaxation or of different body areas. Some relaxation techniques.

they are not suitable for people with PC, because they increase their level of
anxiety and/or emotional tension.

Breathing exercises in different positions (lying down, sitting), until

learn the diaphragmatic breathing that improves inspiration and
expiration of air, increasing lung capacity.

Muscle training of the stomatognathic system and associated organs.

Vocal training, which teaches the person to phonate (produce voice, speak)
correctly, coordinating the breathing and movements of the system
buccopharyngeal and avoiding the use of unnecessary muscles and guidelines
incorrect.

ANNEXES

Speech Therapy: The Importance of Speech

[Link]
importance of speech

New technologies allow people with paralysis to communicate.

cerebral

[Link]

153
 48
Therapy
OCCUPATIONAL

For an activity to be understood as therapeutic, it must meet a

series of characteristics, the most important being:

to be directed towards a goal

to have a useful meaning for the user

be a suitable tool for the prevention of dysfunction, the

maintenance or improvement of function, skill, and quality of life.

specify the user's participation in vital tasks

to be gradable and adaptable

to be determined by the professional criteria of the Occupational Therapist,

who will base themselves on their knowledge of the pathology in question,
the specific indications of the treating physician, the relationships
interpersonal and the specific value of the indicated activity.

Its purpose is the development of the skills necessary to manage oneself.

with autonomy in daily life (dressing, eating, using the bathroom, etc.). The therapist
occupational also provides advice on technical aids
specific to compensate for the difficulties in carrying out the different
activities (for example, the most suitable computer when you cannot write
with a pen or a pencil), teaching him to use them optimally.
tools.

154
 49
Therapy
Conductive Education

49.1 Introduction

It is a learning system specifically designed for rehabilitation

people with neurological disorders, such as cerebral palsy. It is based on
the interaction of the educator and the student, under certain circumstances of
learning and considering his age. The treatment can
to be given individually or in groups of people of ages
homogeneous. It comprehensively addresses movement disorders, the
learning problems, cognitive skills and communication. Teaches
help children with cerebral palsy to achieve what they want and to accomplish the
necessary motivation to reach your goals.

49.2 Main objectives

Learn how to lead a normalized way of life.

Build a new operating method: that learns to walk,

attend school, go to work.

Stimulate the development of personality.

Develop cognitive functions.

Develop an educational program that can be adapted to the

characteristics of regular schools and those of special education.

155
 50
Therapies
ARTISTIC: dance, theater, etc.

There are a number of institutions that use different artistic disciplines with
therapeutic purposes. These therapies conceive treatment in a way
integral, working on the physical, psychological, social, and artistic aspects of the
person. The playful and creative component of this type of therapy contributes to
aumentar la autoestima.

50.1 Example of artistic therapy: DANCE ABILITY METHOD

50.1.1 Background

Dance Ability is a unique dance methodology founded in 1987 by Alito.

Alessi and Karen Nelson. Dance Ability uses improvised dance to promote
the artistic expression and its exploration among people with and without
disabilities.

Through the experimentation of movements, the misunderstandings or prejudices

that people with or without disabilities can have of themselves are
extracted. The dance skill courses provide an atmosphere that
helps to change attitudes, in addition to helping people in the
learning through beauty and enjoying communication through it
of the movement.

156
50.1.2 Objectives

The fundamental objectives are:

develop a work process where people with or without
disabilities and people from diverse cultures can come together to
artistic exploration and community building;
help to explore and eliminate misconceptions and prejudices among people
with or without disabilities;
cultivating cultural and artistic diversity through the practice of dance,
communication, and education; and
promote the evolution and realization of the New Dance.

The purpose of Dance Ability is to cultivate a common awareness of

creative expression for all people. The material is extracted from the group.
present and the situations that arise do not exclude anyone. The method
supports training and personal value through ways in which everyone and
each one can participate and openly express their creative ideas
respecting the limits of others. The foundation of Dance Ability teaching,
it is the follow-up of the interests and personal energies of each person to
apply them for the benefit of their own community.

Dance Ability International continues with its vision of using art as a

means to change preconceived ideas about disabilities through
of shows, workshops, educational programs, teacher training and
choreographies in the United States and around the world.

50.1.3 Contact

There are teachers and Dance Ability groups in Germany, Austria, Cyprus, Croatia,
Finland, Greece, Holland, Italy, and Switzerland. Courses are expected to be conducted for
certified Dance Ability teachers in Spain.

Information: [Link]

157
ANNEXES

Tango is being used to treat several diseases.

[Link]
The tango is being used to treat various diseases

A festival advocates cinema as therapy through 50 short films.

videoclips

[Link]
therapy-cross-50-shorts-videoclips/[Link]

158
 51
Method
JACOBSON

The practice of relaxation has been known since ancient times associated with
therapy or meditation. However, it is not until well into the 20th century
when it starts to be considered as a measure against stress and
as treatment for some psychosomatic diseases.

One of the most widely disseminated methods and of great application in different fields is
the one from Dr. Jacobson.

Edmund Jacobson was a professor of physiology at the University of Chicago.

In 1934, he developed a physiological method aimed at combating tension.
muscular and emotional anxiety, situations that he saw as very related
between them. He verified that stress caused muscle tension, and at the same time
it generated anxiety reactions in the patients. This turned into a
vicious circle and there was a need for external help to break that dynamic.
His studies started in the early decades of the 20th century concluded that the
tension caused a shortening of the muscle fibers making it difficult or
making it impossible for the individual to carry out a large number of activities that included
the most routine, mechanical, and necessary movements for the person.

According to his hypothesis, if the person is helped to relax the tense muscles,
both anxiety and psychological distress resulting from them may
disappear.

Jacobson concluded and postulated that contracting and distending the muscles of
systematically and rhythmically the muscles primarily involved in the
tension was going to improve their condition and, in turn, also improving those
muscles that were in better condition, the person could
acquire and recover an optimal physical and muscular state and a psychological state
harmonic.

159
It has been shown that after conducting relaxation training
progressively there is a drop in pulse, blood pressure, and in
respiratory frequency that gradually leads each person to achieve
the best state of relaxation.

The practice of this method consists of the alternation of contraction and

relaxation. It is important to follow an order and do it symmetrically. The
The classic route is as follows: fist, arm, neck, chest, abdomen, legs, feet.
and face. The procedure consists of pulling tightly, maintaining that position
a few seconds and then relax as much as possible.

Once this simple practice is mastered, one can move on to a phase of

improvement that consists of recognizing the sensations that provoke the
contraction and relaxation. Simultaneously contract muscle A and the
muscle B relaxation. Detect the muscle tensions associated with
emotional disorders.

The most advisable position for practicing relaxation at the beginning

it is supine position, since all the joints are kept in position
anatomical and the chest and abdominal area are free to carry out
a breath is not taken freely and in a lateral position the load is directed to
a hemi-body, therefore, there is no symmetry.

160
 52
Method
PERFECT

Cognitive Therapeutic Exercise, commonly known as 'Method

Perfetti is a rehabilitation method that originated in Italy in the early
70s under the direction of neurologist Carlo Perfetti and his collaborators. This type
rehabilitation has evolved to our days in parallel with the
interpretation and application of studies that contribute to the different
neurosciences.

Cognitive Therapeutic exercise recovers deficient functions.

integrated and personalized taking into account the issues presented by each
Patient. Movement is not considered merely as a simple muscle contraction.
but as the result of a much more complex activation that originates in the
brain.

For this reason, the treatment is not directed solely at the muscle (reinforcement
muscular) but takes into account how movement is organized at the level
cerebral. Therefore, to recover movement it is necessary to activate the
cognitive processes responsible for that organization.

These processes are perception, attention, memory, language,

motor image, reasoning, etc.

It is said that, normally, spasticity is treated as a single disorder, and with

modest results.

The components are encompassed under the concept of Motor Specific, and they are
following:

Excessive reaction to stretching (in relation to speed and the

importance of stretching.

161
Pathological irradiation.

Elementary schemes (gross motility of the patient, with components

synergistic and more appreciable in the root of the members.

Motor recruitment deficit: difficulty in activating an adequate number of

sufficient motor units for the execution of evolved motor tasks.

Cada componente individualizado puede ser tratado de forma específica por

by means of:

First grade exercises.

The patient learns to relax by paying attention to perceptual hypotheses.

proposals. The patient is not required to contract their muscles. These are exercises for
control the exaggerated response to stretching.

Second grade exercises.

The patient begins to progressively and guidedly recruit motor units.

with what there is already muscle activity and movement does not develop
passively. They are exercises for the control of irradiations and the schemes
elementary.

Third grade exercises.

The patient performs the exercises even more actively.

162
 53
Electrotherapy

Functional Electrical Stimulation (FES): It involves electrostimulation, by

medium of low-frequency excitomotor currents with pulse trains
exponential rectangles, of muscles without central nervous control for
achieve its contractile activity with a functional objective. Its has been demonstrated.
effectiveness in the treatment of motor reprogramming. Kern applied FES to 10
spastic paraplegics for 8 months: not only did the hypertonia decrease, but
which improved muscle perfusion and trophism and increased the presence of
aerobic and anaerobic enzymes.

Neuromuscular electrostimulation: There are various modalities, such as the

spinal electrical stimulation, either locally or directly on the
affected muscle.

T.E.N.S: There are studies that reveal effectiveness in 90% of cases, Potisk and
Gregory proposes an application protocol along the nerve, with
frequency of 100 Hz and 20 minutes of application, Levin proposes applications
longer (30-45 minutes), for periods of about 3 weeks.

Chronic Cerebellar Stimulation (CCS): results have been obtained

functional in spastic subjects varying the voltages (from 0 to 40) and the
frequency (from 0 to 200 Hz), although the consulted works do not indicate
specifically the decrease in spasticity.

163
ANNEXES

ASPACE will incorporate an electrotherapy device with the help of Caja

Cantabria

[Link]
electrotherapy-device-help_201006091148.html

164
 54
VESTIBULAR STIMULATION

Vestibular stimulation therapy is aimed at improving the

following aspects:

Develop and perceive the position in space.

Provide reference points about your own body from

vestibular stimuli.

Associate visual, tactile, and proprioceptive experiences with movements.

of the own body.

Gentle oscillations of the spastic patient supported on a cylinder or a

Reeducation balls are usually effective in reducing hypertonia.
muscular.

165
 55
Therapy
OROFACIAL

It consists of teaching the child to control their oral zone in the best possible way.
to prevent deformities, sialorrhea and promote the movements involved in the
speak, this is directly addressed:

Feeding (food therapy). The child is taught to swallow, chew and

drinking while inhibiting abnormal patterns and establishing other correct ones. It
it aims for the child to learn to use their mouth in the most appropriate way and
activate possible.

Sialorrhea. Escape of saliva from the mouth.

Expressive means

With children who have communicative intent, the aim is to progress in the
language comprehension and provide them with a means of expression (oral, gestural,
graph or combined.

If the child has the possibility to express themselves orally, we work on:

General relaxation in order to better control your phonation.

The breath.

The phonation.

Children who lack any control over their oral area are introduced to a
alternative communication system. With this procedure, we are not negating the
oral route, but rather to encourage their communicative attempts and give them from the first
moment a valid and functional method of expression.

166
All expressive resources he has will be utilized, movements, gestures,
etc., and all vocal productions will be reinforced: laughter, screams, coughs, etc.
that can be used as call signals.

Gestures

We addressed the child using not only words but also natural gestures.
bimodal language gestures (meaningful gestures that accompany the word and
maintains the same syntactic structure as spoken language). The gesture is
something less abstract than the word, and the child understands it much earlier.
Another part, the use of gestures helps to understand, discriminate, and memorize the
word, especially those that sound similar (homophones) since
these children due to auditory perception problems, hearing loss, disorders
of articulation and lack of personal vocal experiences, they have difficulty in
discriminate words. In children with some motor possibility, it can become
in their medium of expression.

To children with severe motor impairments, who have limited

visual resources to access a graphic system, they are taught to use
any minimal movement controlled for communicative purposes: to take out the
a tongue to say no, closing the eyes when thirsty, lowering the head
to say yes, to wrinkle the nose when hungry, etc.

Graphic systems.

A child eager to communicate and who understands images is ready.

to start in a graphic system. The choice of the system will depend on
its cognitive development and visual acuity. We always tend, as is natural, to
that the child learns to communicate in a reading and writing manner. It should be valued.
also their motor skills, because it is important that they use them in the way
as autonomous as possible and that is located in a space that he encompasses.

There are a series of standardized systems based on symbols.

graphics that represent from concrete objects to abstract concepts
(Picsyms, Pic, Mosman, Rebus, P: C: S, Bliss).

The child communicates by pointing to the appropriate symbol. The method of selection is
adapts to their motor skills and can do it directly by pointing
with his hand, head, etc., in a coded manner, establishing a code for
that the interlocutor locates the symbol, or by scanning system.

167
168
 56
Method
TARDIEU

Physiotherapist from the Tardieu school (France). Their method is based on the fact that the
education and training are only possible to the extent that the areas
associated are able to function.

The method is based on the normal child, on their neuromotor reactions.

trying to provoke in the child with cerebral palsy, as soon as possible, patterns
normal neuromotor.

The French technique can be defined in these points:

Assessment of the neurological development level of the child with movement disorder
cerebral, defining in each child the pathological neurological pattern
predominant.

Factorial analysis as one of the points of assessment and motor examination in

search for: rigidities, control of reactions to external stimuli,
observation at rest and in dynamic period.

Postural maintenance examination that informs about weaknesses and

motor organization defects. Execution of mobilization maneuvers that
allow to achieve a state of complete relaxation.

Try to guide the child to go through the different levels of motor development.
essential for the acquisition of normal motor patterns, linked to
the different static reactions, straightening reactions and
balance according to the level of difficulty.

Biomechanical assessment in search of possible contractures or deformities

installed or possible to install, as well as the collection and preparation of
containment systems to help the child preserve function in the

169
daily life activities. For example, the making of the molded seat.
the pelvic corset that, based on pelvic symmetry, helps the child improve the
active control of the body without restriction of active mobility and assistance to the
prevention of hip and spine deformities. Splints to enhance
the bipedalism and maintaining the hips, with dysplastic predisposition in
correct alignment.

Functional examination of locomotion, games, hygiene, dressing, sitting down,

allowing to determine the level of autonomy in different activities

Assessment of associated disorders: vision, hearing, sensitivity, pressure.

170
 57
Method
THAT MEANS

This therapeutic method allows for positively influencing and modifying development.
motor development from the earliest age. It uses specific stimuli that
They will provoke the activation of the nervous system obtaining a maximum
functional response of the child with minimal assistance.

El método MEDEK sigue el criterio de la organización evolutiva de ―modos

neuromotor, respecting the patterns of ontogenetic development and
considering that treatment should progress gradually, without skipping
motor behavior patterns. The therapeutic intervention begins by promoting the
head control and then progressively sitting, standing and
march, and finally the free ambulation is stimulated through the
superior integrations of the balance.

With MEDEK techniques, we do not work on organs or planes of.

integration of the neuromuscular system individually or in isolation but by the
Conversely, each exercise aims to stimulate the complex interrelationship.
existing function between eyes, proprioceptive receptors, muscles, tendons,
ligaments and articular surfaces.

It is expected that the minors intervened with this system will achieve the milestones of
motor development in cephalocaudal progression, according to corrected age.

Based on the results obtained in the initial assessment, the planning is done
exercise and maneuver program required in each particular case, with two
variants:

the group of maneuvers and exercises that must be applied by the

physiotherapist.

171
 The set of therapeutic recommendations based on MEDEK that
They must be carried out by the parents at home, according to a plan.
predetermined and specific (repetition of the movements and maneuvers by
10 times, 3 times a day.

This methodology seems to have a direct relationship with the Doman technique.
Delacato.

172
 58
Curriculum
CAROLINA

The Carolina Curriculum is a method of Evaluation and Exercises for infants and
young children with special needs who operate at certain levels of
development corresponding to ages between 0 and 24 months.

It is based on the normal sequences of development but without assuming that it should
to have a more or less equal development in all fields (for example: a
a child can show normal cognitive development along with a development
very slow motor). Therefore, the program was designed so that it could be
to use as much with children with slow development, but following a normal model,
like those who suffer from multiple disabilities whose development models
they are noticeably atypical.

This program recognizes that most babies and children with limitations
graves will never be 'normal' despite all efforts from the
intervention. Therefore, when working with these children, it is necessary
teach non-normal skills, but very adaptive ones, that can
replace, temporarily or permanently, the normals, if necessary.
For example, if a child cannot speak, it would be appropriate to teach them to point or
to dominate another indicative response that allows him to choose between different
possibilities, communicate their wishes, etc.

The Evaluation Notebook is very complete; it has items from the 26 sequences.
of the Curriculum, with spaces to note the evaluations of several weeks. The
Numbers assigned to the sequences of the Curriculum have no relation.
with its importance. Each sequence represents a significant area of
development. Therefore, it is important to evaluate the children to whom it is applied
program in all sequences, except in cases where this is not
possible due to a specific limitation.

173
Within each sequence of the Curriculum, the items are numbered according to the
order in which it is supposed to be learned. It is important that a value is placed on a
enough items in each sequence to know if they have
whether or not the corresponding skills have been developed. The number has not been set.
items that must be valued; this decision must be made by the person who
make the assessment according to your criteria. As a general rule, the application of three
items above the first failure and three below the first success, in each
the sequence will provide a fairly comprehensive idea of the child's abilities.

In early intervention, the Portage guide is also used, which is a guide for
child development from 1 to 6 years old (what they do and what they don't).

[Link]

174
 59
CROMOTHERAPY or
COLOR THERAPY

This therapy is based on the therapeutic use of colors, as they

Different wavelengths of colored light stimulate different centers.
cerebral and trigger a wide variety of physical responses and
psychic at the level of the organism.

59.1 The application of colors can be done in different ways:

Decorative painting on the walls of the house.

Clothing and accessories.

Colored panels.

Lamps with filters that reflect light of different colors.

Objects of certain colors (colored stones or crystals).

59.2 Therapeutic actions of colors

Each color is attributed a different therapeutic action, whether on the

nervous system or about the different organs of the body.

175
Red
Physical activity: Stimulates the heart and the circulatory system, promotes
restoration of individuals after suffering from an illness, improves the
anemia and physical exhaustion.

Psychic action: Stimulates learning processes and facilitates relationships

with others promoting an extroverted behavior, too
it increases the willpower and constancy of the person.

Orange
Physical action: Useful in cases of nervous exhaustion and digestive disorders.

Psychic action: Increases the desire to live and joy.

Amarillo
Physical activity: Stimulates the digestive metabolism, relaxes the muscles, and relieves
the discomforts of menopause.
Psychic action: It helps overcome depression because it facilitates trust.
in oneself and reduces excessive worry in response to situations
of tension.

Green
Physical action: Stimulates the detoxification and regeneration processes of the
cells of the body, it also relaxes the muscles and relieves tired eyes.

Psychic action: Stimulates creativity and releases emotional tensions.

aggressive, also renews the desire to live.

Blue
Physical action: It exerts a relaxing and sedative effect, facilitating sleep;
it is also useful when there are throat problems.

Psychic action: Helps to relax and overcome fears and complexes.

176
Violet
Physical action: Acts as a purifier of the organism, promoting the
removal of toxins from the body, also helps to relieve the
inflammation improves cellular oxygenation.

Psychological action: Stimulates brain activity and communication between the

people.

Black
Physical action: Relieves pain and exerts a overall relaxing effect.

Psychic action: Absorbs excess energy by removing blockages and

reinforces personal stability and security.

White
Physical activity: Strengthens the immune system.

Psychic action: Stimulates a positive mood.

The secondary and tertiary colors, that is, those that are a mix of several
primary colors have the same action as the colors that compose them but
more subdued.

59.3 Treatment methods

Several methods are used as treatment, it all depends on the therapist, with
which of them feels more comfortable and at ease.

In traditional chromotherapy, the projection of colored light is used. This is

project onto the body as close as possible to the patient. The time of
exposure is not strict, so the organism uses them based on its
needs and possibilities. To create the application, a lamp is enough.
of the corresponding color or, failing that, a white light in front of which one
they interpose color filters.

Another method is Water. It is used in internal treatments. For it is

it is necessary to put a certain amount of water in a container and expose it to light
color that is determined to be no less than 8 hours.

Air is used in chromatic breathing exercises when there is a

respiratory pathology.

177
Color visualizations have the same effect as projections of
―colores físicos‖.
It consists of visualizing a color and transmitting it to the patient in the place of the
organism with problems. Exercise may be difficult for some people.
it's more difficult, it's just a matter of starting to memorize the colors. For that
it can be practiced with a colored paper, staring at it for a while
determined time and then close your eyes and remember it exactly how
es.

Especially in therapy, colors are used to apply them.

directly on the body. A well-known method is the application of rays
ultraviolet, to eliminate germs and bacteria, as well as to calm some
pain or inflammation in muscles or tendons. Currently, studies have been conducted on the
different frequencies in which colors vibrate and the effects they have when they
they are applied directly to the skin, especially at acupuncture points,
achieving calm in cases of pain, relaxing in cases of stress, optimizing in
cases of depression or sadness, activate the immune system in cases of
infection, strengthen in cases of weakness, balance emotional imbalances, and
others. Colors are very useful tools in many ways, one can
create a certain atmosphere, you can combine clothing to achieve effects, and
through therapy, help is obtained at both the physical and mental levels
emotional.

178
 60
Therapy
SPIDER

60.1 What is it?

The therapy -Spider- consists of a series of elastic cords of different

tension attached to belts at certain points of the patient's body in a
extreme and on the other to the base of the team.

This allows the therapist to work with the patient in an upright position.
independent and functional in a way that it can perform exercises in positions
which normally cannot be carried out and stimulate the muscles and parts of
body that needs strengthening and rehabilitation. Spider also allows
that a single therapist can do the work that is sometimes needed for
conducted by two or more people and that are only carried out with the patient
lying on a therapy mattress.

Working at Spider helps improve coordination, balance, and endurance.

muscular.

179
60.2 Who is it aimed at?

The SPIDER therapy helps in a wide variety of neurological conditions and

Neuromuscular, such as:

Distrofia muscular (ciertos tipos, el paciente necesita ser evaluado y la

medical history reviewed by an orthopedist.

Cerebral palsy.

Multiple Sclerosis

Spina Bifida

Agenesis of the corpus callosum or sella turcica.

Scoliosis.

Hydrocephalus.

Blind patients.

The purpose of therapy is to create the appropriate postural reflex mechanisms.

through the weakening of pathological postural patterns and by
stimulation of postural tension.

At the level of the Peripheral Nervous System, there is an integration of all the
components of motor functions:

Engine pattern

Postural system

Postural tension

These elements are inseparable, they are mutually conditioned and

integrated. They form the Mechanism of Proper Postural Reflexes.

Although diagnostic methods are constantly being developed, there are still
lack of objectivity in the correlation of the morphological damage exponents and
the clinical symptoms.

180
DIAGNOSIS

It is very important to analyze the following points to establish a diagnosis.

adequate

Assessment of postural tension paying attention to asymmetry

Evaluation of spontaneous activity in various positions.
Assessment of physiological and pathological reflex activity.
Evaluation of motor and postural patterns.

THE THERAPY

Exercises in any position

Ability to release and compress

Ability to practice asymmetric exercises

Stimulation of the sense of balance

Proprioception stimulation.

60.3 Centers

The Norman Center is located in Koszalin, [Link]

In Spain: Essentis Method in Barcelona. Contact: info@[Link]

and the phone: (+34) 637.905.867.

181
 61
Method
ABA

61.1 Background

ABA stands for Applied Behavioral Analysis.

or, indiscriminately, Behavior Modification Method. It has its origins
scientific in Thorndike, in the studies that began in 1913 about
cause and effect learning in the United States, which continued later the
Russian philosopher Ivan Pavlov, in 1927 with his famous experiments on dogs.

Another background can be found in John B. Watson and learning in children and
Burrhus Frederic Skinner, who made valuable contributions to
individual investigations on reinforcement programs in the decade of
the 50.

61.2 What does it consist of?

The modification of behaviors, Rimbland points out, was initially a rough

system, rather similar to animal training, through the system
of rewards and punishments. It has evolved over the last 25 years towards a system
highly refined and effective pedagogical.

Maurice (1996) specifies that the method is basically based on the division of
tasks that are still complex and/or abstract such as communicative language,
a series of hierarchical steps; each of which paves the way for
the next. Teaching through separate efforts, therapists and parents
they work together to create a structured environment, with
planned activities and a coherent way of learning. The child is
awarded for overcoming each small step. Gradually the children

182
they discover not only the separated portions of what is taught to them, but the
integration.

Lobas (2000) states that ABA employs methods based on principles.

behavioral scientists: children do not learn naturally
spontaneously in typical environments, as other children do.
So, they try to build socially useful behaviors by working
also to reduce the problematic ones.

Aragona (2003) has stated that every skill that the child does not have (such as
example imitate, speak, etc.) is divided into small steps. Each step is a
measurable and specific unit of the behavior that is desired to be achieved. It
always work with small objectives to achieve, to be able to reach
those of us who want the child to learn.

The enormous evolution of the ABA method, as Gare and Pear (1998) argue, has been
expanded in such a way in the developed world as its areas of
application.

The trend in behavior modification is directed towards controls.

positives of behavior, but because many professionals do wrong
use of techniques, violating the ethical and legal codes to which it has
the patient sometimes has a distorted concept of Therapy
Behavioral.

The ABA Method conducts a behavioral assessment, obtaining a

description of problematic behavior (Functional Analysis of the
Conduct. Regarding the more detailed description of that behavior, it is observed that the
possible reinforcements that cause that behavior to be repeated -consequences- that
they are in the environment. With the proper management of them, it
proceed to carry out the behavioral intervention, which will be decreasing the
frequency at which the problem behavior occurs, until it disappears by
complete. The techniques are also applied to encourage positive behaviors and
other learnings.

183
 62
Method
PROMPT

62.1 Introduction

PROMPT is a philosophy, a system, and a technique of approach developed by

Deborah Hayden in 1980 in the United States and Canada to address the
disorders in speech production.

PROMPT is a philosophy because it consists of the study of processes that

govern thought and lead to the acquisition and/or alteration in the
speech production. It is a set of general principles where the
advising and treatment are conceptualized. Moreover, it constitutes a
way to organize and study the connection between internal and external forces in
the development or alterations in speech production.

PROMPT is a system, that is, a set of facts, principles, rules,

classified in a regular and orderly manner in a logical plan that connects different
parts in a unit.

PROMPT is an approach as it constitutes a way of evaluating,

organize, conceptualize, and address the disorders in speech production. This
the approach utilizes all aspects of motor and language theory pursuing
a consistent goal.

PROMPT is an approach technique because it constitutes a method or

procedure to carry out technical and mechanical operations
necessary to create a balance in the speech motor system. It is also
considered technical because it requires highly developed skills of
practice, knowledge, observation and integration in order to achieve the
desired changes.

184
PROMPT is based on neurological, anatomical, and motor theoretical principles.
and has been used as one of the main approaches for treatment of
children with speech production disorders.

With the PROMPT system, the Therapist will touch the child around their face and
under the chin to help guide its joints to produce sounds
specific or words.

The prompts are designed to help the child become aware of: the
movement, the muscles necessary to produce the movement, the way to
produce them and the connection of the movements that are needed to produce
words and phrases.

Speech therapists can also help the patient to limit movements.

unnecessary things that make speech even more difficult.

We can say that: - the PROMPT system directly transfers the system
phonetic to the neuromuscular movements required for sequences
articulatory.

The foundations of the PROMPT system were found in a method created by

Edna Hill Youge in 1938 called Kinesthetic Motor Focus. This approach was
the first therapeutic system to use a series of tactile signals to
promote phonetic articulation.

The PROMPT system uses tactile bases to guide the mechanism.

articulatory developing multi-dimensional points that can mark several
phonetic components such as mode, manner, action, and tension of the
grupos musculares, cierre, influencias de tiempo y función de los coarticuladores
during transitive movements, accentuation and prosodic changes.

Depending on the degree of severity and the type of disorder, the prompts
they can be used strictly to give location signals, for
to favor co-articulation, to program units of words or phrases
whole, or to help in the spontaneous productions where one must go through
from one phoneme to another. The system also allows the patient to know their level
of self-monitoring and self-correction.

PROMPT has been used in fluency disorders, apraxia, dysarthria, and delays
phonological and speech disorders due to hearing loss.

185
62.2 Definition

It is a dynamic tactile-kinesthetic system designed to help organize.

to plan and execute the phonemic elements of speech production.

The professionals, when using the PROMPT System, will help the child to use the
integral verbal production system and in a systematic form.

With the PROMPT System, all sensory systems are used.

auditory, visual, and tactile, and regarding learning, words are used
real and useful. If the therapist feels it is absolutely necessary, they will work on
las habilidades pre-lingüisticas (alimentación o movimientos orales).

During the application of the prompts, the pressure on specific muscle groups
and the tension located in those muscle groups helps to develop
references for the development of an appropriate programming. The main
The system's approach is to provide feed-forward information for the child.
where, in a preselected sequence, can be guided towards positions
correct and appropriate translations.

186
 63
Therapy of
SENSORIAL INTEGRATION

63.1 Introduction

It is a scientific response to multiple and very diverse childhood problems.

learning, behavior, development, and motor coordination issues, such as the
hiperactividad, la mala inserción escolar, las disfunciones relacionadas con el
autism and PC or the difficulties in the feeding process.

Sensory integration can be defined as the ability that one has

central nervous system to interpret and organize the information captured
through the various sensory organs of the body. Such information, received
through the brain, they are analyzed and used to allow us to make contact
with our environment and respond appropriately.

The theory of sensory integration was created to address problems of

learning in children. It is more about a specific technique,
therapeutic approach. Its creator was Dr. Jean Ayres, a therapist.
American occupational, who formulated the theory of sensory integration
based on its own research and also established the evaluation and the
treatment of sensory integration dysfunctions.

Ayres initially became interested in perceptual problems whose origin is

I found in cranial traumas, cerebrovascular accidents and
cerebral palsy. In the 1960s of the last century, it began to formulate
hypotheses about the neurobiological processes that may be associated with
learning problems in children, and created a systematic assessment
to be able to measure perceptual-motor functions.

These evaluations were perfected by Ayres himself throughout his

research and currently serve to measure the different processes

187
neurological factors that contribute to the ability to learn. The results of the
evaluations of normal children allowed the development of scales of
average performance by age. The analysis of these results allowed for
they will identify various types of sensory integration dysfunctions.

63.2 Objective

The objective of sensory integration therapy is to facilitate the development of the

capacity of the nervous system to process sensory inputs of the
the most appropriate way possible.

Sensory integration therapy encompasses three main areas: vestibular,

proprioceptive and tactile. The vestibular system, located in the inner ear, is
related to balance–gravity. It offers the sensation of weight in
our body and also indicates where we are in space: if we are
we stand up or move our head, if we fall or turn our face, etc. Therefore,
It directs the movements of our head and body in all directions.

The proprioceptors, tendons, muscles, and joints tell us where we are.

our feet and how to push back to give a thrust, how to kick the ball
At what height should we raise our hand to comb our hair? Through the
proprioception we have sensations or sensory inputs every time we
we move and, therefore, we receive a source of stimuli and these can vary
in intensity.

The tactile system has three different types of receptors: one that responds to a
light touch, like touching the hair with one hand and it is a protective and comforting sensation.
alert, which makes us control what is happening to us in case of
it is something dangerous, like an insect crawling on our skin. The second
the receptor discriminates touch, for example, when you put your hand in your pocket
and it is known by touch that they are the keys to the house. Thirdly, there are the
receptors that receive information about cold, heat, pain, etc.

Sensory integrative therapy works on all the senses, but

especially about the vestibular, tactile, and proprioceptive that are important because
be a great source of information input.

In this therapy, movement activities are carried out without forcing, but
stimulating walking, climbing, rocking, etc. These activities help to
develop the vestibular system.

This therapy is carried out exclusively by occupational therapists.

188
63.3 Contact

Occupational therapy clinic in Oviedo. Contact: info@[Link]

189
 64
Treatment of
AUDITORY DISORDER

The recovery work in this aspect will be oriented according to the following points:

General physical recovery.

[Link] training for the maximum utilization of auditory waste.

Periodic explorations to establish the necessary modifications of

treatment according to the recovery achieved, the skills acquired,
temperament, intelligence, maturation, etc.

4. Continued study of the social development of the child, always maintaining a

intimate relationship between doctors, physiotherapists, family members, and teachers. It is
convenient, after a thorough psychophysical exploration, to form groups
special with children of similar characteristics.

Sometimes there is no actual auditory disorder, but hearing is

developed more slowly due to inability to direct the head or gaze at
the sources of sound (Illingworth).

It is advisable to speak to children with hearing deficits more loudly, slowly, and
vocalizing better, while showing their face or speaking to them next to the ear
or with the help of a rubber tube. We will assist in the use of the waste
auditory teaching these people to pay attention to sound (increase and
education of attention), while being trained in the kinesthetic sense and
touch for sounds. The family will be taught and warned on how to handle
these patients, their collaboration being valuable to stimulate them.

The use of hearing orthotic devices can be valuable if it is accurate.

indication and adaptation. They will be applied early, provided that they do not involve
danger (falls) or they can be bothersome (constant rubbing in athetotic children).

190
If the deafness is absolute, the teaching will be expressive (similar to that of the
deaf-mutes), using the physiotherapist not only the movement of the lips,
but also the face and the general attitude.

191
 65
Treatment of
VISUAL DISORDER

Breakey indicates that the treatment of all visual disorders must begin
as soon as possible after making the diagnosis, while Denhoff does not
consider relevant before 12 months of age. Nystagmus and strabismus
are two quite common effects in these patients. For their treatment, it
The following care is recommended:

1. Cover the more preserved eye for periods of 2-3 weeks, which will
improves the vision of the defective eye, preventing amblyopia. If both eyes are
affected individuals are covered alternately for a total period of 2 months to 2
years.

2. Use of glasses that improve vision, reducing the increase of

strabismus and avoid headaches.

Guibor starts using glasses between 6 months and 1 year of age. In the
For very young children, the use of plastic glasses is advisable.

3. Instillations of atropine, use of prisms, and muscle and exercise

relaxation.

Surgical treatment to annul the contractions of the eye muscles

(it is contraindicated in athetotic patients).

Cataract cases can be treated using glasses in the

postoperative period. If the child is old enough, it is possible to perform the
common eye muscle exercises for strabismus (reading with a ruler
interleaved, bringing two pencils close to the eyes by the tip, etc.

192
 66
The bandage
NEUROMUSCULAR
Kinesiotape

66.1 Introduction

This new technique is the subject of a large number of clinical trials.

it is in the midst of development and is being established as a method
therapeutic routine in working with children.

Neuromuscular taping or kinesiotape has emerged as an innovative and effective

bandaging method and is being successfully and well accepted within
all international medical communities.

In a relatively short time, the technique of neuromuscular taping, also

called 'Kinesiotaping' or 'Medical Taping' or 'Colored Bandages' has
conquered its place in the daily therapeutic practice of many physiotherapists.

The functions attributed to neuromuscular bandaging are the ability to

retrain the neuromuscular and proprioceptive system, improve posture of
patient thanks to the sensorimotor information it provides, facilitates drainage
lymphatic, reduce pain, and accelerate the healing process of the injury
permitiendo en todo momento el movimiento y facilitando la circulación y su
subsequent nutrient contribution. The neuromuscular bandage provides support and
stability for the joints and muscles without affecting the range of
movement. It is a technique based on the body's self-healing process.

193
66.2 What is it about?

After assessing the child's level of development, the following are established
objectives of physiotherapy treatment.

Based on these objectives, basic motor skills are proposed that allow us
help to achieve it and then we must prioritize the function that is desired
act with kinesiotaping, this method also has its assessment test
(Linder test) that will be useful for establishing the area in which to apply it.

Several aspects must be taken into account:

Buscar objetivos concretos orientados a la funcionalidad.

Minimize the number of Kinesiotaping strips as much as possible

used more and more, since each of them provides a stimulus
proprioceptive that the central nervous system will have to integrate, which
We should not overwhelm the number of information.

Due to the characteristics of children's skin and although the reactions

allergies are not common, we should be more cautious, stay alert to
possible skin reactions and be more careful when removing it. Therefore
In general, applications on the belly button will be avoided, with special care.
in the neck and stomach areas and we will not apply bandaging
neuromuscular in children under 6 months, possibly using cross tape (is
made up of strips or crossed bands in mesh, non-elastic and without any type
of medication, forming a grid-shaped patch), instead if it
we consider it appropriate.

194
We can summarize the TREATMENT PROCEDURE as follows
way

1. Analysis of movement and posture, in which different aspects will be assessed:

How is normal movement performed.

Main muscles, agonists, antagonists, synergists.

Muscles that limit the normal functional pattern and causes (spasticity,
hypotonia, retractions...

Joint mobility and osteoarticular alterations that limit function.

Evaluate the Linder test.

2. Establish priority action based on treatment objectives.

3. Select the treatment with kinesiotaping to facilitate or inhibit function.

muscular, realizar una corrección mecánica.

4. Reassess posture and movement after the removal of the Kinesiotaping.

As evaluation methods, depending on the cases, one can use: the execution of
movement (possibility and quality of it), goniometric measurements, records
photographic or audiovisual...

195
 67
YOGA

Medical research has

documented the benefits
of Yoga in some groups
with special needs.

Yoga is a generic term

it means many things.
It can be a technique or
state of being... It's like
when we talk about dance,
there are many styles.

In the case of Cerebral Palsy (whether spastic, athetoid, or ataxic), the

práctica del Yoga puede ayudar a reducir el tono muscular alto, el cual es
characteristic in many children with Cerebral Palsy.

The muscles and tendons receive a relaxing stretch, relaxing the

physical stress and the blockages of the musculature and around the tendons. And
it also relaxes the body providing resistance to exercise the areas
with less muscle tone.

But the most important aspect for these children is the ability to stretch and
reposition the column, which bends and twists in various directions.
It also helps create more space between the vertebrae and reduces pressure.
in the discs and the nerves of the spinal column. Reduce the pressure on these
radial nerves facilitate the relaxation of the body's muscle tone and improve the
nervous functioning. As a result, the child may develop greater
mobility, coordination, and independence.

196
 68
Ozone Therapy

68.1 Introduction
Ozone therapy is based on ozone, a gas found in the upper layers of the atmosphere.
the atmosphere, and that can be obtained by modifying the molecular structure of the
oxygen (O2), adding a molecule, forming (O3), known as ozone
therapeutic.

Ozone therapy is the application of medical ozone (O3) for therapeutic purposes.
taking advantage of its properties as a fungicide, bactericide, and antiviral. It has
a great oxidation power that slows down cellular aging,
stimulating white blood cells and boosting the body's defenses.
It also activates the metabolism of red blood cells, increasing transport.
of oxygen to the cells and the blood circulation in general.

Ozone therapy should be performed by professionals, being compatible with

any other conventional medical treatment, as it does not create effects
secondary.

Among the most well-known applications is the treatment of pathologies.

neurological conditions such as Alzheimer’s, multiple sclerosis, amyotrophic lateral sclerosis,
senile dementia, Parkinson's disease, and childhood cerebral palsy.

68.2 Application methods

Locally: through a bag or glass bell placed over the

area to be treated. It is used in infectious and bactericidal pathology, by creating a
aerobic medium in which viruses and bacteria cannot survive. The
the most common diseases in which it is used are vascular ones such as
ulcerations, gangrene, and for the disinfection of wounds and ulcers
diabetics.

197
 2. Rectally:

Through a probe: for intestinal pathologies.

Systematic rectal application: similar to the previous one, used for diseases
liver, pancreatic and biliary, also being effective in cases of tumors
and acute or chronic hepatitis C.

Rectal application of ozonated water: the same as systemic but less.

painful for the patient.

3. Hematic route: blood washing, similar to dialysis treatments. Causes

an increase of oxygen and nutrients to the entire body.

4. Systemic route: by subcutaneous or intramuscular injection. Very commonly used for the
osteomuscular pathology such as herniated discs.

ANNEXES

Ozone: gas that protects and cares

[Link]

198
 69
Method
FRENKEL

69.1 Introduction

H.S Frenkel was the medical superintendent of the Freihof Sanatorium in Switzerland.
he forecasted a method for treating ataxia through exercises
systematic and graduated.

He predicted the achievement of voluntary regulation of movement through the

use of any part of the sensory mechanism that has remained intact,
particularly vision, hearing, and touch, to compensate for the loss of the
kinesthetic sensation. The learning process of this alternative method of
Regulation is similar to what is required to learn any new exercise;
its essential principles are:

Concentration of attention.

Precision.

Repetition.

The ultimate goal is to achieve the regulation of movement, so that the patient
be able to do it and gain confidence in the practice of those
activities that are essential for their independence in daily life.

Frenkel believed that despite the sensory pathway being affected, the patient
tabetic-ataxic individuals can learn to perform a complete movement through
the constant repetition thanks to maintaining its muscle sense.

Exercises based on Frenkel's principles are used for teaching.

of smooth movement and precision, highlighting particularly the target

199
primordial to help the patient perform normal activities of
daily life.

69.2 Progression

The progression is made by altering the speed, amplitude, and complexity of the
exercise.

The progression of the exercises must be in difficulty, at no point should it be

power.

Under no circumstances should exhausting work or work that implies

a great muscular load. To progress in its execution, the patient must
show in the exercise a perfect execution, otherwise it is not advisable to start
make another.

The progression must respect the difficulty of precision of the exercises; of

so that initially, those movements would be made
fundamentals of large amplitude used in large joints
and then they are replaced with the finer and more precise movements of the
small joints (grasp); furthermore, they must be performed first.
quickly and then slowly.

The progression is characterized according to the degree of incapacity, the exercises

of reeducation, they start in the supine position, with the head
erect and the members firmly supported; progressing afterwards to the
exercises in a seated position and finally to standing position.

The exercises will be carried out, first with the support of vision, to
subsequently, when you master it, do it with your eyes closed.

69.3 Techniques

The patient dresses appropriately so that they can see their own
members, in the course of all the exercises.

Before attempting the movement, the physiotherapist must explain it to you in a

clear and concise manner and must demonstrate the even exercises
that the patient has a clear vision of them.

The patient must pay full attention to the practice of exercise,

so that the movement is smooth and appropriate in a rhythmic and precise manner,
to be effective.

200
The speed of movement is dictated by the Physiotherapist, through
rhythmic numbering, through the movement of their hands or by the use of the
suitable music.

The amplitude of the movement must be indicated by a signal or spot on

the one that places the foot or the hand.

The exercise must be repeated many times until it is perfect and easy.
once achieved, it must be replaced by a more difficult one and must be carried out
around half an hour twice a day.

As, at the beginning, the exercises are very tiring, they must be allowed.
frequent periods of rest. The patient has very little capacity to
recognize fatigue, but it is generally indicated by a decrease in
the quality of the movement or due to an increase in the pulse rate.

Constant exercises for the trunk and balance should be performed.

respiratory.

It is very important to prevent fatigue for the patient. The signs of

fatigue are: Frequent pulse, rapid breathing, and signs of distraction.
therefore, initial control of heart rate is necessary and
frequently during rehabilitation exercises. The exercise should be
stopped if the heart rate reaches 120 beats and can be restarted
when it is close to the one that occurred at the beginning of the exercise. It should not be repeated.
more than four times, it is necessary to take a break
rest between exercise and exercise.

It is important that the exercise area has good lighting and a

mirror so that the patient can observe the movement of the segments.

The exercises should be performed within a normal range of motion

to avoid muscle overstretching.

201
 70
THERATOGS

Theratogs is based on the correction of alignments.

musculoskeletal, something well known in any orthopedic technique. Perhaps
The novelty of Theratogs is the material and the way it is applied to the body.
which are more comfortable than others and apparently more effective.

Among the objectives of Theratogs, promoting bone development was highlighted.

and optimal articulation, as well as improving posture, balance, gait, and skills
of the movement.

It consists of pants and a top that provide a 'skin' lined with

foam and breathable, fitting to each patient individually
comfortable and non-slip, which provides greater stability and
containment. The younger the bone, the greater the possibility of achieving
positive results, since when the bone ossifies it is less malleable and
therefore, the changes are less noticeable.

The Theratogs is indicated for all types of pathologies, from ataxia to autism,
cerebral palsy, spina bifida or strokes.

Limitations are marked by advanced age, patients with

tachycardia or another cardiac arrhythmia, since any restrictive clothing
around the patient's chest with these pathologies can cause
problems. Therefore, the possibilities of using Theratogs are virtually
unlimited.

202
70.1 Information and centers

Information about Theratogs, on the website:[Link]

In Spain, it is distributed and applied at the Sant Joan Institute in Barcelona.

[Link]éfono: 93.2469994.

203
 71
DAFOS

71.1 What are they?

The term DAFO refers to dynamic orthoses for the foot-ankle. These
Orthoses are designed to support the foot and ankle, but they also affect the
whole body movement.

Dynamic orthoses are commonly used in patients with disorders.

neuromuscular. They are especially aimed at patients
pediatric, but many adults can also benefit from the concepts
of design.

A distinctive feature of DAFOS compared to other designs

orthotics for the foot and ankle, present the concept of foot grip.
This concept is very important, as it allows for correcting the frequent
postural anomalies (in pronation and supination) present when there are
neuromuscular alterations. AFOs are flexible and fit closely.
with the contours of the foot, thanks to the individualized measurement for each
patient, offering a high degree of correctness and comfort.

In addition, the SWOT concept provides the possibility of creating a variety of

different models. There is a complete range of products with an extensive
variety of functional options. This provides various advantages when it comes to its
application. On one hand, the possibility of being able to offer the most suitable model
for each patient based on their physical characteristics, and on the other hand, the
possibility of varying the degree of correction or assistance provided by the orthosis
as the patient's skills improve. It is important to keep in mind
at all times as the patient grows or their goals change
functional, the orthotic requirements also change.

204
71.2 How can SWOTs help?

DAFOs can help to achieve one or several of the following objectives:

Correct the foot to the best functional position to provide

stability.

Improve standing and walking skills.

Prevent and/or correct deformities.

Maintain and/or increase the range of motion.

Facilitate the development of motor skills by reducing effort and

required concentration for standing and walking.

71.3 What damages are they suitable for?

Dynamic foot-ankle orthoses have proven to be effective against:

patients with developmental delays.

Patients with neurological or neuromuscular problems, especially

cerebral palsy, spina bifida, Down syndrome, muscular dystrophy
sequelae of poliomyelitis injuries medullary, traumas
cranioencephalic, cerebrovascular accidents.

205
71.4 Information and centers

Information: [Link]

In Spain: [Link] Barcelona. Phone: 93.2469994

ANNEXES

A Coruña stands out in pediatric orthopedics

[Link]
infant/[Link]

Holidays present breast prosthesis

[Link]

206
 72
Art Therapy

We understand Art Therapy as a combination of art and psychotherapy, in

where each of the parts is stimulated in conjunction with the other, where the
the most important is the person and their process; art is used as a means of
non-verbal communication, as a means of conscious and unconscious expression; to
acknowledge that thoughts are expressed more easily in the
images that in the words. Through the creative process, it is reflected upon
the development of personal conflicts and individual interests.

Through Art Therapy, people with disabilities have the opportunity to

being able to communicate their feelings and needs to others in a way
more noticeable. It is highly beneficial for both physical and mental growth,
since it helps them develop self-confidence and achieve results
satisfactory.

72.1 Art Therapeutic Objectives with People with Cerebral Palsy

Communicate using codes that are more flexible and closer to the experience
sensory.

Be autonomous in material handling and decision-making.

Socializing through group experiences.

Maturity, contributing to the harmonious development of personality.

Promote the resilient approach.

207
72.2 The concept of resilience

Ability to rise from adversity, adapt, recover and access

a meaningful and productive life (ICCB, Institute on Child Resilience and
Family 1994).

It is the human capacity to face the adversities of life,

overcome them and be transformed by them.

In this concept where pediatrics, psychoanalysis, and health converge

public health is based on a prevention and promotion model based on the
potentialities and the resources that the human being has within themselves and to their
around. It is supported by the interaction between the person and the environment.

Resilient individuals: they are those who, when immersed in a situation of

adversity, that is to say, when exposed to a conglomerate of factors of
risk, they have the ability to use those protective factors to
overcome difficulties, grow and develop properly, reaching
mature as competent adult beings, despite unfavorable forecasts.

72.3 Factors

The commitment (believing in the certainty and the value of what one does as
valuable and capable person.

Sense of belonging.

The control or responsibility of feeling capable of changing the course of the

events.

The challenge of challenge and change. Giving oneself the opportunity to grow and improve.

The pillars of resilience are:

Introspection

Independence

Ability to relate

Initiative

Humor

Creativity

208
 Ethics

Conscious self-esteem

Resilience is dynamic in nature. Promoting resilience is recognizing the

strength, beyond vulnerability. Aims to improve the quality of life to
based on their own meanings, as they perceive and face the world.

209
 73
Method
Feldenkrais

The method is named after its inventor, Moshe Feldenkrais. Through a

unique combination of physical therapy, psychology, and martial arts, Feldenkrais
its purpose is to develop the movement and physical growth of its
practitioners.

The method can help people with cerebral palsy do things as

basic things such as moving through pain, its cessation or avoidance.

The Feldenkrais method for cerebral palsy is based on the reorientation of

misguided patterns of physical and psychological behavior. In people
with cerebral palsy in particular, this therapy can be helpful for
overcome movement problems.

Combined therapy involves developing movement, biomechanics, the

psychological treatments, and even martial arts. The Feldenkrais method
for cerebral palsy, you can organize these elements of the person in
learn to better control and to form the nervous system in acting
different ways.

The method can help by using very simple techniques that assist
in the spastic muscular function and its development. Many patients in the
cerebral palsy has spasticity or stiffness in their muscles. The technique
Feldenkrais can be used to help with spasticity and assistance for
walking, sitting or relieving muscle tension pain.

Using the method, a person affected can work to control and

manipulate their own body. This control is essential for maintaining balance
when walking or standing. The Feldenkrais therapist is trained in these

210
developments. This therapy is often very light, non-invasive, gentle and
pleasant, even.

73.1 ANAT BANIEL METHOD

Based on the Feldenkrais method, the ANAT METHOD emerges.
BANIEL, the information we present below is taken from your page.
web: [Link].

The Anat Baniel Method (ABM) helps people of all ages to

overcome pain and the limitation of fitness and achieve all of life and vitality-
mental, emotional and spiritual physical. The method of access to the remarkable capacity
of the human brain to form new connections and new patterns and
achieve performance levels never before reached.

Derived from the pioneering method developed by Dr. Feldenkrais, the ABM is based on
in the scientific theory of cutting and in the understanding of how our brain
learn and transform our body, our mind and our spirit. Dozens
of thousands of people looking for an alternative and complementary approach to
medicine, physical training, the therapy of exercise programs and the
ways to help children with special needs have been used the
activity management with great success.

With ABM, the approach is very different. Instead of trying to fix the
problem directly, focusing on the limitations, the approach shifts
to the place where solutions actually meet the brain. The ABM
focuses on helping the injured child's brain do its job better.
Helps the brain recover its strength and creativity on its own.
new neural patterns that provide successful solutions regarding.

We apply gentle techniques that communicate directly with the system.

nervousness of the child mainly through greater awareness and in the
non-verbal movements kinesthetic experiences.

With the ABM, the brain of the child with cerebral palsy or any other injury
the brain recovers its ability to function in a healthy way. That is
when the damaged child can start to do what children do
healthy. We have countless examples of success with our work.

It is very important to understand that only when we create the conditions for the
the child's brain to function in high quality in a healthy way will be
when I can overcome the limitations, so that it can be surprising
and inspiring.

More information and testimony [Link]

211
 74
Method
PILATES

The Pilates method is a system of physical and mental training created in

principles of the 20th century by the German Joseph Hubertus Pilates, who created it
based on their knowledge of various specialties such as gymnastics, the
traumatology, ballet or yoga, combining dynamism and muscle strength with
mental control, breathing, and relaxation.

There are many applications, and one of the most pioneering is its use as
tool to improve the abilities to move and feel, in people with
any disability.

The Pilates method enhances the motor sensitivity of people with mobility.
reduced and also helps to improve the balance of people with paralysis
cerebral or to stabilize when moving for those who suffer from injuries
medullary.

Es una disciplina que busca conseguir un reequilibrio del cuerpo corrigiendo los
postural errors and strengthening the internal and external musculature. This is

212
first of all, it works on the internal muscles of the abdomen and the
pelvic floor, considered "the core" of the body by specialists and, starting
from there, everything else.

The tools to achieve this seemingly intangible goal are the

contraction of the muscles and breathing.

The final result is that all the musculature becomes much stronger.
deep and stable, which in a healthy person prevents the appearance of
injuries and with a pathology improves many aspects. In the case of the
rehabilitation, for example, the results are much better and faster. In
other areas, taking into account that Pilates improves the circulation of the whole
body, calcium absorption is also improved and pain is reduced by
postural vices. Strengthening the muscles also prevents fractures if
There is already a decrease in bone mass.

These objectives are achieved in different phases: first working on

floor, the most basic modality, and then on different machines that combine
Bars and springs to facilitate certain movements.

The discipline is recommended for people of any age and condition.

-healthy or with pathology-, since the exercises are adapted to the situations.
particular. However, it is not a relaxing exercise like yoga can be.

ANNEXES

A Pilates center will offer a discipline course for people with

disability with the support of various foundations

[Link]
discipline-people-disability-support-several-foundations
[Link]

213
 75
Therapy of
MOTION INDUCED BY
RESTRICTION (TMIR)

Constraint-Induced Movement Therapy is an alternative of

Physical therapy treatment and its goal is the functional restoration of the hand
of the affected upper limb. It consists of the restriction of the movements of the
uninjured upper limb and the intensive execution of exercises and
various activities with the paretic upper limb.

Para desarrollar esta terapia es necesario que el miembro superior afectado no

is completely paralyzed (plegic), but has some movement,
although these are carried out through a synergistic pattern and it is suggested that in the
The greater the mobility, the better the functional outcomes will be.

Constraint-Induced Movement Therapy has been designed to

solve the problem of 'learned non-use' in patients with injuries
cerebral and to foster great advances in the use of the extremities
parietal superior in different pathologies. It is estimated that at least the
50% of the population that has suffered a Stroke could
benefit from such therapy. The clinical efficacy of Movement Therapy
Induced by Restriction has been demonstrated and documented with effects
positive in motor results and the therapeutic outcomes are considered
capable of being transferred from the clinic to the "real world", just like the
patients to society.

Research in the past decade has demonstrated the effectiveness of the

Constraint-Induced Movement Therapy in individuals who had
weakness of the upper limb as a result of an injury of the
upper motor neuron. The basic component of Movement Therapy

214
Induced by Restriction involves the restriction of the upper limb
unharmed during 90% of the waking hours, along with a period
where repetitive training of the upper limb is performed more
affected. The less affected upper limb is restricted with a mitt,
sling or glove. The subjects generally spent 6 or 7 hours of therapy
focused on household activities and daily life. The individual also
maintains a daily treatment to use on the affected limb when not
is at the clinic.

The Constraint-Induced Movement Therapy (CIMT), also known as

as forced use therapy, it is a therapeutic approach to rehabilitation
of the patient who has suffered a brain injury with topographic involvement of
a hemibody. The intensity and schedule of the therapy are different from the
traditional physical rehabilitation treatments.

The TMIR requires a range of rehabilitation techniques with a common goal: the
to induce individuals with hemiparesis to increase the use of their limb
affected.

The TMIR has its origin in experimental work carried out on monkeys, Taboo.
and collaborators revealed that retraining the denervated upper limb
for more than three days through TMIR, the monkeys could learn to use the
the member in question and at the same time reinforces the long-term use of it.
extremity in daily life activities.

Two clinical trials showed positive trends in favor of the therapy of

movement induced by restriction (TMIR) and forced use, while another
showed a positive treatment effect in favor of the modified TMIR as
treatment for children with spastic hemiplegic cerebral palsy. These
tests are based on an essay with methodology and ambiguous reports and a
controlled clinical trial. High-quality further research is needed
to appropriately support the use of this therapy.

215
 76
REFLEXOLOGY

76.1 Introduction

It is a therapeutic technique that is based on the manual stimulation of the

called reflex points and zones with which an indirect action is achieved on
different organs, tissues, and conditions of our entire being, obtaining from this
a self-regulation in the functions and therefore an improvement in our
health problems can be detected using this technique.
earlier stage, making it an effective way to prevent
more serious problems.

76.2 What is the purpose?

The purpose of reflexology in the feet is:

1. Relieve stress and tension.

Improve blood flow and promote the unlocking of impulses
nervous.
[Link] nature achieve homeostasis.

Foot reflexology alters the body's energy flow, eliminating the

blockages.

Blood and lymph flow can also be normalized in certain regions.

of the body.

The feet are the final end of the body. Far from the heart, the blood and the
The lymphatic fluid from the feet must fight against gravity. The movement of these
vital fluids are essential. Like any current, heavy particles
they will tend to settle as sediment, especially when the current does not
it is fluent.

216
On the other hand, slow flow can lead to poor oxygenation of the tissues.
and improperly dispose of the waste. The blood flow can
to become slow, then to get stuck. Crystals can form in the tissues. There are
7200 nerve endings in each foot.

Research is being conducted on the effects of massage in cerebral palsy.

help children achieve greater muscular flexibility.

217
 77
Spheroidynamics
THERAPY (TECH.
VOGELBACH

77.1 Introduction

The use of Kinetic spheres as a complement to treatments

therapeutics dates back to the early century. Dr. Susanne KleinVogelbach
he used them in Switzerland starting in 1909 for the treatment of problems
articular and for the rehabilitation of neurological patients. They are used
since then in that country with young patients affected by paralysis
cerebral, to help them regain balance and improve responses
you reflect.

The German physiotherapist Berta Bobath also used spheres as

complement to the work he developed since his arrival in England in 1930,
treating patients with spasticity and different types of brain injuries.

The balls were introduced by a student of Dr. Klein-Vogelbach in

United States in 1970, where they were used during the 1970s and
the 80s to treat spinal injuries and other structural disorders
I mean, and starting from 1990 as a complement to sports training.
occupational therapist and dancer Bonnie Bainbridge Cohen, disciple of the
Bobath and creator of the experiential anatomy method called Body-Mind
Centering has also been used since the 80s for the research of reflexes,
the straightening reactions and the balance responses that make up
our basic movement patterns.

218
77.2 What are they?

Over time, spheres have been identified by various names,

but generically they are called 'stability balls', since their
The main characteristic is that they have a surface for balance and motor control.
of the people who use them.

The balls can be used to model the body, but they are useful for
everything to increase the registration of joint and muscle areas especially
compressed or tense. Once we achieve that, it is much easier to reorder
the posture, adjusting muscle tone and training the body. Using the ball
Correctly, it is much easier to reorder the posture, adjust the muscle tone.
and train the body. By using the ball correctly, we can isolate,
strengthen and stretch each muscle effectively and efficiently. The position of
unstable balance on the ball allows to maintain the correct alignment
using the body integrally in each exercise.

They are also a valuable therapeutic element for

treat painful or tense areas, and to regulate the
stress levels. Pain in the lumbar areas
Cervical issues can be caused by postures.
incorrect, due to an imbalance in tone
muscular or in areas of limited mobility in the
spinal column, among other reasons. Through
Through proper training, we can relieve those discomforts, balance the
muscle tone and improve the mobility of the spine and the body in general,
promoting health and well-being.

The size and material of the ball to be used will depend on the type of work to be carried out.
and the characteristics of the person: the softest are suitable for
decrease muscle tone and the hardest to increase it.

In a small ball, the work is more localized; in a large one, on the other hand,
it is more global, and the stretches can be held for longer.

Similarly, a hard or overinflated ball offers greater resistance, the surface

support on the floor is lower, it moves faster and requires more control of the
reflections from a soft or less inflated ball, which has a contact area
the mayor with the floor moves with more slowness and requires less effort to
maintain the balance.

219
77.3 Educate the body

Spheroidynamics is found within the field of Somatic Education, which

group the disciplines that emphasize learning through the body
in motion, from its internal record and its relationships with the environment
as a basis for perception and for action in everyday reality.

The therapeutic aspects are present, but the emphasis is placed on the
education or reeducation of the body in movement, with the consequent
transformations that occur in the complex body-mind unit.

In Therapeutic Spheroidynamics, work is done on function and structure.

structure limits the function to the extent that the body, due to the
muscle shortening, unable to perform movements to their fullest
amplitude range. On the other hand, it is functional learning that will allow us
make the most of that structural capacity through a more efficient use of
body with economy of muscular effort.

Based on this, the practice on balls may emphasize one of the

two aspects, or both at the same time.

In functional learning exercises, we train the ability

proprioceptive, that is, the body's ability to perceive itself
internally and in relation to space, in stillness and in speed, using or
consciously inhibiting reflexes, the righting reactions, the
responses of balance and the basic neurological patterns (cellular respiration,
pulse, umbilical radiation, oral, prevertebral, spinal, etc.) that form the
support of the body's ability to move in space. Furthermore, it
acts on muscle tone.

From a neurological point of view, muscle tone is the tonic contraction of

the muscles maintained over time. It is based on the reflex
myotatic, and it is originated by stimuli coming from the same muscle
(autogenic regulation of tone) and the proprioceptive receptors located in
different areas of the body, especially in the neck and in the auditory labyrinth
of the inner ear. It is the basic muscular activity, the state of 'rest' of the
muscles and express the ability they have to respond or relax.

Each individual has a basic tone that begins to develop in the womb and
is modified by the way we relate physically, perceptually and
emotionally with the environment and with gravity. This is reflected in the quality
of the movement.

A low tone indicates difficulties in facing the gravitational force; a high tone
indicates that we are excessively resisting the attraction of gravity; a tone

220
balanced and uniform shows us that we have a comfortable relationship or
balanced with the force of attraction of the earth.

This work allows us to perceive muscle tone and learn to regulate it.
training the tension capability of the muscles in relation to the surface
of the ball and the weight bearing down on it.

In the structural exercises of alignment and elongation of the different

muscle chains (whose shortening is responsible for poor postures or
deviations from the ideal model), work is done to increase the
mobility of the joints.

The unstable support on the ball requires gentle stretching.

extended over time, which are more effective for correction than the
sudden braking, as it minimizes the risk of injuries and the
compensations that the short muscles produce in the body to avoid the
stretching. The possibility of maintaining gentle traction for the longest
possible time allows for gradually stretching the shortened muscles, and
that the stretching lasts after the exercise is finished. To optimize
the work, these stretches are combined with pushes, in order to carry out
lengthening contractions. In this way, strength training is combined and
flexibility, thus achieving long muscles that are also strong. In its relationship
With the space, the balls allow us to work the body in all planes.
of movement.

77.4 Results

The results that can be obtained with the practice of Esferodinamia

Therapeutic actions will have to do with the way learning is supported.
All work must be based on respect for diversity, for the differences that
they determine the meaning, rhythm, and quality of individual processes.

ANNEXES

A round exercise

[Link]

221
 78
Method
BRUNKOW

This method induces a reflex mechanism with extension movements that

they are used for the facilitation of physiological motor sequences. Through the
push movement of the hands and feet in different positions, it
produce an overflow of energy (muscle irradiation) to the musculature
from the trunk that causes the reflex straightening of the trunk. The tension is
induce from the extremities towards the body.

This Brunkow facilitation technique induces tension in the chain.

muscular anterior and posterior.

222
 79
INTEGRATION
SENSORIAL

79.1 What is sensory integration?

Sensory integration could be defined as the ability that one has

central nervous system (CNS) to interpret and organize information
captured by the various sensory organs of the body. Such information,
received by the brain, are analyzed and used to allow us to enter into
contact with our environment and respond appropriately.

The theory of sensory integration was created to address problems of

learning in children. It is more about a specific technique,
enfoque terapéutico. Su creadora fue Jean Ayres, terapeuta ocupacional
American, who formulated this theory of sensory integration based on
his own research and also established the evaluation and treatment
of sensory integration dysfunctions.

Ayres became initially interested in perceptual problems whose origin is

I found in cranial trauma, cerebrovascular accidents and
cerebral palsy. In the 1960s of the last century, after having
completed doctoral and post-doctoral studies in neurophysiology, began
to formulate hypotheses about neurobiological processes that are susceptible to being
associated with learning problems in children, and created an evaluation
systematic approach to measuring perceptual-motor functions.

Their first theoretical concepts were based on neuroanatomy studies.

neurobiology and neurophysiology. For more than twenty years he conducted numerous
clinical investigations, both with normal children and with children affected by
learning problems, for which he used the assessments that were available
created.

223
These evaluations were refined by Ayres himself throughout his
investigations and currently serve to measure the different processes
neurological factors that contribute to the ability to learn. The results of the
evaluations of normal children allowed for the development of scales of
average performance according to age. The analysis of these results allowed for
they will identify several types of sensory integration dysfunctions.

Jean Ayres established very strict criteria for the administration and the
analysis of their evaluations. Therefore, specific training is needed for
to evaluate and treat dysfunctions of sensory integration.

79.2 The process of sensory integration

Sensory integration is a neurological process and Ayres' theory.

establish the relationship between said neurological process and the
behavior. Ayres developed her theory of sensory integration with the
the objective of describing, explaining, and predicting the specific relationships between the
neurological functioning, sensorimotor behavior, and learning
academic.

I expected to be able to identify patterns of dysfunction among children with issues

of learning and being able to develop specific treatments. I was looking, above all,
to be able to explain the causes of these problems in order to determine the
optimal treatment.

Jean Ayres formulated a hypothesis about the development of sensory integration.

which currently serves as the basis for all their approach. It allows us to understand the
process of sensory integration, from the senses to the products
finales, that is, from the basic perception of our environment to the
active participation through more specialized skills such as the
language, visual perception, and motor coordination.

In a normal individual, the development of sensory integration verifies

automatically following a series of successive stages, of which the
the first ones are preparing the following. The development of sensory integration
it would start during fetal life to reach maturity around 10 or 12
years. After that, sensory integration continues to perfect itself throughout the
life.

At the first level of development, tactile, vestibular and

Proprioceptive influences would play a fundamental role in the development of control.
of the movements of the body.

At the second level, the child develops more refined skills. Thanks to the
development of his body image, the child improves his planning of his

224
Joel starts a new life

Viable, treating cerebral palsy with stem cell transplantation

They advocate hormone treatment to improve patients with damage

cerebral
of a theory about the relationships between the brain and the rest of the body. More
specifically, we can say that the theory of sensory integration was
developed to explain and observe relationships between difficulties for
interpret sensory information from the body and the environment and the
difficulties for academic learning in individuals who show
general learning problems or clumsiness.

226
 80
MECHANOTHERAPY

80.1 What is it?

Mechanotherapy is the therapeutic use of mechanical devices.
employees in physical rehabilitation, whose purpose is to perform regulated exercises in
its strength, trajectory and amplitude, avoiding joint contractures. Improving
muscle flexibility and strength.

80.2 Effects

Increase movement arcs

Increases flexibility

Increases muscle strength

Improves muscle trophism

Improves balance and coordination

Gait reeducation

This therapy is mainly applied to patients with cerebral palsy.

The devices used in the area of mechanotherapy are:

1. Fixed ladder with high and low step

2. Ramp

3. Electric love

4. Bicycles

227
5. Parallel bars

6. Swedish bars

7. Mattresses

8. Mobile mirror

Mechanotherapy is a medical prescription and must be exclusively

indicated by a Doctor specialized in Physical Medicine to ensure the
effectiveness of the treatment.

Therapeutic exercise room.

228
 81
MAGNETOTHERAPY

81.1 What does it consist of?

Magnetotherapy (MT) consists of treatment using

magnetic fields. These can be produced by electric current
(magnetotherapy) or through magnets (magnet therapy).

Magnets, also called permanent magnets for

differentiate them from the electromagnet that retains its magnetic properties only
when connected to the power supply, they have proven to be highly
beneficial for certain ailments, and since ancient times (China,
Egypt) were used to alleviate bodily pains and relieve "stiffness".
of the muscles and joints.

The magnetic field (MF) is established between a north pole (N+) and a south pole (S-)
), in the form of CM lines that run from south to north. These poles do not act
in the same way and have various therapeutic actions.

The properties of a magnetic field differ according to its orientation.

As for pain, it is known that the North Pole is relaxing, while
that the south pole is anti-inflammatory.

In case of pain from muscle spasm, the N pole should be applied to the area.
and if there is inflammatory pain, it will be applied in that region at pole S.

Magnetotherapy (MT) is a safe physiotherapeutic method in treatment

of multiple diseases, being used as a standard procedure in the
Rehabilitation Centers and SPAs.

The magnetic fields used in Medicine are low frequency (less than
at 100 Hz) and of low intensity (up to 100 Gauss); which can be static or
buttons.

229
Recientemente se está utilizando la modalidad de magnetoterapia denominada
"Low-frequency pulsed electromagnetic field therapy", known
as PEMF (Pulsed ElectroMagnetic).

The pulsating application allows taking advantage of the biological effect of the component.
magnetic, with minimal thermal effect produced by the field
electric

Modern PMF devices allow for the generation of various frequencies (1-
100Hz), intensities (1-100 gauss), pulse shapes (sinusoidal, rectangular,
etc.), duration of exposure (timer).

The magnetotherapy devices consist of a console (control panel) and a

solenoid (applicator). This is included in a cylinder made of plastic material,
where the area to be treated is placed. Generally, there are 2 diameters of
solenoids: 15-20 cm for extremities and 60 cm for the whole body.

In addition, there are various biomedical devices, collars, bracelets, belts,

pillows, insoles, etc., that base their therapeutic effects on the use of
magnetic fields (magnetotherapy).

230
81.2 Fundamentals

There are three established mechanisms through which the fields

pulsating magnetics interact with living matter:

1. Magnetic induction

2. Magnetomechanical effects

3. Electronic interactions

Summarizing the data on the research regarding responses.

physiological and pathophysiological effects of the application of magnetic fields (M.F) are
It postulates that C.M present the following biological effects or actions:

[Link] vasodilation

2. Analgesic effect

[Link]-inflammatory action

4. Spasmolytic/muscle relaxant activity

5. Acceleration of healing

[Link] of ossification

7. Anti-edema effect

[Link]-tissue effect

The proposed mechanisms for such effects or biological actions are

they describe in:

[Link]

As it is known, MT acts at the cellular level by producing the activation of the

enzymatic processes, induction of metabolic systems and functions of the
cell membrane.

Cellular respiration is activated in the area exposed to such fields. The

CMP therapy (―Pulsating Magnetic Fields‖) induces positive changes in the
immunological condition of the patient, vasodilation of the arterial portion of the
capillaries and reduction of blood coagulation.

It is remarkable its trophic stimulation capacity of bone and collagen, effect

linked to the local production of very low intensity current, due to the effect

231
piezoelectric. Magnetotherapy helps with calcium fixation, so it
used in Osteoporosis, Sudek's disease, delays in ossification and
pseudoarthrosis.

81.3 Indications

Rehabilitation

Osteoarthritis (coxarthrosis/gonarthrosis)

Spondylosis (cervical/lumbar)

Ankylosing spondylitis

Osteochondritis

Osteoporosis

Tennis elbow

Frozen shoulder

Soft tissue post-traumatic processes.

Algoneurodystrophy

Aseptic necrosis

Pediatrics

Myopathies

Rheumatoid arthritis

Spinal muscular atrophy

Cerebral palsy

Neurology

Migraines

Peripheral neuropathies

232
 Lumbar pain/Lumboischialgia

Trigeminal neuralgia

Post-herpetic neuralgia

Dermatology and Orthopedics

233
 82
QUANTUM SCLO
FEEDBACK

As is typical in children with brain neurological disorders, their

evolutions take place in certain erratic areas, sometimes they tend to have greater
advances in certain areas and lesser in others. The Quantum ScIo Biofeedback is
a team designed to reinforce those control functions of the brain towards
the muscles, organs, and systems of the body that are defective.

With this team, we work on: Cerebral palsy, Neurodevelopment, Optic nerves,
Auditory System, Respiratory System, Blood Circulation, System
Linfático, Sistema Inmunológico, Intestinos, Hígado, Riñones, Inteligencia, ADN,
Genes, Etc.

With this device, we manage to stimulate the brain towards greater normality.
possible to achieve over time. The treatment is completely non-invasive,
no medications of any kind are ingested, do not bother or harm the child in
no aspect; therapy is completely external and achieves great improvements in
the aspects previously described.

234
 83
Therapy
with BACLOFEN
Intrathecal

The use of a baclofen infusion pump can help you move and
to walk more easily, to loosen the muscles that are
excessively rigid and minimize pain related to spasticity. The
The implantable pump continuously administers medication in the fluid of the
spinal cord.

83.1 What is it?

A baclofen infusion pump (ITB Therapy) is a precise therapy with

defined objectives that are used to reduce severe spasticity caused
for cerebral palsy. Treatment may be even more effective if used in
combination with physiotherapy, speech therapy or occupational therapy.

Uses a programmable medical device powered by a battery that stores and

administers a medication called baclofen. The device is implanted
surgically in the abdomen and a thin and flexible silicone tube called
catheter is inserted into the spinal column and connected to the pump.

235
The medication consists of a baclofen solution that goes directly into
the intrathecal space where a fluid (cerebrospinal fluid) is found that
circles around the spinal cord.

Since baclofen is administered directly where it is most needed, in the

intrathecal space, alleviates spasticity with lower amounts of medication
to the required when taken orally. This method of administration
it can help minimize the side effects caused by baclofen
oral.

83.2 Components of therapy

The system consists of:

Bomb: a programmable and implantable bomb, battery-powered and with

a deposit from where the drug is administered, at a rate
programmed, through the catheter.

Catheter: a flexible silicone tube that carries medication from the pump
up to the intrathecal space.

Liquid baclofen: a drug that reduces severe spasticity in some

people.

83.3 Benefits and risks

Although it does not eliminate the main cause of their condition or severe spasticity,
can help relieve tense and stiff muscles that hinder your life
daily.

236
BENEFITS

It has proven to be beneficial for people who have been affected by

cerebral palsy, brain injury, stroke, multiple sclerosis, and spinal cord injury
the following modes:

Various studies show that it significantly reduces spasticity and

the spasms.

At least in seven studies, the therapy has helped people to be more

independent, allowing them to perform daily activities such as eating or
dress themselves, sit more comfortably, or move more easily
ease.

A study has shown that this therapy can provide control

durable spasticity in people living with cerebral palsy or
brain injury.

Several studies have determined that this therapy also reduces the
spasticity in the upper and lower limbs of the patients who
they live with cerebral palsy, brain injury, and stroke.

A study of people suffering from cerebral palsy showed that reducing the
muscle tone with this therapy can delay or prevent the development of
hip problems. Another study found that if therapy is offered in the
appropriate moment for those suffering from cerebral palsy, orthopedic surgery
it can be delayed or completely avoided.

RISKS

Always follow the doctor's instructions to the letter because if you do

sudden interruption of therapy can lead to serious disorders (syndrome)
of withdrawal) such as high fever, changes in mental state, muscle rigidity and,
in rare cases, multiple organ failure and death. It is very important that you call
your doctor if you experience any of the above symptoms.

It is important that the scheduled visits are fulfilled so that it does not go without
medication and thus avoid withdrawal symptoms. Some people have
more risk than others of experiencing withdrawal.

The side effects associated with this therapy are usually temporary and
They can be resolved by adjusting the dose of the drug contained in the pump.

237
Common side effects include:

Loose muscles

Drowsiness

Stomach ache

Nausea and vomiting

Headache

Dizziness

The pump failure can cause an excessive or insufficient dose. The signals
and symptoms of an overdose include:

Drowsiness

Vertigo

Difficulty breathing

Stroke attacks

Loss of consciousness or coma

The signs and symptoms of an insufficient dose include:

Increase or return of spasticity

Tiny

Low blood pressure

Vertigo

Tingling sensation

The possible complications of the device are:

The catheter or the pump could move inside the body or displace to
through the skin.

The pump could stop because the battery has run out or due to a failure
of some component.

238
 The catheter could have a leak, tear, twist, or disconnect.
resulting in an insufficient dose or abrupt discontinuation of the
drug administration. The sudden interruption of the medication
antispasmodic can lead to: high fever, alteration of mental state, return
of spasticity, muscle stiffness, death (in rare cases).

It is important to know that the pump emits an alarm when it needs to be replaced.
or if the medication needs to be refilled or if there is a problem with the pump.

It is always necessary to inform the healthcare staff that you have.

this system should be implemented before performing any medical procedure or
diagnosis.

83.4 Contact

For more information about this therapy at:[Link] in the following

address

Medtronic Ibérica S.A.

C/ María de Portugal, 11. 28050. Madrid.

239
 84
BACH FLOWERS

84.1 Introduction

Bach flowers are a series of natural essences.

used to address various emotional situations,
such as fears, loneliness, desperation, stress, depression and
obsessions. They were discovered by Edward Bach between
the years 1926 and 1934.

Dr. Bach was a great researcher, in addition to being a doctor and

homeopath. He experimented with various wildflowers
natives of the region of Wales, in Great Britain, until
find 38 natural remedies, each with healing properties for
distintos problemas emocionales. A estas 38 flores se le llaman flores de Bach.

Bach flowers are also known as Bach flower essences and

Bach flower essences.

Her theory was that physical diseases have an emotional origin, and that if
emotional conflicts persist for a long time, the illness of
the body starts to appear, however, by restoring emotional balance it
resolves physical illness. It was in this way that he developed Therapy of the
emotions.

After more than 70 years, Bach flowers have been proven as a

magnificent system for addressing physical, mental, and emotional problems of
living beings.

84.2 Who can take Bach flowers?

They can be taken by anyone.

Babies, children, and adolescents.

240
 Pregnant and breastfeeding women

Elderly

Animals

Plants

People who are taking other medications

Sick or convalescent people

Unconscious or comatose individuals.

They have no side effects and are not contraindicated for any person or
condition. They can even be taken along with other medications and therapies.

Unconscious or comatose people can take the flowers of

Bach through the skin, using a cream to which has been added
Bach flower tincture.

People with serious mental illnesses can also take flowers.

of Bach, but in these cases, their therapist, whether a psychiatrist or psychologist, must
to assess whether they are taken in conjunction with other medications or if it's the only one that
toman

241
 85
Therapy
DEEP MUSCULAR
(TMP)

85.1 Introduction

Deep tissue therapy (DTT) is a technique that focuses on the layers

deeper layers of muscle tissue. Its main objective is to release the patterns
chronic tension in the body through slow manipulations and pressure
deep in the contracted areas, either in the same direction or in the opposite direction
contrary to the fibers of muscles, tendons, and fascia.

The purpose of TMP is to "unattach" the fibers of the muscles, to release the
patterns that reproduce the deep tension within, remove the toxins, and
relax the muscle. Deep tissue therapy can be used to eliminate
fibrosis, realign the muscle fibers, help eliminate trigger points
myofascial and muscular adhesions, ensuring that all
muscles of the body should be worked to prevent possible injuries. From
In such a way that deep muscle therapy is both corrective and therapeutic.

Es necesario destacar que para que el tratamiento este bien fundamentado es

essential to analyze the origin of pathologies.

In this way, TMP is revealed as the new cutting-edge technology in

treatments for mechanical pathologies. The union of therapeutic chiropractic massage with
the vision and treatment of muscle chains make these techniques a
of the most advanced of our times.

242
85.2 Objectives

Locate the cause of the pathologies and inform the patient that the symptom or pain
It is not where the problem arises, but rather that most of the time it is a cause.
distal to where the pain is felt.

Treatment of muscle chains, with instant improvements, of the arch of

movement, and reduction of pain, up to 50% in most of the
pathologies in a single session.

Natural treatment (without medications).

Indicated for: Cerebral palsy, sclerosis amyotrophic lateral sclerosis

multiple, muscular dystrophy, Parkinson's, sports injuries, trauma, arthritis,
fibrosis, back pain, neck tension, chronic fatigue syndrome and the
circulatory problems, to name a few.

243
 86
THERAPEUTIC TOUCH
(PRANOTHERAPY)

86.1 Introduction

It is a type of contactless massage that is applied using energy from

physiotherapist, nurse, or parents, it is known as pranotherapy.
This type of therapy may seem a bit strange but it has been widely accepted.
among the staff that works with this type of children. Their beneficial effects
They are backed by many clinical research tests.

86.2 Method

Sit next to the baby, preferably when he is calm. Let's look at him and
let's focus our attention on him. We will do it for as long as
seem appropriate to us.

Next, let's place one hand palm down on top of

the baby's head at a distance of 5-10 cm, and with the other hand we make
the same but on top of their feet. If we have very large hands it
we can do with our fingers. We will try to transmit our energy to you with
the hands.

If we want to do a little more, let's move our hand down from the head to the
feet, imagining that we are stroking the baby, but always without touching him.
keeping it at a distance of 5-10 cm from the body. Let's do it as many
times as we see fit (the norm is one or two minutes).

To finish, we return the hands to the initial position, on top of the

head and feet of the baby. We hold them like this for a few seconds.
and we will have finished.

244
86.3 The objective of the mobilizations

Prevent deformities

Early stimulation of voluntary active movements

Inhibit abnormal reactions and promote normal ones.

Acquire control and coordination

Create in the environment stimuli for the child

245
 87
CRYOTHERAPY

87.1 Introduction

The use of cold as a therapeutic technique is nothing new and exists

certificate that the Egyptians used cold water for healing
various diseases and ailments. However, it was not until the 19th century
when the German Sebastián Kneipp discovered the healing properties of cold
and its applications.

A very low temperature (cryotherapy uses temperatures of up to 165

degrees below zero) applied in a localized and continuous manner produces
vasoconstriction, which reduces blood flow; with that, it also reduces
inflammation and bleeding. In addition, cold decreases the frequency
respiratory and the sensitivity of the skin is also lower. It is also used
as anesthetic.

Cryotherapy, when applied at such a low temperature to the whole body,

acts especially vigorously on the muscle reducing its
hypertonia and spasticity.

87.2 Recipients

Extreme cold is used as therapy to treat a range of illnesses.

chronicles such as fibromyalgia, osteoporosis, arthrosis or arthritis. The cold can also
to be used in the treatment of bipolar disorders in children or in patients with
cerebral palsy, as they tend to suffer from muscle contractures

87.3 What does it consist of?

The cryotherapy treatment is proposed in about 15 chamber sessions.

Previously, patients undergo a medical check-up to rule out a

246
series of contraindications since there are people who cannot use this
therapy, such as for hypertensive or decompensated diabetic patients,
patients who have a cold allergy or suffer from claustrophobia. Once they are
check that the indication for cryotherapy is valid, the patient must dress up
to enter the chamber in an appropriate manner. One puts on some pants of
towel, knee-high socks, a wool hat, a mask
surgical to prevent air from being inhaled at that temperature, some clogs and gloves from
ski

Before entering the chamber

properly speaking, one moves to a
antechamber where the patients are
approximately for a minute to
a temperature of 60 degrees below zero,
accompanied by control personnel.
Next, they go to the cryochamber, in
the temperature is already 140
degrees below zero. Inside the chamber
groups of four are usually put in or
five people with a professional who explains to them what they have to do
Inside. They are three minutes, in which they move in circles and after this time.
they go back out to the ante-room and from there to the outside (said temperatures are
they support because the humidity level is very low, below 20%. The
the sensation is of intense thermal shock and when it ends the sensation is of
having exercised for 40 or 45 minutes, relaxation is noticeable in the
legs and a certain sedation.

Each cryotherapy session (usually three a week) is accompanied by

following physiotherapy or rehabilitation appropriate to the disease of which
it is about.

87.4 Centers

In Spain, there is only one cryochamber at the Activa Club Center in Jerez (and not
applies to all the diseases mentioned above.

The distributor in Spain is Grupo Dironte located in Palma de Mallorca.

Information: info@[Link]

Where is this therapy commonly applied and included in its assistance network?
it is sanitary, Warsaw that is implemented in both public hospitals as
privates.

247
 88
TAICHI

88.1 Origin and Philosophy of Tai Chi

Tai Chi is the ideal martial art for improvement and

restoration of health and with it improves our
physical condition. Build the inheritance left by the
Taoists of ancient China and consists of a series of
gymnastic exercises based on ancient medicine
traditional and in the experience of the daoyin, that
she was transmitting within the Huashan sect.

These body movements are intended to channel vital energy in order to

to maintain good health and achieve longevity. It is a gymnastics
aimed at channeling the meridians, the circulation of energy, the Chi.

Its peculiarity consists of harmoniously combining its three foundations:

Body movement

Concentration

Conscious breathing

There are several main styles, two of the most widespread are the Yang style and
the Chen style. Depending on our physical condition, we can lean towards practicing
one style or another. In the Yang style, long, smooth movements predominate.
without altering breathing or strength. In Chen style, the work involves transitioning from
the relaxation to the explosion in one continuous movement.

248
For this reason, the first style, the Yang, is one of the most suitable for the
mainly of our second or third youth. This does not mean that it is
easy their practice, since every movement of extending an arm can
It takes hours of practice to achieve the fluency of relaxed movement.

88.2 The movement

Mind and concentration. Tai Chi should never be practiced, according to the
Chinese teachers, automatically, as if we were reciting the alphabet.
while we think about anything. It is a very composition
complex of different exercises. The activity transitions from one part to another of the
body without any area making an excessive effort and the mind is
completely active.

Softness and lightness. In Tai Chi, the movements are soft, continuous,
light and fluid; it gives the feeling that no effort is needed to
to carry them out. However, in order to practice them, the body must be firm,
stable and strong. The mind must be alert and active.
Tai Chi movements are circular, forming arcs and spirals. According to
Tai Chi masters say that moving in circles helps to preserve the
energy, creates security and relaxes the nerves.

Force and movement. During the exercise process, the muscles never
they reach maximum tension. The amount of effort and tension used
it completely depends on what the position or movement requires
same. The muscles behave in a natural way. Strength never
add to the movement, apply as much force as necessary to carry out
the movement.

Balance. Balance is an essential element in the practice of Tai Chi.

through the control of each movement, the muscles and the joints are
They reinforce. A body balance naturally produces a posture.
correct and lighten the movements. Physical balance also contributes to the
mental and emotional stability.

Fluency. Tai Chi is continuous and fluid. Each movement, each unit of
exercise, is linked to the next one without a visible pause. The calm and the
lightness is manifested in that fluidity. Resistance increases as
the ability to maintain that continuity is developed.

Slowness. It is about a slow exercise. Breathing should be natural.

slowness helps to develop patience and strength. But this does not mean
that Tai Chi has no changes or is not dynamic. The delicate changes in
strength, stillness, and activity constantly alternate along the

249
 Exercise. The variation in dynamic flow produces flexibility and resistance in
who practices it.

Diversity. The dispersed energies in the body cause diseases.

when they circulate in a disordered and chaotic manner. Tai Chi
helps to feel, to unify, and to guide those energies. Traditional medicine
China attributes diseases to an imbalance between Yin and Yang, in order to
It is necessary to remedy it by reducing the excess of one and avoiding the insufficiency.
of the other. The exercise was designed to generate what they believed were
the two vital energies of life, yin and yang. Yin represents all the
receptive and calm things. The yan encompasses all active and energetic things.
various forms contrast yin and yang in the practice of Tai Chi.

88.3 Tai Chi and its therapeutic effects

In the treatment of individuals with motor impairments, the contribution of

Tai Chi can be very beneficial. Two important aspects emerge.
related to this topic: the globality of the movement and the postures help to
the person to feel a part of the body in relation to their whole body. For
another part, practice awakens a sensitivity that helps to integrate the
reduced bodily part. In the case of lasting and difficult injuries.
healing, Tai Chi exercises can develop a more unified perception
and at the same time contribute to an improvement. It awakens the body's awareness and facilitates the
body exploration, thus benefiting joint mobility and flexibility, the
strength and muscular endurance, coordination and balance.

The circular movements performed without breaks activate circulation of the

blood and regulate blood pressure. Abdominal breathing maintains the
flexible abdomen and relaxed chest, turning it into a deep breath,
slow, even and smooth, providing greater balance in the operation of the
respiratory system.

Similarly, Tai Chi promotes digestion, as its movements activate the

intestinal function.

The influence of Tai Chi on the nervous system is as tangible as it is obvious.

The balanced toning of the nervous system through unified execution of
the movements have a highly beneficial effect on the whole of
body, promoting the capacity for attention and calmness.

The inhibition of the body can express sorrow, anguish, and distrust.
oneself, etc. The practice of Tai Chi can help promote the
harmonization, the progressive release of movement, of breathing and of
Attention. Practice teaches to feel the flow of gestures and to discover the

250
softness in activity. It influences our mind and we will discover how it affects us
we become less rigid and more flexible.

Attention to the breath allows images and thoughts to gradually fade.

thoughts are expressed without one being invaded by that inner activity.
Practice helps to perceive the movement of inner energy, to feel, to
contain the wave of mental activity without fleeing or fighting. Develop the capacity
to perceive the images and unconscious feelings that correspond
also at the beginning of attention and not fighting, which is the basis of Tai Chi.
It provides a therapeutic benefit when one practices it consistently. Its
practice gradually ensures a greater harmony with oneself and with the
environment, allowing for the remediation of the imbalances in the conditions in which
we live, a product of being agitated and rigid, externally and internally.

251
 89
SHANTALA
Ayurvedic Massage

Shantala, the Ayurvedic massage, is an ancient technique.

developed in India for babies and children. The
massages are an important pillar in many treatments
pediatrics from Ayurveda

89.1 Who can it help?

Shantala or Ayurvedic Infant Massage is used in India for all

newborns, with the aim of warmly welcoming the child that is born, to embrace
the mother/father-child relationship and helping in the sensory-motor development of the newborn.
All newborns and their parents benefit from this massage and
especially those who are premature or of low weight, as it has been
it has been demonstrated that massage helps with weight gain.

On the other hand, massage has also been developed for the childhood stage.
During this period, the goal is to correct the conditions that are disrupting
the health and overall development of the child. Patients with the following conditions
they would especially benefit from a Shantala therapy:

Attention deficit

Growth delay

Dermatological pathologies such as atopy and psoriasis

Endocrine pathologies such as type I diabetes

252
 Neurological pathologies such as cerebral palsy, mental retardation, myopathies,
etc.

Joint pathologies

Obesity

Also children with special needs who require stimulation

they can greatly benefit from massages, as it helps to
strengthen the body, integrating bodily perceptions with the
feelings and emotions

89.2 What are the benefits?

Massage is an ancient technique that provides affection and well-being.

who receives it as to whom it is given. It is a natural alternative for
increase well-being in healthy children and restore health in children with some
type of condition. In some cases, Ayurvedic Pediatric massage is useful.
as an adjunct therapy in patients who are undergoing treatments
prolonged or aggressive, or in those with chronic diseases. The benefits
the most important are:

Help with sensory-motor and psychological development

Increases the tone, strength, and flexibility of muscles and joints

Regulates metabolism

Allows for greater attention

89.3 How does it work?

The Ayurvedic Children's Massage uses natural resources to enhance the

health status and vitality of the recipient. Medicated oils are used with
essential oils or medicinal plants specially selected for the
constitution of the baby or child. In cases of malnutrition and pathologies
neurological conditions such as spasticity due to cerebral palsy, preparations are used
specialized with the aim of revitalizing damaged tissues. The massages
an adult (mother, father or guardian) is always present in the room.
que acompañe al niño durante la sesión.

253
 90
Method
ESSENTIALS

The Essentis method is an intensive and multidisciplinary neuro program.

rehabilitation.

The method does not follow a protocol but adapts to the individuality of each
child.

An 'intensive treatment' lasts from 2 to 4 weeks, with a duration of 4 hours.

per day, 5 days a week.

During the intensive, the following will take place:

Evaluar al niño y hacer hincapié en sus capacidades en los ámbitos físico y

cognitive.

Test the different clues that will allow for progression.

Select therapies and workshops adapted to the child.

Advise parents on guidance and monitoring at home.

After each intensive, parents will receive a written report and a video of
the different workshops to continue the work started at home.

The results are optimized if the child attends several intensive sessions a year and if
works from home regularly.

The objectives of the program:

Desarrollar al máximo la motricidad funcional. Estimulación repetida de las

peripheral joints during functional activities for retro-
feed the central nervous system with correct sensory information.

254
 Improve self-confidence and fear management (of falling, of
fail...)

Promote the child's autonomy.

Improve the child's quality of life: care for functional disorders

such as dysphagia (difficulty swallowing), constipation, excessive salivation,
the difficulties in breathing, etc.

Give the child the opportunity to fully develop their abilities: to improve
the functions affected by Cerebral Palsy and develop others
potentials.

During the sessions, the patient goes through different workshops in which their
posture, their disability and symptoms are assessed by different
team members (osteopaths, acupuncturists, physiotherapists) with the aim
to create a program adapted to needs.

It has a holistic approach to treatment, meaning the patient is assessed in their

totality. We carefully analyze all the factors to establish a
diagnosis and an appropriate treatment strategy for the patient (factors
physical, emotional, and social, current symptoms and medical history.

In this method, great importance is given to the preparation of the tissues.

to optimize the exercises done afterwards.

In parallel to the physical treatment, the patient will undergo numerous workshops.
rehabilitation with the aim of maximizing functional motor skills. The
the center of the essentis method has varied material allowing adaptation to
the needs of the patient and their progress: floor work, the bars
{"paralelas":"parallel bars","contra la pared":"against the wall","caminador":"walker","muletas ortopédicas":"orthopedic crutches","Spider":"Spider","Therasuit":"Therasuit"}

Biodetox... All these tools used at the right moment

will allow optimizing the patient's progression.

90.1 Workshops and therapies of the method.

In this method, they are as follows:

Osteopathy

Acupuncture, Chinese Medicine and Cranial Electro-acupuncture

Ground work

Therasuit

Spider Therapy

255
OSTEOPATHY:

It is a holistic manual therapy aimed at restoring the

homeostasis in the body (the body's ability to self-regulate).

According to the osteopathic concept, the structure and function of each tissue
(muscles, bone, joint, organ…) are closely linked.
Acting on the different structures of the body, the osteopath tries to
restore its normal function.

The osteopathic treatment aims to improve the vascularization of the

structures and thus favor their function and their "self-healing".

To carry out your treatment, the osteopath uses various types of techniques: inhibition
muscular manipulations articles manipulations visceral
fascial unwinding, craniosacral therapy...

Craniosacral osteopathy is made up of a system of membranes that

they extend from the skull to the base of the spine (sacrum). The fluid that
circulates between these membranes (cerebrospinal fluid) is constantly
renewed (secreted and reabsorbed). This creates subtle movements known
as "primary respiratory movement". This movement informs the therapist
about the general condition of the body.

Visceral osteopathy, the proper function of an organ depends on its mobility.

physiological, and with correct vascularization and innervation.

A mobility restriction, a lack of venolymphatic drainage or a disorder

Of the innervation and peristalsis (involuntary visceral movement) harms the
good function of the viscera.

Osteopathic work ensures the path of the arteries, veins and

nerves are free from restriction or adherence.

The organs are attached to the bone and muscle structures, and held in place.
between each other by ligaments.

ACUPUNCTURE:

It is one of the five branches of Traditional Chinese Medicine. This therapy is

founded on an energetic and holistic approach.

According to oriental medicine, it acts on the 'Qi' (pronounced chi) that circulates in the
body through the meridians.

256
Precise acupuncture points are stimulated with needles to regulate the Qi.
and to balance physiological, organic, and psychic functions.

From a Western perspective, it could be said that it helps strengthen the

self-regulation and healing processes that are activated when the organism
faces an attack (caused by a virus, stress, an injury, etc.).

There is a detailed map of the acupuncture points, of the meridians and

of their papers to re-establish the health and balance of the patient.

Acupuncture often allows for treatment in combination with other

therapies, a variety of imbalances in the musculoskeletal systems,
respiratory, gastrointestinal, nervous, etc.

THERASUIT:

It is presented as a 'suit' that, through a system of elastic bands, allows for

patient's body to align in a more 'normal' way.

This restructuring of the optimal posture and the appropriate functioning of the
muscles allow the patient to learn or relearn movement patterns
correct (sensory integration).

The tensions exerted by the elastics (which can be moved to adapt

to the needs) stimulate the appropriate muscle groups to stabilize
the posture.

The Therasuir is particularly adapted in the case of muscle stiffness.

passive: acts as a flexible orthosis, guiding the joint without locking it.

SPIDER

It is a verticalization tool that produces excellent results and that

you can adapt at home.

It is a very playful work instrument that allows the child to vent.

freely and in total safety.

The patient is standing in the center of a room, restrained by cables.

elastics fixed to the walls. This type of support is dynamic and allows the
patient to train by practicing any type of movement in a way
independent, improving its sensory integration.

257
The child discovers sensations of verticality and can practice it.
any movement without the fear of falling (standing up, pushing on the
legs, straighten the head, move the arms, lift a leg, jump...)

The verticalization of the spine is an essential stage in

development of walking.

Working at Spider allows for improvements in coordination, balance, and endurance.

muscular.

It is excellent for the development of head and trunk control and allows
also develop the child's sociability so that they can interact with their
environment.

The higher the elastics, the less the child has to bear their own weight.
This way we can control the level of difficulty and the amount of muscle effort to be produced.

This controlled loading of the joints stimulates an ossification.

correct and thus allows for the prevention of osteoporosis and dislocations
from the hip.

90.2 Centers and contact

The center of the Essentis method is located in Barcelona, to obtain

the following links exist:

[Link]

info@[Link]

Official website of the ROE (Register of Osteopaths of Spain)

[Link]

258
 91
Treatment
with TIZANIDINE

Tizanidine is an imidazoline derivative that acts centrally as an agonist.

inhibiting the release of excitatory amino acids in the interneurons
spinales, and that could facilitate the action of glycine. The antispastic effect is
it has been studied in experimental animals; it has been shown that the
tizanidine suppresses reflexes in cats with spinal cord section, stimulates the
inhibition of the H reflex in humans and reduces abnormal contraction, and this is
it is also due to an adrenergic effect. The strength of the effect on the tone is
similar to baclofen but also facilitates the torque of the spastic muscle
through increased amplitude of the agonist contraction. The reducing effect of the
tone, spasms begin to be noticeable after 3 hours.

The most common side effects are sedation, nonspecific dizziness,

asthenia and dry mouth, and other rarer effects have been mentioned such as
visual hallucinations, digestive discomfort, insomnia, skin rashes and
fatigue; all of them can be eliminated by reducing the dose.

The main positive clinical effects of tizanidine are the decrease in

tone (especially in extensor muscles) and hyperreflexia, improvement of the
posture, antinociceptive, and facilitator as a consequence of the activities of the
daily life and hygiene. Other effects that have been used are induction
of sleep in tetraplegic patients with sleep disorder refractory to others
treatments or the supposed improvement of language disorders.

In general, it is recommended to start with a low nightly dose, which ranges

between 1 and 4 mg, then gradually increasing to a maximum amount
from 9-12 mg. The differentiation of doses according to age is specified rarely,
but the usual cutoff point for transitioning almost all medications to adult doses

259
It is at the ages of 12-13 years, other ages that are used to make dosage changes.
are they 7 or 10 years.

It is a medication that produces relatively few effects.

secondary, so it is better tolerated by patients than other drugs
antispasmodics, which means that both children and their parents engage in
a high appraisal of it.

Therefore, tizanidine appears as a drug with potency against the

spasticity similar to that of others but with the ability to cross the barrier
blood-brain barrier, it does not cause muscle weakness like baclofen and the
benzodiazepines, it is better tolerated and shows better results on the
function and daily life activities, and yet it is often proposed
as an alternative to baclofen even in injuries of brain origin.

The utility of tizanidine in the treatment of spasticity is exposed.

infant, especially as an initial measure against generalized hypertonia or
harmful, in order to apply other global (physiotherapy) or focal treatments
botulinum toxin

260
 92
Cerebral palsy and
SCOLIOSIS

Most children with severe cerebral palsy have significant

spinal curvatures (SCOLIOSIS), which often require surgery.
Because the pelvis and the spine are connected, any procedure
surgical procedure to correct scoliosis should take into account the possibility of a
malaligned pelvis. The degree of asymmetry, they add, should dictate the size, type
and location of the surgical screws and rods to stabilize the spine
vertebral and the pelvis in such corrective procedures. Among the treatments
It is worth noting:

It depends on the cause of scoliosis, the size and location of the curve, and
how much growth is expected.

As the curves become more pronounced (above 25 to 30 degrees

in a child who is still growing), the use of a is generally recommended
orthopedic device (brace) to reduce progression. Many are used
different types of such devices that have names like corsets
Boston, Wilmington, Milwaukee and Charleston.

Each corset or orthopedic device has a different appearance and there are
different ways to apply it. The selection of a corset is determined by
the specific characteristics of curvature.

The back braces do not stop the curve from progressing, but
they exert pressure to straighten the column and can be adjusted during growth.
These devices do not work for congenital or neuromuscular scoliosis and
they are less effective in idiopathic scoliosis in children or adolescents.

A curvature of the spine of 40 degrees or more requires surgery for its

correction, due to the high risk the patient faces of suffering further deterioration
after the bone growth has stopped.

261
The surgery involves correcting the curvature (though not all of it) and fusing the bones in
the curve. The bones are held in place with one or two metal rods
sustainability with hooks and screws until the bone heals. Sometimes, the
surgery is performed through an incision made in the back, in the abdomen or by
under the ribs.

A corset or orthopedic device may be necessary after surgery.

to stabilize the spine.

The limitations imposed by the treatments tend to be emotionally

difficult, especially in adolescents, as it harms self-image.
Therefore, emotional support is important to adjust to these
restrictions.

Among the methods for treating SCOLIOSIS, the following stand out:

Niederhöffer Method

An exercise system for scoliosis and spinal deviation. It consists of

mainly in the consolidation, through isometric contractions, of the
individual muscles attached to the spine. This method was
developed by the German doctor Egon von Nierderhöffer, around 1900 and
published after his death in 1942, with his personal notes, by his
wife and work colleague, the physical therapist Luise von Egidy (1873-1946).

To treat scoliosis, besides the Niederhölffer Method, there are others.

methods and techniques that are:

262
 ASYMMETRIC METHOD OF RUDOLF KLAPP (it is the oldest)

Method based on the spinal column discharge. The variations of

The quadruped position allows for situating the corrective action on a level.
delimited.

KLAPP was a German surgeon from the early century who based his treatment
for spinal deformities in their observation of animals.

He advocated that quadruped animals, among which initially were

the man said, they never had problems with their spine in their frontal plane,
since the lateral deviations while on all fours were almost negligible. For this reason, his
the method is based on placing the patient in a crawling position and the
further development of specific exercises for their deformity. That is,
although some exercises for the treatment of deformities are explained in the
lateral plan, such as dorsal hyperkyphosis and lumbar hyperlordosis, their
results are not too good compared to the treatments of
scoliosis by this method.

Thus, Klapp places the patient on all fours (in a crawling position) leaving the
suspended column with four support points as if it were a hammock
It will try. The crawling positions are four that vary depending on the segment.
vertebra that we want to mobilize.

Two types of exercises are associated with these starting positions: walking and
the stretches.

To do this, Klapp uses six positions that can be adopted in kyphosis and in
lordosis.

The following shows through the next drawings the Positions:

["Low","Semi-low","Horizontal","Semi-upright","Upright","Inverted"]

263
And the three ways of movement that are used:

1. Walking should have the opposite arm and leg in habitual use.

2. Walking in gait: marching is done with the arm and the leg
on the same side.

3. Alternating displacement of homologous limbs: it is done

advance the two upper limbs and after them the two lower limbs

After learning the positions and gestures that should be made

movements are performed at a forced pace, increasing the amplitude. In this way, it
It simultaneously obtains an elastic and muscular rachis and quick overall effects.
intense, increasing the heart rate, increased breathing and
sweating. Klapp initially did not present his method as a
therapeutic, but rather as preventive gymnastics.

264
 93
OTHER THERAPIES

TREATMENT OF DROOLING

Drooling can be reduced through certain medications, surgery, or

bio-feedback. Several surgical techniques have been developed for
to reduce drooling with varying degrees of success. Generally speaking, the goal
The main purpose of these operations is to decrease salivary secretion more than that of
mejorar la circulación de la saliva en la parte de atrás de la boca. Estas cirugías
they mainly focus on the extraction of the submandibular glands, the
relocalization of the salivary glands, the section of the efferent nerves
parasympathetic fibers that serve the salivary glands as well as numerous
modifications or combinations of these techniques.

With this series of surgical interventions, the subject is seen frequently.

affected by undesirable side effects. For example, Torelmalm and Bjerre
(1976) they observed the temporary loss of taste functions as well as a
decreased sensitivity of internal oral tissue. According to Green in 1977
Pain and swelling in the face often appear. The increase in number
dental caries in certain subjects and the formation of cysts occur
occasionally (Ericson, et al, 1973). Even when surgery manages to mitigate the
Babeo questions the success of this type of treatment. Additionally, it is necessary
Remember that drooling is not due to increased salivary secretion. One
decrease in saliva secretion due to surgery is even
contraindicated as normal swallowing depends on stimulation
adequate saliva.

Surgical treatment may be accompanied by complications, worsening

the difficulties in swallowing. Biofeedback is a technique that alerts
when they start to drool so that the person can control it. It consists of a
device that emits a light and/or sound signal (light/sound) when the
the person starts drooling and, thus, can swallow saliva when they perceive it
signal

265
How to reduce uncontrolled drooling in children with cerebral palsy?

[Link]

TREATMENT OF BLADDER INCONTINENCE

To treat incontinence, there are a series of possible interventions that

includes special exercises, biofeedback, drugs or implantation
surgical apparatus that help control the affected muscles.

TREATMENTS FOR FEEDING PROBLEMS

Difficulties in chewing and swallowing can lead to problems with

choking and/or malnutrition. To alleviate them, the doctor or therapist
occupational, sometimes, they recommend specific diets and train the person
con PC en nuevas formas de comer. En los casos más graves, podrán
recommend a gastric tube that carries food from the throat to the
stomach, or its surgical implantation after making an opening for it
through a gastrostomy.

An expert advises families on the nutrition of individuals.

with autism and other pervasive developmental disorders

[Link]
[Link]

PATTERN THERAPY

It seeks to teach motor skills in the same sequence in which they

develop and evolve normally, that is, the therapist guides the child to
that it follows the same learning sequence that a child without a PC follows when they go
going through the different stages of motor development, regardless of the
patient's age. This therapy is surrounded by a lot of controversy and arouses

266
hesitations among those who believe that there is a lack of studies demonstrating their
efficacy.

SURGERY TO LENGTHEN MUSCLES

It is especially recommended in cases of severe contractions that

they reduce the mobility options of the person. Its purpose is to detect
the muscles and tendons that are contracted (short) in order to then lengthen them.
Identifying defective muscles is not an easy task. For example,
to take just two steps with a normal gait, thirty muscles are needed, but
the problem in just one of them is enough to cause abnormalities in the
way of walking.

To detect the source of walking problems, there is a

technique called gait analysis that combines the information obtained
through video tape recording, analysis of the sections of the passage through
computer, force plates that detect when the feet touch the ground and the
electromyography, which records muscle activity.

Among the disadvantages of surgery, it is important to highlight the possibility that it may
weaken the muscle and the need for a prolonged period for the
recovery.

BEHAVIORAL THERAPY

Behavior Therapy aims to enhance the skills of the child.

with PC, through psychological learning techniques. It therefore constitutes,
a complement to rehabilitation and occupational therapy. The foundation of
Behavior Therapy is the reinforcement or reward of appropriate behaviors.
(for example, every time the child with CP achieves a therapy goal
occupational, a balloon is given) while they are extinguished, ignoring the behaviors
inadequate (e.g.: attention is withdrawn when having tantrums for not wanting to)
carry out the rehabilitation).

BRUNNSTROM METHOD

It is one of the classical treatment methods in neurology. Brunnstrom uses

the primitive movement patterns (especially flexion synergies and
extension) through proprioceptive and exteroceptive stimulations. As it progresses towards
the voluntary control by the patient under maximum resistance, the evolution
The hypertonia develops throughout the seven phases of motor recovery.
in the fourth phase, hypertonia decreases, parallel to the beginning of the
basic combinations of movements, towards the sixth phase, the hypertonia

267
disappears, and motor coordination is quite good, Remy-Néris and
Chauviers is cited as effective for treating spasticity, although other authors
they reflect the controversy arguing that the use of movement schemes
primitives and their repetition can increase hypertonicity.

HIPPS METHOD

Movement restriction. Prevention or correction of deformities through

orthopedic devices and therapy based on motivations according to age.

FRAENKEL METHOD

Teaching coordination, especially in ataxic forms.

MONTESSORI

Montessori demonstrates the validity of sensory and motor education for a

post-access to intellectual and moral education. It was considered
absolutely supportive of pedagogy with people with disabilities, worked for two years
direct interactions with children. He stated that the purpose of the method is to guide the child
by hand to educate from its muscular system to its nervous system and
sensory; from notions to ideas; from ideas to morality.

Combined education of sensory reactions and movements.

RUNNING, PLUM

Intensive application of selected different methods.

THOM

Complete therapy individually adapted using all methods.

conservative and surgical methods to achieve certain goals.

STEINER, KING

Motor apparatus education from relaxed positions.

268
Place the patient in a calm environment, positioning them in a fetal position. They
begin the learning of head control, to then work on the
different parts of the body.

BEAMAN and OBHOLZER METHOD

It is a method that has been used in athetotic patients, focusing on making

repeat the exercises until fatigue prevents performing more exercises, in that
at this moment relaxation occurs and incorrect movements disappear
the involuntary actions of the patients.

More concretely:

Beaman: relaxation through fatigue during intensive exercises.

Obholzer: relaxation through exercises despite fatigue.

DANE METHOD and NEUMANN–NEURODE

The method is based on baby gymnastics exercises and adapts and applies them.
to children with motor disabilities.

ELECTRO-MECHANICAL FEEDBACK

The method consists of the patient becoming aware of the variations of the
electrical activity of certain muscles that he will need to control voluntarily,
after the relevant training.

The device requires surface electrodes. The effectiveness of this method has
has been demonstrated in hemiplegics by authors such as Schleenbacker et al.

PLUM

Supports the strengthening of spastic muscles and their antagonists. Without

embargo, exercises the spastic muscles in their external amplitudes, since,
normally, these muscles are shortened, while you exercise the
antagonists in middle and internal races.

COUNTERSTIMULUS TECHNIQUE

269
It consists of the passive provocation of certain stimuli on joints of
the spastic areas. It also has its greatest indication in the limb.
superior, thus, the passive stretching of the extrinsic flexor muscles of the
spastic hand facilitates the function of the extensor muscles, according to the
Carey's experience.

CARLSSON METHOD

Therapeutic approach based on motivations to achieve goals.

FUNCTIONAL ELECTRICAL STIMULATION

Studies have shown that it is an effective way to attack and reinforce the
spastic muscles, but the method of administering the electrical pulses
requires bulky and expensive devices implanted by a surgeon, or the
stimulation of the skin surface by a trained therapist. The
Researchers have developed a high-tech method that eliminates the
bulky device and the electrodes, using a hypodermic needle to inject
microscopic wireless devices inside muscles or nerves
specific. The devices are guided by a telemetry rod that can
direct the number and strength of its pulses remotely. The device has
has been used to activate and strengthen the muscles of the hand, shoulder, and ankle
in people with cerebral palsy as well as in survivors of accidents
cerebrovascular.

SPINAL CORD STIMULATION

It was developed in the 1980s to treat spinal cord injuries and

other neurological conditions involving motor neurons. An electrode
implantado estimula selectivamente los nervios en la base de la médula espinal
to inhibit and decrease nerve activity. It still needs to be tested in studies
clinical effectiveness of spinal cord stimulation for treatment of
cerebral palsy. It is considered an alternative treatment only when
other conservative or surgical treatments have not succeeded in relaxing
muscles or relieve pain.

REIKI THERAPY

Reiki is a Sanskrit word that means REI, universal energy, and KI, energy.
vital

270
It is a technique for channeling and transmitting vital energy through the
laying on of hands, which is used to obtain peace and balance in all
niveles:

Physical: improvement in ailments, injuries, metabolism, etc.

Emocional:problemas sentimentales, agresividad, infelicidad, etc.

Mental:hábitos dañinos, estrés, insomnio, etc.

Spiritual: harmony, peace, balance, etc.

Reiki acts deeply, going to the root of the physical or emotional problem.
allowing the emotion or the behavior pattern that has created the
imbalance, manifest and be healed.

Reiki therapy can be received by all human beings (healthy adults,

sick people, pregnant women, children and babies), including also animals and the
plants. It is a complementary therapy to conventional medicine and therapies
psychological disorders recognized by the World Health Organization (WHO).

The Reiki method is based on the Hindu belief about the Chakras, which
they would explain the health states of human beings. According to this belief, the
malfunction or blockage of one or several Chakras would be what causes or
worsens the poor state of health leading to diseases and disorders.

The reiki practitioner acts as a channel for universal energy and their objective is
re-harmonize the physical, emotional, mental, and spiritual planes that have become sick.
Ha sido oficialmente reconocido y recomendado por OMS por sus resultados
positive. Currently, there are many currents of Reiki and in each one of
they are taught in a different way, however in all of them it is channeled the
same Universal Energy, that is why these Reiki currents act under the
same principle.

Through this method, we make our body healthier.

thought becomes calmer and we increase the joy of living.

271
 RPG (GLOBAL POSTURAL REEDUCATION)

It is a restructuring treatment method for the apparatus.

musculoskeletal with beneficial effects on the locomotor, aesthetic,
organic, functional, and psychological. Based on active, progressive postures and
global, try to stretch the muscle chains. Correct the deformities and
static imbalances avoiding compensations.

There are eight postures, divided into four families that are chosen based on the
pathology and morphotype of each person. Physiotherapist and patient work together
coordinated form.

Currently, there are more than 1,000 RPG practitioners in Spain (physiotherapists and
doctors) and more than 10,000 worldwide.

MATROGYMNASTICS

It is a technique that involves exercises only between the mother and the child.

Mother gymnastics is an important element that needs to be introduced in the

early intervention to inhibit primitive reflexes and stimulate reactions of
straightening facilitated by the mother-child duo; for this, a requirement is needed
mother's guidance and participation and the need for appropriate stimulation
en el mantenimiento de posturas. Es importante mencionar que también se
it integrates the active participation of either the mother, father, or both, through
various forms of exercise such as gymnastics, dance, play, the

272
body expression, etc., aimed at the development and learning of patterns
basic motors and the consolidation of others.

With the practice of Matrogymnastics, many aspects of

child and his parents, the most important besides the physical aspects are:

Strengthen the emotional bond between the mother or father and the child

Socialization

The integration

The values

Hygiene

Physical culture

Matrogym turns out to be a very powerful tool during the stage

preschool, but it can be applied at higher levels with good results.
This applies in sessions of 30 to 50 minutes, structured in an initial part,
core part and final part, with a physical education class, in this one can
stimulate different aspects, both physical and cognitive

The eye contact between mother and child promotes visual stimulation.
auditory, labyrinthine, and cervical.

A patient with cerebral palsy and persistent difficult TAC

you can establish eye contact with the mother, that is why it is very important the
stimulation that we carry out on the little one.

273
 TREATMENTS WITH DEVICES Ex N´ Flex

The therapeutic exercise machines Ex N'Flex, the name of a group of

electrical devices that allow for combining active exercise - in which the
the person makes part of the effort - and the passive - that is characterized by being the
machine that does all the "effort" through a motor - thanks to which the
people with damaged limbs have greater chances of doing
daily exercises and thus improve their quality of life. With especially results
notable in the treatment of patients with hemiplegia, multiple sclerosis,
Parkinson, Alzheimer, muscular dystrophy or cerebral palsy but also in the
cases of debilitating diabetes, arthritis, back injuries, and overweight. The
periodic use of these machines allows for increased strength, endurance,
flexibility and movement of the limbs, promoting blood circulation and the
oxygenation, reduce spasms, edema, pain, and stiffness in the
extremities, improve the functioning and control of the intestines and bladder,
increase energy and aerobic capacity, and improve balance in the
patients with outpatient capacity. It should be added that these machines
they incorporate an automatic system by which they turn off immediately if the
the degree of resistance to the movement of the patient's arm or leg is excessive to
cause of, for example, a muscle spasm. Thus, the patient has the
peace of exercising safely.

THE NEURALTER

The Neuralter is a Spanish device that uses electromagnetic waves not

ionizing and very low power exert a proven therapeutic action in the
bone tissues - accelerates calcification, improves osteogenesis, and increases
collagen production and fixation as well as vascularization and mineralization
that is, in the epidermal tissues - it acts on collagen and has an effect
antioxidant-, in the nervous system–calms pain-, in the digestive system–
regulates intestinal motility - and in the circulatory system - increases blood flow
blood peripheral and favors defenses by stimulating the reticulo-
endothelial – in addition to eliminating muscle spasm. And it achieves this because it is
able to transmit to the patient around 300 million very frequencies
limited power that manages to raise the cellular biopotential and normalize the
area in which it is applied facilitating its energy rebalancing. In summary, it is a
effective device in the treatment of multiple pathologies that does not produce side effects
serious secondary effects, often allows the patient to reduce the
amount of medications taken daily that alleviate pain and the
inflammation, accelerates the healing processes and, in general, improves the
metabolism since although the greatest contribution of the signal occurs in the area
tratada sus efectos beneficiosos se pueden percibir en zonas distantes gracias a
the good conductivity of the human body to the waves emitted by the equipment.

274
 BALANCE POLAR ELECTROMAGNETIC

Balance Polar Electromagnetic (BPE) is a medical-therapeutic system based

in the laws of quantum physics, which seeks to rebalance the polarities
electric and magnetic fields of the organism to restore, in an integral way, the
health of the person in its different levels of manifestation.

Every electromagnetic field is made up of an electric aspect and another

magnetic that manifests through electric polarities - negative and
positive- and by magnetic poles -north and south- that have the same
representation of the yang and the yin, of the masculine and the feminine, of the active
and the passive, of the structural and the functional.

In this therapeutic process, the body is worked on as a field.

electromagnetic in which the electric is expressed, fundamentally, in the
physical aspect and the magnetic in the emotional, the mental, and the non-physical. The
alterations that occur in it, either because they originate from within or because
They come from the outside (environment), generating changes in the polarities of the organism.
that are expressed as a disease.

The Polar Balance therapy was developed by Dr. Francisco Ríos.

Álvarez, Colombian acupuncturist and psychologist, based on the principles
of quantum physics, of the synthesis of various disciplines and of observation
diligent in a large number of patients in their physiological processes,
biochemical, emotional, mental, etc., and their relationship with the environment that it
surrounds.

The interaction between the therapist and the patient allows for obtaining information.
necessary alterations of its electromagnetic field in the different
levels of manifestation of their organism, thus obtaining knowledge of
his health status.

The normalization of polarities is done with acetate filters that exert

your action based on the photoelectric effect. These are small fields
electromagnetic with a specific vibrational frequency that, when placed on
the patient, contribute to the rebalancing of the organism, giving the person
elements that help you integrate your individual processes and the
relationship with their environment, so that they can find the purpose of their life.

As far as the Electromagnetic Polar Balance is a process of

management of information, the more complete the patient's medical history is and
the more knowledge the therapist has, the greater the possibilities of
give that patient everything they need and only what they need. That is why
the handling of a homeopathic medication, an acupuncture needle or
an allopathic medication, with the same criteria used for working with filters,
it allows to expand the possibilities of help to patients.

275
Information regarding this [Link]

GINDLER METHOD

System of bodily education aimed at the development of

sense of posture, muscle tone, and movement as well as
sensory acuity. It includes practice in breathing and relaxation, techniques of
automasaje y en las sesiones de grupo se hace masaje mutuo. Probablemente
es el más profundo de los sistemas modernos para desarrollar el conocimiento
of the body, - to be in contact with oneself - and to express oneself in a
natural and true way. Created in the 1920s by the Kinesiotherapist Elsa
Gindler (1885-1961) from Berlin. None of his writings have been published.

276
 NEWS

News published on April 29, 2010 by universy:

USE XENON GAS TO AVOID BRAIN DAMAGE IN BABIES DUE TO

FIRST OCCASION.

Xenon gas was successfully provided to a newborn baby in an attempt to

prevent a brain injury due to a lack of oxygen at birth. This technique
the pioneer has been developed by Professor Marianne Thoresen of the
University of Bristol and carried out at Michael's Hospital St, part of
Hospitals of the University of Bristol NHS Foundation Trust.

They have been pioneers in new treatments for brain injury in babies.
since 1998 when Professor Thoresen used cooling in babies
after a lack of oxygen and they demonstrated that this technique could reduce
the damage in the brain of the newborn.

Professor Thoresen, starting in 1995, has demonstrated that cooling

after the lack of oxygen reduces brain injury in animal models.
Clinical trials in humans showed that mild cooling
for just a few degrees for 72 hours, it is a safe treatment and
beneficial. However, cooling only partially reduces disability and
it does not prevent all babies. The search began like this to a second
treatment that could be added to cooling to further reduce the
disability.

After rigorous analysis by the health authority and

healthcare assistance and regulatory approvals and other issues of
regulation, the device is now authorized for clinical trials and
It will be used in a minimum of 12 babies in the coming months. The approval of
this essay is about feasibility in the first necessary step before further tests
big things that can be done in baby units on a larger scale
big.

278
News published on May 20, 2009

ROBOTIC THERAPY FOR CHILDREN WITH CEREBRAL PALSY

MIT robotic engineers have spent decades developing robots.

capable of assisting people who are recovering from an accident
cerebrovascular. Lately, however, researchers are using
these knowledge to help children with cerebral palsy and others
neuromuscular disorders.

The devices are based on the same principle: that it is possible to reconstruct the
brain connections using robotic devices that carefully guide
the limb when the patient tries to make a movement.

When the researchers initially decided to apply their work to children with
cerebral palsy, Krebs (one of the creators) was optimistic that it would have
success because their developing brain is more malleable than that of the
adults and therefore, it is more suitable to establish new connections.

The MIT team focused on enhancing the ability of patients with

cerebral palsy to reach and grab objects. Patients squeeze the
hand to the robot through a handle, which is connected to a monitor of
computer that shows functions similar to those of video games
simple.

In a typical task, the young person tries to move the robot's handle towards a target.
mobile or stationary that appears on the computer screen. If the child is
moves in the wrong direction or does not move, the robotic arm directs it
gently guide the child's arm in the right direction.

Krebs began his work in robotic therapy as a graduate student at MIT

almost 20 years ago. In their initial studies, he and his colleagues found that
for patients with strokes it was important to make a
conscious effort during physical therapy. When the brain's signals
they will appear with the robot's assistance movements, this helps the brain to
create new connections and to learn again how to move the limb
yes only.

According to Krebs, although strokes kill

many neurons, those remaining quickly establish new synapses or
they strengthen the latent synapses.

For this type of therapy to be more effective, a lot is required.

repetitions at least 400 in a one-hour session.

279
The published results of three pilot studies conducted on 36 children,
they suggest that patients with cerebral palsy may also benefit
from robotic therapy. Studies indicate that these therapies helped the
children to reduce their impairments and to improve the continuity and speed of their
movements.

One of these robotic machines is the LOKOMAT, it consists of a

robotized gait orthosis and a modern weight discharge system
corporal, combined with a conveyor belt.
Automated operation reduces the physical effort of therapists and
allows for longer and more efficient therapy sessions.

The LOKOMAT helps disabled patients to perform the movements of

march on a treadmill and combine functional locomotion therapy
intensive with assessment tools and the patient, in Galicia there are three in:

La Merced Clinic in Pontevedra.

Brain Damage Foundation FUDACE in Lugo.

Juan Canalejo Hospital in A Coruña.

ANNEXES

They create a robot with arms that helps disabled people to imitate their
movements

[Link]
html

Robots that bring life

[Link]

A robot that teaches how to drive the wheelchair

[Link]
.html

A physiotherapist robot

[Link]
[Link]

280
News published on Saturday, November 6, 2010

In vitro children have a higher risk of cerebral palsy.

Source: BBC World

Danish scientists claim that fertility problems in fathers do not

they can explain the risk of cerebral palsy in children born after
in vitro procedures.

Aarhus University discovered that couples who had problems with

to naturally engender presented similar risks to those that it
they achieved it quickly.

However, what Danish scientists discovered is that the risk of

cerebral palsy is more prevalent in babies born with the help of fertilization
in vitro.

Other potential causes, such as the treatment itself, should be

investigated, the scientists indicate.

UK experts say that despite the low risk, the matter must
to take seriously.

The safety of in vitro procedures, and other fertility treatments, has

has been closely monitored since the birth of the first 'test tube baby' in the
70.

As the number of in vitro babies increases, initial concerns

about the development problems have disappeared; however, what is
the rates of cerebral palsy remain high.

There are several possible reasons, including that there is more risk of
complications in multiple pregnancies, which until recently had
are much more frequent when the pregnancy is the result of an embryo of
test tube.

281
The doctors had the presumption that the underlying reasons were
infertility could play a role, but the most recent studies raise doubts
about it.

It's not a matter of time

The team examined a national medical information data center.

with thousands of pregnancies and births, reported the Reproduction magazine
Humana.

They compared the rates of cerebral palsy in babies grouped according to how much
It will take their mothers to become pregnant after trying to conceive.

This interval is used as a way to assess fertility. If the interval is of

a year, this may involve some kind of problem, although not as serious as
to prevent pregnancy.

When those who 'procreated quickly' were compared with those

which took more than a year, there was no significant difference in the rate of
cerebral palsy

However, a group of babies born after in vitro fertilization, or

from the technique in which sperm is injected directly into the egg,
they presented nearly double the risk of cerebral palsy compared to
those parents who were able to conceive quickly.

Multiple pregnancies
As the number of in vitro babies increases, the initial concerns
about development issues have disappeared; however, what remains
high rates of cerebral palsy are maintained.

The average risk was not high, approximately 1 in every 176 babies born.
although the figure represents a significant amount when put in relation to
the 12,000 babies born each year in the United Kingdom, after the
application of in vitro fertilization techniques.

Dr. Jin Liang Zhu, who led the study, says: "Our research has shown that...
allowed to examine whether low fertility without treatment, measured by the time that
this delayed until the pregnancy, could be the reason for a higher risk of
cerebral palsy after the indicated techniques.

Our results showed that this was not the case since, even for the
couples that took more than a year to conceive, there was no increase in the
statistically significant risk.

282
The researcher states that parents must remember that the increase in risk
it continues to be very low.

The other suspicious factor in the increase of cerebral palsy is constituted by

multiple pregnancies, which bring a greater amount of problems
both for the mother and for the babies, and they often involve a
premature birth.

One single embryo

The other suspicious factor in the increase of cerebral palsy is

multiple pregnancies. A recent study conducted in Sweden indicates
that the trend, in recent years, of implanting an embryo in women
instead of two as part of the in vitro fertilization process, it was reducing the
number of children born with cerebral palsy.

Professor Karl Nygren, one of the authors of that study, said that the risk
extra 'may have disappeared' in countries that implant a single embryo.

However, Professor Richard Fleming from the Center for Reproductive Medicine
from Glasgow, stated that the difficulty was still present.

It is clear that the issue persists. Although the risks are very low for the
Babies are tall enough to warrant a broader study.

The implantation of a single embryo will improve things, but it will not solve
entirely the problem

283
News published on November 24, 2010.

ASPACE now has the new electrotherapy equipment

AND HYDROTHERAPY FOR THOSE AFFECTED BY CEREBRAL PALSY.

It is the first center of its kind in Spain to have this

rehabilitation system.

The Aspace Cantabria association, which serves people with cerebral palsy,
has put into operation the new electrotherapy equipment with technology
TECAR tip and the new hydrotherapy room, to treat those affected by
this type of pathology.

The facilities, financed with 30,000 euros by the Social Work of Caja
Cantabria and that are already serving the users of the association, have been
officially inaugurated this Wednesday. In this way, Aspace Cantabria is
becomes the first center of its kind in Spain that has
a TECAR team, system used in injury recovery of
elite athletes.

The inaugural event was attended by the president and the director of the Social Work.
Francisco Rodríguez Argüeso, and Juan Muñiz, respectively, as well as the
director of Aspace Cantabria, Antonio Ruiz Bedia, and the president of this
entity, José Manuel Cruz.

TECAR equipment develops a technology that allows for local elevation of

the temperature of human tissue through the circulation of high currents
frequency.

According to the representatives of Aspace, the main applications

therapeutic services of this team for the center's users are related to

284
treatments for painful processes of muscular and articular origin,
muscle shortness, circulatory and respiratory problems, constipation
regeneration of postoperative scars or musculoskeletal injuries that
they have inflammation and/or pain.

Aspace estimates that, prior to medical prescription, around 65 users

attended in the centers and services of the association in Cantabria will
benefit from the application of this new therapy.

Generally, this therapy is indicated in treatments for

rehabilitation in adults, such as musculoskeletal injuries, in pathologies
from the joints and in inflammatory processes that occur with pain in the
extremities and the spine.

The president and the director of the Social Work have attended the inaugural event.
Francisco Rodríguez Argüeso and Juan Muñiz, respectively, as well as the
director of Aspace Cantabria, Antonio Ruiz Bedia, and the president of this
entity, José Manuel Cruz.

TECAR devices develop a technology that allows for local elevation of

the temperature of human tissue through the circulation of high currents
frequency.

According to the officials from Aspace, the main applications

the therapeutic activities of this team for the users of the center are related to
treatments for painful processes of muscular and joint origin,
muscle shortening, circulatory and respiratory problems, constipation,
regeneration of postoperative scars or musculoskeletal injuries that
they have inflammation and/or pain.

Aspace estimates that, following medical prescription, around 65 users

attended in the centers and services of the association in Cantabria will
to benefit from the application of this new therapy.

In general, this therapy is indicated for the treatments of

rehabilitation in adults, such as musculoskeletal injuries, in pathologies
of the joints and in inflammatory processes that present with pain in the
extremities and the spine.

285
 OTHER NEWS

A cold therapy prevents damage to the brain in those born with low birth weight.
oxygen

A cold therapy prevents brain damage

born-little-oxygen-152399-1

Magnesium sulfate prevents cerebral palsy in children.

[Link]

New technique to save premature infants

[Link]
30422

La Fe begins hypothermia treatment for neonates

[Link]

They develop a technique for babies who suffered asphyxia during birth

A technique is being developed for...

they suffocated during birth.

Torrecárdenas develops a program for the detection of paralysis

cerebral

[Link]
[Link]

Arrive early

[Link]

When life is overcoming

When Life Is Overcoming

vn60624-vst216

287
The Wii becomes a useful tool for treating children with paralysis.
cerebral

[Link]
treat-cerebral-palsy/[Link]

Movement games serve more than just exercise

Games with movement are useful for something.

more-than-exercise/

They praise virtual therapy

[Link]

Healthcare centers incorporate virtual reality as therapy for

mental health patients

[Link]
[Link]

The bus care arrives to relieve the tensions of the caregiver

Cuidabus arrives as a remedy

tensions-caregiver/[Link]

A new technique elongates bones by up to 15 centimeters.

[Link]
[Link]

Intras organizes a course to improve a system that helps recover the

memory

[Link]
[Link]

New devices to improve the quality of life for the elderly and
disabled

[Link]
.html

Félix wants colorful crutches

Felix wants color crutches

[Link]

288
The Generalitat collaborates with FUVANE in neurorehabilitation treatment
of minors with cerebral palsy and related conditions

[Link]
[Link]

Operation in the maternity hospital so that certain paralytics can walk.

cerebral

[Link]
/walk/certain/cerebral/[Link]

My son asks me: 'Mom, when are we going surfing?'

[Link]
[Link]

Electrical stimulation could restore voice to the mute and improve the
communication quality for people with cerebral palsy and others
disorders

Electrical stimulation could restore voice to

the-mutes_a5900.html

New technologies are a 'priority' in cerebral palsy

[Link]
ensures-new-technologies-are-priority-cerebral-palsy
[Link]

Strength exercise practice delays functional decline in children

with cerebral palsy

[Link]
cerebral-logran-reduce-functional-deterioration-practice-strength-exercises
[Link]

Therapeutic massages: "Healing" with hands

[Link]

289
 ANNEXES

Article on Growth Hormone year 2010, prepared by Jesús

Devesa founder Foltra Project (integral).

Introduction

Classically, growth hormone (GH) has been considered

as a hormone with fundamentally metabolic actions, responsible
of the organism's longitudinal growth before maturation is complete
sexual. Similarly, in a classical way, it is considered that this hormone is a
product of adenohypophyseal secretion, subject to hypothalamic regulation by
GHRH and somatostatin and partially gastric (depending on the intake), for
Ghrelin.

In light of the data that has appeared in recent years, these concepts, although
currently, they must be thoroughly reviewed as we now consider GH
as a pleiotropic hormone that plays very diverse roles in the organism
papers that go far beyond those established so far.

This article aims to outline these multiple actions of GH.

different from the merely metabolic ones and those exerted at the growth level
longitudinal of the organism.

1 Peripheral GH system.

At the current moment, it is perfectly known that they are very numerous.
tissues in which GH expression exists, to the point that we can
talk about a true peripheral GH system, as our group proposed in
1999, different from the classic somatotropic system, functional both under conditions
physiological as well as pathological, although the mechanisms are still unknown by
those that this system is regulated at the tissue level. Its local role would be to
act in an autocrine/paracrine manner, addressing specific needs of
cell proliferation or survival.

291
2 Neurotrophic effects of GH

2.1 Effects of GH on adult neurogenesis

The effects that the hormone plays as a factor are now clear.
neurotrophic, either directly or via IGF-I, at least at the central level, although the or
The mechanisms by which they act in vivo are far from clear.

Recently, GH production has been demonstrated in the hippocampus, source, with

the Subventricular Zone, of continuous Neurogenesis in the first adult, and to this
the hormone appears in the cytoplasm of newly formed neural precursors
induced brain damage in rats. Also at this level, it has been observed that IGF-I
increases the proliferation of neural progenitors through a
MAPK-mediated signaling. It seems clear then that the GH—IGF-I axis
has a special significance in the processes of adult Neurogenesis.
physiological and in response to brain damage. This assumption has been seen
evidenced, indirectly, by the work of Katakowski's group, who
demonstrate that the activation of the PI3K/Akt pathway, one of the main ones in the
signaling of GH through its receptor is responsible for migration
from neuroblasts to damaged brain areas, likely to act in the
regeneration. In fact, the Scheepens group demonstrated that during the
recovery process after brain damage caused by hypoxia-ischemia, GH
and its receptor increase their expression in the infarcted areas of the cerebral cortex
and adjacent areas, which suggests that the hormone is part of a system
neuroprotection center. On the other hand, there is increasing evidence
that the GH—IGF-I axis is directly involved in the regulation of
growth, development, and brain myelination, so that the plasticity in the
SNC, contemplated as the game of functional interrelationships among the three
main types of cells, neurons, astrocytes, and oligodendrocytes, can be
modulated by GH-IGF-I which affect those three cell types very
various forms. Aberg et al. have demonstrated that after 5 days of administration
GH to hypophysectomized adult rats increases markedly.
the production of neural precursors in the hippocampus, parietal cortex, striatum and
piriform cortex, while the administration of the hormone to cell lines
neurons produce a very rapid proliferation response of these
precursors...

Data from our group in rats with induced brain damage demonstrate
It is clear that treatment with GH clearly enhances the response.
proliferative triggered by damage. Significantly increases the number
of neural precursors in the Dentate Gyrus and in the cytoplasm of these appears
a marked irGH. This data shows an increase in the proliferation of precursors
neural is also evident from the higher irGFAP detected in this territory
after damage and administration of GH. GFAP is an astrocytic marker, which is
expresses very early in neural proliferation. All of this is consistent with

292
Christophidis' data: marked increase of the GH receptor in the area
subventricular of the damaged hemisphere. On the other hand, the presence of irGH in
cells of the CA3 area constitute clear evidence in favor of the important role that
the hormone can play a role in these processes of neurogenesis and neural repair.
It is to this area of the hippocampus where the newly formed neurons migrate.
the subgranular zone of the dentate gyrus, after having begun its process of
maturation in the granular zone and emit axonal extensions towards the zone
CA3. In their migration, they are accompanied by networks of astrocytes that
they provide the trophic factors necessary for their survival and
ripening. It is, therefore, perfectly feasible that the presence of irGH in
those cells detected in CA3 are related to that trophic role and d
survival. The detection of irGH in post-mitotic cells (irBrdu+ in CA3,
with the morphology of neurons, but also of astrocytes, supports this assumption.

It seems clear then the positive effect that GH has on Neurogenesis.

of the adult, both physiological and restorative, at least in animals. Our
data in patients with acquired brain damage, evidence that this assumption
it also occurs among our species.

Experiments are not new in which it has been observed that after damage
Different types of cerebral changes occur in the interaction between axons.
from the damaged area and the glial cells. These mechanisms would prevent a
excessive neuronal death and scar formation, while also stimulating
the remyelination and reforming compensatory circuits and synapses. In this
It should be noted that in Neurogenesis, Astrocytes form a network.
in which neurons grow, but also release a series of factors
key neutrotrophics for regeneration processes. From the areas
damaged cerebral cells would release cascades of chemotactic cytokines that
they would activate the migration and neuronal differentiation of adult progenitor cells.
The release of cytokines is one of the characteristics of the response.
inflammatory, and among them are such important neurotrophic factors
in neurogenesis such as BDNF, NGF, NT3, and NT4, also a product of
secretion of the lymphocytes themselves that go to the damaged area.

At this point, it is important to remember, first of all, the effect that GH

it plays a role in the processes of bone marrow hematopoiesis, directly and through
Erythropoietin, but also the fact that it is a powerful cytokine capable of
induce marked neutrophilia and activate the cascade of massive release of others
cytokines in inflammatory response processes.

Aside from all the aforementioned, there are already many indicative data that GH and IGF-I
they model a series of biochemical processes at a central level, related to
other aspects, with the acquisition of knowledge. Data from the Mora group, in
Old rats treated with GH show that a series of amino acids are involved
in neurotransmission they increase their levels to values of animals

293
young people: this is the case of glutamine and arginine in the hypothalamus, diencephalon and
parieto-temporal cortex, the same occurs with hypothalamic aspartate. By the
on the contrary, citrulline, a degradation product of arginine after synthesis of
NO, increased in the mentioned areas decreases when treating animals with
GH.

Some of these GH effects can be attributed to IGF-I, well captured.

from the periphery or produced locally in the brain itself. Other effects
shared with GH and IGF-I can be explained by the crossover of actions
among the pathways of transduction of both hormones; however, there are also
a lot of data suggesting that the brain action of GH may be exerted from
direct form without IGF-I participation, since it acts in areas where it does not
the receptor for IGF-I is found and also that of GH.

It is clear that to attribute a certain action to a factor in a

It is essential to demonstrate that this determined territory expresses the
GH receptor (GH-R) in neurons, astrocytes, and oligodendrocytes, but in
significant areas such as the choroid plexus and hippocampus have been observed a
marked expression of this receptor, both in rodents and in humans. GH-R
GH is expressed in a series of brain territories, including the hippocampus.

The production of GH in the hippocampus of adult rats is positively regulated.

by estrogens and stress stimuli although it is unknown whether the presence of
the hormone is the product of the expression of precursors and/or cells in process of
differentiation and maturation, or alternatively the product of the capture of that produced by
other cell types. In this sense, brain damage is accompanied by a
important inflammatory response, with massive presence of cells of the series
white that are going to release large amounts of all kinds of cytokines. Many
of these play an important role in the neural proliferative response, but
Among them could be GH itself, produced by blood cells.

Aside from the fact that GH presented at the neural level is a product of expression
own cell or that captured from other brain territories,
There is clear evidence that circulating GH at the systemic level can
reach the brain parenchyma through different mechanisms. In relation to
this fact, the presence of the GH receptor in the choroid plexus suggests that
plays a role in the transport of the hormone from the blood through the
blood-brain barrier, although other studies indicate that the mechanism of
entry may not be dependent on the receiver and can occur through simple diffusion. In
in any case, the administration of the hormone to GH-deficient patients leads to
that GH levels in the cerebrospinal fluid can multiply up to 10 times
which clearly indicates that the hormone crosses the blood-brain barrier.

294
3 What is the actual role that the hormone plays at the central level?

3.1 Effects of GH on cell survival.

It was our group that first demonstrated that GH is a potent factor.

of cellular survival, at the expense of the induction of the anti-apoptotic enzyme
Currently. Numerous subsequent studies have validated this mechanism of action in
very diverse cell types.

Unlike the previous approach, other authors suggest that the effect
The hormone's neurotrophic factor may be related to its role as a factor of
cell survival more than as an inducer of neurogenesis.

In several animal models of nerve degeneration, it has been shown that the
GH protects both the brain and the spinal cord from cell death and is
capable of promoting neuronal survival after a hypoxic-ischemic insult.
In relation to this data, it is feasible that the decrease in GH associated with
Aging can affect the brain and contribute to its deterioration.

The hippocampus is a brain area related to episodic memory and

space that deteriorates with age in parallel with skills
cognitive. In this area it has been observed that, associated with aging, there is a
significant decrease in the number of neurons, both in humans and in
the Fischer 344 rat. The same occurs in both male and female Wistar rats, while
that treatment with GH at doses can restore IGF-I levels
plasma levels similar to those found in young adults, it is
capable of preventing that neuronal decline.

At the present time, and in light of the data presented, we can affirm that it
important neurotrophic role that GH plays, at least at the central level,
it depends as much on its inductive effect of Neurogenesis as on its role as
Cell survival factor. The question to be solved is: is it about a
direct and own effect of GH or consequence of its induction of others
neurotrophic factors?

3.2 Neurotrophic effects of GH at the peripheral level

Unlike what happens at the central level, the neurotrophic effects of GH to

peripheral levels have been less studied. Very recent data from Baudet et al.
et al. indicate that the hormone can act in an auto- or paracrine manner, as a
signaling molecule to promote axonal growth during the
development of the nervous system. On the other hand, data from our group,
They demonstrate that the administration of the hormone is capable of inducing a
complete, anatomical, histological and functional regeneration of the sciatic nerve after
its section in rats. Likewise, our group has demonstrated, in humans, that

295
GH treatment is capable of restoring oropharyngeal innervation 15 years
después de haber sido perdida tras exéresis quirúrgica de un Astrocitoma bulbar.

In principle, it is reasonable to think that the hormone can play a role at the level
peripheral a role similar to the one we have described at the central level, proliferation and
survival. Support for this assumption is given by the Winkler data in a
rat model with spinal cord injury, as well as by those from our group at
tetraplegic patients.

4 Other positive effects of GH

Based on the work of Rudman et al., replacement therapy has been proposed with
GH in the elderly, and most studies conducted demonstrate the effects
beneficials of the hormone. But this therapy is not without effects.
secondary factors to be taken into account: reduction of sensitivity to
insulin and glucose intolerance, carpal tunnel syndrome and retention of
liquids, although these symptoms are infrequent and of minor significance.

4.1 Metabolic benefits and effects on body composition

Just as occurs in adults with GH deficiency, in the elderly the therapy

substitutive with GH increases lean mass proportion and reduces fat
corporal, improving muscular strength. Experiments on animals corroborate
this data.

Substitutive treatment with GH also has beneficial effects on the

plasma lipid levels in old age, as it decreases levels of
cholesterol and improve the HDL/LDL ratio.

Since they are already well known, we will not dwell on this review.
in the analysis of the effect that the hormone has on osteogenesis in the case
of bone fractures.

4.2 Cardiovascular effects

Adult GH deficiency is associated with changes in body composition and

dyslipidemia, alterations that constitute cardiovascular risk factors.
Indeed, these patients present a higher risk of pathology and mortality.
premature cardiovascular events. Numerous studies have shown that the
patients with GH deficiency show endothelial dysfunction, even prior to the
establishment of overt atherosclerotic disease. This dysfunction remains
reflected in a lesser endothelium-dependent vasodilation, and possibly

296
It is due to a lower production of endothelial NO, as they are diminished.
the levels of nitrites and GMPc in the urine.

Today it is known that the main effects of GH on the system

cardiovascular is the stimulation of the growth of cardiomyocytes and the
production of nitric oxide (NO), a fundamental molecule for homeostasis
vascular, induced by IGF-I. GH replacement therapy restores function
endothelial, and simultaneously decreases oxidative stress, this phenomenon
intimately linked to endothelial dysfunction. This improvement in function
endothelial occurs independently of the lipid profile of individuals.
Similarly, the administration of the hormone is capable of reversing injuries.
incipient structural vascular changes, such as media-intima thickening.

The role of GH and IGF-I as modulators of myocardial structure and function

is therefore well established. In GH-deficient patients, treatment
substitutive is capable of improving cardiac function, increasing the mass
muscular of the left ventricle. Various experimental studies show
the beneficial effects of GH in the treatment of myocardial infarction in
experimental animals. Thus, treatment with GH post-infarction in rats
it decreases the telesystolic and telediastolic volumes, and prevents the decrease in the
ejection fraction that occurs after a myocardial infarction. Therefore,
it seems that the administration of GH preserves the function of the
left ventricle and prevents its pathological remodeling.

At the cardiovascular level, the positive effect of GH is not limited to the mentioned improvement of
the myocardial function. The hormone is capable, likely via induction of
vascular endothelial growth factor (VEGF), to enhance the revascularization of a
territory in which it has been lost, at the expense of starting a
potent angiogenic effect.

5 Is GH an oncogenic risk factor?

Overall, all the presented data suggest that the administration of GH,
in patients who so require, even if there is no hormone deficiency,
including that of the adult, has more beneficial effects on the body than
potential risk effects. In fact, the main risk factor that has been
I have been invoking regarding the hormone, its possible role as
inductor of the development of a series of tumors, an effect that has not been
demonstrated despite the hundreds of thousands of subjects that have been with it for years
they are treaties. It is true that there is expression of the hormone and its receptor in
a series of tumor types (breast, colon, leukemia, prostate...), and in fact it was
our group who demonstrated that GH was a proliferation factor and

297
survival in human myeloid leukemia cells. This does not mean, however,
embargo, that the hormone promotes tumor development, although it could
to favor it in accordance with its proliferative and anti-apoptotic effects and the
fact that it is practically expressed, physiologically, in all the
tissues. However, even this assumption is questionable. The case is different
of the GH expressed in the periphery. According to Lobi, the properties
oncogenic GH are exclusive to the locally produced hormone who
acts in an autocratic manner, since the exogenously administered GH imitates
the effects of the secretion by the pituitary do not induce transformations
oncogenic. Perhaps this is due to the fact that exogenous and autocrine GH regulate
different form the expression of a series of genes, probably due to the
different pattern with which each reaches the cells: pulsatile and secreted to
high concentrations for the first, and in a tonic form and at low levels for the second.

While exogenous GH induces a transient activation of MAP Kinase.

p44/42, the hormone produced in an autocrine manner leads to activation
maintained of this mitogen, for at least 48 hours. These effects such
different, at the oncogenic level, of exogenous GH and autocrine GH are fully
concordant with the large number of neoplasms in relation to the population
normal.

The effect that IGF-I, like insulin, has on is very different.

induction of anomalous proliferations, something that currently seems to be
perfectly contrasted, when one hormone and the other are at high levels
plasma concentrations. The administration of GH, due to its induction of
IGF-I expression should therefore be carried out at doses that do not increase the rate.
from circulating IGF-I levels higher than 2 standard deviations above the normal average for the group
of the age to which the treated patient belongs.

Conclusions

Although at the moment the management of GH is fundamentally

restricted to patients with deficits, in light of the data presented we believe that
In the future, not too far away, the spectrum of applications will expand.
considerably, and presumably the high price that currently a
treatment would decrease substantially, but it would also decrease the
healthcare spending by reducing sequelae and length of hospitalization.

6 What could those applications be?

Acute treatment of brain damage (whether of traumatic origin or

hypoxic-ischemic), due to its anti-apoptotic effect; revascularization of territories
in which blood flow has been affected; central nerve regeneration

298
the peripheral; acute treatment of perinatal anoxia for prevention of the
cerebral palsy, reduction of callus formation time in fractures,
healing of sluggish ulcers, etc. These would undoubtedly be the most processes.
susceptible, and frequent, to be effectively treated with the hormone. The
time will tell whether our approach is correct or not, although the data that
currently we have rather indicate the first.

Finally, an important aspect when starting treatment with GH is

the consideration of its immediate suppression at the moment it exists, or is
suspicion, an infectious process that endangers the patient's life, such as
It could be pneumonia.

The marked neutrophilia that the hormone induces, combined with the response itself to
infectious process can trigger a deadly cascade of release
massive cytokine release, leading to death from multiple organ failure, a
exaggerated response of defense mechanisms against infection.

Summary
Growth hormone (GH) is a pleiotropic hormone, expressed at the level
pituitary and peripheral and that in the organism plays multiple roles beyond
of the known metabolic and longitudinal growth.

Among its actions, neurotrophic effects stand out: increase in the

proliferation of neural precursors in response to neurological damage and
increase in their survival, probably in relation to a response
repairer. At the cardiovascular level, the hormone improves the lipid profile and
reduces risk factors, restores endothelial function, improves function
cardiac and enhances revascularization in ischemic territories. The
GH management does not seem to be related to tumor development, to
difference between what happens with the one produced in an autocrine manner.

Based on their actions, there are multiple possible preventive applications and
therapeutic uses of GH: acute treatment of brain damage, due to its effect
anti-apoptotic; central or peripheral nerve regeneration; acute treatment of
perinatal anoxia, for the prevention of cerebral palsy; revascularization
of ischemic territories; reduction of the bone callus formation time in
fractures; healing of sluggish ulcers, as the most significant.

299
 BIBLIOGRAPHY

Alcantud Marin, Francisco (2008). My daughter has cerebral palsy.

Madrid

Alcantud, F and Soto, F.J (2003). Assistive technologies for people with
communication disorders. Valencia. Nau Llibres

Arcas, M.D and others (1990). Special educational needs. Manual

theoretical-practical. Málaga: Aljibe

Baker, B.L (1997). Entrenamiento a padres, en Siglo Cero, vol. 28, 13–19

Ballesteros Jiménez, 5 (1982). The body schema. Basic function of

body in motor and educational development. Madrid. TEA

M.V. Neighborhood (1986). Psychosomatic disorders and habitual disorders

engines in VARIOUS. Topics of child psychopathology. Valencia. Promolibro

Basil Almirall, C and Soro-Comats, E (1995). Motor disability, interaction and

language acquisition. Madrid: Alianza

Baugmart, Johnson, and Helmstetter, E (1996). Alternative systems of

communication for people with disabilities. Madrid: Alianza

Benenzon, R. Manual of Music Therapy. Barcelona; Piados

Benjamin, B. J (1988). Un niño especial en la familia. Guía para padres.

Barcelona. Editorial: Trillas

Bidabe, L and Lollar, J.M (1990). MOVE. Process of improvement in mobility

through a comprehensive education. Madrid: Distesa

Bobath, K (1976). Cerebro-motor disorders in children. Buenos Aires.

Panamerican Editorial

Bobath, B and Bobath, K (1992). Motor development in different types of paralysis

cerebral and motor delay. Madrid. Panamerican Medical Editorial

301
Bustos Barcos, Mª del Carmen. Speech and language reeducation in the
cerebral palsy. CEPE Editorial

Brunnstrom, S. Reeducación motora en la hemiplejia. Ed. Jims. 1977

Cabezón Herrero, J (Coor) (1994). Alternative languages for people with

difficulty in communication. Madrid: CEPE

Cobos, P (1995). El desarrollo psicomotor y sus alteraciones: manual práctico

to evaluate it and promote it. Madrid: Pirámide

Collection of Health Professions. Physiotherapy treatment in pediatrics.

Mad-Eduforma

Count J.L and Viciana, V (1997). Fundamentals for development of the

motor skills in early ages. Málaga. Aljibe

ASPACE Confederation (2008). My baby has cerebral palsy. What to do?

Guide for first-time parents. Madrid.

ASPACE Confederation. Discovering cerebral palsy.

Cruickshank, M. William. The boy with brain damage. At school, in the

home and in the community. Editorial Trillas

Doman, Glenn (2010). Que hacer por su hijo con lesión cerebral. Editorial
Edaf

Doman, Glenn and his team from the Institutes for the Achievement of Human Potential
human. How to multiply your baby's physical intelligence. Editorial Diana

Doman, Glenn and Doman, Janet. How to Multiply Your Baby's Intelligence.
Edaf Editorial

Doman, Glenn and others. How to give encyclopedic knowledge to your baby.
Diana Publishing

Doman, Glenn y otros. Como enseñar matemáticas a su bebé. Editorial Diana

Estalayo, Víctor and Vega, Rosario. The method of intelligence bits.

Edelvives Editions

García Prieto, A. Children with cerebral palsy. Description, action

educational and social integration. Narcea Publishing

González Más, Rafael (1996). Medical Rehabilitation. Elsevier Spain

ASPACE Confederation (2008). My baby has cerebral palsy. What

What to do? Guide for First-Time Parents

302
ASPACE Confederation. Discovering cerebral palsy

Gallardo, M (1993). Manual de logopedia escolar. Málaga. Ediciones Aljibe

Gimeno, A (1999). The family: the challenge of diversity. Barcelona. Edition

Ariel

Gisbert and others (1980). Special education. Madrid De Cincel

Goddard, Sally (2005). Reflections, learning, and behavior: a window

open to understand the mind and behavior of children and adults. Ed.
Barcelona

Institutes for the Achievement of Human Potential. Ed. Diana

Jiménez Treviño, Carlos Manuel (2007). Neurofacilitation. Techniques of

neurological rehabilitation applied to children with cerebral palsy. Editorial
Trillas

Kovacs, Francisco Dr. A guide to intelligent education. Publisher

Martínez Rocas, S.A

Levitt, S (2000). Treatment of cerebral palsy and motor delay.

Madrid. Panamerican Medical Publishing

Le Metayer, M. Cerebro-motor reeducation of the young child. 1994

Lewis, V (1991). Desarrollo y déficit. Barcelona. Editorial Piadós

Martin Betanzos, J (2007). Guide for evaluation, orientation, and attention to

students with motor disabilities in regular schools. Madrid. Publisher
EOS

Martón-Caro, L (2001). Communication system and cerebral palsy

Martínez Menajeros, A and others (1994). Accessibility in the physical environment.

Madrid: ONCE

Moreno Manso, J. M, Montero González, P. J (coord.) (2005). Evaluation

psych educational of cerebral palsy. Interventions in the area of language
and communication. Mérida: Department of Education of the Junta of
Extremadura

Speech disorders:
case study. Madrid: EOS

N. M, Johnson-Martin, K, Jens, S. M Attermeier and B. J Hacker. Curriculum

Carolina, assessment and exercises for babies and toddlers with
special needs. Publisher: TEA Ediciones

303
Pardo Serrano, A. M (2004). Cerebral palsy: contributions of psychology
clinic for psycho-evolutionary development. Madrid: EOS

Perfetti C., Jiménez D., Ghedina R. Cognitive therapeutic exercise for

the motor reeducation of the adult hemiplegic. Ed: Edika Med. 1999

Polonio López, Begoña., Romero Ayuso, Dulce Mª. Occupational Therapy

applied to acquired brain injury 2010. Panamericana Ed.

Puyuelo Miguel and Arriba José Angel (2000). Cerebral palsy in children.
Communicative and psychopedagogical aspects. Guidelines for the teaching staff.
to the family

Ruíz Pérez (1987). Motor development and physical activities. Madrid: Gymnos

Russell, J (1992). Graduated activities for children with difficulties

engines. Madrid. Akal

Sánchez Montoya, R (1996). Ordenador y discapacidad. Madrid. CEPE

Seldin, Tim. (2007). How to get the best out of your children: Develop their
boost your self-esteem with the Montessori method. Publisher:
Grijalbo

Shea M. Thomas and Anne Marie Bauer. Special education: an approach

ecological. Ed. McGraw Hill

Tomatis, Alfred. El oído y el lenguaje. Ediciones Marinez Roca, S.A.

Barcelona, 1969. Exclusive rights Spanish edition, Home of the book,
S.A. 1990

Tomatis, Alfred with the collaboration of Loic Sellin. Academic failure.

Editions La Campana

Tomatis, A.A (1979). Educación y dislexia. Editorial CEPE

Toledo, M (1998). El niño deficiente en el sistema nervioso central.

Publications University of Seville

Toledo, M (1999). The ordinary school facing the child with needs
specials. Madrid. Santillana

Toro, S and Zarco, J. A. (1995). Physical education for boys and girls with
special educational needs. Málaga. Aljibe

Much, E. The Kabat Method. Ed. Masson 1989

Vojta, V (1991). Childhood cerebral motor disorders: diagnosis and

early treatment. Madrid. Atam-Paideia Editorial

304
Vojta. V, Peters, A (1995). The Vojta principle: Muscle games in the
reflex locomotion and motor ontogenesis. Barcelona. Springer Publishing
Iberian Publishing

Verdugo Alonso, M.A. Persons with disabilities. Perspectives

psychopedagogical and rehabilitative. Madrid: [Link] of Spain Publishers

305
 INTERNET ADDRESSES
HIGHLIGHTS:

- Institute for the Achievement of Human [Link]

- [Link]

- [Link]/ [Link]

- [Link]

- Toma Student Associationtis: [Link]

- [Link]

- [Link]

- [Link]/Aspace/fotos/[Link]

- [Link]

- [Link]

- [Link]. Spanish Society of Pediatric Physiotherapy

- [Link]

- Peto Method or conductive education, [Link]

- [Link] in Spaininfo@[Link]

- [Link]

- [Link]

- [Link]

- [Link]

- [Link]

307
- [Link]

- [Link]

- [Link]

- [Link]

- [Link]

- [Link]

Similarly, information was gathered from PARENT AND PROFESSIONAL BLOGS:

[Link]

[Link]

[Link]

[Link]

[Link]

[Link]

[Link]

[Link]

[Link]

[Link]

[Link]

308