Children evaluated in the developmental paediatrics department are guided to a multidisciplinary therapeutic environment that usually involves one or more of these—physiotherapy, occupational therapy, speech therapy and developmental therapy, besides nutritional advice and psychological assistance. I am convinced that each discipline has a significant contribution to make in order to help the child develop his complete potential. What are the reasons for the arrangement being not received so well? Many times I find families hesitating to invest their resources and time with paramedical professionals once their child has been diagnosed with a developmental disability. After reasoning with many I think I know some of the influences that bring on this situation and I want to address them.
The most important roadblock is the disappointment that comes from knowing that a disability has to be endured throughout life. From it springs an indignation, considering their helplessness being unable to handle their child’s needs by themselves. I can see how much that hurts now, as a parent. There is a constant need to change the family’s lifestyle and work preferences in order to help the child. Other members and children need to prioritise their time and resources, and make some sacrifices. In this scenario, stress often leads to unrealistic expectations from therapy and many do not persevere. Like the poem goes:
And many a failure turns about,
When he might have won had he stuck it out;
Don’t give up though the pace seems slow
You may succeed with another blow.
The practice of clinical medicine with its daily judgments is both science and art. We must integrate therapy as much as possible into activities of daily living and aim at eager participation from the child. Treatments should not be mere procedures, they have to be aligned to the child’s personality. Therefore it is crucial that the therapist develops a rapport with the child and this takes time. We must figure out the time of the day when child is best receptive. He needs to overcome anxiety at being pushed to limits of his endurance, which manifests as resistance. The therapist learns not only by observing and interacting with the child but also from the way he relates to family and caregivers. Allow the bond to form and strengthen.
Only those who have patience to do simple things perfectly ever acquire the skill to do difficult things easily.
Effectiveness of therapy comes from being proactive. Successful physiotherapy means assessing the strength of muscles and nerves and working on them thereby preventing stiff joints. It is not making a stiff joint flexible. The occupational therapist aims at making the child as independent as possible with his daily activities before teaching him any other skills. The child needs to feel empowered in his own environment before heading out to learn. They aim at making the child understand the concept of space and control. This appropriately reduces hyperactivity and impulsiveness. A good speech therapist will work on strengthening control in muscles of the oral cavity (controlling drooling, ensuring proper swallowing etc.)before attempting at teaching the child to talk. The emphasis will be to be able to get the child to communicate than to vocalise. The developmental paediatrician can, after assessing the child, estimate the difficulty the child has to overcome. If seen in the early months parents may not obviously recognise problems. So there is chance that we underestimate these valuable interventions.