Physiotherapy Methods PDF

Alternative therapies applied to
Cerebral Palsy Research study Year

2011
Index
. Introduction
. Therapies
1. ABR technique
1.1. Concept
1.2. Aim
1.3. Recipients
1.4. What is the method?
1.5. Centers
2. Doman Method
2.1. Neurodevelopmental Profile

2.2. Theories about which grounds
2.3. Methodology
2.4. Why is it questioned?
2.5. Centers
3. Therasuit- Pediatric intensive therapy
3.1. Background
3.2. The methodtherasuit
3.3. Goals
3.4. Recipients
3.5. What does it consist of?
3.6. Program intensive exercisetypical
3.7. Effects
3.8. Centers
4. Nazarov- Tenotomies
4.1. Background
4.2. Recipients
4.4. Centers
5. Tomatis Technician (Psychoaudiophonology)
5.1. What is it?

5.2. Target population
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6. Vojta Method
6.1. Recipients
6.3. Advantages
6.4. Differences with other methods
6.5. Contraindications
6.6. Centers and addresses
7. The NF-Walker walker/stander
7.1. What is it?

7.2. Results
7.3. Contacts
8. Ulzibat fibrotomy
8.1. Background
8.3. Recipients
8.4. Treatable pathologies
8.5. Contacts
9. Bobath
9.1. Background
9.2. Concept
9.4. Centers
10. Katone therapy
10.1. Introduction
10.3. Results
10.4. Centers
11. Hippotherapy
11.1. Background
11.3. Operation of hippotherapy
11.4. Horse benefits
11.5. Centers
12. Dolphin therapy.
12.1. Background
12.3. The Cyberdolphin.
12.4. Assisted therapy by dogs
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13. Peto Method – Conductive Education
13.1. Background
13.2. What is it?
13.3. Functioning
13.4. Recipients
13.5. Pillars of conductive education
14. Padovan Method

14.1. Background
14.3. Main novelties of the method
14.4. Centers
15. Cranio-sacral therapy

15.1. Background
15.2. What is it?
15.3. How does it work? Benefits
15.4. Contact
15.5.
16. Foltra Method
16.1. Background
16.2. Goals
16.3. Information
17. Sensory stimulation rooms

17.1. What is it?
17.2. Aim
17.4. Advantages
17.5. Other utilities
17.6. Room elements
18. Subthreshold, threshold therapeutic electrical stimulation and

hyperbaric oxygenation therapy
19. Selective dorsal rhizotomy

19.2. Who benefits from RDS? Results to
19.3. Expect Ideal Candidate for
19.4. Rhizotomy
20. Rhythmic movement therapy and primitive reflexes
20.1. Background
20.2. What is rhythmic movement therapy?

20.3. What is it based on?
20.4. Benefits
20.5. Information
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21. Cognitive-neuro therapy
22. Neurofeedback and Biofeedback
23. Kabat Method
24. Hydrotherapy
24.1. Recipients
24.2. Benefits
24.3. Thalassotherapy
24.4. therapeutic effects of thethalassotherapy
24.5. Indications for thalassotherapy
24.6. Halliwick therapy
25. X-cell-Center Treatment for Cerebral Palsy
25.1. Introduction
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 indications for the effectiveness of treatment with
TBA
26.4. Recipients
26.5. Contraindications
26.6. Conclusions
27. Homeopathy

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?
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29. Functional myotherapy
29.1. Introduction
29.3. Conclusions
30. Kinesitherapy
30.1. What is it?

30.2. Benefits
31. Pharmaceutical therapy
31.1. Drug for check seizures

31.2. Drug for check spasticity
31.3. Drug for check athetoid movements and drooling.
32. Music therapy
32.1. Definition
32.2. Goals
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. Le Métayer method
35.1. Techniques
36. Schwartz Method
37. MOVE Program
38. Physiatric Treatment
38.1. Ease psychomotor development

38.2. Reduce spasticity
38.3. Prevent muscle hypoextensibility
38.4. Step of sitting to standing
38.5. Reduce functional limitations
39. Pohl method
41. Phelps method
40. Collis Method
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41.1. Background
41.2. Basis of the method
41.3. 15 Modalities of treatment
42. Temple Fay Method
43. Deaver Method
44. Brushstroke technique – Rood Method
44.1. Introduction
45. Castillo Morales Method
46. Guy Bérard method
46.1. Background
47. Speech therapy treatments
47.1. Goals
48. occupational therapy
49. Conductive education
49.1. Introduction
49.2. Main objectives
50. Artistic therapies: dance, theater, etc.
50.1. Therapy example artistic: Dance Ability Method

50.1.1. Background
50.1.2. Goals
50.1.3. Contact
51. Jacobson method
52. Perfetti Method
53. Electrotherapy
54. Vestibular stimulation
55. Orofacial therapy
56. Tardieu Method
57. DEMEK method (dynamic kinesic stimulation method)
58. The Carolina Curriculum (Early Attention)
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59. Chromotherapy or Colortherapy
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 addressed to?
60.3. Centers
61. ABA method
61.1. Background
62. PROMPT method
62.1. Introduction
62.2. Definition
63. Sensory integration therapy
63.1. Introduction
63.2. Aim
63.3. Contact
64. Hearing disorder treatment
65. Treatment of visual disorder
66. Neuromuscular taping or Kinesiotape
66.1. Introduction
67. Yoga
68. Ozone therapy
68.1. Introduction
68.2. Application routes
69. Frenkel method
69.1. Introduction
69.2. Progression
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69.3. Techniqu
es
70. Theratogs
70.1. Information and centers
71. SWOT
71.1. What are they?

71.2. How can they help DAFOS?
71.3. For what effects are they suitable?
71.4. Information and centers
72. Art therapy
72.1. Art therapeutic objectives with people with CP

72.2. The concept of resilience
72.3. Factors
73. Feldrenkais method
73.1. Anat Baniel Method (ABM)
74. Pilates Method
75. Constraint-induced movement therapy (CIMT)
76. Reflexology
76.1. Introduction
76.2. What is the purpose?
77. Therapeutic spherodynamics (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 the integrationsensory?

79.2. The processoftheintegration sensory
80. mechanotherapy
80.1. What is it?

80.2. Effects
81. Magnetotherapy
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81.2. Basics
81.3. Indications
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
84. Bach flowers
84.1. Introduction
84.2. Who can take Bach flowers?
85. Deep muscle therapy (DMP)
85.1. Introduction
85.2. Goals
86. Therapeutic touch (pranotherapy). Alternative to mobilizations
86.1. Introduction
86.2. Method
86.3. Objective of the mobilizations
87. Cryotherapy
87.1. Introduction
87.2. Recipients
87.4. Centers
88. Tai Chi
88.1. Origin and philosophy of Tai Chi

88.2. The movement
88.3. Tai Chi and its therapeutic effects
89. Shantala. Ayurvedic massage for babies and children
89.1. Who can you help?

89.2. What are its benefits?
89.3. How does this work?
90. Essentis Method
90.1. Workshops and therapies of the method

90.2. Center and contacts
91. Tizanidine Treatment
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92. Cerebral Palsy and Scoliosis (Treatment)
92.1. Niederhöffer method

92.2. Asymmetric methodRudolph Klapp
93. Other therapies
93.1. Drooling treatment

93.2. Incontinence treatment bladder
93.3. Treatment of issues to feed
93.4. Pattern therapy
93.5. Surgery to lengthen muscles
93.6. Therapy of the behavior
93.7. Method by Brunnstrom
93.8. Method hipps
93.9. Method Fraenkel
93.10. Montessori
93.11. Lunning, Plum
93.12. Steiner, Koning
93.13. Beaman and Obholzer method
93.14. Dane and Neumann-Neurode method
93.15. Myoelectric feedback
93.16. Plum
93.17. Counterstimulus technique
93.18. Carlsson method
93.19. Spinal cord stimulation
93.20. REIKI Therapy
93.21. RPG (Global Postural Reeducation)
93.22. Matrogymnastics
93.23. Treatment with Ex N'Flex devices
93.24. The Neuralter
93.25. Electromagnetic Polar Balance
93.26. Gindler method
News
Annexes
Bibliography of interest
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INTRODUCTION
Cerebral palsy cannot be cured. But if the affected person receives adequate care that helps
them improve their movements, stimulates their intellectual development, allows them to
develop the best possible level of communication and stimulates their social relationships, they
will be able to lead a full life.
Traditionally, it is accepted that there are four pillars of the treatment of cerebral palsy:
physiotherapy, occupational therapy, compensatory education and speech therapy. There are
different techniques and approaches in its treatment, as long as they are applied by qualified
professionals they can be effective.
With the aim of achieving comprehensive care for the person with cerebral palsy and taking into
account the specificity of this type of disability (due to the global nature of the disorder, the
diversity of areas in which it manifests itself and the variety of consequences that can be appear
in each of them), ASPACE considers working with people with CP and related people as a
construction process in which both the person, the family and the professionals have to 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, educational,
social, work; and the possible responses in terms of more specific services that they may need
(in addition to the usual health, educational and social services): Treatment Centers (early care,
physiotherapy, communication, language, speech and feeding, psycho-pedagogical,
neuropsychological rehabilitation, psychotherapy, social intervention ), Adult Centers,
Occupational Centers, Special Employment Centers, Residences, Sheltered Apartments.
For this reason, the methodology used is that of meaningful learning in which the person is the
active subject of the process. From it and with it, the objectives will be designed and the
contents will be planned in such a way that they adjust to the level of individual development, to
previous experiences and to the different contexts in which their life takes place or will take
place, in order to guarantee functional authorization. For this, each person's repertoire of useful
behaviors is used, which are those that direct their activity, to promote the gradual development
of both personal and social autonomy.
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Therapy
APR
ABR, is the acronym translated into Spanish: Advanced Biomechanical Rehabilitation, is the
only rehabilitation method based on biomechanics, which provides recovery of the
musculoskeletal structure and motor functions to children and young adults with brain
damage.
It is a method of structural correction of musculoskeletal deformities, this is a method carried

out by parents, who learn the technique and individual application of ABR by its
professionals.
ABR improves the musculoskeletal structure in such a way that motor functions are restored
spontaneously, making special equipment and treatments for “motor disabilities”
unnecessary.
No drugs, electrical instruments or surgeries are used. ABR is a method of manual

application on the child's body, based solely on biomechanical principles.
The results are visible, due to the number of hours invested in each exercise, as well as the
changes in the alignment, mobility, size, tone and strength of the child's body (thorax,
abdomen and size of the pelvis). Each application of ABR on the body is calculated for each
individual.
1.1 Concept
Everyone believes that children with cerebral palsy (CP) have impaired function because
their brain is too damaged to control normal movements. Children with CP are considered
incurable because the damage to the brain is irreversible.
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ABR has a different philosophy. They believe that even severely damaged brains have
sufficient electrical plasticity to control normal motor functions; however, for this plasticity to
“take place,” the child's musculoskeletal structure has to improve to a certain level; at the
threshold of plasticity.
1.2 Goals
It is to restore the motor functions of people with brain damage, spontaneously through the
reconstruction of the musculoskeletal structure, and the restoration of the bioelectric signals
that flow between the muscles and the brain.
ABR is distinguished from other methods by a critical factor: while all others focus on the
functional learning of the person with brain damage, ABR asks another question: “How to
normalize the musculoskeletal system?”
While it is common to believe that people with brain damage need special treatment for their
motor functions by making “better use” of their deficient musculoskeletal system, ABR
demonstrates that true biomechanical structural improvement of the musculoskeletal system
automatically becomes progress. of motor functions, eliminating any need for specific
treatment to execute motor tasks. Motor functions develop as a “spontaneous” result of
structural normalization.
1.3 Recipients
A wide range of children and people with brain injuries, such as cerebral palsy,
microcephaly, flaccidity, developmental delay, seizures, tilt stroke, vaccine injury, dyspraxia,
scoliosis, head injury, Down syndrome, Angelman syndrome, West, Rett and many others.
1.4 What is the method?
The technique targets the inner layers instead of the outer ones, causing the internal
muscles to react automatically. The child is a passive recipient.
The rehabilitation program is based on a series of exercises that transfer kinetic energy
through a quasi-static movement to the membranes (tissues and cells). It is a pumping, hand
and arm (piston) movement that reaches deep into the layers of involuntary muscles.
This mimics the way the lungs move, rhythmically pushing air into the chest and abdomen
against the internal muscles. It firmly maintains electrical activity by developing and
maintaining blood supply. Likewise, it accumulates a normal volume that gives control to the
head and neck, creating an effect similar to a downward waterfall through the entire body.
Towels are used as “air cushions” to ensure that there is no pressure on the superficial
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tissues (skin and superficial muscles) and allows energy to pass through the skeletal muscle
barriers penetrating the inner layers (smooth muscles). The gentleness of the method is very
relaxing for the patient and is extremely safe.
The muscles that will be targeted are the intrinsic involuntary muscles of the neck and trunk
(thoracic cavity, abdominal cavity and pelvic floor). The strong muscle group (which is
associated with the most pronounced effects of CP, spasticity and contractures) is never
worked directly through these exercises. Improvement is achieved through strengthening the
opposing muscle group (smooth muscle).
Once the “quality” of the musculoskeletal elements is improved, the brain improves the
quality of the “matrix” of the musculoskeletal system by incorporating these positive
changes, then the child begins to execute motor functions spontaneously.
1.5 Centers
In Spain there is no center where they are carried out, during the year 2009-2010 talks on
the therapy were given in Madrid, but to contact this therapy they refer us to the Danish
website whose email is: info@blyum.com or at your page www.blyum.com .
Likewise, we also find information about this technique on the website

www.abrtherapy.com , where you can also obtain a free video or DVD about ABR by filling
out a form. The blog in Spanish is http://abrhispano.blogspot.com/ .
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Method
DOMAN
Dr. Glenn Doman, an American physician, began treating children with brain injuries with
neurologist Temple Fay. He used his methods, based on progressive movements, very
effective both in motor areas and in more intellectual areas. They focused on working with
reflexes, mainly with children with cerebral palsy.
Upon observing the progress that was achieved in these children, Doman decided to transfer
his knowledge to the rest of the children, so that their learning capacity would be enhanced.
He elaborates his theory about brain development, a Neurological Development Profile and
systematizes educational work, structured through sequenced programs, with precise and
effective methods.
At the end of the 1950s, he founded the Institutes for the Development of Human Potential in
Philadelphia (USA), initiating 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, they
developed a scale of neurological development.
This scale allows you to "measure" the level of development of the child, to set objectives.
They start from the premise that the differences between some children and others are
fundamentally due to the environment, since at birth all children have the same potential.
The Neurological Development Profile measures, on the one hand, the development of the
cerebral strata, that is, it indicates the functions of the spinal cord, the brain stem, the
midbrain and the cerebral cortex. In this way, it is
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possible to work in a systematic and orderly manner and know the child's objectives in each
of the developmental areas based on the level reached. Furthermore, it differentiates the
sensory areas and functions from those of a motor nature, since the former are afferent
pathways (traveled by the stimulus to bring information to the brain) and the latter are
efferent, that is, they leave the brain to give the order for movement. to the body.
According to this profile, the motor areas are mobility, language and manual dexterity.
Mobility is the key or the driving force of the development of intelligence in all its
expressions, and it has a decisive impact on other areas, just as it happened in the evolution
of species towards more and more complex and perfected brain structures and functions.
According to this theory, the degree of perfection achieved depends largely on whether
these basic functions are achieved as soon as possible, when brain plasticity is greater.
2.2 Theories on which your teaching method is based
• All pathologies, including Down syndrome or Autism, lead to brain damage, as occurs
in cerebral palsy.
• Children with brain injuries should not be classified by their severity, but by their
developmental potential.
• Children's learning and maturation come as a consequence of the spontaneous
experimentation of a series of schemes. Its repetition causes these movement and
performance patterns to consolidate in the end. Children who do not experience this
spontaneously must be guided and exposed to the same stimuli so that they develop
properly.
2.3 Methodology
Its intervention methodology is based on making the most of the individual's possibilities,
being essential the early moment in which it begins, since later on many goals will not be
achieved.
Parents become “professional parents,” since they are the ones who must apply, with the
tutoring of the professional, the method to their child. This method requires the repetition of
various activities several times a day, which translates into hours of daily intervention.
Furthermore, he is very strict about complying with these routines. Therefore, the father or
mother who decides to apply the method must seriously commit to it.
In the motor aspect, he uses what he calls the basic movement patterns:
• Ipsilateral pattern
• Cross pattern
• Extremity relaxation techniques
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• Drag exercises and of crawl
• Brachiation exercises andof March.
In addition to the motor area, it has its own teaching methods for reading (global),
calculation, and other areas. Thus, almost all their learning is developed by the method of
intelligence bits (as in computers, the intelligence bit is the maximum amount of information
that can be processed at the same time in one second). The words, numbers, animal
pictures... are taught to children in groups of 10, several times a day (3 or 4 times) and each
picture is shown for one second. The child eventually ends up recognizing the picture,
whether it is a drawing, a word, a picture or a set of dots.
Although the results they present can be spectacular, both in children with Down syndrome
and in children without alterations (month-old children who recognize words or recognize the
number of points on a sheet), their methodology may not be entirely functional, for which in
children with Down syndrome runs the risk of not developing significant learning, even more
so with the abstraction and generalization difficulties they have.
2.4 Why is this method questioned?
Although some of his postulates indicated above are accepted by the entire scientific
community, there are important aspects that are strongly questioned, such as: the excessive
simplification and generalization of his scientific proposals, his attempt to cover the entire
complex pathology of development within rigid coordinates. , and the excessive rigor of its
methodology that requires 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 supported by scientific
studies.
2 .- No serious studies have been published on the results and merits achieved, but their
guarantees are only based on the testimonies of parents.
3 .- It requires enormous dedication from parents, both in terms of time and money.
Furthermore, the American Academy of Pediatrics comments that after various comparative
studies, no significant differences have been observed in the progress achieved by children
who followed this or another stimulation method.
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, that there is no evidence of its effectiveness and that children
with Down syndrome They learn to read, write, walk and speak through other types of
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programs, which do not require as much effort and dedication on their part or that of their
parents. Furthermore, this Association is concerned about the daily time required for
treatment, as well as the consequences it may have on family life.
4 .5 Centers
Fay Institute, in Madrid. www.institutofay.com .
There are numerous links on the internet to download the bits of the Doman method, as well
as on paper-cardboard edited by Bruño, Edebé and Edelvives among others. On YouTube
there are numerous videos about it, both its explanation and cases in which it is applied.
Likewise, there is a website of parents who tell their experience with this method, showing
with videos and photos all the activities they carry out in their child's daily life,
www.isidroarias.org along with an explanation about it.
The family of a child with cerebral palsy plans to hold an auction with Andrés Iniesta's
boots
http://www.20minutos.es/noticia/765530/0/
Bertin's Crusade
http://www.lavozdigital.es/cadiz/v/20100814/gente/cruzada-bertin-20100814.html
The blog of hope
http://www.elmundo.es/elmundo/2011/01/31/solidaridad/1296479684.html
Walk through Andalusia raising money for a girl with cerebral palsy
http://www.elmundo.es/elmundo/2010/03/18/andalucia/1268941133.html
The Philadelphia Institute on Cerebral Palsy meets in Valencia
http://www.diariocriticocv.com/noticias/instituto/de/filadelfia/fundacion/osborne/pa
ralisis/cerebral/not311334.html
Puçol is holding a charity market today to help a 6-year-old neighbor with cerebral
palsy with profits
http://www.elperiodicodeaqui.com/noticias/pucol-celebra-hoy-mercadillo-
solidarity-to-help-with-neighbor-benefits-6-/1456
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THERASUIT
Pediatric intensive care
3.1 Background
Invented in Russia during the space age and designed to combat the negative effects
(muscle atrophy, osteoporosis) that astronauts suffered (lack of gravity) during long space
trips.
In the 1990s, the suit was used to treat children with muscle disorders. In 1997, it began to
be used in North American children and in 2002, the TheraSuit suit was designed and
registered with the US FDA (Food and Drugs Administration).
3.2 The Therasuit method
• It combines an intensive, personalized strengthening program for children with cerebral

palsy using TheraSuit and the Universal Exercise Unit.
• Combat the effects of loss of condition and immobilization.
• Recognizes that standardized therapeutic approaches are less effective.
• Based on the principles of intensive therapy and strength development.
• Educate the body of the disabled child like that of a child without disabilities.
• New approach by which the field of physical therapy learns from the field of health and
fitness.
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Structured program that improves the growth and development of the person.
3.3 Goals
• Normalize the child's muscle tone.
• Increase active joint excursion.
• Increase strength and endurance.
• Control over newly strengthened muscle groups so that children can improve their
functional skills to gain independence.
3.4 Recipients
• Children with cerebral palsy
• Patients with stroke
• Brain concussions
• Spinal cord injuries
• Neuromuscular disorders
3.5 What is Therasuit?
TheraSuit is a soft, dynamic and proprioceptive orthosis that consists of a hood, a two-piece
suit, knee pads and shoe straps joined by a system of elastic bands. It is an effective and
safe tool that we use in combination with our intensive exercise program to accelerate the
child's progress.
Among other benefits:
• Improves proprioception
• Reduces pathological reflexes
• Recover postural and movement patterns
• Provides external stabilization and strengthens weak muscles
Corrects body alignment
Improves the vestibular system.
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3.6 Typical intensive exercise program
3 to 4 hours a day, 5 days a week, for 3 or 4 weeks:
• 1st week: Work to reduce muscle tone, decrease pathological movement patterns,
increase correct active movement patterns and overall strength development.
• 2nd week: work to strengthen the specific muscle groups responsible for movement.
• 3rd week: use the gain in strength and endurance to improve the child's level of
functionality (sitting, crawling, walking).
3.7 Effects
• Reduces pathological movement patterns
• Increases strength and endurance
• Increases muscle control and coordination
• Increase functional activities (sitting, crawling, walking, etc.)
DEGREE OF LEARNING AND INDEPENDENCE ACHIEVED WITH THE THERASUIT METHOD

roll More than 90%
Feel More than 85%
Crawl 50%
Stop Near 40%
Walking with Assistance More than 35%
Walk alone 20%
DEGREE OF IMPROVEMENT ACHIEVED

WITH THERASUIT METHOD
Range of Motion 100%
Elasticity 100%
Balance 60%
Coordination About 60%
Movement Control More than 60%
Functional Skills About 90%
3.8 Centers
• Nipace Foundation, in Guadalajara. www.fundacionnipace.org .
• CREIX Center, in Palma de Mallorca.www.creix.com or therasuitcreix@hotmail.com .
• Neusens Clinic in Palencia.www.clinica-neusens.es , telephone: 979.710607, email:

comercial@clinica-neusens.es .
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Ibercaja provides funds for a “miraculous” suit against childhood cerebral palsy
http://www.lacronica.net/articulo.asp?idarticulo=36966
Nipace, the perpetual dream of the father of a girl with cerebral palsy
http://www.abc.es/agencias/noticia.asp?noticia=688459
If kisses could heal...
http://www.abc.es/20110220/sociedad/rc-besos-curaran-201102200131.html
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NAZAROV-TENOTOMIES
4.1 Background
The treatment has been practiced and developed since 1992 and continues to be practiced
today, it can be defined as a selective and closed myotenofasciotomy.
4.2 Recipients
The muscular problems of patients with sequelae of cerebral palsy and also with sequelae of
craniocerebral trauma (forms of hemiparesis, diparesis, tetraparesis, etc.) can be treated. In
addition to patients with foot deformities (club feet, equine feet, etc.), hand deformities
(obstetric branchial paralysis), neck deformities (congenital torticollis) and other deformities.
The main problem of these pathologies is the retractions that can form in practically all motor
segments of the human body. A retraction is produced by a shortening in a soft tissue, either
in a muscle or in an aponeurosis that keeps the respective part of the motor apparatus in a
vicious position, difficult or impossible to correct by passive movements.
4.3 What does it consist of?
Myotenofasciotomy consists of percutaneous (closed) operations, which are performed with

a fine scalpel, sectioning only the shortened fibers that limit movements.
When the pathological fiber is severed in a soft tissue structure, it has no other fixation point
and can no longer prevent the stretching and correct function of this structure; and in this
way, it is possible to eliminate all the shortened fibers that exist in all areas of the soft
tissues, saving the healthy structures as much as possible and without interrupting the
continuity of the muscle. Postoperative immobilization is not used.
The basis of this technique are the operations: fasciotomy, tenotomy, myotomy,
aponeurotomy, ligament operation (e.g. Myotenotomy: Surgical section of a muscle tendon
or section of muscle and tendon) that have been used until now throughout the world, to
2
treat different diseases as well as muscular diseases and those derived from cerebral palsy.
The growth of the affected limb is limited and if the retractions are very severe, dysplasias,
dislocations and deformities appear. At the same time, during the growth of children, joint
contractures may form, as a result of limitation of movement (generally from 13 to 15 years
of age). To treat and eliminate soft tissue retractions in patients with cerebral palsy, different
surgical methods are currently used, starting with tenotomies and ending with very
complicated reconstructive operations on the musculoskeletal apparatus. The results of
these operations are not always efficient since they are:
• Quite invasive.
• Not all retractions that exist are operated on, for example, often in the lower extremities,
only the adductors and Achilles tendons are operated on.
• The immobilization carried out after these operations further weakens the muscles and
other structures of the motor system that already suffer from weakness.
• Sometimes, after open operations, significant scars remain that do not have the capacity
to adapt to the subsequent growth of the child's operated area and also make it difficult to
repeat the surgical method used, in the case of relapse.
4.4 Centers
• Insmicort Medical Institute of Barcelona: www.insmicort.com
05
TOMATIS TECHNIQUE
(Psychoaudiophonology)
5.1 What is it?
The Tomatis technique is an auditory stimulation technique created by Dr. A. Tomatis, who
stressed the close relationship between the ear and the nervous system, and explained that
we could have excellent hearing and yet not know how to listen. Poor listening can seriously
affect the ability to communicate and relate to others, to life, to oneself and to the universe
that surrounds us.
2
5.2 Target population
It is aimed at people of all ages (children, adolescents and adults) who wish to:
• Harmonize the internal state. Indicated in cases of stress, anxiety, anguish, depression,
hyperactivity, insomnia, emotional problems, low self-esteem, etc.
• Improve oral and written expression and comprehension (poor language, sound
articulation, intonation, dyslexia, etc.).
• Improve communication and relationships in general.
• Improve thinking and reflection.
• Improve memory, attention and concentration.
• Improve memory, attention and concentration
• Improve organization and planning capacity.
• Improve performance at school or at work. Increase interest in learning.
• Improve balance, body image, posture, psychomotor skills, coordination and temporal
and spatial orientation.
• Promote development and maturity.
• Stimulate creativity and artistic expression in general.
• Improve and facilitate language learning.
• As personal growth, it helps expand consciousness. Stimulates both body and mental,
emotional and spiritual awareness.
It is also indicated for:
• Pregnancy and preparation for childbirth. Helps the future mother to live her pregnancy
and birth to the fullest. To overcome fears, improve uterine dynamics and facilitate muscle
work, improve mother-child communication, etc.
• Adopted boys and girls.
• Boys and girls who have experienced difficult circumstances during pregnancy, childbirth
or the first years of life.
• Third age. It helps to be more dynamic, stimulates hearing and the nervous system, etc.
2
It consists of listening to music or sound through the electronic ear (a complex simulator of
the human ear). The muscles of the middle ear are re-educated, the lost frequencies are
restored and the proper functioning of the nervous system is restored. In this way we can
recover the ability to listen and provide energy to the brain and body.
Listening is the open door to consciousness.
5.4 Centers
• I will attend. Listening therapy. Cinty Martínez Villar. celattendere@attendere.es . (A

Coruña)
• Ester Viña Gundin, estervg@mundo-r.com . (Lugo).
El Ángel Center, info@angeltomatis.com .
To contact therapists who perform the Tomatis Technique in different parts of Spain, you can
do so through the Tomatis Student Association: www.altomtomatis.com .
2
06
Method
VOJTA
6.1 Recipients
Although Vöjta therapy can be applied until adulthood, it is especially indicated for children:
• Infants, in whom movements have not yet been established

abnormal (substitution patterns). These movements appear as a consequence of the
infant's repeated attempt to contact the environment, to straighten up or move in a
pathological way.
• Young children of school age or young people with psychomotor delay, secondary motor
alterations, peripheral paralysis, muscular or other diseases in order to improve their
maturation and growth process.

It is an activating principle of the Central Nervous System, which consists of evoking normal
posture and movement patterns activated through the two patterns of Reflex Locomotion:
reflex crawling (prone position) and reflex turning (supine and lateral decubitus).
Reflex crawling (prone position)
3
Reflex turning (supine and lateral decubitus)
The treatment focuses on placing the child in

different positions, stimulating specific points and
opposing resistance to the movement that is triggered. This resistance facilitates the
appearance of innate functions that develop throughout the first year of life such as crawling,
rolling and walking.
6.3 Advantages
Early diagnosis and treatment through Vöjta therapy allows the patient's alterations to not
evolve into a definitive pathological situation, therefore implying an important qualitative
improvement in their quality of life. Some of these improvements are:
Postural control or automatic maintenance of balance during movement.

The righting of the body against gravity.
Phasic mobility or purposeful grasping or stepping movements of the extremities.
Development of innate functions such as crawling, rolling, walking, and support and
pressure functions.
More relaxed movements, decreased stiffness and improvements in motor skills. More
intelligible language and speech.
More complete defecation and urination, thus helping sphincter control.
Improvements in sucking, 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 that parents or
guardians have in this therapy is crucial, since they will be the ones who must perform
the exercises on their little one up to a maximum of 4 times a day. Not all families can do
it, since it requires a great effort on their part. They must learn the exercises well and
understand what they are doing in order to help their child.
• There must be perfect coordination between the child's parent or guardians and the
therapist who will be available to resolve any doubts that may arise about the therapy.
• This parental involvement calms their anxiety. Feeling active in their child's rehabilitation
helps them eliminate the “guilt” that they often have since they feel that they are a key
and essential piece in the therapy.
3
6.5 Contraindications
It is not indicated in the following cases:
• Children with imperfect osteogenesis

• Children with major metabolic problems
• Patients with brain tumors
• in shoots in patients with sclerosis multiple
• Patients with asthma attacks in the outbreak.
• Cases of fever.
6.6 Centers and addresses
• Vöjta Spain Association: www.vojta.es / e-mail: info@vojta.e
One chance in a thousand
http://www.elmundo.es/elmundosalud/2010/12/09/noticias/1291881547.html
“By evoking pain, little pieces of joy are also attached”
http://www.lavanguardia.es/lacontra/20101026/54061018202/al-evocar-el-dolor-
they-stick-too-bits-of-joy.html
3
0
7
NF-WALKER
WALKER/STANDER
7.1 What is it?
It is a medically recognized device in Germany, which has passed technical inspection and
complies with current European regulations, and is included in the catalog of medical
procedures.
The awarding of this device to a child with a motor deficit requires a specialized analysis of
the child's capacity. There is a first contact whose purpose is to present the product, get to
know the child and become aware of the child's personal situation. During the appointment,
the possibilities and objectives of using the walker are discussed with parents, doctors and
therapists.
The walker wears shoes that act as stirrups supporting an 80 90% of the child's weight (not
100%). In this way the child is somewhat less weighted and has a better chance of being
able to take the step.
Straps facilitate reciprocal walking, without it being possible for both feet to move forward at
the same time (as soon as one knee flexes, the other extends).
The child is aligned and held by a strap at the pelvic level and another at the thorax level,
and is not allowed to sit in any case. In addition, other head accessories are available, if
necessary to control a possible extensor pattern.
7.2 Results
In many cases it is effective as a walker, in others only as a stander. There are certain
contraindications such as: knee, ankle and hip flexion of more than 20º, spina bifida.
3
3
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
commute.
7.3 Contacts
www.eofunktion.com
In Spain, the contact person is Leandro González 629.096.006
Children with reduced mobility can move independently using the NF-Walker
3
0
ULZIBAT FIBROTOMY 8
People and children who suffer from cerebral palsy live disabled by the muscle spasms and
pain caused by their disease. But for 20 years the Russian surgeon Dr. Valeri Borisovich
Ulzibat has been successfully applying a technique, fibrotomy, which manages to eliminate
pain to a certain degree and recover part of the mobility for these people.
8.1 Background
Valeri Borisovich Ulzibat is the name of the research surgeon and precursor of the technique
called gradual staged fibrotomy. He was born in 1946 into a military family and studied
medicine at the University of Kemerova. He practices as an orthopedic traumatologist and
professor in traumatology and orthopedics, developing his activity in various universities and
hospitals. In 1990, a whole series of recommendations on the methodology of pain treatment
were accepted by the Ministry of Health of the USSR.
In 1985, and trying to relieve the muscle pain suffered by a close family patient, he began to
carry out a series of investigations and surgical interventions that led to a surgical technique
that today is called gradual fibrotomy in stages. For the practice of surgical interventions, he
designs and patents a series of specific medical instruments that, although at first they were
manufactured almost by hand, today their manufacturing has a complex system.
In December 1996 he defended his doctorate thesis in medical sciences due to the excellent
results of his methodology; in 1998 to V. b. Ulzibat was awarded the title of emeritus
researcher of the Russian Federation and in December 1999 the title of professor.
The technique began to be applied to a whole series of patients with muscular or myofascial
ailments and with excellent results in pathologies that
3
5
entail Spasticity (cerebral palsy, dysplegia, hemiparesis...) Since 1992 and with the name of
the Tula Clinical Rehabilitation Institute, a team of surgeons, anesthetists, neurologist and
specialized nursing, have been developing and perfecting the gradual fibrotomy, reaching to
be what it is today. Patients with cerebral palsy from all over the world have since traveled to
undergo surgery at the clinic. Eight theses have been defended by the doctors of the
institute and more than 165 scientific articles have been published that support fibrotomy
before the Russian medical community. A whole series of conferences and interventions in
various medical congresses in different countries around the world help to spread knowledge
of the technique to other countries. Unfortunately, the professor died suddenly in 2003 and
many of the extension plans were cut short. His legacy remains in the hands of the Tula
Clinical Rehabilitation Institute that he founded in 1992 and its components are developing
new concepts and various modifications of the technique, which are applied to this day.
Although the technique has been perfected and refined in various aspects by his pupils, the
lack of this entrepreneurial character of Dr. Ulzibat, the problems with the language and
some other factors, slow down to a certain extent the expansion of gradual fibrotomy in
stages outside the Russian Federation after her death, although among cerebral palsy
patients and due to her frequent associationism she is quite well known.
Fibrotomy consists of making small incisions in fibrous areas of the muscles that keep them
permanently contracted. This achieves two things: regaining mobility and suppressing pain.
This surgical technique, which is performed in just 15 minutes, prevents the muscle spasms
typical of cerebral palsy from causing compression on the arteries that feed the muscle, thus
making the pain disappear, since blood flow is restored.
From a few to 20 cuts are made. In simple cases it can be done on an outpatient basis. In
more complex cases, admission to a hospital and the assistance of an anesthetist is
recommended.
Gradual staged fibrotomy is a surgical technique that is generally, although not always,
performed under general anesthesia with scalpels specially designed for this purpose called
microfibrolotome.
1. It basically consists of the percutaneous elimination of those muscle contractures that

prevent or hinder the correct functioning or appropriate angle of a joint. In addition, the
elimination of myofascial pain syndrome is pursued.
2. Gradual fibrotomy can be considered microsurgery with a minimal level of trauma in the
absence of cuts in the skin, scars and bleeding. Since no complete section or
transposition of muscles is performed, nor does it affect bone structures or tendon tissues,
it does not require immobilization or subsequent casting of the patient, contributing to the
patient's early return to their activities.
3
3. It has a universal character because, regardless of the etiology, it offers high functionality
by being able to intervene at the same time in various muscles or muscle groups, taking
into account their synergism or antagonism, thus increasing the effect of the intervention.
4. They allow a considerable advancement of other types of therapies by facilitating the

active or passive mobility of the patient.
8.3 Recipients
It is indicated in patients with muscle contractures and or myofascial pain syndrome. This
pathology is very manifest in patients who suffer from spasticity, cerebral palsy, hemiplegia,
paraparesis, dysplegia, hemiparesis, sequelae in accident victims with trauma, fibromyalgia,
plantar fasciitis...
This method, in the case of cerebral palsy, is usually indicated to be carried out from the age
of two, although each case is particular, especially in cases of cerebral palsy, the criterion
that prevails is always that of the surgeon.
8.4 Pathologies treatable with the Ulzibat method
In general, all those where muscle contractures or muscle or myofascial pain appear. The
goal is to eliminate or reduce pain and increase joint movement. In the case of cerebral
palsy and similar, the results facilitate the application of the rest of the therapies (physio,
swimming pool, postural education...) with a good benefit-risk ratio, especially when
compared to much more aggressive techniques such as tenotomy. In cases of severe
involvement, the reduction of pain and help in managing the patient (cleaning, postural
control, drooling...) make the technique the only truly effective aid. In the case of
fibromyalgia, fasciitis, carpal tunnel and other diseases that cause muscle pain or myofascial
pain, it produces notable and in many cases total improvements.
8.5 Contacts
• Tula Clinical Rehabilitation Institute (Russia)
• Los Madroños Hospital (Madrid). i nfo@ulzibat.es
3
“We improve the patient's quality of life, allowing them to do basic things with less
effort”
http://www.diariovasco.com/v/20101001/bajo-deba/mejoramos-calidad-vida-
patient-20101001.html
Half the world in one step
http://www.farodevigo.es/sociedad-cultura/2010/05/25/medio-mundo-
step/441704.html
3
09
BOBATH
9.1 Background
Berta Busse was born in Berlin in 1907. She initially studied at the Anna Hermann school of
gymnastics and dance. Once her training was completed, she remained at this school as an
instructor until 1933. During this period he gets married, which lasts approximately one year.
In February 1933 their son named Peter was born. Karel Bobath was born in the same
district of Berlin as Berta, they both met during their teenage years. Karel Bobath graduated
as a Doctor from the University of Berlin in 1932 and later in Czechoslovakia he graduated in
Medicine for the second time in 1936. In 1939 he emigrated to London.
Later, due to the Second World War, Berta also emigrated to London, where she met Karel
Bobath again and remarried in 1941. Berta, in 1943, was called to attend to a famous painter
"Simon Ewes", with whom she began to apply her different way of managing spasticity, an
approach that she would later continue to develop not only for the treatment of adults with
hemiparesis, but also in children. with sequelae of Cerebral Palsy.
Together; Berta from the clinical aspect and Karel from the neuroscience available at that
time, developed the Bobath Concept for the treatment of children and adults with neuromotor
disorders. Both from their place of residence as well as traveling to different parts of the
world, they taught and trained different professionals in the Concept, who continued and
continue today with the development of this “Living Concept.”
So great was the impact of his Concept that it motivated many forms of recognition
throughout the world. Just as they developed their work and personal lives together, together
they decided to leave on January 20, 1991.
9.2 Concept
The Bobath approach is a specialized therapy applied to treating movement and posture
disorders resulting from central neurological injuries. It was started in London in the 1940s
by Physiotherapist Berta Bobath and Dr. Karel Bobath who studied normal development,
what effect lesions of the Central Nervous System (CNS) produced, and how to help patients
in these situations. His hypothesis was based on work by several neurophysiologists,
3
including Sherrigton2 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 it innervates).
The Bobath Concept is an important concept in the rehabilitation of people with brain or
spinal cord injuries. It owes its name to its creators, the physiotherapist Berta Bobath and
her husband, the neurologist Karel Bobath.
It is based on the brain's ability to reorganize itself; which means that healthy parts of the
brain learn under certain circumstances can compensate for functions that were previously
performed by damaged regions of the brain. The prerequisite for this is, however, a support
and encouragement applied to the patient by the Physiotherapist. The concept has achieved
good success in rehabilitation, particularly in the case of patients who suffer from paresis on
one side of the body (hemiparesis) after a vascular accident.
The person affected by hemiparesis often tends to neglect their paretic side, and therefore
their limitations, to compensate with their less affected side. These movements performed
with only one side of the body, however, only help the patient in a basic way, since the
affected side is not given the ability to receive and work with the new information. The brain
therefore does not have the opportunity to restructure itself. Even due to sasymmetric
movements, there is a danger of developing painful spasms 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 in accordance with the less affected
side of the body. It is, in short, a way to balance the body in terms of functionality and
mobility.
Another key to the Bobath concept is to modify the abnormal patterns that result from the
injury itself and facilitate movement to
4
achieve it in the most functional way, always following the milestones obtained in human
neurophysiological neurodevelopment .
Bobath Therapy is a “life concept”, not a method . It does not offer strict treatment
regimens that must be followed to the letter; provides elements to apply according to
individual needs and responses; is a problem-solving approach involving the treatment and
management of patients with movement dysfunction. It describes both the problems of motor
coordination in relation to the normal postural reactions of the central mechanism of the
same, as well as the characteristics of normal motor development. It is observed what
children do in the 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; It explains why babies do a certain activity at a certain time. Those that
are obligatory (osteo-tendinous, etc.) are called “primitive reflexes”; On the other hand, those
observed in young children, such as Moro, grasping, etc., and which are not obligatory, are
called "primary responses, primary, temporary or primitive motor patterns", and the variability
of the responses and their modification as the CNS matures, maintaining up to 4 months. If
these mass or primitive patterns are maintained beyond 6 months, we speak of “primitive
patterns in appearance.” Abnormal or pathological motor patterns are those that are not
observed at any stage of normal development. The concept of therapy
Neurodevelopment (NDD) is based on the recognition of the importance of two factors: a)

Interference with normal brain maturation by an injury that leads to delay or arrest of some or
all areas of development. b) Presence of abnormal patterns of posture and movement, due
to the release of abnormal postural reflex activity or an interruption of the normal control of
postural and movement reflexes. Its main objective is the control of postural tone, inhibiting
patterns of abnormal reflex activity by facilitating
more normal motor patterns (obtained as automatic
responses to specific manipulations, achieving more
effective functional control), and preparing for a greater
variety of functional skills, which increases children's
ability to move and function as normally as possible .
The Bobath couple demonstrated that the quality of
postures and movements could be varied, achieving
finer and more selective activities (such as vision,
respiratory mechanisms, eating and speaking). This
management of ODD is applied in daily life and
includes the family in activities incorporated into daily
tasks and transforming them into therapeutic ones: how
to feed, dress, move, position; adaptation of furniture; etc Parents are active participants in
them, thus extending them for 24 hours a day, from which the concept of functionality arises.
9.4 Centers
Aiphysioterapia. Coruna. 981.174829
4
Madrid. Aleka Center . info@centroaleka.com
Bobath Foundation
http://www.hoymujer.com/Hoy/mujeres-hoy/Hernandez-anos-Terapeuta- occupational-
618283032011.html
4
10
KATONA
therapy
10.1 Introduction
The premature diagnosis of brain damage in

newborn babies makes the difference so that the
little ones can develop a normal life.
The technique called Katona neurohabilitation

makes it possible to diagnose at an early age if
the baby suffers from a disability such as
cerebral palsy, psychomotor problems, deafness
or attention, language or learning disorders that
are detected after the age of three.
The method consists of placing the child in certain positions and analyzing
whether he responds like a normal child. These positions are unique to human
beings, because other animals do not present them.
The postures consist of lying down the child and holding his hands to get him up.
A normal child will be able to stand vertically and look directly into the eyes of the
mother or whoever practices the technique.
Another position is to hold him by the thighs without any support, in the air and so
that he can lift his back vertically.
Putting him on all fours is the last position, if the child moves as if he were
crawling and can perform the other positions it means he is fine. If, on the other
4
hand, he does not show the expected movements, he is likely to suffer some
brain damage, which will prevent him from developing a normal life.
The most effective way to prevent the child from aggravating his injury is to take
advantage of when the plasticity of the brain is high, this happens when the child
is newborn. In such a way that the nervous system is taught to learn the correct
behaviors before the injury worsens over time and when treatment is too late.
At first the therapy can be very hard, but over time it will become automatic.
The exercises should be repeated five times a day and last 45 minutes, leaving
between four and five hours to rest. It consists of forcing babies to perform
postures that they should do naturally.
10.3 Results
Recovery is sometimes not total, but partial. Some limbs, such as 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 Katona neurohabilitation, 159 of the
188 babies showed significant progress and will be able to develop a normal life.
Family participation in therapy is very important. Furthermore, the little ones are
studied and monitored all the time; Prior to the implementation of
neurohabilitation, a series of medical examinations are applied to evaluate brain
damage.
10.4 Centers
Dr. Roberto Jorge Ortega Ávila, Katona neurotherapist, recognized by Professor

Ferenc Katona as qualified to teach and apply the method in our country. Contact
: www.ceneneiap.org
ANNEXES
Katona therapy, alternative for brain damage
http://www.eluniversal.com.mx/articulos/55817.html
4
11
HYPOTHERAPY
11.1 Background
This therapy has been used systematically since the 50s and 60s, although its
advantages have been known since ancient
times. The ancient Greeks, including
Hippocrates, advised the practice of horseback
riding to improve the mood of people with
incurable diseases and later, in the 17th century,
some doctors recommended riding a horse daily
to combat gout.
From the Greek "Hippos" (horse), hippotherapy is a therapeutic alternative that

takes advantage of the horse's movements to treat different types of conditions. It
is a treatment that uses the multidimensional movement of the horse. It is a
special physical training, which can be used therapeutically as a medical
treatment, for patients with movement dysfunctions and other diseases.
Historically, the therapeutic benefits of the horse were already recognized around
the year 460 BC. Hippocrates already talked about the healthy rhythm of the
horse and throughout history, we can find many references to the physical and
emotional benefits of horse riding since the year 1600.
Classic hippotherapy in Europe reflects the German model that has been
widespread since 1960, where it is fundamentally the movement of the horse and
the response of the patient that constitutes the treatment. Because of its
naturalness, therapeutic riding influences the person as a whole and the effect on
the entire body can be profound. Therefore, a natural progression developed
throughout the world, in the application of the horse medically.
It is therapeutic riding; It is a rehabilitative activity, recognized throughout the

world.
4
It consists of taking advantage of the horse's three-dimensional movements to
stimulate the muscles and joints. Furthermore, contact with the horse provides
therapeutic facets at cognitive, communicative and personality levels.
Occupational therapy with a suitable horse requires a consultation to establish the

program, specifically directing the sessions to the patient's areas of motor
planning and sensory integration. The horse is selected for patients carefully for
its movements and behavior. The patient, depending on the therapist's
instructions, can adopt different positions on the horse in different sessions.
11.3 How hippotherapy works
Hippotherapy consists of people affected by chronic diseases or disorders riding

horses. This causes the patient to receive a physical stimulus throughout their
body, causing areas that have never been physically stimulated to receive stimuli,
which can cause incredible effects.
To be able to ride the horse, any patient must follow some steps in the first
sessions and depending on the type of condition, they will begin by making some
first contacts with the horse from below. Get to know the animal a little and
establish a certain contact relationship. This is usually during the first session or
two.
It should be explained to the patient what their treatment consists of, what they
have to do with the horse and what risks they may run. In the case of children,
these explanations must be intelligible to them. Before riding for the first time, the
patient must undergo an evaluation by the center's health personnel, who will
assess the degree of condition based on their examination and the medical
information that the patient can or should provide and will establish:
• whether or not the patient can ride a horse

• what type of side effects it could have and therefore, establish a prevention
plan
• establish a work plan (which horse the patient should ride and the work
program that should be carried out on it).
Before each session, the patient must warm up in the gym, so that their muscles
and joints are prepared for the exercise they will have on the horse, which can
last between 15 and 20 minutes. Then, the patient will go to the horse, where he
will carry out the planned program, always assisted by the riding monkey and the
assistants who will be attentive to him during the ride. The time spent working on
the horse varies, but initially, it usually lasts between 15 and 30 minutes. Once
the work on the horse is finished, the patient will go back to the gym, where for
about 20 minutes, they must carry out a relaxation process before leaving the
4
center. Many of the patients who receive treatment with horses must travel in a
wheelchair, since they suffer from mobility problems that prevent them from
walking. This is not a problem for accessing the horse, since in these cases, such
as those where crutches, walkers or other types of aids are used, an access ramp
is used that raises the patient to an appropriate height, to that you can ride the
horse comfortably, with the help of an assistant.
The horse is always led by an assistant; Only patients who have considerable
practice and demonstrate that they have acquired a certain level of horsemanship
are allowed to ride in the absence of an assistant, even if he or she is a few
meters away observing.
11.4 Horse benefits
Horseback riding provides sensory input through variable, rhythmic and repetitive
movement. The resulting movement response in the patient is similar to human
movements of the pelvis when walking.
The variability of the horse's gait makes it therapeutically possible to graduate the
degree of sensations that the patient receives. They respond enthusiastically to
this fun learning experience in a natural environment. Physically, hippotherapy
can improve balance and mobility, although it can also positively affect
communication and behavioral functions for patients of all ages.
The horse is a great equalizer that allows the disabled to compete with their
healthy peers. It is known that the physical act of riding a horse breaks the
isolation of the patient and puts him on equal terms with the unimpaired rider.
This is why horse riding makes it easier to overcome fear, improves confidence
and the ability to concentrate, and makes you lose physical and emotional
tensions and inhibitions.
The first research to demonstrate the therapeutic value of horse riding dates back
to 1875. The opinion of various psychiatrists is that the horse, for children who
live in a wheelchair, allows them to look, for once in their lives, above their peers,
which greatly stimulates their self-esteem.
4
11.5 Hippotherapy centers
This therapy is carried out in numerous centers both at the Galician Autonomous
Community level and at the National level.
11.6 HYPOTHERAPY SIMULATOR
This is a project called “Development of an advanced hippotherapy platform

and study of its therapeutic benefit in children with cerebral palsy” , it 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 subsidized by the Department of Science, Technology
and University of the Government of Aragon and aims to study the therapeutic
benefits of a hippotherapy emulator in children with cerebral palsy.
The Tecnodiscap group (technology for people with disabilities) is a

multidisciplinary group made up mostly of engineers, although it has
physiotherapists and occupational therapists, among other professionals. AIDIMO
is a non-profit Association made up mostly of physiotherapists, some of whom are
currently dedicated to research as a result of the collaboration agreement signed
with Entities such as the University of Zaragoza.
In this project, before starting, each child is classified according to their level of
motor development according to a scale called GMFCS, which differentiates 5
levels. Each child receives 10 free physiotherapy sessions on the emulator that
reproduces the horse's movements, once a week. The study is a randomized
clinical trial that involves the participating children being divided into two groups
when determining what type of treatment they receive during the 10 sessions:
intervention group (emulator + physiotherapy) and control group (physiotherapy).
4
Every day, an AIDIMO physiotherapist assigned to this research project, in
addition to giving you the corresponding physiotherapy treatment, is responsible
for taking several measurements before and after for individual monitoring. These
measurements focus on:
• Record the muscle activity of the adductors with an electromyograph.
• Measure the separation of both legs with the hip and knee flexed with an
electronic inclinometer.
• Measure hip abduction in extension with a goniometer.
These measurements will allow at the end of the 10 treatment sessions to assess
whether there have been changes in terms of 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 which they are assessed again at the end of the 10 sessions and 3
months after having concluded to be able to objectively determine if there have
been changes in their postural control and motor development .
They denounce that some equine therapy centers do not exercise the
necessary rigor
Elegance even to help
http://www.latribunadealbacete.es/noticia.cfm/Local/20110313/elegancia/ayudar/
A3CBD74B-CDC3-25A6-E5AA0FA70AD04D4E
Horses that heal in Alda
http://www.elcorreo.com/vizcaya/v/20101107/alava/caballos-curan-alda-
20101107.html
“Asnotherapy” stimulates more than 220 disabled people from Córdoba
http://www.ideal.es/agencias/20100901/mas-actualidad/andalucia/asnoterapia-
stimula-discapacitados-cordobeses_201009011324.html
4
The Sada center for cerebral palsies begins therapy with pets
http://www.lavozdegalicia.es/coruna/2010/07/11/0003_8603911.htm
A child with paralysis manages to walk thanks to a duckling
http://www.antena3.com/noticias/sociedad/nino-paralisis-logra-caminar-gracias-
patito_2010021200052.html
They create an equine simulator with heat as a substitute for equine therapy
in children with autism, cerebral palsy and spina bifida
Effective therapy on a virtual horse
http://www.diariosur.es/v/20110323/sociedad/eficaz-terapia-sobre-caballo-
20110323.html
5
12
DELPHINOTHERAPY
12.1 Background
The pioneers of what is now known as “Delphine Therapy” were Horace Dobbs in
Scotland and Dr. David Nathason in Florida. In Spain, the first to use dolphins in
the treatment of patients with Down syndrome, depression and autism were the
members of the Mediterranean Dolphin Foundation. His work in the dolphinarium
on the Costa Brava in Girona obtained truly spectacular results. A novel therapy
is making its way in the treatment of autism, psychomotor retardation, cerebral
palsy, etc.
It is the combination of Biosonics and Cranial Sacro Therapy that uses the
acoustic emissions of dolphins to unblock and rebalance for certain cases in
which other more conventional treatments are not appropriate.
The skin, as a support for the receptors of the nerve endings, receives the waves
emitted by the dolphins, and through the transmitting channels they reach the ear
and the brain, performing a selective stimulation, since within the acoustic
emissions of the dolphins we find sounds so audible through the human being as
infrasound. All this without ignoring the powerful importance of the aquatic
environment and the particular weightlessness it offers us.
We could define these therapies as aimed at awakening certain areas of the brain
and rebalancing the cerebral hemispheres, reaching states of greater coherence
and synchrony. This has been verified by performing electroencephalogram tests
and other computer-assisted measurements.
5
12.3 THE CYBERDOLPHIN
In cases where therapy cannot be afforded, there are other alternatives such as
"Ciberdelfin", which is virtual dolphin therapy.
In this modality, the patient lies on a water mattress and begins to listen to dolphin
sounds through speakers, while through his virtual reality glasses he sees himself
surrounded by dolphins. Patients who have undergone this virtual treatment claim
to end up tired as if they had really been swimming with dolphins.
12.4 DOG ASSISTED THERAPY
These therapies aim to encourage the participation of dogs in therapeutic

interventions to promote human health and well-being, taking advantage of the
animal's intrinsic values, such as its fidelity or its inability to judge. In this way,
they manage to facilitate the professional work of the educator or therapist in the
education, rehabilitation, recovery, treatment or improvement of the quality of life
of people with special needs.
They ask for help to care for the disabled using pets as therapy
Dolphin therapy, therapeutic technique
http://www.enoriente.com/noticias-magazine-105/salud-y-vida-magazine-
127/13826-delphinotherapy-technical-therapeutic
5
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, who until then were not
considered susceptible to receiving education. Thus, the first specific motor
therapy center for children in an educational regime was born. In 1950, the first
Institute of Conductive Education was built in Budapest and in 1965, the specific
training of “conductors” was officially approved, the professional who provides
rehabilitation treatment integrated into school learning. Currently, this training
lasts 4 years and is considered an intermediate degree university cycle.
In 1970 the Institute opened its doors to the treatment of children from other
countries.
13.2 What is it?
Peto grants education a fundamental role in the rehabilitation of the child. It

understands that altered or undeveloped functions, although it is not always
possible to "recover" them, thanks to neuronal plasticity, they can be restructured
and reorganized, and this is done through learning, that is, the nervous system
has the ability to readapt. and replace altered functions, and to do this, learning
programs must be established in which there is a purpose and that at the same
time are integrated into the patient's daily routine and activities.
What began as a neurorehabilitation method applicable to children with perinatal

injuries was soon applied to other brain injuries originating in adult life. Well, the
assumptions of brain reorganization are similar in these cases. Today we know
that neuronal plasticity does not end in the perinatal period, and that the adult
brain has the capacity for functional reorganization .
The rehabilitative approach that this method involved differs from others not only
in the form but in the very concept of rehabilitation. While in other methods,
5
importance is given to specific motor exercise in a passive and disaggregated
way, the Petö method proposes the global stimulation of functions in order to
achieve practical functional objectives, with the active participation of the patient
himself in his recovery process.
13.3 Functioning
A first consultation is carried out, in which information related to the child's or

adult's medical history is collected. Together with the initial examination carried
out, the most suitable treatment group is assigned and the rehabilitation program
is planned.
When the child begins rehabilitation treatment, an evaluation of the motor,

functional, cognitive, affective and behavioral status is carried out by the Driver-
rehabilitator team.
At the end of the treatment period, the team of Driver-rehabilitators prepares a

report that includes the most relevant aspects of the rehabilitation process
followed by the child. An interview is carried out with the parents and/or family
members in order to transmit this process and the future guidelines to follow.
Likewise, and as a complement to our rehabilitative work, parents or family
members are given the instructions that we consider most appropriate regarding
orthopedic follow-up, speech therapy care, trying to establish collaboration with
the centers and specialists that care for the child in their habitual place of
residence .
13.4 Recipients
• Cerebral palsy.
• Strokes
• Sequelae of brain injuries
• Head trauma
• Spinal cord injuries: Spina Bifida and paraplegia.
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 way of working:
5
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 and adults, is an
ideal framework to enhance motivation, interrelation and acceptance of the
situation. The fact that we work in a group does not mean that all patients do the
same programs: the tasks are adapted to the situation and the needs of each
person. There are differences in the way the exercises are carried out, the time
required, the degree of help provided, the level of skill achieved, etc.
The driver – rehabilitator
In Conductive Education, the professional who works with patients in the group is
called the “conductor.” Petö conceived this profession as specific, hence it
requires four-year training, which integrates knowledge of anatomy, physiology,
neurology, orthopedics, pedagogy, psychology, etc. This specific training is
endorsed by the Hungarian Ministry of Education, and is what our Spanish drivers
have received.
The rhythmic intention
András Petö defends that the use of language (verbal or not) with a certain
rhythm and cadence facilitates action (intention), achieving an internalization of
movement.
In Conductive Education, ―every movement is directed towards an objective and

entails a certain motor task. At the level of instinctive behavior, with its elementary
structures, these motor tasks are dictated by innate programs; During life, at the
level of complex conscious actions, these tasks are dictated by intentions that are
formed with the close participation of language, regulating human behavior‖
(Luria, 1961).
The facilitations
Facilitation is a pedagogical element that involves a way of guiding through

methods and techniques to achieve an objective. Facilitations are all those aids
that are offered to the individual to achieve their objectives: verbal instructions,
manual aids, instrumental aids, techniques, etc. The driver - rehabilitator himself
assesses the possibilities of recovery from a specific dysfunction, and throughout
the entire therapeutic process the appropriate facilitations are proposed, the
desirable being that, over time, the patient needs fewer facilitations (helps) to
achieve their goals. goals. Depending on the different types of dysfunction,
different facilitations will be necessary and these will be different for each
individual.
5
The programs
The Conductive Education system has its own motor and cognitive tasks, etc.,
integrated into programs that are structured and occur throughout the
rehabilitation process. These programs are designed according to the needs of
each patient and are developed in the group. A certain routine is followed in terms
of the type of tasks in various positions, lying down, sitting, standing, walking...
13.6 Centers
In Budapest there is the Peto method institute, but in Spain there are several
centers that carry out this method, for example: the Fay institute in Madrid and
also since 2000 ASPACE Navarra began the Neurorehabilitation program based
on the Peto method.
Aid cut to 32 children who go to rehabilitation
http://www.diariodenavarra.es/20101106/navarra/recortadas-ayudas-32-ninos-
go-
rehabilitation.html?not=2010110601135908&idnot=2010110601135908&dia=20
101106&seccion=navarra&seccion2=sociedad&chnl=10
14
PADOVAN
method
The Padovan method is a therapy used basically by speech therapists who seek
to solve language problems in children.
5
14.1 Background
Beatriz Padovan is a pedagogue and speech therapist who, after learning the
postulates of Steiner, Fay and his followers Doman and Delacato, among others,
devoted herself to the world of neurology, studying and researching everything
related to the neurological and functional development of the child. child and its
implications in all fields, mainly in the field of language development.
In this way he reached the conclusion on which the method and all the philosophy
that comes from the great masters such as Temple Fay are based: like the rest of
the functions of the human being, language cannot be properly developed if it has
not first been developed. there was a good and adequate neurological
organization.
Neurological organization is a natural process that occurs within the normal

evolution of the child. It is made up of the different phases that the baby goes
through, from birth until it has completed and acquired the basic functions of the
human being. These phases have a natural order and must be maintained within
this sequence, that is, it is necessary to mature each of the phases in order to
advance to the next without problems arising.
Babies turn to both sides, crawl, crawl, stand, walk and begin to use language,
finally at the age of six, they have lateralized as right or left-handed and are
perfectly prepared to read and write without difficulty.
The Padovan method works with traditional exercises that come from the Doman
method of Neurofunctional Reorganization. These help the child as a whole,
improving many of the problems suffered by children with language difficulties,
since these difficulties are often associated with others and cases of autism, brain
injury, trisomy, attention deficit with or without hyperactivity, dyslexia, etc.
These exercises try to imitate nature in the evolution of the child's development,
so they work on movements that the baby makes naturally, performing them
continuously and intensively to overcome possible gaps or imbalances that arise
during development.
They are not the only activities worked on in the method, they are the basis for
other specific exercises for each of the children according to their needs,
neurological reorganization of all children regardless of the problems they
present, and they are also worked on. Beatriz Padovan, instead of working on
5
words and articulation, chooses to begin working on the functions known as
prelinguistics, that is: breathing, sucking, chewing and swallowing.
14.3 Main novelties provided by the method

Children go through all the phases of development in their neurological
reorganization, unlike the Doman method, where each child is evaluated to
determine the stage of development they are in and work from this stage
onwards.
The intensity and frequency of the sessions varies, since in the Padovan method
these are not daily, but are done twice a week for 45 minutes, less in the most
serious cases. The intensity with which each exercise is repeated depends on the
possibilities and needs of each patient. While in Doman's program it is the parents
who carry out the activities in their homes, in Doman's
Padovan, these are carried out by therapists, with the parents present to convey
peace of mind to the children and to help in certain cases. During the exercises,
poems and songs are recited, which also works on the rhythm and
synchronization of movements along with hearing and imagination. This also
brings a playful element to the treatment.
The Padovan method is a very complete therapy that not only solves and
improves language difficulties, but as has already been said, it affects the maturity
of all the child's skills and abilities by reorganizing their nervous system globally.
14.4 Centers
INPA in Madrid, information: www.inpa.info
5
15
Therapy
CRANIO-SACRAL
15.1 Background
Dr. Sutherland (1873-1954) discovered, in the early 1900s, that bones of
the headthey had certain mobility, based on the idea that
the
bones of the skull are not soldiers solidly, but
there is
micromovement or flexibility through the bony sutures where the bones are
separated. For the next 50 years he dedicated his life and clinical work to
demonstrating and finding the implications that this mobility had for the human
body.
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 an
expression of the basic life force of the individual. The nature of this pulsation is
rhythmic; It has an expansion phase and a relaxation phase; and it is expressed
in all fluids, bones, tissues, membranes, and in and around the central nervous
system, although it is also possible to feel it throughout the rest of the body. This
pulsation is called "Primary Respiratory Drive", and it plays a fundamental role in
maintaining order and body/mind integration.
15.3 How does it work?
Our body, as a living organism, is immersed in a continuous movement of each
5
and every one of its structures. This mobility represents life in
6
itself, which is often disturbed by agents, both internal and external, that represent
the setbacks that the future of life throws at us. These alter body rhythms and the
mobility of our structures. The paralysis of this movement will result in illness, pain
and suffering
With the technique of Cranial Sacral Therapy, the therapist, properly trained, will
promote, through small pressures exerted on different structures, the recovery of
this lost movement, as a consequence of both physical and psychological trauma.
15.4 Benefits
The effects occur at a deep level. The person on a stretcher may feel great
relaxation. After a session the body may need to rest or, on the contrary, feel
great energy. The work begins in the session, but as it is based on natural self-
correction mechanisms, it continues long after leaving the consultation. Each
session builds on the previous one, thus reaching deeper physical layers each
time.
As a comprehensive therapy, the treatment can help almost any condition,

increasing vitality and allowing the body to use its self-healing processes.
Carried out with specialized physiotherapists.
15.5 Contact
www.asociacioncraneosacral.com
6
1
6
Method
FOLTRA
16.1 Background
A method based on the comprehensive treatment of the patient with the

application of growth factors to functions beyond the usual ones as a key element,
makes the center a pioneering project in Europe and an international reference, to
which patients come from all over the world. .
Foltra was founded in 2005 as a Foundation with the aim of alleviating part of the
shortcomings of the public system in the field of acquired brain damage. Since
then, it has proposed a new perspective on treatment based on a comprehensive
vision of the aspects necessary for healing: diagnosis, treatment, rehabilitation
and reintegration into daily life.
From a medical point of view, the key to treatment is the application of growth
factors that facilitate the release of stem cells and their transformation into
neurons. This is an innovative approach that has not yet been carried out in public
health. What's more, Dr. Devesa himself will be in charge of directing the clinical
trial that will be carried out at the National Center for Paraplegics in Toledo before
the end of the year.
16.2 Goals
Carry out a specific rehabilitative treatment for each case, medical,

physiotherapy, psychological and speech therapy, until the maximum possible
recovery of the patient with acquired neurological damage, central or
peripheral, and their reintegration into society, without the treatment time and
daily dedication to it or individual economic availability are a limiting or
conditioning factor.
6
2
• Conduct and support research in reparative neurogenesis.
• Promote the dissemination of knowledge in reparative neurogenesis through
commented dissemination of scientific publications of interest; organization of
meetings, conferences and symposiums with the participation of national and
international specialists.
16.3 Information
Read more in Suite101: Foltra: a pioneering therapy for brain and spinal
cord injuries http://investigacionmedica.suite101.net/article.cfm/foltra-una-
terapia-pionera-para--danos-cerebrales-y-medulares#ixzz14DYxbew3
The full article written by Jesús Devesa, founder of Proyecto Foltra, on growth
hormone appears in the Annexes.
A miracle against paralysis
http://www.diariodealcala.es/articulo/general/4758/un-milagro-contra-la-paralisis
The experience of the Foltra Project surprises at a conference held at the

University of La Coruña
http://www.lavozdegalicia.es/barbanza/2010/10/08/0003_8770430.htm
“Markel's improvement after his stay in Galicia has been very important”
http://www.diariovasco.com/v/20110226/comarca/mejora-markel-tras-estancia-
20110226.html
“Our son's life is broken by a medical error”
http://www.diariodecadiz.es/article/provincia/819162/la/vida/nuestro/hijo/esta/rota
/por/error/medico.html
An expert affirms that neuroregeneration treatments will be the order of the

day in five years
http://www.dicyt.com/noticias/un-experto-afirma-que-los-tratamientos-de-
neurorregeneracion-estaran-en-cinco-anos-a-la-orden-del-dia
Foltra, the first steps of hope
http://www.farodevigo.es/portada/2009/11/01/foltra-primeros-pasos-
hope/382466.html
6
Devesa: “Growth hormone opens a path in brain repair”
http://www.farodevigo.es/portada/2009/11/01/foltra-primeros-pasos-
hope/382466.html
At the CRE in September 2010, a presentation session of the first clinical

trial with growth hormone in spinal cord injuries took place. Said
information in this regard is available at:
http://www.crediscapacidadydependencia.es/cresanandres_01/documentac
ion/m_audiovisual/devesa/index.htm
6
1
7
MULTI-SENSORY
STIMULATION ROOMS
17.1 What is a multisensory stimulation classroom?
The concept of Snoezelen Room was born in Holland as an initiative to stimulate

people with disabilities, especially children.
Multisensory stimulation classrooms or “snoezelen environments” are spaces

where people who have some sensory doors closed reinforce the expression of
sensations, feelings or desires. At the same time, they improve their capacity for
self-control and relaxation. All of this in a multisensory experimentation space,
that is, one in which the stimuli are perceived through a combination of senses:
touch, hearing, sight, smell, vestibular, proprioceptive, etc. These spaces aim to
open the experience to all the senses.
The multisensory experience is achieved by creating spaces specially prepared

and equipped with multiple sensory elements that open the door to the different
senses: visual, sound, auditory, tactile, olfactory, gustatory and mobility. Elements
distributed in an environment where relaxing music and soft lighting create an
atmosphere of relaxation, safety and protection.
17.2 Aim
“Snoezelen” is a contraction of two words that mean “to soak in” and “to dream”
and even today they give names to spaces where we invite you to give free rein
to your imagination to capture the environment.
The objective of multisensory stimulation spaces or Snoezelen Room, is to

improve the physical and emotional well-being of the person with a disability, in
this case the person with Cerebral Palsy, as well as their relationship with the
environment.
6
5
From the feeling of calm and security that the environment provides, we promote
the person's relaxation and improve their muscle and postural tone.
Relaxation with the environment is achieved by providing information from various

sensory channels.
In this way, we teach the person to integrate different stimuli in order to enrich
their sensory experiences and expand their knowledge of the world.
With all this, we open the door for the person with disabilities to incorporate and
organize the information received, have knowledge of themselves and their body,
make decisions, gain autonomy and independence and express their needs and
feelings. Always respecting the rhythm and motivation of each person.
During the work developed in these spaces, two relationships are created:
• Therapist – person
• Person – environment
In the case of contact with the therapist, by generating an individualized

relationship, a climate of mutual trust is created. If we reinforce this climate, the
entire educational team, including the family, participates in the person's new
sensations and learns 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 their sensory domain, we generate a motor reaction.
17.4 Sensory benefits for people with cerebral palsy
In the case of people with cerebral palsy, multisensory stimulation classrooms

offer the possibility of treating and rehabilitating each child individually from a
comprehensive perspective.
In most cases, we find people with multiple disabilities who, thanks to "snoezelen"
environments, open the doors of their five senses.
Thus, through these spaces, people with cerebral palsy relax their muscle tone,
know their body better, and improve their mobility and posture. All this through
contact with different elements of the classroom such as mats or through
therapeutic and rehabilitation exercises.
Touching, picking up, holding is a great challenge for some people with cerebral
palsy. Therefore, by using balls or surfaces of different sizes and textures we
make the child aware of their hands, learn to hold objects, pick them up or drop
them voluntarily.
6
In addition, the person improves their visual efficiency, visual control and posture
of the visual organs (some children have strabismus, for example). At the same
time, we promote the capacity for muscle imitation and response. Bubble
columns, mirrors, projectors, special lighting systems will make the person with
cerebral palsy open their eyes to the world.
On the other hand, the possibilities offered by the sense of hearing are endless.
Through relaxing music, sounds of nature, different rhythms and levels, we
ensure that the person, in addition to relaxing, is motivated and encourages their
listening ability.
In the classroom, we can also create a space for the person to know the smells
and their sensations. We apply massage oils to the child's skin who will feel the
stimulation in their skin and brain.
Some children with cerebral palsy have difficulty chewing and swallowing. We
improve the child's taste experience by using different flavors and textures in the
classroom. The little one will not only show his preferences but will expand his
swallowing and chewing capacity.
17.5 Other utilities
The multisensory stimulation classroom, in addition to generating new sensations

and experiences in the child, prepares them to relate effectively to their
environment.
Therefore, in multisensory spaces two aspects of the person are combined: the
relationship with oneself and the relationship with the environment. With all this,
we will increase the physical, emotional and social well-being of the child.
In addition, classrooms give the opportunity to generate various utilities:

educational, rehabilitative and socializing. 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 rehabilitator enhances "atrophied" physical abilities. Furthermore, the
professional guides the child towards socialization and integration into their
environment, through the generation of responses, relaxation or active
communication.
The child's entire learning process is supported by a prior study of their needs and
motivations in such a way that we create an individualized program. The child's
responses and progress, in turn, give us clues for future interventions. Therefore,
we teach and learn at the same time .
17.6 The elements of the room
• Foam mats, poufs and sofas: Located on the floor or covering the walls,
They stimulate the sense of touch and create an environment of
comfort and protection.
6
• Microball pouf: Covered with the same material as the mats and filled with
polystyrene balls, it helps children adopt a certain posture.
Touch panels: Made with materials of different textures and colors, they
stimulate the sense of touch and sight.
Ball pool: They caress the body, generate relaxation and encourage the little
one to play, choose, and move with ease.
Vestibulator : Allows swings in all directions and turns. Thanks to its
accessories, we can vary the degree of difficulty.
Mirror podium: Set of unbreakable mirrors in front of which we place the child
in different positions, we bring him closer or further away so that he can touch
his image and become aware of his gestures, his postures and, ultimately, his
body.
Bubble columns: Acrylic tube through which bubbles of different colors rise
while vibrating, stimulating the sense of sight, touch and hearing.
Fiber optic bundle: Bundle of 100 glass fibers to which a light source is connected,
which generates points of light that change color. These variations generate a
relaxing effect on those who look at them.
Luminous heart and ultraviolet light: They have tubes of different colors as
accessories that glow when placed under the light. In this way we stimulate the sense
of sight.
Musical water mattress: It has a heater and speakers in such a way that the sound
transmitted through the water produces a relaxing vibration with the help of heat.
Colored staircase: Staircase with steps of light and colors that light up while there is
voice intensity and decrease when said intensity goes off. Another possibility is that
the colors go up while there is a strong voice and when there is a weak voice, the
colors go down little by little.
Light and sound panel: Screen that responds to any noise by changing color and
luminous appearance. We can use it with background music or talking through the
microphone.
Reflective ball: Mirror ball with a spotlight inside that makes a multitude of colored
lights rotate slowly around the room.
Image projector : Several rotating discs generate different images that stimulate the
child visually.
Aroma rainbow: System that relates aromas to colors.
These rooms are run by associations such as Amencer - Aspace (Pontevedra) or

Aspace Coruña.
6
“Sensory disco” in a center for the disabled in Majadahonda
http://www.madridiario.es/2009/Enero/municipio/majadahonda/123613/discoteca-
sensory-inaugurado-centro-discapacitados-majadahonda.html
10 capons auctioned to create a garden for people with cerebral palsy
6
1
8
SUBTHRESHOLD, THRESHOLD
THERAPEUTIC ELECTRICAL
STIMULATION AND
HYPERBARIC OXYGENATION
THERAPY
• Therapeutic (subthreshold) electrical stimulation, also called neuromuscular

electrical stimulation (NES), pulses electricity to motor nerves to stimulate
contraction in selected muscle groups. Many studies have shown that NES
appears to increase range of motion and muscle strength.
• Threshold electrical stimulation, which involves applying electrical stimulation
at an intensity that is too low to stimulate muscle contraction, is a controversial
therapy. Studies have not been able to demonstrate its effectiveness or any
significant improvement with its use.
• Hyperbaric oxygenation therapy. Some children have cerebral palsy as a
result of brain damage from oxygen deprivation. Proponents of hyperbaric
oxygenation therapy believe that brain tissues around the damaged area can
be “awakened” by forcing high concentrations of oxygen into the brain. body
under more pressure than
atmospheric. Hyperbaric Oxygenation (HBO) is a treatment method of
orthodox medicine, which consists of making the patient breathe 100%
oxygen under pressure, between 1.5 to 3 atmospheres absolute (ATA). Which
is equivalent to the pressure supported in water at a depth of between 5 and
20 meters. Oxygen is supplied in specialized handling equipment, which is
called hyperbaric chambers.
7
0
A recent study compared a group of children who received no hyperbaric
treatment with a group who received 40 treatments in 8 weeks. On each measure
of function (gross motor, cognitive, communication, and memory) at the end of 2
months of treatment and after 3 more months of follow-up, the two groups had
identical results. There is no added benefit with hyperbaric oxygenation therapy .
Electrical stimulation could give voice back to the mute
http://www.tendencias21.net/La-estimulacion-electrica-podria-devolver-la-voz-a-
los-mudos_a5900.html
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9
SELECTIVE DORSAL
RHIZOTOMY
This is a surgical intervention that is performed on the posterior roots 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 doctor

specializing in neurophysiology, the nerve roots that are part of “abnormal
circuits” that produce and maintain spasticity are determined.
The identification of these roots is carried out by individually stimulating each of

the rootlets that form the posterior roots of the lumbosacral segments destined for
the lower limbs. The “normal” clinical response to stimulation of a posterior
(sensory) root is a muscle contraction at the same level as that stimulated. An
"abnormal" clinical response is one by which a diffusion of the stimulus is
obtained to other levels of the stimulated.
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2
This diffusion of the stimulus and the persistence of muscle contraction, added to
the "incremental" electromyographic pattern, shows that the stimulated root is part
of an "excessively facilitated circuit" by it, just as the other roots with "abnormal"
responses are selectively sectioned. under microsurgery, thus interrupting the
abnormal circuits that cause spasticity.
Roots that show “normal” responses are not interrupted and, therefore, there is
no possibility of sensory alterations occurring. The anterior motor roots are not
interrupted either, which avoids any possibility of postoperative muscle paralysis.
The basis of Selective Dorsal Rhizotomy is that, under normal conditions, muscle
tone results from a balance between the inhibitory or "braking" action, which
pyramidal life exerts on said muscle tone, and the transmitted excitatory or
"facilitating" action. by the posterior roots of the spinal nerves from the muscles to
the spinal cord.
The pyramidal lesion, which exists in patients with brain or spinal injuries, such as
those mentioned, breaks this balance, which is restored by Selective Dorsal
Rhizotomy, by selectively interrupting the action of the posterior roots of the
spinal nerves.
19.2 Who benefits from RDS?
An important group of patients who benefit from selective dorsal rhizotomy are
those who have a spastic form of cerebral palsy. It is indicated in cases where
spasticity prevents them from maintaining an upright posture (scissor gait posture
with club foot).
19.3 Result that can be expected.
In patients who walk, although abnormally, it is possible to improve the

appearance, performance and effectiveness of their gait; As spasticity is reduced,
the patient can stand and walk straighter; In addition, the range of hip and knee
movements increases, making the steps longer and the walk faster.
In patients who walk abnormally and with the help of elements (canes, crutches,
etc.), it is possible to improve the quality of their ambulation and reduce their
dependence on these elements.
In those who crawl or crawl on the chest and abdomen and who remain standing
with help although without moving forward or walking, a better maintenance of the
standing position is obtained, opening up the possibility, through
neurorehabilitation, of achieving assisted ambulation with the help of canes or
7
crutches, (It should be noted that to obtain achievements the
Patients must undergo intensive neurorehabilitation work before the operation,
with the aim of obtaining the best possible results; it is not expected that a patient
without prior neurorehabilitation preparation will be able to obtain results).
19.4 Who is an ideal candidate for rhizotomy?
• It is between 4 and 6 years old
• You have pure spasticity without other types of muscle tone problems
(dystonias) and also alterations in balance (ataxias).
• Having undergone neurorehabilitation treatment prior to surgery does not

less than 6 months with stabilization in results.
• Have control of movement (you can move the muscle but your tone prevents
you from using it effectively)
• You have spastic muscles, primarily in the legs (spastic diplegia), spasticity in
the legs and arms with the legs most affected (spastic quadriplegia), or
spasticity affecting one arm and one leg on the same side of the body (spastic
hemiplegia) .
• They do not have severe scoliosis (deforming curve of the spine) or have not
had a spinal fusion in the lumbar (lower back) area for scoliosis.
• He is well motivated and has the ability to cooperate in the long-term therapy
program.
• You have a family who understands the long-term commitment to intensive

physical therapy.
ANNEXES
An operation reduces stiffness in the legs of children with cerebral palsy
http://www.diariosur.es/v/20110225/malaga/operacion-reduce-rigidez-
legs-20110225.html
7
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0
therapy
RHYTHMIC MOVEMENTS
AND PRIMITIVE
REFLECTIONS
20.1 Background
Harald Blomberg, a Swedish psychiatric doctor, is the creator of rhythmic

movement therapy or RMT. He has more than fifteen years of experience and has
helped many children and adults with locomotor problems, ADHD, learning
disabilities and autism.
For a few years now, it has been training many professionals in the field of health
and early childhood education in our country.
20.2 What is rhythmic movement therapy?
It is an easy therapy to carry out and is usually pleasant for most patients. It is the
repetitive performance of rhythmic movements that involve the entire body. They
are carried out on the floor and are mainly based on the imitation of the
movements made by babies naturally during their growth and development.
20.3 What is it based on?
Mainly through sensory stimulation and movement, the most basic and primitive
areas of the brain (those that receive this stimulation most directly) are activated
and develop. At the same time, they stimulate and connect with other more
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5
2
0
evolved areas. For the brain to be mature, it is not only necessary that all areas
be stimulated and active,
7
6
but rather that they are interconnected with each other, functioning together. If
this interconnection and the correct activation of all brain areas fail, both physical
and cognitive, learning, emotional or relationship problems may arise.
When the stimulation has not been correct and the baby has not made the
spontaneous movements it needs for its development (due to problems during
pregnancy, childbirth, not having spent enough time on the floor, abuse of
chairs...) and has not adequately completed all the stages of its development
during the first year of life, blocks in development may occur with the consequent
problems mentioned above.
If the lower parts of the brain have not matured, the higher parts responsible for
functions essential for learning will not. And we cannot hope to reach these areas
without having first gone through the lower ones, remedying their dysfunction in
order to make all the other areas mature. For this it is necessary to use specific
stimulation techniques such as TMR or Rhythmic Movement Therapy.
20.4 Benefits
When the child's development is slow, we can accelerate it through the

stimulation of rhythmic movements. A stimulation of the most basic and primitive
parts of the brain that, when activated and stimulated, will in turn activate more
evolved areas necessary for learning and emotional and behavioral control.
To correct deficiencies or deficits in development, we will make movements

similar to those that the baby does naturally. This is the goal of the rhythmic
movements that make up RTM (rhythmic movement therapy and primitive
reflexes) and that mimic the repetitive rocking movements that babies experience
and evolve with in their first year of life.
Thus, movements that are spontaneous in the baby become therapeutic in the
older child and the adult. Looking for a way to stimulate neuronal connections
between different parts of the brain.
Once this is achieved, benefits will be noted in attention span, impulsivity and
hyperactivity, language or literacy, and all academic tasks in general. It will
improve muscle tone, posture, balance and coordination. In addition, greater
maturity and emotional control will be achieved.
20.5 Information
In Galicia, for example the Galician Optometry Center COGA, www.siodec.com
http://www.reflejosprimitivos.blogspot.com
7
Rhythmic movement therapy
http://www.diarioextra.com/2010/enero/18/espectaculos02.php
7
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2
Therapy
NEURO COGNITIVE
A new approach to cerebral palsy treatment from Snowdrop. It is based on two

proven principles:
• Neural plasticity. The brain is capable of altering its own structure and
functioning to meet the demands of any particular environment. Consequently,
if the child has an appropriate neurological environment, he will have the best
chance of progressing.
• Learning can lead to development. As early as 1900, this was being tested by
a psychologist named Lev Vygotsky. He proposed that children's learning is a
social activity, achieved through interaction with the most qualified members
of society. There are many studies that provide evidence for this claim,
however, there are still no controlled studies on neuro-cognitive therapy.
7
9
NEUROFEEDBACK
AND BIOFEEDBACK
NEUROFEEDBACK
Discovered in the 1970s in the US, it helps the brain reorganize for better
function.
Using electrodes placed on the skull, the system analyzes the brain's electrical
activity and then returns information about its own functioning.
Neuroptimal is a new and special method of neurofeedback. It differs from the

previous one in that it is basically only interested in the variability of the brain, that
is, the characteristics of its fluctuations, while the other methods detect
differences in the relative levels of a "normal" brain.
There is no need to carry out a preliminary diagnosis because the application of

the method in a session is completely independent of the expected changes. It
informs your own brain function and the brain reorganizes itself, improving its
ability to self-repair and self-control.
8
Neurofeedback:
www.neurofeedback-spain.com
Contact in Spain:
estherdb@hotmail.com
2
2
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 with cerebral palsy.
Brucker Biofeedback in Miami:
www.bruckerbiofeedbackcenter.com
8
1
2
3
Method
KABAT
The main characteristic of this method is the use of massive movements, based
on observations between functional activities, such as walking, eating, etc. These
models are spiral, rotation and diagonal with a synergy of muscle groups. They
consist of the following components:
• Flexion or extension
• Abduction or adduction
• Internal or external rotation.
Resistance to movement is used to facilitate the action of muscles that contract

against resistance and auditory and visual stimuli.
The Kabat method is a rehabilitative method that uses proprioceptive

neuromuscular facilitation techniques. Dr. Hernán Kabat and Margaret Knott at
the Kabat Kaise Institute, did their first internships between 1946 and 1951; The
first known communication was provided by Dr. Kabat at the first World Congress
of Physical Therapeutics in 1953.
The bases of the method are implied in the name of the method: “Propioceptive
Neuromuscular Facilitation Techniques.”
Facilitation: Perfectly studied in physiology, especially by Sherrington and where

they talk about sums of stimuli and the concept is born that when an afferent
pathway is excited, the passage of the impulses produced by a second stimulus
reached the center by the same way or one way
8
2
convergent. In this method, facilitation would be the prompt obtaining of a motor
response through appropriate stimuli.
Neuromuscular: It is in the neuromuscular mechanism, where the increase in

response is expected.
Proprioceptive: The nerve endings included within the muscles, joints, ligaments,
tendons are those that give knowledge of the position that the body occupies in
space. By stretching, relaxation, pressure, etc. It generates a complicated series
of reflexes (myotatic reflex) that in a certain way governs the action of the agonist
and antagonist muscles. It is the stimulation of this pathway that is used in this
technique.
These techniques can be defined as methods of promoting the responses of the

neuromuscular mechanism through the stimulation of proprioceptors. To carry out
this method, the kinesiologist approximately follows this scheme: Verbal
command, Manual Contact, Traction and pressure, Stretch stimulus and reflex,
Maximum resistance, Movement patterns, Muscle training and Relaxation
technique.
1. Verbal Command: The execution of any movement indicated in this method

must be preceded by a command voice that serves as a stimulus. Much
importance is placed on clarity, precision, tone and timing.
2. Manual Contact: it is used as a procioceptive stimulus by placing the hand

always opposite the indicated movement.
3. Pressure and Traction: can be used for the same purpose of proprioceptive
stimulation.
4. Stimulus and Stretch Reflex: used in cases where there is no other technique
that leads to voluntary contraction, it consists of quickly and suddenly passively
extending the muscles involved in the movement, before ordering their
contraction.
5. Maximum Resistance: is the application of a force opposite to that of the arc of

movement. A little less to the patient's strength in an isotonic contraction and a
little greater in the isometric one. This causes, in addition to the stimulus, a
relaxation of the antagonist muscles.
6. Movement Patterns: Kabat adds other techniques that serve to re-educate and
strengthen the muscular part, taking advantage of the stretching stimulus and
maximum resistance. This is achieved with repeated contractions, hold-relax
and active movements; slow inversion and rhythmic stabilization, this is called
muscle training.
8
7. Relaxation techniques: all these techniques serve to relax spastic and
contracted muscles. In addition, the excitation of the muscles antagonistic to
the spasticity or contracture is obtained.
In summary, the Kabat Method has demonstrated its effectiveness in the treatment
of consecutive hemiplegia or cerebrovascular accidents, where since it is a
central problem, no peripheral treatment can be used, but rather rational and
scientific re-education. The different techniques mentioned are used in
combination or successively, depending on the case, achieving highly satisfactory
results.
8
24
HYDROTHERAPY
It consists of a physical activity in which water is used therapeutically, either for its
thermal effect or for its mechanical properties, such as being a medium that
cushions the impacts of the exercises performed in it. In this way, the harmful
effect exerted by gravity is counteracted, which is imposed in the majority of
sports regularly practiced on the ground, this being the main advantage obtained
in the aquatic environment, marking the great difference with respect to the rest.
of sports activities.
Hydrotherapy allows exercises to be carried out in physically limited people, from

ailments that affect the spine, to more focused diseases, such as: meniscus
injuries, ankle, strains
muscular...
Likewise, it manages to improve psychological pathologies such as anxious and

depressive states, which, through physical activity, release endorphins, obtaining
a feeling of well-being and pleasure that water provides, the relaxation obtained,
the music that can accompany them and, the integration and social relationship.
This creates an optimal climate that, together with the drugs and psychotherapy
necessary in each case, improves the patient's state of health.
24.1 Recipients
Hydrotherapy is good for both children and adults. In children with cerebral palsy
it is of great help, improving control of movements and breathing.
8
24.2 Benefits
• About the musculoskeletal system: thanks to the principle of flotation, it

releases a large part of the body's weight from the bone and muscular system,
and from the joints. By reducing the load, it allows new possibilities for active or
passive mobilization of damaged joints. Likewise, the greater density of water
With respect to air, it represents a hydrodynamic resistance to
certain movements, toning the body.
• Circulatory system: blood vasoconstriction due to the cooling of the hot body
produces, as an immediate reaction, vasodilation, which increases blood
circulation.
• At the respiratory level: the greater density of water produces compression of
the thoracic cavity, strengthening the muscles related to inspiration, and
facilitating expiration.
• At a neurological level: thermal changes influence the regulation of the
sympathetic-parasympathetic system, which influences the regulation of the
digestive, respiratory, cardiocirculatory, and renal systems...
Depending on the nature of the therapeutic agent; water, hydrotherapy is also

classified into:
• Thalassotherapy: Sea or salt lake water.

• Balneotherapy: Medicinal mineral water.
24.3 Thalassotherapy
It is a treatment whose active ingredient is seawater, a living system in which a

series of elements are combined whose letter of introduction is conferred by its
composition, since it is a highly mineralized water, in whose composition chlorine,
sodium predominate. , iodine, etc., although it also contains sulfate, magnesium,
and other terrestrial minerals, as well as dissolution gases (nitrogen, oxygen,
carbon dioxide). These are therefore hypertonic sodium chlorinated waters, which
act as general stimulants of the body, in which its response capacity improves
given the transmineralizing effect through the skin that is achieved through
balneation techniques, to which we must undoubtedly add the physical,
mechanical (flotation, hydrostatic pressure) and thermal factors, which make
water an ideal medium in the functional recovery of multiple pathologies.
The use of seawater, from the point of view of health, has been known since
ancient times.
8
24.4 Therapeutic effects of thalassotherapy
He seawater, behaves as a therapeutic agent whose effects

Biological conditions will depend on various physical and chemical factors:
• Factor mechanic.
• Factor thermal.
• Factor chemical.
24.5 Indications for Talosotherapy
Talosotherapy becomes an important therapeutic resource, especially in those

processes of a chronic nature, mainly degenerative, that cause pain, joint
destruction or bone lesions, which lead to great functional impotence, since the
physical-chemical factors of the Sea water provides necessary elements to
reduce the painful component, facilitating the recovery of muscle tone and
balance, as well as functional re-education through balneokinesitherapy
techniques, which translates into an increase in mobility and an increase in
strength.
These benefits are undoubtedly more evident in load-bearing joints (hip, knees,
spine...) where the weight reduction, even greater in such high-density water,
extraordinarily favors mobility.
Pathologies that can be treated include:
• Sequelae of stroke.
• Spinal cord injuries.
• Cerebral palsy.
• Polyneuritis.
• Neuralgias.
• Parkinson's disease.
24.6 HALLIWICK THERAPY
It all started when James McMillan (1913-1994) visited Halliwick School, where
many girls with cerebral palsy were housed. During the study he carried out on
the effects of swimming on this type of pathology, he discovered that only those
with mild damage were able to enter the pool (using the traditional system) and
therefore enjoy the water. The fact that girls with profound brain damage could not
benefit from the effects of hydrotherapy moved this hydraulic engineer so much
that he dedicated himself to creating a specific methodology.
Around 1948, McMillan, helped by his wife, launched a new method based on the
scientific principles of fluid mechanics and the rotations of the human body
8
observed in water. Since then, there is no reason to deprive children with severe
cerebral palsy or any other type of pathology of motor training combined with the
pleasure that play produces. Physical activity on land can be very difficult, even
impossible for them; However, the aquatic environment significantly facilitates the
possibility of movement and transfer.
Starting from Halliwick (London), there have been many countries interested in
this methodology that subsequently, according to their needs, have been adapting
to their environment as it is one of the most important strategies in the field of
hydrotherapy. McMillan and his colleagues continued their research and founded
an association for therapeutic swimming. Beginning in 1963, the impact of the
program became even more evident. Currently it is not considered a method, but
rather a concept since it covers the aspects of swimming from a physical,
psychological and social point of view.
Human beings are terrestrial and therefore will have to learn new patterns of
movement in water. To achieve this, the following will be trained: head control,
breathing, coordination, perception, balance, standing, walking, etc.
When the human body moves in water, two forces act in opposition and
simultaneously; that is, the buoyant force or upward thrust and the force of gravity
or downward thrust. In this case, the physiotherapist will be able to use an
additional three-dimensional potential for aquatic exercises that will offer greater
stimulation towards the perceptual training of the senses of vision, hearing and
touch. Breathing, balance and rotational control will also benefit.
Many of the elements of the Halliwick concept can be learned through games and
group activities since by motivating the child they allow greater social interaction
while learning.
Psychic adaptation and the restoration of control of body balance are of vital
importance and take first place in the demands for greater activity in the water;
However, in an adequate treatment protocol many therapeutic effects can be
obtained while these attitudes and skills are developed, always taking into
account the mind, body and spirit.
These considerations are referenced in the Halliwick bases and in the widespread
use of hydrotherapy. There are 10 points that make up this methodology, divided
into four phases:
Phase 1. Adaptation to the aquatic environment:
- psychic adaptation
- Looseness
Phase 2. Rotations:
8
- Rotationvertical
- Rotationside
- Rotationcombined
Phase 3. Controlof movements in the water:
- Floatation
- Balance
- Transfer due to turbulence
Phase 4. Mobility in water:
- Basic movements
- Fundamental movements
Phase 1: Adaptation to the aquatic environment
Psychic adaptation is essential so that both the physiotherapist and the child
know what they can expect from the aquatic environment. For this, it is important
to understand the elements that will intervene, such as: the ability to adjust to new
sensations, turbulence, flotation and the weight of all these effects on body
balance.
As terrestrial beings we are subconsciously adapted to the effects of gravity;

However, when they become nullified in the water, they result in great postural
confusion. Thus, the child will have to be taught how to behave in this new
environment so that he or she can carry out the proposed activities.
Respiratory control is part of the basic preparation for all activities, since it is not
only a prerequisite for head control, but is also essential for swimming. The
patient must learn to blow when the water comes close to the face and to expel
the air slowly when submerged.
Water is a medium of support in itself, a fact that often suppresses pain, allowing
freedom of movement to increase. As the psychic adaptation grows, the child is
encouraged towards greater activity that demands independence and control over
new acquisitions, in which case it is vital that he be allowed to move on his own:
walk, turn, jump and make postural changes through the movement of the upper
and lower limbs.
Phase 2. Rotations
8
Because water reacts with respect to shape and density, the body is continually
subjected to rotational force. The smaller the surface area and mass density of an
object, the less chance there is of buoyancy.
Vertical rotation consists of a person's ability to regain verticality from the supine
position. This requires a strong flexion of the trunk, hips, knees, cervical spine and
shoulders, which will be followed by a precise balance of the head on the body in
order to maintain the vertical position.
With respect to lateral rotation, it must be said that human bodies are
asymmetrical and, consequently, in the recumbent position there will be a
tendency for the body to rotate around its longitudinal axis. Rotational motion
occurs when the factors of elevation and descent are not equal and opposite.
Combined rotation is used to prevent the child from falling into a vertical rotation
during treatment and ending up in a prone position over the water. Through lateral
rotation you will be able to turn towards the supine position and thus, by
combining the rotation, reach a position in which you can breathe freely.
Phase 3. Control of movement in water
Lifting force can be used to assist movement in a conventional manner and also
as a counterweight taking into account the effects of gravity. The stillness of the
water will initially help the child learn to control his balance.
Later you will, however, have to be able to maintain that balance in different
positions, but against the deliberate turbulence that occurs around you. If these
turbulences occur directly towards a part of the body, the water pressure will be
lower and a rotation or drag effect will be observed. In this case, the child will tend
to move in the area of turbulence that has the least pressure, an effect that can be
used to produce postural compensations according to therapeutic needs .
Phase 4. Mobility in water
Once rotational control is good, while the child is “towed” by turbulence in the
water, he or she can begin to perform simple movements of the upper and lower
limbs. This range of movements can be increased gradually, increasing their
difficulty and working each muscle group more specifically.
Something important to keep in mind is the way you hold the child, since it is not
advisable to provide more help than is necessary. On the other hand, negative
words, such as “sinking,” “drowning,” etc., should be avoided and replaced with
positive terms associated with land and safety.
Every active program must not only include the use of a wide range of sensations,
movements, postural changes, etc., but the introduction of rhythm through songs
9
and music is highly advisable.
The game, in addition to being fun, in this case serves to help the child forget his
fear while enjoying it and dare to participate in the activities like the other
members of the group, thus achieving the realization of the 10 basic points
described above.
Conclusion
After more than 50 years of development and implementation, the Halliwick
concept remains one of the most important strategies in aquatic therapy,
especially in pediatrics. Researchers consider it as a logical learning to move in
the aquatic environment, and many of them even call it "Bobath in the water."
The value of swimming as a therapeutic activity is beyond doubt. If all

rehabilitation programs are planned taking into account recreational activities in
accordance with the individual diagnosis, the child will acquire multiple
advantages of both a physical and psychological nature. For this reason, more
and more centers are using the aquatic environment as a complementary part of
the enabling or rehabilitating treatment. Children acquire greater self-confidence,
improve their self-esteem and ability to concentrate, experience new sensations
and have greater possibilities of relating to others.
Contact in Spain: www.halliwicktherapybcn.com
The hydrotherapy guru
http://www.lavozdigital.es/cadiz/v/20100901/jerez/guru-hidroterapia-
20100901.html
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5
Treatment
X-CELL-CENTER FOR
CEREBRAL PALSY
25.1 Introduction
X-cell-Center's cerebral palsy treatment differs from standard methods as it

attacks the root cause of cerebral palsy inside the brain. Stem cell therapy is a
drug-free alternative that focuses on causing 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 at X – cell-
Center have shown clear improvement
Most patients with cerebral palsy are treated by lumbar puncture, where stem
cells are injected into the cerebrospinal fluid that transports them through the
spinal canal to the brain.
Lumbar puncture is an outpatient procedure that requires patients to stay in

Germany for 4 or 5 nights .
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 entire procedure
normally lasts about 30 minutes.
Because the bone marrow harvesting procedure requires patients not to move, it
is performed under general anesthesia in children and elderly patients who for
some reason cannot sit still.
9
2
Once the bone marrow extraction is complete and after a short recovery period in
the clinic, patients can return to their hotel and engage in their normal activities.
The next day, the bone marrow stem cells are processed by a novel, high-quality
technique in an approved laboratory with government permission. In the
laboratory, the quantity and quality of the stem cells are also measured. These
cells have the potential to transform into multiple cell types 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 with mannitol in cases where a lumbar
puncture is not advisable.
Patients who are treated by lumbar puncture are required to stay in town the day
after the procedure for general safety purposes. They can return home on the fifth
day.
25.3 Results
The type of improvements reported include: decreased spasticity, better

coordination, improved motor function, greater stability of posture, improved
cognitive abilities, especially in communication. Many have gained the ability to
sit, stand or walk without assistance, improved spoken language and even
reported a decrease or even absence of seizures after treatment.
The average age of the patients was 8.9 years, while the median was 6 years.
The oldest of the treated patients was 44 years old (data from 2009).
25.4 Centers
He has two private clinics in Dusseldorf and Cologne in Germany.
Joel will be able to have surgery on Monday in Germany
http://www.laopiniondemalaga.es/costa-sol-occidental/2011/02/02/joel-podra-
operarse-lunes-alemania/399075.html
Joel overcomes the transplant to reduce his paralysis
http://www.laopiniondemalaga.es/costa-sol-occidental/2011/02/11/joel-supera-
transplant-reducer-paralisis/401280.html
9
Joel starts a new life
http://www.laopiniondemalaga.es/costa-sol-occidental/2011/02/17/joel-empieza-
nueva-vida/402692.html
Viable, treating cerebral palsy with stem cell transplant
http://www.cronica.com.mx/nota.php?id_nota=560868
They defend treatment with hormones to improve patients with brain

damage
9
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6
BOTULINUM TOXIN
TYPE A Application
(BOTOX)
26.1 Background
In 1820, a German clinician (Kerner) reported a case of sausage poisoning in 76

patients, whose clinical description was very similar to what we currently know as
botulism.
This same author raised the possibility of using the toxin contained in sausages
as a remedy for some diseases of the central nervous system.
In the mid-1940s, botulinum toxin type A was purified, but it was not until 20 years
later that Dr. Scott began using it in the treatment of strabismus. In 1989, the US
Food and Drug Administration (FDA) approved its use for the treatment of
strabismus, blepharospasm and 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 PCI are multiple (drugs, physiotherapy,
occupational therapy, orthopedic aids, orthopedic surgery, etc.), but most of these
procedures are aimed at alleviating the repercussions of said spasticity.
It is therefore very important in the treatment of spasticity to be carried out early,

before the progressive shortening of muscles and tendons becomes fixed.
9
5
Physiotherapy and orthoses have traditionally been the procedures of choice in
the first stage, with the administration of botulinum toxin having recently been
added.
Koman et al. In 1989, they were the first to report preliminary results of treatment
with botulinum toxin in patients with PCI and dynamic orthopedic deformities,
proving a decrease in spasticity without major side effects. Subsequently, multiple
documented studies have been published that demonstrate the effectiveness of
botulinum toxin in the treatment of spastic CP.
It is accepted that botulinum toxin improves the motor function of some children
with spastic PCI, but other achievements must also be attributed to it that can
sometimes be even more important.
In this regard, it delays the appearance of fixed retractions and therefore the need
for surgery, helps physiotherapy and placement of orthoses and contributes to
improving the degree of well-being in patients with severe involvement by
facilitating their hygiene or reducing pain. The use of TBA in these children should
be part of a global treatment plan, taking into account that reducing muscle tone is
not the only objective.
It is necessary to know some aspects to take into account before starting

treatment with TBA in a child with PCI. The objectives of therapy must be
reviewed before each intervention on an individual basis, and must be realistic
and clearly stated to the patient or their parents in order to avoid false
expectations.
It is important to clarify whether the goal is to avoid surgery or just delay it, if the
aim is for the child to be able to walk freely or with the help of devices, or if the
child can only hope to improve adaptation to daily activities in a wheelchair or
hygiene. Likewise, a written informed consent must be signed describing the
characteristics of the treatment and its possible side effects.
26.3 General indications for the effectiveness of treatment with TBA
• It must be a dynamic or reversible spasticity, with no

fixed contractures or retractions that prevent reaching the neutral position
of the joint.
• Spasticity must be localized. The treatment must 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.
• The movement disorder must depend on the spasticity of a muscle group

and not on the weakness of the antagonists.
9
• Spasticity must interfere with limb or body function.
26.4 Recipients
Regarding the age of treatment, although there are authors who infiltrate infants,
in general, it is recommended to start it between 2 and 6 years since this is when
dynamic motor development occurs and the course of the disease can be
modified.
A lower functional response is described in older patients, however, the

effectiveness on dynamic spasticity continues to exist as long as there is no joint
contracture or tendon shortening.
26.5 Contraindications
Most contraindications for toxin administration are relative.
A fixed retraction is an absolute contraindication, although each case must be

assessed individually, since a minimal benefit may be important in a given case.
Hypersensitivity to the toxin or infection at the injection point, false expectations at

the injection point, false expectations and lack of security - collaboration of the
patient or their parents may be contraindications to be considered. An imminent
intervention requires delaying the administration of toxin, as well as the placement
of a vaccine. Severe mental retardation excludes the functional benefit of the toxin
but it could be used as a palliative measure.
Certain drugs interact with the toxin by acting and competing for the site of action,
either enhancing its effect such as aminoglycosides or inhibiting it such as
chloroquine or hydroxychloroquine.
In summary, botulinum toxin type A is well tolerated, safe, and effective in the
treatment of patients with spastic CP. The achievement of good results through its
administration requires an individualized assessment that correctly defines the
needs of each patient, a careful selection of the same and a multidisciplinary team
that complements and makes possible the comprehensive treatment of these
children in order to improve their quality of life.
26.6 Conclusions
Currently, several TB medications are marketed in our country, distinguishing: TB-

A and TB-B for clinical use and TB-A for cosmetic use; whose power units are not
equivalent so they cannot be considered interchangeable.
All TB medications require a prescription and are classified as medications for

hospital use and must be administered by doctors in authorized health centers.
9
The clinical uses of TB are usually reserved for processes (usually painful or
disabling) for which effective alternatives are not available.
The administration of TB usually requires repetitive injections, and the minimum

time interval indicated in the drug's technical information sheet must be respected.
In case of lack of response, it is important for the doctor to 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 may
be caused by spread to the muscles near the administration area. It is important
to carefully assess the benefit/risk ratio in each patient and closely monitor
administration.
ANNEXES
Carlos Haya publishes a clinical guide on treatment with botulinum toxin
http://www.elmundo.es/elmundo/2010/10/29/andalucia_malaga/1288351762.html
Botox, effective in treating babies with cerebral palsy
http://www.periodicodigital.com.mx/index.php?option=com_content&view=article
&id=118602&catid=135&Itemid=217
9
27
HOMEOPATHY
Homeopathic therapy consists of the administration of microquantities of a

substance of animal, vegetable or mineral origin, subjected to a process of
successive dilutions.
In the preparation of homeopathic medicines, the conventional laws of physics

and thermodynamics do not intervene; their effects are explained by the
phenomenon of resonance, which is the means by which information is
transmitted from the molecules of the solute (the mineral essence). , animal or
vegetable), to the water molecules, in a process renewed indefinitely through
successive dilutions and succussions, which lighten the speed of formation of
solute characteristics thanks to the plasticity conferred by its hydrogen bonds,
which They are capable of acting as resonators of information and thus carry it to
the last molecule of water in the system, which in the end will have the same
energetic pattern of the matter used in the first dynamizations.
The effects obtained after the administration of homeopathic medicines are

probably the result of the mobilization of neurotransmitters at different levels of
the neuroendocrine system and the consequent neurovegetative responses; If we
review the materia medica of many of the main remedies, we will find in their
9
characterization a symptomatic complex that clinically corresponds to an excess
or a deficiency 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 but sick people; For every pathology, acute or chronic, there is a
homeopathic remedy whose pathogenesis faithfully reflects that ailment.
The homeopathic doctor must approach the patient with cerebral palsy taking into
consideration each of the symptoms: physical and mental, exhibited by the little
patient, and with this he will be able to choose the indicated medicine, the
similimum : which responds to the closest similarity between the symptoms.
symptoms produced by the medication in pure experimentation or pathogenesis
and the symptoms that characterize the sick individual; the organistic remedy: one
that has selective action for a localized area, some organ or tissue, correcting
pathological processes, abbreviating the curative evolution, in this pathology the
organoprepared remedies are of choice for the treatment of associated
disorders: diluted organs and tissues and dynamized ones that act on their human
counterpart to correct the disturbed activity, their choice is made taking into
account the physiology, pathophysiology and topography of the lesions, in this
case in particular of the central nervous system; These medications behave as
cell regenerators.
The following remedies are some of the most used in the treatment of patients
suffering from CP, the choice depends on the individual signs and symptoms,
there is a "medication for each patient", the potency, dose and duration of the
prescription are particulars, there is no rigid scheme in the prescription of
homeopathic remedies that is common for all patients .
Similimun Remedies
Agaricus muscarius: produces spasms, muscle jerks and tremors that resemble
choreic movements, limbs in continuous movement, clumsy movements of hands
and fingers, weak and numb arms, lower limbs with extreme laxity, paresis that
progresses to paralysis.
Causticum: depressant of the nervous and muscular system, it modifies nutrition,

the child for whom this medication is suitable is extremely thin, with delay in
psychomotor development and progressive decrease in muscular strength,
paralysis of nervous territories, especially in the face, the larynx and sphincters,
hemiplegia, paraplegia, muscle rigidity and contractures, retraction and
contracture of the flexors and extensors of the hands and feet, joint ankylosis.
Seizures of the petit mal type.
1
Gelsemiun sempervirens: medication with selective action on the central nervous
system where it produces a depressive and paralyzing action on the motor and
sensory centers, prostration of the entire muscular system with total or partial
paralysis, inability to transmit voluntary nerve impulses, tremors when treating
walking or grabbing an object, difficulty focusing attention.
Helleborus niger: elective action on the nervous system causes tonic-clonic

seizures followed by a paralytic state, produces depression of sensory activity,
especially auditory and ocular activity, spasmodic movements of arms or legs,
decreased sympathetic activity, which causes weight loss and wasting. muscle
due to alteration of cellular trophism.
Secale cornutum: acts on striated and smooth muscles, deeply modifies the
muscle fiber, producing disorders of muscle tone, decrease or absence of
contractility and reflexes, paralysis and atrophy.
Organistic
The characteristics of the motor deficit, learning disorders, intellectual and

sensory deficits will depend on the injured brain area. The choice of
organotherapeutic remedies will be determined by the neurological structure that
is to be regenerated, we have this:
Regio motorica, gyrus praecentralis, Lobus frontalis, in spastic type cerebral

palsy.
Basal ganglia, globus pallidus, thalamus , will be used in athetoid or dyskinetic

type paralysis.
Substantia alba, myelin, in cases of cerebral palsy due to periventricular atrophy.
Cerebral cortex, hyppocampus, temporal lobus, lobus apriétalos, lobus occipitalis,

for sensory or motor deficits, specific learning disorders, memory disorders,
decreased intellectual abilities.
Musculus buccinator et masster, musculus orbicularis oris , companions of the

corresponding nerves, in articulatory and swallowing disorders.
medullary region, nerve plexuses and muscle groups, the choice of which will
depend on the anatomical region that you wish to improve.
The homeopathic doctor, with these tools, can be part of the work team that
supports the small patient with cerebral palsy. Early intervention and homeopathy
produce surprising and unimaginable progress in these children, the results are
maintained over time, the effects of this noble medicine will not be suppressed
once the expected healing process has been achieved.
1
Alternative medicine can be dangerous in children
http://www.europapress.es/chance/elbuenvivir/noticia-medicina-alternativa- may-
ser-peligrosa-ninos-20101224131341.html
1
28
THE SHOES OF ISRAEL
28.1 Background
Step of Mind has launched and participated in several high-ranking scientific

investigations in the field of motor rehabilitation, functional assessments, transfer
of motor achievements and retention.
In its research activities SOM has collaborated with universities, industrial

centers, private companies and clinics in Europe, the United States and the
Middle East.
28.2 What is it?

Re – Step is a training system through a sandal that modifies the environment
during walking and aims to improve stability and walking in children and
adolescents with cerebral palsy at home and in 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, which will target adults and will
also be effective for motor rehabilitation of adults with cerebral palsy, people after
stroke (hemiplegia) and traumatic brain injury.
28.4 How does it work?

The system consists of a pair of training wear sandals that changes its surface
1
and facilitates a person's reaction in real time. Portable devices communicate with
a PC in a feedback loop.
Among other effects, Step of Mind:
• Induces the solution of the brain problem
• Improves brain plasticity
• Provides immediate and accurate clinical results
• Programmed for different levels of motor disability
• Lightweight and portable
• Treatment can be done at home or in the clinic
• Non-invasive rehabilitation
• Allows you to transfer and preserve achievements in “real life” environments
Contact : info@stepofmind.com
1
29
FUNCTIONAL MYOTHERAPY
29.1 Introduction
Functional myotherapy includes a set of procedures and techniques used to

correct orofacial muscle imbalance, normalize muscle behavior, reduce harmful
habits, and improve the patient's aesthetics.
Muscle imbalance plays an important role in the growth and development of the
stomatognathic apparatus.
The importance of correct muscle balance and its function has been recognized
for many years since abnormal patterns and harmful habits contribute to favoring,
causing or recurrent dental malocclusions.
The importance of occlusion for good dental health must be recognized by

pediatric dentists.
The orofacial complex is functionally designed to withstand daily pressures

caused by chewing, swallowing, resting position and phonation.
The introduction of abnormal habits can alter the normal balance of the
stomatognathic system. Due to the importance of the perioral musculature, the
clinical examination of all patients must include the study of all facial and
masticatory muscles, especially those that according to Garliner cited by Di Santi
make up the triangle of forces. Point A of this triangle is formed by the masseter
and buccinator muscles, point B, by the tongue and the orbicularis oris, and finally
the chin muscles constitute point C. The first muscle point exerts lateral forces,
group B exerts pressure anteriorly and group C must be inactive. These forces
must cancel each other to maintain muscular and occlusal balance.
Due to all the negative consequences of muscular imbalance, the application of

functional myotherapy gains more strength every day. According to Segovia
(1977), the protocol used must be planned according to the individuality of each
patient, the age, the needs and the interest that the patient expresses.
1
Myofunctional therapy consists of three stages: awareness, correction and

reinforcement, and unawareness, which have the ultimate goals of achieving
orofacial balance and preventing, intercepting or treating malocclusions and
correcting linguistic articulation problems. For all this, the key to success is the
motivation of the patient and their parents.
Muscle characteristics and action patterns can be genetically inherited. However,

they also propose that genetic forces can be modified by environmental
circumstances, thus modifying growth and development.
Functional myotherapy has been used for some years to improve muscle,
chewing and swallowing dysfunctions and to control drooling in patients with
Infantile Cerebral Palsy, because conventional physiotherapy and speech therapy
have a limited influence on these problems. , Castillo Morales et al, 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 Conclusions
Health professionals, particularly child care specialists, must fully understand the
application and use of myofunctional therapy and form a multidisciplinary team to
treat or prevent possible malocclusions. In many cases the deformation of the
occlusion is not entirely due to habit but to the important help of the perioral
muscles. In addition to that, poor muscular functioning can bring social and
psychological consequences due to the affectation of aesthetics, interference in
normal growth and development, associated muscular habits, atypical swallowing,
mouth breathing, incorrect chewing and even alterations in phonation.
1
30
KINESITERAPY
30.1 What is it?
Kinesitherapy is the set of interventions that use 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 movement, either in a relaxed or
forced way.
Kinesitherapy has positive effects on the cardiovascular, respiratory and muscular

systems.
30.2 Benefits
• External resistances that hinder or prevent movement are overcome
• Shortened or contracted fibers are distended.
• Greater muscle tension is produced, increasing strength and volume

muscular.
• The functioning and transmission of nervous impulses is favored,

improving balance and coordination of movement.
• Increasing weight is applied progressively.
• The repetitions of the exercise should not be many and must be performed
spaced out to achieve good recovery.
• It can be done manually or using instruments (pulley circuit, springs, etc.).
Likewise, the child with CP should be offered an enriched and varied environment
that stimulates him when he cannot explore the environment on his own.
Stimulation programs provide you with learning experiences and the opportunity
to interact with the world around you.
1
3
1
Therapy
PHARMACEUTICAL
Pharmaceutical therapy is indicated to relieve and reduce some of the symptoms

associated with cerebral palsy.
It is important to know that drugs can only be taken if there is a prescription from
the doctor who cares for the person with CP.
31.1 Drugs to control seizures
Various drugs are available to prevent and/or control seizures associated with
CP. The doctor must determine the specific type of seizure to prescribe the most
appropriate medication, since there is no known effective medication to treat all
seizures. Furthermore, in some cases, the most appropriate is the combination of
several of them.
31.2 Drugs to control spasticity
In case of spasticity, medication is especially indicated after surgery. Although

their long-term effectiveness has not been proven, they are useful in reducing this
symptom in short periods of time. The most commonly used are diazepam,
baclofen and dantroline, which are administered orally.
• Diazepam: acts as a sedative muscle relaxant for the nervous system.

• Baclofen; blocks the signals transmitted by the spinal cord so that
contract the muscles.
• Dantroline. It interferes with the muscle contraction process.
10
8
These medications can cause adverse side effects, such as drowsiness.
Furthermore, the long-term consequences they may have on the nervous system
are not yet known.
Alcohol injections into the muscle are also being used to reduce spasticity. This
technique is especially indicated in incipient contractures, to correct them when
they are still forming and thus avoid surgery. The technique involves injecting
alcohol into the contracted muscle to weaken it long enough so doctors can
lengthen it with various techniques (orthopedics, therapy, casting).
31.3 Drugs to control athetoid movements and drooling
Athetoid symptoms are characterized by lack of control, incoordination, and

slowness of movement. It mainly affects the hands and arms, as well as the legs
and feet. The medications used in this case are called “anticholinergics,” whose
function is to reduce the activity of acetylcholine. This is a chemical substance
that facilitates communication between certain brain cells, such as those related
to muscle contraction. Antiocholinergic medications are also used to reduce
drooling, because they reduce the flow of saliva, although, in this case, they can
have side effects, such as dry mouth or cause digestion problems.
1
3
2
MUSIC THERAPY
Music for therapeutic purposes has important benefits on emotional and

motivational aspects, physical health, cognitive and sensorimotor functions, as
well as social and communication skills. Music therapy sessions can be received
individually or in a group, depending on the person's specific needs.
The treatment program consists of very varied elements and exercises (musical
improvisation, listening to and singing songs, lyrical discussion, playing
instruments, etc.) that will be adapted to the characteristics and aptitudes of each
person.
Regarding music therapy, there are a series of prejudices and myths that must be
banished, such as that it is only suitable for certain types of patients or the belief
that there are musical styles that are more effective in achieving the desired
goals. However, personal preferences, as well as the specific needs and
circumstances of each person, must be taken into account when developing the
treatment program.
32.1 Definition
Music Therapy can be defined from two points of view: from the scientific point of
view and from the therapeutic point of view.
From the scientific point of view "Music Therapy is a scientific specialization that
deals with the study and research of the sound-human being complex, whether
musical sound or not, aimed at searching for its diagnostic elements and
therapeutic methods."
11
0
From the other point of view. "Music therapy is a paramedical discipline that uses
sound, music and movement to produce regressive effects and open
communication channels with the aim of undertaking through them the process of
training and recovery of the patient for society."
32.2 Goals
• Develop orientation and locomotion: body scheme and spatial terms (above,
to the side, etc.). Activities are used that include this type of instructions,
instruments that help identify the location of space and rhythm, as a signal of
time and movement.
• Promote social skills and interpersonal communication; Participating in

musical groups and cooperating with others involves social skills, such as
taking turns or following instructions, etc.
• Express and develop sensory emotions: they are not affected by themselves,
but the attitudes of sighted people can damage their self-esteem, so they must
express themselves in activities such as composing or writing song lyrics.
• Facilitate the learning of academic behaviors, develop hearing 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
• Reinforcement of self-esteem
• That he knows and recognizes the place and adapts to the open space
• Acquire security and confidence and communicate as a therapist with the

group
• Recognize small musical motifs, or songs
• Let him work individually
• Follow simple instructions
• That they respond in an organized way to sensory information
• That it be integrated into the activities carried out through music or gestures,
voice and words.
1
• Let him progressively become uninhibited
• Know the basic work materials, whether musical instruments or objects in

general.
32.3 Types of therapy
• Verbal (psychoanalysis): you talk to the patient. To the talk, work on

areas of our personality. language works consciously,
We tell what we want or not.
• Therapies non-verbal: non-language is included. HE they are going to try

many
tasks through gesture and sound. Put them in a situation where they can
manipulate and express themselves. It works before all expression. The
gestures and sounds we make, and how we do them, manifest our personality
in a closer, more real and sincere way. Both therapies complement each
other.
32.4 Music therapy and cerebral palsy
Music therapy acts fundamentally as a psychological technique, that is, its

therapeutic support lies in the modification of emotional problems, attitudes, and
dynamic psychic energy that, ultimately, will be the predominant effort to modify
any pathology suffered by the patient. human being.
In our current society the largest group of physically disabled people is those who
suffer from cerebral palsy.
The population with cerebral palsy generally suffers from neuromotor impairment
and disturbances in psychological functioning and emotional control. They
especially present weak motor control, distraction, hyperactivity, irritability and
disinhibition.
These children present a challenge to rehabilitative therapy and general

education.
Music and musical activities have a beneficial influence on the level of tension,
disturbance, hypersensitivity and emotional tone of many children with cerebral
palsy.
Authors such as Bruner, Cass, Frampton and Rowell point out that music and
musical activities help to achieve the relaxation that is needed. Additionally, music
helps bring attention and increase the level of concentration. Carlson points out
that music can serve as an agent to minimize the effects of undesirable stimuli in
1
the environment. Suggests that music stimulates or motivates activity; believes
that music provides emotional relief to children suffering from cerebral palsy.
When music is used as an environmental stimulus to improve motor control or

achieve relaxation, the different diagnoses of cerebral palsy must be carefully
considered. It must then be observed very carefully to determine if the patient
actually responds to the therapeutic goal.
The value of music as an environmental stimulus in group situations where

patients with different types of paralysis are found depends 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 may be valuable to use more or less
sedative or stimulating music in order to establish an atmosphere conducive to
therapy or learning activities. It seems impossible to establish a musical
environment for any group of children with cerebral palsy that will benefit
everyone on any given day. Again, before planning the extensive use of music in
a group situation, it is necessary to observe the group's response to different
types of music.
These considerations indicate that differential diagnoses of paralysis can provide

a clue 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 evidence
is available, it will indicate that music therapy is valuable and helpful for children
with cerebral palsy.
32.5 Effects
Music has had on man the effects that he expected from its use, whether
integrated with various functions or as a pure aesthetic experience.
It is difficult to dissociate the physiological effects and the psychological effects of

music. Over the centuries, among philosophers, doctors and musicians, there
have been various schools of thought that have tried to explain the mechanism of
responses to music. They oscillated between two theories: some believed that
music primarily affected emotions and awakened moods that in turn acted on the
body; Others thought that the process was reversed: from the physiological to the
psychological.
A children's music therapist Louise E. Weir has expressed: "that sound affects the
autonomic nervous system, which is the basis of our emotional reaction."
Throughout history man's responses to music have been fundamentally similar

influenced by the same factors; that is, man's physical receptiveness to sound, his
sensitivity, innate or acquired, to music and his mental state.
Man can only respond to the music of his civilization, which has meaning and
1
emotion for him. Their culture, or their civilization, is not only ethnographic, since
even in the same society, people's responses to artistic experiences vary
according to their social or educational background. In the same society we can
find people who have been deprived of certain musical contacts or who have
been forced to turn to music; Others have discovered music by themselves
without any guidance. Some ignore or accept only a certain kind of music without
personal or social prejudices intervening. Some good listeners have been born,
others have been made; It is not necessary to discriminate them. These factors
are among many that can help or hinder the task of music therapy, which seeks to
offer its patients an entertaining and effective means of communication.
Patients usually react normally to the elements of music, its dynamism and its
emotional and intellectual appeal. They normally react to the conventional
character of music: happy, sad, exciting or sedative.
Some people who suffer from psychological disorders have not developed
normally. Many of them cannot act or progress at the current pace. Some are
incapable of projecting into the future: they need an immediate musical reward.
These two deficiencies may include response to music. Musical sessions based
on a normal extension or normal development program are likely to fail with them,
even if the musical activity has been well suited to their personality. There has
been a distinction between the emotional and purely physical effects of music on
man.
Music therapy does not cure, but it helps, says an expert
http://sevilla.redperiodista.es/2010/09/23/la-musicoterapia-no-cura-pero-ayuda-
affirms-una-exerta/
1
33
ACUPUNCTURE
33.1 What is it?
Acupuncture is a therapeutic method of Traditional Chinese Medicine that

consists of the introduction of metal needles into specific points of the body for
therapeutic purposes, which originated in China approximately 2500 years ago,
so it has a vast and profound clinical experience.
Currently it continues to be essential in health systems in countries such as

China, Japan, Korea and Taiwan; and in the West, Acupuncture is among the
best known, accepted and recommended alternative therapies by the WHO.
33.2 Effects
Numerous studies in animals and humans have shown that acupuncture has
multiple biological responses such as:
• Regulates the body's nervous response
• It has an analgesic effect, that is, it raises the pain threshold through the
body's own modulating mechanisms.
• It has anti-inflammatory effect
1
• It has an anti-stress effect: it increases tolerance to harmful stimuli and
factors.
• Promotes proper emotional management
• Improves sleep pattern
• Regulates metabolism and the endocrine system
• Regulates the immune system
• Promotes restoration mechanisms of the nervous system
• Regulates the digestive system
• Promotes the regulation of blood pressure
33.3 Acupuncture and cerebral palsy
Some studies have shown that acupuncture improves physical functions or

provides a notable therapeutic effect in patients with cerebral palsy. Other studies
suggested that acupuncture may be effective in managing pain associated with
muscle spasms in athetoid cerebral palsy.
As a result, it improves the patient's attention, emotions and hyperactivity levels,

and allows the introduction of communication or cognitive skills. What would be
really interesting would be to apply a multidisciplinary approach (with Western
and Eastern medicine) to the treatment of cerebral palsy.
Russian children with cerebral palsy receive treatment in China
http://www.granma.cubaweb.cu/2010/10/09/interna/artic10.html
1
3
4
SWIMMING
Without a doubt one of the most pleasant activities is swimming, which can
become not only an exciting distraction but at the same time provides great health
benefits.
Swimming, unlike other therapies, provides several advantages, such as the

impossibility of the patient being injured by falling. In addition, using warm or
tempered water considerably helps relax stiff muscles or any type of pain.
Likewise, the simple fact of being able to float in water relieves stress. Not to
mention that all the exercise performed in water helps to reduce weight while
gaining muscle mass. One of the main problems in cerebral palsy is the lack of
coordination in movements and swimming can help improve this incoordination.
Contact with water is beneficial to promote better blood circulation and therefore
improves the nervous system. Various exercises can be performed that are useful
for these diseases and best of all without causing collateral problems for these
patients.
Of course, in special cases of people with very severe paralysis, it is necessary

that everything be supervised by experienced people who can monitor the
treatment.
11
7
3
4
Method
Le MÉTAYER
Le Métayer bases his method on the fact that education and training are only
possible to the extent that the association zones are able to function. Starting
from the neuromotor reactions of the normal child, they try to provoke normal
neuromotor schemes in the child with cerebral palsy.
35.1 Technique
The technique can be specified in these points:
• Assessment of the level of neurological development of the child with cerebral

motor disease, defining, in each child, the predominant pathological
neurological scheme.
• Factor analysis as one of the points of assessment and motor examination to

determine rigidities, control of reactions to external stimuli, observation at rest
and in the kinetic period.
• Postural maintenance examination, which will report on weaknesses and

defects in motor organization. Execution of mobilization maneuvers that allow
obtaining a state of complete relaxation.
• Try to lead the child to go through the different levels of motor evolution
essential for the acquisition of normal motor schemes, together with the
different static reactions, straightening and balance reactions according to
order of difficulty.
• Biomedical assessment in search of possible contractures, installed or

possible deformities, as well as the preparation and placement of support
11
8
3
systems.
4
11
9
adaptation to help the child improve function in activities of daily living and to
prevent musculoskeletal disorders resulting from abnormal muscle forces.
• Functional examination of locomotion, play, grooming, feeding, dressing and

sitting, which allows determining the level of autonomy in different activities.
• Assessment of associated disorders: sight, hearing, sensitivity, eating, gnostic

disorders, organization of gesticulation and grasping, etc.
1
36
SCHWARTZ
method
It is a locomotor learning system for children with cerebral palsy or similar

conditions, in which relevance is given to the psychological, intellectual and
physical stimuli typical of 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 developed in 1951, has also been used along with the method by
orthopedic surgeon R. Planto Schwartz (1892-1965).
He must be voluntarily encouraged to try various activities, this depends on the

emotional, intellectual and physical level.
1
37
MOVE
Program
Linda Blair started this program in California in 1980 for children with severe
disabilities who lose motor skills as they get older. Uses material adapted for
mobility, sitting and standing.
The program involves developing a curriculum to integrate motor skill learning

with MOVE education and training. The material and learning provide new
opportunities for children to develop new skills through movement.
The physiotherapist plays an important role in supporting educators and helping

children develop mobility in a functional and safe way.
1
38
PHYSIATRI
C Treatment
Physiatric treatment can improve or prevent the deterioration of the autonomy of a

patient with cerebral palsy.
38.1 Facilitate psychomotor development
An important goal in childhood is to facilitate the experiences

sensorimotor activities and promote the learning of psychomotor activities.
In therapy, development is focused taking into account alignment and postural

stability, allowing at the same time the appearance of motor activities such as
head control, turning, sitting, reaching for objects, crawling or crawling, changes
in posture, standing and walking, which promote the development of spatial
perception, knowledge of one's own body and exploration of the environment.
The movements include trunk rotations, dissociation of body segments, weight

loads and isolated movements that are incorporated in the different gross motor
exercises and in different activities that are promoted with adequate alignment so
that the child can obtain a Sensory feedback from normal movement patterns.
In children with head control problems, it is necessary to assess the symptoms

that alter the alignment of the head with and without severity, and the possible
existence of a visual deficit, and favor those postures in which the child can better
organize his head control. whether prone, sitting or standing.
The objective to achieve a functional sitting position is determined by the degree

of stability provided by the lower part of the body (mainly the pelvis) to maintain
flexibility and free movement in the upper part of the body (trunk, head and arms).
When the objective is for the child to learn a means of moving on the floor, it is
1
known that this can be in the form of rolling, crawling, crawling or perhaps sliding
along the floor while sitting.
While for crawling it is essential that the child have strength in the upper limbs to
drag his body, crawling requires coordinating the support of the arms and legs,
the ability to laterally shift the weight while moving forward, and applying
adequate force to alternate the limbs. in diagonal.
It is essential to give early experience of standing to the child with cerebral palsy.
The activity from squatting to standing should be practiced in very young children,
since propulsion, support and balance are the most important attributes of the
lower extremities and in children with movement dysfunction it is essential to
practice these attributes before shortening occurs. muscles or atrophy due to
disuse.
38.2 Reduce spasticity
The objective is to prevent secondary alterations, provide well-being and improve

positions and functional movement. In preschool ages, reducing spasticity makes
it possible to avoid muscle shortening during growth, and to delay or avoid
orthopedic surgery.
38.3 Prevent muscle hypoextensibility
Functional exercises:
Maintaining the extensibility of muscles and soft tissues can be achieved through
functional exercises that involve active stretching and muscular activity of
hypoextensible muscles, flexors as extensors at a length appropriate for function.
The transition from recumbent to sitting involves an elongation of the oblique

muscles, therefore, exercising this change can mean that the child learns to
maintain the extensibility of the muscles necessary for the change to be adequate
and that he learns to use the segments of the body. that intervene in this change.
Use different materials of different sizes, such as balls or rollers, to practice

various sitting balance exercises or to facilitate postural transactions. Exercises
and the practice of functional activities must also be planned to encourage the
child to apply appropriate muscle strength.
Proper placement or postural control:
1
It usually allows for more efficient motor activity and avoids changes in length in
the soft tissues associated with poorly aligned postures. Postural changes will
need to be provided throughout the day through positions that help minimize
muscle shortening and maximize the benefits of well-directed movement using a
standing frame, pelvic molded seat, dynamic orthoses, or various material options
adapted for postural control.
Passive muscle stretches:
The usefulness of these passive maneuvers is difficult to assess, since children

also simultaneously perform active exercises, postural control programs, etc.
However, passive muscle stretching is usually a common practice to prevent
hypoextensibility of spastic muscle.
Long stretches:
The effects of prolonged stretching programs have been studied by Tardieu

(1988). According to their studies, an equinus contracture can be avoided if the
plantar flexor muscles are stretched below the minimum stretch threshold (length
at which the muscle begins to resist stretching) for at least 6 hours a day.
Lespargot et al (1999) suggest that physiotherapy, together with moderate
stretching for about 6 hours a day, prevents muscle contracture but not tendon
shortening.
Anti-equinus night splints can have a certain effect in preventing muscle

hypoextensibility due to bone growth, and extension splints to avoid popliteal
shortening of the knee are also usually applied as a postural control guideline.
Serial splints:
Serial splinting over a 3-week period is usually effective if the hypoextensibility is

due to a lack of muscle balance between the triceps surae and dorsiflexor
muscles, but not if the primary dysfunction is a delay in muscle growth in
response to bone growth.
Serial splints are also used on the hamstrings and elbow flexors.
Dynamic orthoses:
In the lower extremities they are used to prevent hypoextensibility of the muscles
of the foot and ankle, avoid or delay contractures and deformities, provide correct
joint alignment, allow selecting the restriction of movement that interferes with the
1
most fundamental step, protect weak muscles, facilitate function and protect
tissues after surgery.
In children, it is important not to forget that the foot is the last organ in a kinetic
chain of formation, function and information because the quality of plantar support
can often determine the effectiveness of the gesture, postural compensations,
motor insufficiencies, quality of postural information and the possible organization
of movement.
Hinged orthoses with plantarflexion stops allow the child to use the available
degrees of dorsiflexion and allow a stretch of the triceps during active movement
or changes in position.
Electrical stimulation:
The goals of this method are to reduce spasticity, increase muscle contractility,
increase joint range of motion, provide sensory and proprioceptive awareness,
and improve functional activities.
This stimulation is also used in the upper extremities to help increase strength
and coordination and to do so, the effects it may have on the child's manual
activity must be assessed.
38.4 Transition from sitting to standing
The development of getting up is not only essential for walking but also for
independent behavior in other human activities. Getting up requires the ability to
extend the joints of the lower limbs over a fixed support base (the feet).
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 lower limbs from the squatting
position is an apparently innate movement pattern that, if not exercised in early
childhood, can be lost. Lack of practice of this movement pattern is associated
with shortening of the posterior muscles of the leg and the knee and hip flexors.
The proper position of the feet, which must be in contact with the ground, since if
they are not and the child begins the activity in plantar flexion, the activity of the
quadriceps will extend the thigh backwards.
The knees should be directed forward to ensure sufficient ankle dorsiflexion until
the thighs leave the chair so that the body mass remains centered above the
base of support and the knees do not extend until the end of the movement.
The shoulders and head should move forward towards the knees.
1
The way in which the activity is done will depend on the age of the child, their
level of collaboration and their state of alertness. If the child has difficulties in
extensor muscle activity, the movement can be stopped at various points in the
extension phase. To help you develop control of this propulsion, you can also
stop the movement at a certain point in the extension, changing the eccentric
activity to concentric.
For propulsion, the extension of the legs is maintained by the eccentric force of
the plantarflexor muscles that contribute to the stability of the knee and ankle.
To go from standing to sitting, eccentric force is generated from the dorsiflexor

muscles. This activity is crucial in children with a predisposition to triceps
shortening because it helps generate adequate force in muscles that tend to
generate forces opposite to this functional demand, since they are spastic.
38.5 Reduce functional limitations
Children with cerebral palsy are better able to understand and perform concrete
perceptual-motor activities with functional consequences than abstract activities.
There are many children with cerebral palsy who do not have an adequate
cognitive level or have behavioral alterations; Therefore, the activities must be
adapted to their level of behavior and understanding.
The activities designed so that the child is motivated and can generalize them to
other situations are those that may influence their functional limitations.
Therefore, the exercises must be integrated for functional movements.
If the objective is:
• The child must incorporate the change in position, for example, when he or
she wants to change position in bed.
• To increase the strength and coordination of the upper extremities, the
child should incorporate it into their manual activities when reaching and
grasping objects using shoulder flexion and elbow extension.
• Improve balance when standing, the child should maintain balance without
support.
• Improve coordination between the trunk and lower extremities, the child
should stand up without the help of a chair.
• To increase the range of movement in the trunk, the child should use trunk
rotation when turning on the ground and maintain a stable pelvis in sitting
while rotating the trunk to reach objects that are next to him.
• To improve protective reactions, the child should use his hands as
protection in falls and with extended arms.
• Independent ambulation with a rear walker, the child should use the walker
in his or her natural environment, home or school.
Exercises aimed at increasing the skill of functional activities involve feedforward
1
mechanisms (development of postural preparations that are learned through trial-
error practice.
Feedforward is a vital part for functional movement, it involves an organization of

movement and incorporates different constructions of memory, schema and
motor program, taking into account that movement control also involves a
cognitive process. A physical therapist's movement facilitation is useful in
providing sensory and proprioceptive feedback, and is a source of necessary
information in physical therapy practice.
38.6 Standing loading programs
Standers are used to reduce or avoid secondary disorders by maintaining the

extensibility of the lower extremities, to maintain or increase bone mineral density
and to promote adequate musculoskeletal development. Material adapted for
standing must provide correct anatomical alignment of the trunk and lower
extremities. They begin at one year of age, when the child is no longer able to
support his body against gravity .
Ventral plane:
The ventral plane is frequently used for children who cannot maintain an upright
posture while standing. To do this, the child is placed in a prone position with
support on the trunk, pelvis and extremities.
Normally, the ventral plane is used in children with hyperextension of the neck,
retraction of the scapulae, asymmetry of the trunk, lack of muscular balance or
difficulties in controlling the head and trunk in alignment against gravity.
Generally, the ventral planes have tables incorporated so that the child can play
while standing, an aspect that helps him organize his oculomanual control while
maintaining correct musculoskeletal alignment in the different parts of the body.
Supine stander:
It is an alternative to the ventral plane and also allows the inclination to be

adjusted. This type of stander allows the child to perceive the environment and
interact with it from an upright posture. It is important to assess possible
compensations that the child may make when using the supine stander, such as
kyphosis with head protrusion or hyperextension of the cervical spine with
asymmetry secondary to lack of balance and muscle control.
Standing:
The use of standing allows 80 to 100% to be loaded on the lower extremities. It is
1
generally used in children who are able to control the head and trunk against
gravity, but with insufficient control of the pelvis and lower extremities to be able
to maintain static standing. It can be used as a therapeutic tool to prepare for
ambulation, promote symmetry and musculoskeletal alignment in verticality,
promote acetabular development and growth, and maintain muscle extensibility
and balance while exercising Mini standing.
Mini standing:
Mini standing is a variety of standing, in which the support only reaches below the
knees. It is designed for children who can maintain verticality but are unable to
use the different muscular synergies that subserve balance and is also useful for
those children who cannot control the limits of stability sufficient to maintain
dynamic standing and are unable to develop anticipatory postural responses with
their own voluntary movements. It is especially useful in children with vestibular
dysfunction and ataxia.
38.7 Help mobility
Walkers are mobility aids that provide stability for ambulation. For small children
who have a slight delay in acquiring independent walking, it is possible to help
them in this process for a short period of time, using a wooden walker with the
possibility of braking 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 recommend:
The previous walker: the child stands in front of it. It is frequently observed that
the child flexes the hips and trunk as the walker is pushed.
The posterior walker: the child is placed anterior to it and is supported laterally
with the hands.
Both types of walker offer stability, but it has been shown that there are significant
differences between them in terms of postural alignment:
With the anterior walker, the anterior displacement of the body causes the line of
gravity to fall anteriorly, which is not conducive to alignment.
The rear walker allows the child a more upright posture while walking, gait
characteristics improve, stability is increased and the child interacts more easily
with the environment. The child maintains better alignment of the vertical posture,
of the trunk over the feet, and the walker better facilitates the ability to generate
the anterior movement, since the line of gravity favors movement with weight
change and energy expenditure is reduced. .
1
The use of canes allows you to gradually reduce the support for using a cane.
The pattern of reducing walking to a cane is usually dictated by the child as he or
she consolidates his or her security, symmetry and balance in walking.
The adapted tricycle can be recommended so that the child learns to generate
dissociated force in the legs while moving forward. It is necessary to ensure that
the pedals are firmly attached to the feet with a fastening strap and in some
children additional support for the trunk is necessary.
The ability to move helps improve cognitive ability, encourages interaction with
the environment and improves visual and auditory orientation. Children with
significant physical limitations are considered to start using mobility aids from 17
months.
Physiotherapy helps children with cerebral palsy
http://www.rtvcyl.es/fichaNoticia.cfm/CASTILLA%20Y%20LE%C3%93N/2010051
3/fisioterapia/ayuda/ni%C3%B1os/paralisis/cerebral/914DD24C-EDC3-6566-
D5E660D623434D23
Physiotherapists demand to be part of the Educational Guidance Teams of

schools
http://www.cocemfe.es/noticias/vernoticia.php?id=5647
1
3
9
Method
POHL
39.1 Introduction
Try to make the brain aware of the movements made by the muscles and joints. It
is achieved with active (even passive) mobilization at the beginning of a proximal
muscle, then increasing the movement 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, so in the second phase the contractions are carried out
and the information reaches the brain more easily.

In this method, the steps in the overall treatment plan include muscle awareness,
muscle function and coordination, based on the following three principles:
1. Get muscle relaxation.
2. Teach voluntary muscle control.
3. Build a development pattern.
After relaxation, the patient is notified of the movement by waking him up through
the therapist's contacts. This performs three mobilizations and then the patient is
encouraged to make a conscious effort while the therapist guides the movement.
Subsequent active efforts are made by the patient. The treatment develops a
certain sequence of evolutions: rotating, elevating the body (on the
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1
four limbs), crawling, kneeling, kneeling, standing and walking.
Control of a single joint is obtained before other joints are included, until finally the
entire body is involved in the movement pattern.
When the child has acquired the ability to follow the first two stages of treatment,
occupational therapy may be prescribed to help the third phase by providing a
new incentive.
The dominant hand will be established as soon as possible and activities will then
begin with it. The less capable hand will be trained to help. Relaxation will be
obtained before starting any activity, maintaining it throughout it as much as
possible.
Straight-backed chairs are used to help obtain good posture, which will be sought
in all activities. The movements will be graduated from the simplest to the most
complex, using first one hand, then coordination with both and finally all the limbs.
Depending on the age of the patient and the movement required, the activities
can be classified as:
• Imaginative: sand, water, telephone.
• Imitative: taking care of the house(cook).
• Games: ball.
• Music: tambourine, drum.
• Crafts: carpentry, hammer and sewing.
In all activities we will seek to increase control of the muscles and extremities.
1
4
0
Method
COLLIS
Use all possible types of external stimuli. Information is supplied to the brain in a
massive way (tactile, auditory, visual) so that it can sort it. In this way, a motor
scheme is acquired according to the child's age and parents are instructed to also
carry it out.
Collis tends to consider neuronal activity as a whole, affirming the existence of a

combined disorder due to alteration of mental development, postural reflexes and
muscle tone. From the earliest ages, seek postural security that serves as a basis
for muscular coordination.
The essential basis of therapeutic efficacy would be the child's mental capacity
and, the second factor, the accuracy diagnostic. HE resembles
Pohl method,
consider that he employment of devices orthopedics is
totally
counterproductive by interfering with the learning of balance and motor function.
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3
41
Method
PHELPS
41.1 Background
Wintrop Morgan Phelps, Baltimore orthopedic surgeon, medical director of

Children's Rehabilitation Institute, Cockeysville, Maryland.
The Phelps method:
• Therapeutic progress is assessed in terms of functional improvement of

individual muscles.
• Abbott notes that the physical therapist and occupational therapist work
closely together.
41.2 Basis of the method
The treatment method tends to educate the motor system to execute activities in
a correct order, so that the combined movements practiced for Activities of Daily
Living at Home can eventually be taught.
Altogether 15 modalities are used.
41.3 The 15 treatment modalities

1. Massage
2. Passive mobilization
3. Active – assisted mobilization
1
4. Mobilization resisted
5. Movements conditioned
6. Active Mobilization
7. Movements confusing or synergistic
8. Movements combined.
9. Rest
10. Relaxation
11. Movement starting oftherelaxation
12. Balance
13. Movements reciprocal
14. Reach, take, hold andreleaseobjects
15. Skill.
1
4
2
Method
TEMPLE FAY
In this method, the origins of human movement are studied, its evolution through
time to the current human form, observing how certain reflexes that produce
movement schemes in amphibians, reptiles and mammals remain to a certain
degree in man.
The most advanced movement schemes correspond to higher levels of

development of the nervous system in animals, while in man the skills and
knowledge are above the level of the basal ganglia, while coordination, regulation
and the associated movements come from lower levels.
On the PC it may be possible to use certain reflex responses to obtain movement

patterns.
Temple Fay indicates that established therapy for brain injuries refers to
integrative reflexes and movement schemes as much as to individual muscles or
muscle groups. In some cases, remaining cortical areas can be stimulated to
assist motor patterns.
The method, on the other hand, uses pathological and normal reflexes so that
these reflexes can be inhibited. Likewise, positions and movements of the neck
and extremities that cause muscle hypertonia can be used as relaxers. Posture,
proprioception and peripheral stimuli are also used.
As Temple Fay states, "we can use the neck reflex as a guide for assistance,
turning the head to one side with the ipsilateral extremities forward, so that the
thumb approaches the mouth with the patient in a prone position, then beginning,
from passively, a series of
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6
movements of the advanced limbs downward and backward, while the head turns
towards the advanced limbs on the opposite side. "By alternating these patterns
while turning the head at the appropriate time, we can induce a type of movement
similar to that of the amphibian with or without the patient's assistance." "The
continued practice of this scheme facilitates, in many cases spontaneously, the
type of superior movement found in reptiles."
In the prone position the tonic reflex of the neck after turning the head can
respond with an extension movement and, when the arm is lowered and the hand
placed on the back, an inhibition position is created. Mirrors can be used to
reinforce visual aids when encouraging the child to use his or her hands.
Sometimes the action of two therapists is necessary. The combination of the
physical therapist and the occupational therapist improves treatment results.
To relax the muscle approach spasm, the Marie-Fox reflex (withdrawal reflex) is
used after obtaining a good position for the child.
Proper posture and development of movement as close to the ground as possible

(a slippery surface can be used), as well as the use of sand and water, are
effective in increasing stimuli.
Temple Fay considers absolute freedom of the upper extremities very important,
so that there is no restriction on any movement.
In adults, a large thoracic corset can be used hanging from an aerial trolley that
will serve as support and help during walking.
The results obtained depend in part on the level of the lesion, so that the spastic
with involvement of the cerebral surface can be taught to develop movement
patterns of the amphibian and reptile type. The true athetotic with involvement of
the midbrain will be incapable of developing the reptilian scheme (crossed
heterolateral), but will develop the amphibian scheme. The ataxic can be helped
to form a better foundation for posture and balance through pattern learning and
reflex inhibition.
The therapy of “movement patterns” aims to develop certain basic reflexes and
semi-automatic and organized neuromuscular responses so that superior abilities
or skills specific to the human species can be built on them.
Physical treatment cannot be separated from the needs and satisfactions of the
patient. While the treatment is aimed at obtaining movement, this obtaining, even
if it is slight, will give great satisfaction to the patient. Functional life needs for
feeding, dressing, and skills will also be considered and taught.
Temple Fay does not lose sight of the instincts shown by man in the past and
present, which they express as survival, reproduction and conquest.
1
Security, creation, physical stimulation and economic elevation will help the
patient achieve the best in their life scale 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 percussion-stimulated patellar
reflex is used to strengthen the quadriceps).
42.1 Contact
www.institutosfay.com
institutesfay@institutosfay.com
1
4
Method3of
DEAVER
This therapeutic method tries above all to obtain four objectives that it considers
key in rehabilitation:
1. functional use of the hands.
2. Maximum Obtaining an adequate language.
3. Ability to travel.
4. Achieve a normal or normal appearance.
Before applying the method, a prior study is carried out of all the activities that the
child is capable of executing, as well as a thorough assessment of the muscular
situation. The aim will then be to make the child as physically independent as
corresponds to his or her mental and chronological age, type of injury, affected
parts, and severity of the process.
The exercises will be established to maintain maximum joint mobility and prepare
the child to execute the most essential voluntary coordinated movements in daily
life. Spasticity is combated with passive stretching that, at the same time,
prevents contractures and deformities, using the orthopedic correction that is
required at the expense of splints and devices. For maximum function of the
hands, progressive teaching of reaching, catching, jumping and placing objects is
carried out. The training begins with the largest and simplest articulations, before
reaching the teaching of the finer and more discriminative articulations. The use
of orthopedic devices that allow only the execution of two essential movements,
canceling all the rest, is considered essential.
13
9
The ability to move depends on the freedom of movement of the joints, trunk and
lower extremities, as well as reciprocal movements. Initially, the patient will be
taught to move around in a wheelchair. Later, and with the help of orthopedic
devices, you will be trained in reciprocal movements, balance, steps, turns,
elevations and descents, etc. The orthopedic devices will at first be very complete
4
with blocks that cancel all movements, except those of flexion-extension of the
thigh, immobilizing the foot in a 90º position. The walk will be carried out on the
4
parallel lines with the help of the physiotherapist, then progressively unlocking the
different joints, while parts of the orthopedic device are removed.
Normal appearance is achieved by avoiding contractures and deformities,

complete hygiene, appropriate clothing, etc. Patients with CP frequently maintain
copious salivation due to not swallowing saliva, and it is advisable to develop
training sessions to reduce the rate of external salivation. The 20-minute sessions
consist of light stimulations on the midline of the lips, maintaining pressure around
them with stretching, tapping applied to both sides of the larynx, downwards, and
sucking activities.
Deaver insists above all on the teachings of daily life.
14
0
Method
ROOD
Brushing Technique
44.1 Introduction
Created by Rood, it consists of providing proprioceptive stimuli to establish more

normal motor behavior modalities. It consists, for example, of passing a brush or
finger over the child's palate. By stimulating the cutaneous pain, pressure and
temperature receptors located in certain reflex areas, the underlying muscle
contraction is activated, simultaneously inhibiting the corresponding antagonists,
facilitating the motor response.
Rood has developed a treatment method based on the stimulation of cutaneous

and musculotendinous receptors to activate muscle responses in both contraction
and relaxation.
The skin receptors are stimulated by light tapping, brushing or by applying ice to
reduce the threshold of the muscular response and produce a reciprocal inhibition
between agonists and antagonists.
Proprioceptive nerve endings are stimulated by stretching or pressure.
1
Tremblay et al. Following these ideas, they develop prolonged muscle stretching
sessions, especially in the triceps surae, keeping the child on the inclined plane
for 30 minutes with the foot in dorsiflexion, achieving obvious relaxations for
subsequent passive mobilization.
4
The therapeutic program follows a normal developmental sequence and is based
on the mixing and interaction of phasic muscle activity for movement and mobility
responses with tonic muscle groups to produce postures and positions.
4
Functional activities are not stimulated until the treatment of the different body
parts indicates that they are in good condition. The stretching of the contracted
parts will be replaced by the stimulation of the antagonist groups.
14
2
4
5
Method
CASTILLO-MORALES
Dr. Castillo Morales began working with people with neurological disorders in
1959, in Argentina.
His theory inspires philosophy, anthropology, and medical and neurological

sciences. Likewise, it takes aspects of Bobath, Vojta and others. It starts from the
individuality of each individual, and therefore is in favor of combining different
methods, depending on the characteristics of each one. According to him, the
disability must be approached from what the child can do, leaving aside what he
is not able to do, that is, part of a functional evaluation.
Its methodology consists of stimulating, through contact, vibration, pressure and

sliding of the hands, certain points with massages.
Its concepts are two:
• Neuromotor development therapy: Through contact, vibration, pressure and

sliding of the therapist's hands over the patient's different stimulation areas, the
receptors in the skin, muscle and joint tissue are activated.
• The therapy of orofacial regulation: It is a concept of treatment
sensorimotor. Dr. Castillo Morales began this technique with children with
Down syndrome, and then applied it to other disorders. This therapy does not
only improve motor activities, since by improving the motor aspect, a patient's
ability to perceive and communicate with their environment is also increased. It
is not a language therapy, but it facilitates the articulation of different
phonemes. Likewise, it positively influences sucking, chewing, feeding, etc.
It is a therapy that stimulates fundamentally at a sensory level, aimed mainly at
children with sensory, motor and cognitive disabilities, that is, multiple
deficiencies. However, certain therapies, such as orofacial,
14
3
It can be beneficial for children with Down syndrome, since the muscles of the
face and mouth are stimulated.
It is used more and better in hypotonic PCs.
It is based on the stimulation of motor points, in which we achieve a series of

motor acts in the child such as standing up, walking, etc. It can start early, even
before the age of 3; It starts from a facilitating position that enables correct action.
The points that are mainly stimulated are the deltoid, pectoral, bicipital, xiphoid
process, adductors and the big toe.
Exercises are performed in several phases:
• Tumbling exercises
• Crawling exercises
• Preparation for crawling.
• Quadruped position exercises
• Straightening: stimulation of the pectoral point
• Sitting: motor points of the back
• standing
• Walking: stimulation of the calcaneal motor point
1
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 otorhinolaryngologist, invented the hearing re-
education therapy that bears his name more than forty years ago.
It is a method that, by listening to adapted music, aims to improve the quality of

our hearing.
It has been proven that the way we hear determines our mood, our behavior and
other important factors such as attention span...
Despite being a therapy that has not yet been tested by medicine and is generally
unknown to most otorhinolaryngology professionals, 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 several
conclusions: that many of the poorly performing students have deficiencies in
their hearing quality; that the majority of autistic children suffer from hyperhearing
that in many cases can be painful; that almost all depressed children and adults
show a common pattern in their audiogram... These findings give insight into the
importance of hearing's effect on our behavior and how we feel, relate, and
function in our daily tasks. Dr. Berard made many more discoveries and devised
hearing retraining therapy, which
Just as if it were ear gymnastics, it improves many of the problems mentioned.
1
The treatment is simple and is carried out 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 adapt to their specific needs. To determine the
objectives to be achieved with the treatment, an audiometry must be carried out
that reflects the exact conditions of the patient's hearing and the possibilities of
improvement with re-education. On the fifth day of therapy, audiometry will be
performed again to observe the changes and the convenience of readjusting the
music modulation for greater treatment effectiveness. A third audiometry will be
done at the end of the tenth day to check the results. But these will not be
definitive, since the effect of re-education will continue to produce changes over
the next six months, after which the last of the hearing tests will be carried out.
The minimum age at which auditory reeducation can be applied is three years,
although Bérard advises waiting until four or five. As for the maximum age, there
is no limit, and it is a treatment that we could all benefit from.
1
47
Speech
Therapy
Treatment
When there are problems with communication, swallowing and drooling, people
with CP should receive speech therapy. These treatments stimulate preserved
abilities and pursue the development of new skills to achieve the most intelligible
speech possible.
The speech therapist develops and carries out the rehabilitation program,
following the therapeutic guidelines set by the speech therapist, who is the
professional who diagnoses speech problems. The speech therapist also advises
on the use of technical aids that promote communication, such as computers with
voice synthesizers. The speech therapist also teaches exercises to control
drooling.
1
47.1 Objectives
• Reduce factors that hinder communication and/or swallowing. Inadequate

posture, bad teeth, emotional and behavioral alterations, etc.
• Improve impaired functions (communication, drooling and/or swallowing). To

achieve this objective, techniques that consist of the systematic repetition of
tasks are usually used.
Stimulate 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 impaired .
To achieve these goals, speech therapy usually includes the following techniques:
Total relaxation or relaxation of different body areas. Some relaxation techniques

are not suitable for people with CP, because they increase their level of anxiety
and/or emotional tension.
Breathing exercises in different positions (lying, sitting), until you learn costo-
diaphragmatic breathing that improves inspiration and expiration of air, increasing
lung capacity.
Muscular exercise of the oral system and associated organs.
Vocal implantation, which trains the person to phonate (produce voice, speak)
correctly, coordinating breathing and the movements of the oral system and
avoiding the use of unnecessary muscles and incorrect patterns.
1
Speech therapy: The importance of speech
http://www.deia.com/2010/02/08/ocio-y-cultura/on/stronglogopediastrongbr-la-
importance-del-habla
New technologies allow people with cerebral palsy to communicate
http://www.canarias7.es/articulo.cfm?Id=145533
48
OCCUPATIONA
L THERAPY
For an activity to be understood as therapeutic, it must meet a series of

characteristics, the most important of which are:
• be directed at a goal
• have a useful meaning for the user
• be a suitable tool for the prevention of dysfunction,

maintenance or improvement of function, dexterity, and quality of life.
• specify user participation in vital tasks
• be adjustable and adaptable
• be determined by the professional criteria of the Occupational Therapist, who

will base this on his knowledge of the pathology in question, the specific
indications of the treating doctor, interpersonal relationships and the specific
value of the indicated activity.
Its purpose is the development of the skills necessary to function independently in

daily life (dressing, eating, using the bathroom, etc.). The occupational therapist
1
also provides advice on specific technical aids to compensate for difficulties in
carrying out different activities (for example, the most appropriate computer when
you cannot write with a pen or pencil), teaching you how to optimally use these
tools. .
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Therapy
DRIVING EDUCATION
49.1 Introduction
It is a learning system specifically designed for the rehabilitation of people with

neurological disorders, such as cerebral palsy. It is based on the interaction of the
educator and the student, given certain learning circumstances and taking into
account the student's age. The treatment can be given individually or in groups of
people with homogeneous ages. It comprehensively addresses movement
disorders, learning problems, cognitive skills and communication. It teaches
children with cerebral palsy to get what they want and to gain the motivation
necessary to achieve their goals.
49.2 Main objectives
• Learn how to lead a normal way of life.
• Build a new method of functioning: learn to walk, attend school, go to work.
• Stimulate personality development.
• Develop cognitive functions.
• Develop an educational program that can be adapted to the characteristics of

ordinary schools and special education schools.
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Therapies
ARTISTIC: dance, theater, etc.
There are a series of institutions that use different artistic disciplines for
therapeutic purposes. These therapies conceive treatment in a comprehensive
way, working on the physical, psychological, social and artistic aspects of the
person. The playful and creative component of this type of therapy contributes to
increasing self-esteem.
50.1 Example of art 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 artistic
expression and exploration among people with and without disabilities.
Through movement experimentation, misunderstandings or prejudices that people

with or without disabilities may have about themselves are extracted. Dance skills
courses provide an atmosphere that helps change attitudes, as well as helping
people learn through beauty and enjoy communication through movement.
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50.1.2 Goals
The fundamental objectives are:

• develop a work process where people with or without disabilities and people
from diverse cultures can be together for artistic exploration and community
building;
• help explore and suppress misconceptions and prejudices among people with
and without disabilities;
• cultivate cultural and artistic diversity through the performance 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 consciousness of creative

expression for all people. The material is extracted from the present group and
the situations that arise do not exclude any person. The method supports
empowerment and personal value through ways in which each and everyone can
participate and openly express their creative ideas while respecting the
boundaries of others. The basis of Dance Ability teaching is the monitoring of
each person's interest and energies to apply them to the benefit of their own
community.
Dance Ability International continues its vision of using art as a means to change
preconceived ideas about disabilities through performances, workshops,
educational programs, teacher training and choreography in the United States
and around the world.
50.1.3 Contact
There are Dance Ability teachers and groups in Germany, Austria, Cyprus,
Croatia, Finland, Greece, Holland, Italy and Switzerland. It is expected to hold
courses for certified Dance Ability teachers in Spain.
Information: www.espanol.danceability.com
1
ANNEXES
Tango is being used to treat various diseases
http://www.diariohoy.net/accion-verNota-id-95458-titulo-
Tango_is_used_to_treat_various_diseases
A festival claims cinema as therapy through 50 shorts and video clips

http://www.diarioinformacion.com/cultura/2009/11/26/festival-reivindica-cine-
terapia-traves-50-cortos-videoclips/955313.html
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Method
JACOBSON
The practice of relaxation has been known since ancient times, associated with
therapy or meditation. However, it was not until well into the 20th century that it
began to be taken into account as a measure to combat stress and as a treatment
for some psychosomatic diseases.
One of the most popular methods and widely applicable in different fields is that of
Dr. Jacobson.
Edmund Jacobson was a professor of physiology at the University of Chicago. In

1934 he developed a physiological method with the aim of combating muscular
tension and emotional anxiety, situations that he saw as closely related to each
other. He found that stress caused muscle tension, and at the same time
generated anxiety reactions in patients. This became a vicious circle and external
help was needed to break this dynamic. His studies, which began in the first
decades of the 20th century, concluded that tension caused a shortening of
muscle fibers, making it difficult or 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 the anxiety and the psychological discomfort derived from them may
disappear.
Jacobson concluded and postulated that by systematically and rhythmically

contracting and distending the muscles the muscles involved mainly in the tension
were 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 harmonious psychological state.
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It has been shown that after performing progressive relaxation training, there is a
decrease in pulse, blood pressure and respiratory rate, which gradually leads
each person to achieve the best state of relaxation.
The practice of this method consists of alternating contraction and relaxation. It is

important to follow an order and do it symmetrically. The classic route is as
follows: fist, arm, neck, chest, belly, legs, feet and face. The procedure consists of
tensing tightly, maintaining that position for a few seconds and then relaxing as
much as possible.
Once this simple practice is mastered and you can move on to a perfection phase
that consists of recognizing the sensations that cause contraction and relaxation.
Simultaneous contraction of muscle A and relaxation of muscle B. Detect muscle
tensions associated with emotional disorders.
The most advisable position to practice relaxation at first is supine, since all the
joints are kept in an anatomical position and the rib cage and abdominal area are
free to be able to breathe, it is not done freely and in lateral decubitus the Charge
is directed to one hemibody, therefore there is no symmetry.
1
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Method
PERFETTI
Cognitive Therapeutic exercise, commonly known as the “Perfetti Method,” is a

rehabilitation method that was born in Italy in the early 1970s by the neurologist
Carlo Perfetti and his collaborators. This type of rehabilitation has been evolving
to this day in parallel with the interpretation and application of the studies
provided by the different neurosciences.
The Cognitive Therapeutic exercise recovers the deficient functions in an

integrated and personalized way, taking into account the problems that each
patient presents. Movement is not considered as a simple muscle contraction but
as the result of a much more complex activation that arises in the brain.
For this reason, the treatment is not directed only at the muscle (muscle
reinforcement) but also takes into account how movement is organized at the
brain level. Therefore, to recover movement it is necessary to activate the
cognitive processes that are responsible for said organization.
These processes are perception, attention, memory, language, motor image,

reasoning, etc.
He says that spasticity is typically treated as a single condition, and with modest
results.
The components are included under the concept of Specific Engine, and are the
following:
Excessive reaction to stretching (in relation to the speed and importance of the
stretch).
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Pathological irradiation.
Elementary schemes (gross motility of the patient, with synergistic components

and more noticeable in the roots of the limbs).
Motor recruitment deficit: difficulty activating an adequate number of motor units

sufficient for the execution of evolved motor tasks.
Each individualized component can be treated specifically by:
First grade exercises.
The patient learns to relax, paying attention to the proposed perceptual

hypotheses. The patient is not asked for muscle contraction. They are exercises
to control the exaggerated response to stretching.
Second grade exercises.
The patient begins to recruit motor units in a progressive and guided manner, so
that there is already muscular activity and the movement does not develop
passively. They are exercises for the control of radiation and elemental schemes.
Third grade exercises.
The patient performs the exercises even more actively.
1
53
ELECTROTHERAPY
Functional Electrical Stimulation (FES): This is the electrostimulation, through

low-frequency excitomotor currents with trains of exponential rectangular
impulses, of muscles without central nervous control to achieve their contractile
activity with a functional objective. Its effectiveness has been demonstrated in the
treatment of motor reprogramming. Kern applied FES to 10 spastic paraplegics
for 8 months: not only did hypertone decrease, but muscle perfusion and trophism
improved and the presence of aerobic and anaerobic enzymes increased.
• Neuromuscular electrostimulation: There are various modalities, such as

spinal electrical stimulation, either locally or directly on the affected muscle.
• TENS: There are studies that reveal effectiveness in 90% of cases, Potisk and
Gregory propose an application protocol along the nerve, with a frequency of
100 Hz and 20 minutes of application, Levin proposes longer applications (30-
45 minutes ), for periods of about 3 weeks.
• Chronic Stimulation Cerebellar (CCS): HE have obtained results

functional in spastic subjects by varying the voltages (from 0 to 40) and the
frequency (from 0 to 200 Hz), although the works consulted do not specifically
indicate the decrease in spasticity.
ANNEXES
1
ASPACE will incorporate an electrotherapy device with the help of Caja
Cantabria
http://www.eldiariomontanes.es/agencias/20100609/local/aspace-incorporara-
device-electrotherapy-help_201006091148.html
1
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VESTIBULAR STIMULATION
Therapy based on vestibular stimulation is aimed at improving the following

aspects:
• Develop and perceive position in space.
• Provide reference points on your own body based on vestibular stimuli.
• Associate visual, tactile and proprioceptive experiences with the movements

of one's own body.
• Gentle oscillations of the spastic patient supported on a cylinder or a re-

education balloon are usually effective in reducing muscle hypertone .
16
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Therapy
OROFACIAL
It consists of teaching the child to control his or her oral area in the best possible
way to avoid deformities, salivation and promote the movements involved in
speech, for this it is directly treated:
• Food (nutrition therapy). The child is taught to swallow, chew and drink,
inhibiting abnormal patterns and establishing correct ones. The aim is for the
child to learn to use his or her mouth in the most appropriate and active way
possible.
• Sialorrhea. Saliva escape from the mouth.
expressive means
With children who have communicative intentions, the aim is to advance their
understanding of language and provide them with a means of expression (oral,
gestural, graphic or combined).
If the child has the possibility of expressing himself orally, we work on:
• General relaxation so that you can better control your speech.
• The breathing.
• The phonation.
Children who lack any control over their oral area are introduced to an alternative
communication system. With this procedure we are not canceling the oral route,
but rather encouraging their communicative attempts and giving them from the
first moment a valid and functional method of expression.
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All the expressive resources you have, movements, gestures, etc., will be used,
and all vocalic productions will be reinforced: laughter, screams, coughs, etc.,
which can be used as call signals.
Gestures
We address the child using, in addition to words, natural gestures and bimodal
language gestures (meaningful gestures that accompany the word and maintain
the same syntactic structure as spoken language). The gesture is somewhat less
abstract than the word and the child understands it much sooner. On the other
hand, 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, articulation disorders and lack of
vowel experiences, own, have difficulty discriminating words. In children with
some motor ability it can become their means of expression.
Children with severe motor impairments, who have limited visual resources to
access a graphic system, are taught to use any minimal controlled movement for
communicative purposes: stick out the tongue to say no, close the eyes when
thirsty, bow your head to say yes, wrinkle your nose when hungry, etc.
Graphic systems.
A child who wants to communicate and understands images is ready to start

using a graphic system. The choice of system will depend on your cognitive
development and visual acuity. We always tend, naturally, for the child to
communicate through reading and writing. His motor capabilities must also be
assessed, because it is important that he use them in the most autonomous way
possible and that he be situated in a space that he encompasses.
There are a series of standardized systems that are based on graphic symbols
that represent concrete objects to abstract concepts (Picsyms, Pic, Mosman,
Rebus, P: C: S, Bliss).
The child communicates by pointing to the appropriate symbol. The way of

selection adapts to your motor capabilities and you can do it directly by pointing
with your hand, head, etc., in a coded way, establishing a code for the interlocutor
to locate the symbol, or by scanning system.
1
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Method
TARDIEU
Physiotherapist at the Tardieu school (France). His method is based on the fact
that education and training are only possible to the extent that the associated
areas are capable of functioning.
The method is based on the normal child, on their neuromotor reactions, trying to
provoke normal neuromotor schemes in the child with cerebral palsy as soon as
possible.
The French technique can be defined in these points:
• Assessment of the level of neurological development of the child with cerebral

motor disease, defining the predominant pathological neurological scheme in
each child.
• Factor analysis as one of the points of assessment and motor examination in

search of: rigidities, control of reactions to external stimuli, observation at rest
and in the dynamic period.
• Examination of postural maintenance that informs about weaknesses and

defects in motor organization. Execution of mobilization maneuvers that allow
obtaining a state of complete relaxation.
• It tries to lead the child to go through the different levels of motor evolution
essential for the acquisition of normal motor schemes, together with the
different static reactions, straightening and balance reactions according to
order of difficulty.
• Biomechanical assessment in search of possible contractures or deformities

installed or possible to be installed, as well as the preparation and preparation
of containment systems to help the child preserve function in the
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daily life activities. For example, the construction of a molded seat or pelvic
corset that, based on pelvic symmetry, helps the child improve active control
of the body without restricting active mobility and helps prevent hip and spinal
deformities. Splints to enhance standing and keep the hips, with dysplastic
predisposition, in correct alignment.
• Functional examination of locomotion, games, grooming, dressing, sitting,

allowing to determine the level of autonomy in different activities
• Assessment of associated disorders: sight, hearing, sensitivity, pressure.
1
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Method
DEMEK
This therapeutic method allows you to positively influence and modify motor
evolutionary development from the earliest age. It uses specific stimuli that will
cause the activation of the nervous system, obtaining a maximum functional
response from the child with the least possible help.
The MEDEK method follows the criterion of the evolutionary organization of

“neuromotor modes,” respecting the patterns of ontogenetic development and
considering that treatment must be advanced progressively, without skipping
motor behavior modes. The therapeutic intervention begins by promoting head
control and then progressively sitting, standing and walking, and finally free
ambulation is stimulated through the higher integrations of balance.
With MEDEK techniques, we do not work on organs or planes of integration of the

individual or isolated neuromuscular system, but on the contrary, each exercise
aims to stimulate the complex functional interrelationship between eyes,
proprioceptive receptors, muscles, tendons, ligaments and articular surfaces. .
It is expected that minors operated on with this system will achieve motor
development milestones in cephalocaudal progression, according to corrected
age.
Based on the results obtained in the initial evaluation, the program of exercises
and maneuvers required in each particular case is planned, with two variants:
• the group of maneuvers and exercises that must be applied by the

physiotherapist.
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• The set of therapeutic recommendations based on MEDEK that must be
executed by parents at home, according to a pre-established and specific plan
(repetition of movements and maneuvers 10 times, 3 times a day).
This methodology seems to have a direct relationship with the Doman – Delacato
technique.
1
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Curriculum
CAROLINA
The Carolina Curriculum is a method of Evaluation and Exercises for babies and
young children with special needs who function at levels of development
corresponding to ages between 0 and 24 months.
It is based on normal developmental sequences but without assuming that there

should be more or less equal development in all areas (for example: a child may
show normal cognitive development along with very slow motor development).
Therefore, the program was designed so that it could be used both with children
with slow development, but following a normal model, and with those who suffer
from multiple limitations whose development patterns are notably atypical.
This program recognizes that the majority of infants and children with severe
limitations will never be “normal” despite all intervention efforts. Therefore, when
working with these children, it is necessary to teach non-normal, but highly
adaptive skills, which can temporarily or permanently replace normal ones, if
necessary. For example, if a child cannot speak, it would be appropriate to teach
him to point or to master another indicative response that allows him to choose
between different possibilities, communicate his wishes, etc.
The Assessment Booklet is very complete, it has items from the 26 sequences of
the Curriculum, with spaces to write down the assessments of several weeks.
The numbers assigned to Curriculum sequences have no relation to their
importance. Each sequence represents a significant area of development.
Therefore, it is important to evaluate children to whom the program is applied in
all sequences, except in cases where this is not possible due to a specific
limitation.
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Within each Curriculum sequence, items are numbered according to the order in
which they are supposed to be learned. It is important that a sufficient number of
items are assessed in each sequence to be able to know whether or not the
corresponding skills have been developed. The number of items that must be
assessed has not been set; This decision must be made by the person carrying
out the assessment according to his or her criteria. As a general rule, the
application of three items above the first failure and three below the first success,
in each sequence will offer a fairly complete idea of the child's abilities.
In early care, the Portage guide is also used, which is a guide to the development
of children from 1 to 6 years old (what they do and what they do not).
www.estimulaciontemprana.org
1
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CHROMOTHERAP
Y or COLOR
THERAPY
This therapy is based on the therapeutic use of colors, because the different
wavelengths of colored light stimulate different brain centers and trigger a wide
variety of physical and psychological responses at the body level.
59.1 The application of colors can be done in different ways:
• Decorative painting on the walls of the house.
• Clothing and clothing 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, either on the nervous

system or on the different organs of the body.
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17
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Red
• Physical action: Stimulates the heart and circulatory system, promotes the
recovery of people after suffering from an illness, improves anemia and
physical exhaustion.
• Psychic action: Stimulates learning processes and facilitates relationships with

others by promoting extroverted behavior; it also increases the person's
willpower and perseverance.
Orange
• Physical action: Useful in case of nervous exhaustion and digestive disorders.
• Psychic action: Increases the desire to live and joy.
Yellow
• Physical action: Stimulates the digestive metabolism, relaxes the muscles and
relieves the discomfort of menopause.
• Psychic action: Helps overcome depression because it facilitates self-
confidence and reduces excess worry in response to tense situations.
Green
• Physical action: Stimulates the detoxification and regeneration processes of
the body's cells, it also relaxes the muscles and relieves tired eyes.
• Psychic action: Stimulates creativity and discharges aggressive tensions, it

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 you relax and overcome fears and complexes.
Violet
• Physical action: Acts as a purifier for the body, promoting the elimination of
toxins from the body. It also helps relieve inflammation and improves cellular
oxygenation.
• Psychological action: Stimulates brain activity and communication between

people.
1
Black
• Physical action: Relieves pain and exerts a general relaxing effect.
• Psychic action: Absorbs excess energy, eliminating blockages and reinforces

stability and personal security.
White
• Physical action: Strengthens the immune system.
• Psychic action: Stimulates a positive state of mind.
Secondary and tertiary colors, that is, those that are a mixture of several primary
colors, have the same action as the colors that compose it but more attenuated.
59.3 Treatment methods
Various methods are used as treatment, it all depends on the therapist, which of
them feels most comfortable and at ease.
In traditional chromotherapy, colored light projection is used. This is projected

onto the body as close as possible to the patient. The exposure time is not strict,
so the body uses them depending on its needs and possibilities. To carry out the
application, a lamp of the corresponding color is enough or, failing that, a white
light in front of which color filters are placed.
Another method is Water. It is used in internal treatments. For it, it is necessary to

put a certain amount of water in a container and expose it to light of the color
determined for a period of no less than 8 hours.
Air is used in chromatic breathing exercises, when there is a respiratory

pathology.
Color visualizations have the same effect as projections of “physical colors.”
It consists of visualizing a color and transmitting it to the patient in the place of the
organism with problems. Some people may find the exercise more difficult, it is
just a matter of starting to memorize the colors. To do this, you can practice with a
colored piece of paper, staring at it for a certain period of time and then closing
your eyes and remembering exactly what it is like.
Especially in therapy, colors are used to apply directly to the body. A well-known
way is the application of ultraviolet rays, to eliminate germs and bacteria, as well
as to calm any pain or inflammation in muscles or tendons. Currently, the different
frequencies in which colors vibrate and the effects they have when applied
1
directly to the skin have been studied, especially on acupuncture points,
achieving calming 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, you can create a certain environment,
you can combine clothes to obtain effects, and through therapy you get help on
the physical, mental and emotional levels.
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60
Therapy
SPIDER
60.1 What is it?
"Spider" therapy consists of a series of elastic cords of different tension attached

to belts at certain points on the patient's body at one end and at the other to the
base of the equipment.
This allows the therapist to work with the patient in an independent and functional
upright position so that they can perform exercises in positions that they cannot
normally perform and stimulate muscles and parts of the body that need
strengthening and rehabilitation. Spider also allows a single therapist to do the
work that is sometimes needed by two or more people and that is only done with
the patient lying on a therapy mattress.
Working in Spider allows you to improve coordination, balance and muscular

endurance.
1
60.2 Who is it addressed to?
SPIDER therapy helps in a wide variety of Neurological and Neuromuscular

conditions, such as:
• Muscular dystrophy (certain types, patient needs to be evaluated and 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 adequate postural reflex mechanisms by

weakening pathological postural patterns and by stimulating 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, mutually conditioned and integrated. They form
the Mechanism of Appropriate Postural Reflexes.
Although diagnostic methods are constantly developing, there is still a lack of

objectivity in the correlation of morphological exponents of damage and clinical
symptoms.
1
DIAGNOSIS
It is very important to analyze the following points to establish an adequate

diagnosis:
• Assessment of the postural tension paying attention tothe asymmetry

• Assessment of theSpontaneous activity in various positions.
• Assessment of the activity of physiological reflexes andpathological.
• Assessment of motor and postural patterns.
THE THERAPY
• exercises in any position
• Ability to release and compress
• Ability to practice asymmetrical exercises
• stimulation of the sense of balance
• stimulation of proprioception .
60.3 Centers
Norman Center is located in Koszalin, Poland. www.alanspider.com
In Spain: Essentis Method in Barcelona. Contact: info@metodoessentis.com and

telephone: (+34) 637.905.867.
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Method
ABA
61.1 Background
ABA stands for Applied Behavioral Analysis or, interchangeably, Behavior

Modification Method. It has its scientific origin in Thorndike, in the studies that
began in 1913 on learning by cause and effect in the United States, which were
later continued by the Russian philosopher Ivan Pavlov, in 1927 with his famous
experiments on dogs.
Another antecedent is found in John B. Watson and learning in children and in

Burrhus Fréderic Skinner, who made valuable contributions to individual research
on reinforcement programs in the 1950s.
Behavior modification, Rimbland points out, was initially a crude system, more
similar to animal training, through the system of rewards and punishments. It
evolved over the last 25 years into a highly refined and effective pedagogical
system.
Maurice (1996) specifies that the method basically lies in the division of still
complex and/or abstract tasks, such as communicative language, into a series of
hierarchical steps; each of which paves the way for the next. Teaching through
separate efforts, therapists and parents work together to create a structured
environment, with planned activities and a coherent way of learning. The child is
rewarded for overcoming each small step. Gradually the children
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They discover not only the separate portions of what they are taught, but the
integration.
Lobas (2000) states that ABA uses methods that are based on behavioral
scientific principles: children do not learn naturally and
spontaneously in typical environments, as other children do. Then, we try to build
socially useful behaviors in them, also working to reduce problematic ones.
Aragona (2003) has stated that each skill that the child does not have (such as
imitating, speaking, etc.) is divided into small steps. Each step is a measurable
and specific unit of the behavior you want to achieve. We always work with small
objectives to achieve, to achieve those that we want the child to learn.
The enormous evolution of the ABA method, as Gare and Pear (1998) maintain,
has expanded to such an extent throughout the developed world as its areas of
application.
The trend in behavior modification is directed towards positive behavior controls,

but because many professionals misuse the techniques, failing to comply with the
ethical and legal codes to which the patient is entitled, there is - sometimes - a
distorted concept of Behavioral Therapy.
The ABA Method performs a behavioral evaluation, obtaining a description of

problematic behavior (Functional Behavior Analysis). Based on the most detailed
description of this behavior, the possible reinforcements that make said behavior
repeat - consequent - are observed, which are in the environment. With proper
management of them, the behavioral intervention is carried out, which will reduce
the frequency in which the problem behavior occurs, until it disappears
completely. The techniques are also applied to promote positive behaviors and
other learning.
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Method
PROMPT
62.1 Introduction
PROMPT is a philosophy, system, and approach technique developed by

Deborah Hayden in 1980 in the United States and Canada to treat speech
production disorders.
PROMPT is a philosophy because it consists of the study of the processes that

govern thought and lead to the acquisition and/or alteration in the production of
speech. It is a set of general principles where counseling and treatment are
conceptualized. In addition, 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 links different parts into a unit.
PROMPT is an approach since it constitutes a way to evaluate, organize,

conceptualize and treat disorders in speech production. This approach uses all
aspects of motor and language theory in pursuit of a consistent goal.
PROMPT is an approach technique because it constitutes a method or procedure

to carry out the technical and mechanical operations necessary to create 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.
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PROMPT is based on neurological, anatomical and motor theoretical principles
and has been used as one of the main approaches for the 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 their joints to produce specific sounds or words.
The prompts are designed to help the child be aware of: movement, the muscles
needed to produce the movement, the way they are produced, and the connection
of movements needed to produce words and phrases.
Speech therapists can also help the patient limit unnecessary movements that
make speech even more difficult.
We can say that: "the PROMPT system directly transfers the phonetic system to
the neuromuscular movements required for articulatory sequences."
The foundations of the PROMPT system were found in a method created by Edna
Hill Youge in 1938 called Kinesthetic Motor Approach. This approach was the first
therapeutic system to use a series of tactile cues to promote phonetic articulation.
The PROMPT system uses tactile bases to guide the articulatory mechanism by
developing multi-dimensional points that can mark various phonetic components
such as mode, manner, action and tension of muscle groups, closure, time
influences and function of coarticulators during movements. transitives,
accentuation and prosodic changes.
Depending on the degree of severity and type of disorder, prompts can be used
strictly to give location cues, to promote co-articulation, to program word units or
entire phrases, or to assist in spontaneous productions where must move 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, phonological

delays, and speech disorders due to hearing loss.
62.2 Definition
It is a dynamic tactile-kinesthetic system designed to help organize, plan and
execute the phonemic elements of speech production.
Professionals, when using the PROMPT System, will help the child to use the
1
entire verbal production system systematically.
With the PROMPT System, all sensory, auditory, visual and tactile systems are
used and, as for learning, real and useful words are used. If the therapist feels it is
absolutely necessary, he or she will work on pre-linguistic skills (feeding or oral
movements).
During the application of the promts, the pressure on specific muscle groups and
the tension located in those muscle groups help to develop afferents for the
development of appropriate programming. The main focus of the system is to
provide feed-forward information to the child where, in a pre-selected sequence,
he can be guided towards correct positions and appropriate translations.
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3
therapy
SENSORY INTEGRATION
63.1 Introduction
It is a scientific response to multiple and very diverse childhood problems of

learning, behavior, development and motor lack of coordination, such as
hyperactivity, poor school insertion, dysfunctions related to autism and CP or
difficulties in the feeding process.
We can define sensory integration as the ability of the central nervous system to
interpret and organize the information captured by the various sensory organs of
the body. This information, received by the brain, is analyzed and used to allow
us to come into contact with our environment and respond appropriately.
Sensory integration theory was created to address learning problems in children.

It is, more than a specific technique, a therapeutic approach. Its creator was Dr.
Jean Ayres, an American occupational therapist, who formulated this theory of
sensory integration based on her own research and also established the
evaluation and treatment of sensory integration dysfunctions.
Ayres was initially interested in perceptual problems whose origin was found in
cranial trauma, cerebrovascular accidents and cerebral palsy. In the sixties of the
last century, he began to formulate hypotheses about the neurobiological
processes that could be associated with learning problems in children, and
created a systematic evaluation to measure perceptual-motor functions.
These evaluations were perfected by Ayres herself throughout her research and
currently serve to measure the different processes.
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neurological factors that contribute to the ability to learn. The results of the
evaluations of normal children allowed the development of average performance
scales according to age. The analysis of these results allowed several types of
sensory integration dysfunctions to be identified.
63.2 Aim
The goal of sensory integration therapy is to facilitate the development of the

nervous system's ability to process sensory inputs as appropriately as possible.
Integrative sensory therapy covers three large areas: vestibular, proprioceptive

and tactile. The vestibular system, located in the inner ear, is related to balance –
gravity. It offers the sensation of weight on our body and also tells us where we
are in space: if we are standing or moving our head, if we fall or turn our face, etc.
Therefore, it directs the movements of our head and body in all directions.
Proprioceptors, tendons, muscles and joints, tell us where our feet are and how to
pull back to give an impulse, how to kick the ball or how high we should raise our
hand to comb our hair. Through proprioception we have sensations or sensory
inputs every time we move and, therefore, we receive a source of stimuli and
these can vary in intensity.
The touch system has three different types of receptors: one that responds to a
light touch, such as touching your hair with a hand, and is a protective and alert
sensation, which makes us control what is touching us in case it is something
dangerous, like an insect advancing on our skin. The second receiver
discriminates the touch, for example, when you put your hand in your pocket and
you know by touch that they are the house keys. Third, there are the receptors
that receive information about cold, heat, pain, etc.
Integrative sensory therapy works on all the senses, but especially on the
vestibular, tactile and proprioceptive senses, which are important as they are 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 develop the vestibular
system.
This therapy is carried out only by occupational therapists.
63.3 Contact
Occupational therapy clinic in Oviedo. Contact: info@ibeaudry.com
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64
Treatment of
HEARING DISORDER
The recovery work in this facet will be guided according to the following points:
1. General physical recovery.
2. Specific teaching for the maximum use of auditory waste.
3. Periodic examinations to establish the necessary treatment modifications

according to the recovery obtained, the skills acquired, temperament,
intelligence, maturation, etc.
4. Continuous study of the social development of the child, always maintaining an

intimate relationship between doctors, physiotherapists, family members and
teachers. It is advisable, after a thorough psychophysical examination, to make
special groups with children with similar characteristics.
Sometimes there is no actual hearing disorder, but hearing developed more

slowly due to an inability to direct the head or eyes to the sources of sound
(Illingworth).
For children with hearing loss, it is advisable to speak louder, slowly and vocalize
better, while showing their face or speaking next to their ear or with the help of a
rubber tube. We will help the use of the auditory residue by teaching these people
to pay attention to sound (increase and education of attention), while at the same
time training them in the kinesthetic and tactile sense for sounds. The family will
be taught and warned how to treat these patients, and their collaboration will be
valuable to stimulate them.
The use of orthopedic hearing devices can be valuable, if their indication and
adaptation are accurate. They will be applied early, as long as they do not entail
danger (falls) or are annoying (constant rubbing in athetotic children).
1
If the deafness is absolute, the teaching will be expressive (similar to that of deaf-mutes), with the
physiotherapist using not only the movement of the lips, but also the face and general
attitude.
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Treatment6of
VISUAL DISORDER
Breakey indicates that treatment for all visual disorders should begin as soon as
possible after diagnosis, while Denhoff does not consider it relevant before 12
months of age. Nystagmus and strabismus are two quite common effects in these
patients. For its treatment, the following care is recommended:
1. Cover the most preserved eye for periods of 2-3 weeks, which improves the
vision of the defective eye, avoiding amblyopia. If both eyes are affected, they
are covered alternately for a total period of 2 months to 2 years.
2. Use of glasses that improve vision, reducing the increase in strabismus and
preventing headaches.
Guibor starts using glasses between 6 months and 1 year of age. In very
young children it is advisable to use plastic glasses.
3. Altropin instillations, use of prisms and muscle and relaxation exercises.
4. Surgical treatment to eliminate contractures of the eye muscles (it is

contraindicated in athetotics).
Cataract cases can be operated on, using glasses in the postoperative period. If
the child is old enough, it is possible to practice the usual eye muscle exercises in
strabismus (reading with an interleaved ruler, bringing two pencils close to the
eyes by their tips, etc.).
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The bandage
NEUROMUSCULAR or
KINESIOTAPE
66.1 Introduction
This new technique is the subject of a large number of clinical trials, is in the
process of development and is establishing itself as a common therapeutic
method in working with children.
Neuromuscular taping or kinesiotape has emerged as an innovative and effective

method of taping and is being applied with success and great acceptance 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 gained its place in
the daily therapeutic practice of many physiotherapists.
The functions attributed to the neuromuscular bandage are the ability to

reeducate the neuromuscular and proprioceptive system, improve the patient's
posture thanks to the sensorimotor information it provides, facilitate lymphatic
drainage, reduce pain, and accelerate the repair process of the injury allowing
movement at all times and facilitating circulation and its consequent supply of
nutrients. The neuromuscular bandage provides support and stability to the joints
and muscles without affecting the range of motion. It is a technique based on the
body's self-healing process.
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After assessing the child's level of evolution, the objectives of the physiotherapy
treatment are established.
Based on these objectives, basic motor skills are proposed to help us achieve this
and then we must prioritize the function in which we want to act with
kinesiotaping. This method also has its assessment test (linder test) that will be
useful to establish the area in which to apply it.
Several aspects must be taken into account:
• Seek specific objectives oriented to functionality.
• Minimize as far as possible the number of Kinesiotaping strips used each time,
since each one of them provides a proprioceptive stimulus that the central
nervous system will have to integrate, so the number of information should not
be saturated.
• Due to the characteristics of children's skin and although allergic reactions are
not frequent, we must be more cautious, be attentive to possible skin reactions
and be more careful when removing it. In general, applications above the navel
will be avoided, with special care in the areas of
the neck and stomach and we will not apply bandage
neuromuscular in children under 6 months, being able to use cross tape (it is
made up of crossed mesh tapes or bands, not elastic and without any type of
medication, forming a grid-shaped patch), instead if we deem it appropriate.
We can summarize the TREATMENT PROCEDURE as follows:
1
1. Analysis of movement and posture, in which different aspects will be
assessed:
• How normal movement is 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.
• Assess the linder tests.
2. Establish priority action based on treatment objectives.
3. Select treatment with kinesiotaping to facilitate or inhibit muscle function,

perform mechanical correction.
4. Reevaluate posture and movement after Kinesiotaping withdrawal.
As evaluation methods, depending on the case, the following can be used: the
execution of the movement (possibility and quality thereof), goniometric
measurements, photographic or audiovisual records...
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67
YOGA
Medical research has

documented the benefits of
Yoga in some groups with
special needs.
Yoga is a generic term that

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 practice of Yoga can help reduce high muscle tone, which is characteristic
of many children with Cerebral Palsy.
Muscles and tendons receive a relaxing stretch, relaxing physical stress and
blockages in the muscles and around the tendons. And it also relaxes the body by
providing resistance to exercise areas with less muscle tone.
But the most important aspect for these children is the ability to stretch and reposition
the spine, which flexes and twists in various directions. It also helps create more
space between the vertebrae and reduces pressure on the discs and nerves of the
spine. Reducing the pressure on these radial nerves facilitates relaxation of the
body's muscle tone and improves nervous functioning. As a result, the child can
develop greater movement, coordination and independence.
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68
OZONE THERAPY
68.1 Introduction
Ozone therapy is based on ozone, a gas found in the upper layers of the
atmosphere, and which can be obtained by modifying the molecular structure of
oxygen (O2), increasing one molecule, forming (O3), known as therapeutic
ozone.
Ozone therapy is the application of medical ozone (O3) for therapeutic purposes,
taking advantage of its fungicide, bactericide and antiviral properties. It has a
great oxidation power which delays cellular aging, stimulating white blood cells
and increasing the body's defenses. It also activates the metabolism of red blood
cells, increasing oxygen transport to cells and blood circulation in general.
Ozone therapy must be performed by professionals, being compatible with any

other conventional medical treatment, since it does not create side effects.
Among the best-known applications is the treatment of neurological pathologies

such as Alzheimer's, multiple sclerosis, amyotrophic lateral sclerosis, senile
dementia, Parkinson's and childhood cerebral palsy.
68.2 Application routes
1. Locally: using a bag or glass bell placed over the area to be treated. It is used
in infectious and bactericidal pathology, by creating an aerobic environment in
which viruses and bacteria cannot survive. The most common diseases in
which it is used are vascular diseases such as ulcerations, gangrene, and for
the disinfection of diabetic wounds and ulcers.
2. Rectally:
• Through a probe: for intestinal pathologies.
1
• Systematic rectal application: similar to the previous one, used for liver, pancreatic
and biliary diseases, being also effective in cases of tumors and acute or chronic
hepatitis C.
• Rectal application of ozonated water: the same as the systemic one but less
painful for the patient.
3. Hematic route: blood washing, similar to dialysis treatments. It causes an

increase in oxygen and nutrients to the entire body.
4. Systemic route : by subcutaneous or intramuscular injection. Widely applied to

osteoarticular pathology such as herniated discs.
Ozone: gas that protects and cares
http://www.bolpress.com/art.php?Cod=2010120401
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Method
FRENKEL
69.1 Introduction
HS Frenkel was medical superintendent of the Freihof Sanatorium in Switzerland,

he advocated a method of treating ataxia, through systematic and graduated
exercises.
He advocated the achievement of voluntary regulation of movement by using

whatever part of the sensory mechanism had remained intact, particularly sight,
hearing, and touch, to compensate for the loss of kinesthetic sensation. The
learning process of this alternative regulation method is similar to that required to
learn any new exercise; Its essential principles are:
• Concentration of attention.
• Precision.
• Repetition.
The final objective is to achieve movement regulation, so that the patient is able
to perform it and gains confidence in the practice of those activities that are
essential for their independence in daily life.
Frenkel considered that despite the sensory pathway being affected, the tabetic-
ataxic patient can learn to perform a complete movement through constant
repetition thanks to maintaining his muscular sense.
Exercises based on Frenkel's principles are used to teach smooth movement and
precision, particularly emphasizing the objective
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primary goal of helping the patient perform normal activities of daily living.
69.2 Progression
• Progression is made by altering the speed, amplitude and complexity of the

exercise.
• The progression of the exercises should be in difficulty, not in power.
• Under no circumstances should you perform strenuous work or work that

involves a large muscle load. To progress in its execution, the patient must
show perfect performance in the exercise, otherwise it is not advisable to start
doing another one.
• The progression must respect the difficulty of precision of the exercises; so

that at first, those fundamental movements of great amplitude that are used in
the large joints will be performed and then they will be replaced with the finer
and more precise movements of the small joints (grip); Furthermore, they
must first be done quickly and then slowly.
• The progression is characterized according to the degree of disability, the re-

education exercises begin in the supine position, with the head erect and the
limbs firmly supported; later progressing to exercises in a sitting position and
finally to standing.
• The exercises will be performed, first with vision support, and later when you
master doing it with your eyes closed .
69.3 Techniques
• The patient is dressed appropriately so that he can see his own

members, in the course of all exercises.
• Before attempting the movement, the Physiotherapist must explain

in a clear and concise manner and must demonstrate the exercises so that
the patient has a clear vision of them.
• The patient must pay complete attention to the practice of the exercise, so
that the movement is smooth and appropriate in a rhythmic and precise way,
so that they can be effective.
• The speed of movement is dictated by the Physiotherapist, through rhythmic

numbering, by the movement of his hands or by the use of appropriate music.
• The range of motion should be indicated by a mark or spot on which the foot
1
or hand is placed.
• The exercise must be repeated many times, until it is perfect and easy. Once
achieved, it should be replaced with a more difficult one and should be
performed for about half an hour twice a day.
• As, at the beginning, the exercises are very tiring, frequent periods of rest
should be allowed. The patient has very little ability to recognize fatigue, but
this is generally indicated by a decrease in the quality of movement or by an
increase in pulse rate.
• Constant trunk, balance and respiratory exercises must be performed.
• It is very important to prevent fatigue for the patient. Signs of fatigue are:
Frequent pulse, rapid breathing and signs of distraction. Therefore, initial and
frequent monitoring of heart rate during rehabilitation exercises is necessary.
Exercise should be stopped if the heart rate reaches 120 beats and can be
restarted when it is close to what it was at the beginning of the exercise. The
exercise should not be repeated more than four times; it is necessary to take
some time to rest between exercises.
• It is important that the exercise area has good lighting and a mirror so that the
patient can observe the movement of the segments.
• Exercises should be performed within a normal range of motion to avoid

muscle overstretching.
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70
THERATOGS
The Theratogs is based on the correction of musculoskeletal alignments,

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 effective to a greater extent.
Among the objectives of Theratogs, promoting optimal bone and joint

development, as well as improving posture, balance, gait and movement skills,
stood out.
It consists of pants and a top that provide a foam-lined and breathable “outer
skin,” fitting each patient in a comfortable and non-slip manner, thus providing
greater stability and containment. The younger the bone, the more likely it is to
achieve positive results, since when the bone ossifies it is less moldable and
therefore, the changes are less noticeable.
Theratogs is indicated in all types of pathologies, from ataxia, autism, cerebral

palsy, spina bifida or strokes.
The limitations are marked by a high age, patients with tachycardia or other
cardiac arrhythmia, since any restrictive clothing around the chest of the patient
with these pathologies can cause problems. Therefore, the possibilities of using
Theratogs are virtually unlimited.
1
70.1 Information and centers
Theratogs information, on the website: www.theratogs.com .
In Spain it is distributed and applied at theInstitut Sant Joan of Barcelona,

www.institutsantjoan.com . Telephone: 93.2469994.
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71
SWOT
71.1 What are they?
The term SWOT refers to dynamic foot-ankle orthoses. These orthoses are
designed to support the foot and ankle, but they also affect the movement of the
entire body.
Dynamic orthoses are commonly used in patients with neuromuscular disorders.

They are especially geared toward pediatric patients, but many adults can also
benefit from the design concepts.
A characteristic that differentiates the DAFOS from other orthotic designs for the
foot and ankle is that they present the concept of foot grip. This concept is very
important, since it allows us to correct the frequent postural anomalies (in
pronation and supination) present when there are neuromuscular alterations. The
DAFOS are flexible and fit closely with the contours of the foot, thanks to the
individualized measurement for each patient, offering a high degree of correction
and comfort.
Furthermore, 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 several advantages when it comes to
application. On the 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, the possibility of varying the degree of correction or help offered by the
orthosis as the patient's skills improve. It is important to keep in mind at all times
that as the patient grows or their functional goals change, the orthotic
requirements also change.
2
71.2 How can SWOT help?
SWOTs can help achieve one or more 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 range of motion.
• Facilitate the development of motor skills by reducing the effort and

concentration required for standing and walking.
71.3 For what conditions are they suitable?
Dynamic foot-ankle orthoses have been shown to be efficient against:
• patients with developmental delays.
• Patients with neurological or neuromuscular problems, especially in: cerebral

palsy, spina bifida, down syndrome, muscular dystrophy, sequelae of
poliomelitis, spinal cord injuries, trauma
craniocerebral, cerebrovascular accidents.
2
71.4 Information and centers
Information: www.dafo.com
In Spain: www.institutsantjoan.com in Barcelona. Telephone: 93.2469994
A Coruña stands out in children's orthopedics
http://www.laopinioncoruna.es/sociedad/2010/02/23/coruna-despunta-ortopedia-
infantil/361009.html
Fairs present breast prostheses

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72
ART THERAPY
We understand Art Therapy as a combination between art and psychotherapy,

where each of the parts is stimulated in union with the other, where the most
important thing is the person and their process; art is used as a form of non-
verbal communication, as a means of conscious and unconscious expression; by
recognizing that thoughts are expressed more easily in images than in words.
Through the creative process, we reflect on the development of personal conflicts
and interests of individuals.
Through Art Therapy, people with disabilities have the opportunity to

communicate their feelings and needs to others in a more perceptible way. It is of
great benefit for both physical and mental growth, since it causes them to develop
self-confidence and obtain satisfactory results.
72.1 Art-therapeutic objectives with people with CP
• Communicate, using more flexible codes that are closer to sensory

experience.
• Be autonomous in handling materials and making decisions.
• Socialize with group experiences.
• Mature, contributing to the harmonious development of the personality.
• Promote the resilient approach.
72.2 The concept of resilience
―Ability to emerge from adversity, adapt, recover and access a meaningful and
productive life‖ (ICCB, Institute on Child Resilience and Family 1994).
It is the capacity of the human being to face the adversities of life, overcome them
2
and be transformed by them.
This concept in which pediatrics, psychoanalysis and public health converge is

based on a model of prevention and promotion based on the potential and
resources that human beings have of themselves and around them. It is based on
the interaction between the person and the environment.
Resilient individuals: are those who, being inserted in a situation of adversity, that
is, being exposed to a conglomerate of risk factors, have the ability to use those
protective factors to overcome the difficulty, grow and develop adequately,
reaching mature as competent adults, despite unfavorable prognoses.
72.3 Factors
• Commitment (believing in the certainty and value of what one does as a

valuable and capable person).
• Sense of belonging.
• The control or responsibility of feeling capable of changing the course of

events
events.
• The challenge of challenge and change. Give yourself the opportunity to

grow and improve.
• The pillars of resilience are:
o Introspection
or Independence
o Ability to relate
o Initiative
or Humor
o Creativity
o Ethics
o Conscious self-esteem
2
Resilience is dynamic in nature. Promoting resilience is recognizing strength,
beyond vulnerability. It aims to improve the quality of life based on their own
meanings, as they perceive and face the world.
2
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3
Method
FELDENKRAIS
The method is named after its inventor, Moshe Feldenkrais. Through a unique
combination of physical therapy, psychology and martial arts, Feldenkrais aims to
develop movement and physical growth in its practitioners.
The method can help people with cerebral palsy do things as basic as moving
around in pain cessation or avoidance.
The Feldenkrais method for cerebral palsy is based on redirecting misdirected

physical and psychological behavior patterns. For people with cerebral palsy in
particular, this therapy can be helpful in overcoming movement problems.
Combined therapy consists of developing movement, biomechanics,

psychological treatments, and even martial arts. The Feldenkrais method for
cerebral palsy can organize these elements of the person into learning better
control and to train the nervous system to act in different ways.
The method can help by using very simple techniques that aid in spastic muscle
function and its development. Many patients with cerebral palsy have spasticity or
stiffness in their muscles. The Feldenkrais technique can be used to help
spasticity and help with walking, sitting or pain relief from muscle tension.
Using the method, an affected person 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
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developments. This therapy is often very light, non-invasive, gentle and even
pleasant.
73.1 ANAT BANIEL METHOD

Based on the Feldenkrais method, the ANAT BANIEL METHOD appears, the
information that we present below is collected from its website:
www.anatbanielmethod.com .
The Anat Baniel Method (ABM) helps people of all ages overcome pain and
fitness limitation and achieve life-long physical, mental, emotional and spiritual
vitality. The method of accessing the remarkable capacity of the human brain to
form new connections and new patterns and achieve levels of performance never
before achieved.
Derived from the pioneering method developed by Dr. Feldenkrais, ABM is based
on cutting-edge scientific theory and the understanding of how our brain learns
from and transforms our body, mind and spirit. Tens of thousands of people
seeking an alternative and complementary approach to medicine, physical
training, physical exercise therapy programs and ways to help children with
special needs have used activity-based management with great success.
With ABM the approach is very different. Instead of trying to fix the problem
directly by focusing on the limitations, the focus shifts to where the solutions
actually meet the brain. ABM focuses on helping the injured child's brain do its job
better. It helps the brain recover its strength capacity on its own and create new
neural patterns that provide successful solutions.
We apply gentle techniques that communicate directly with the child's nervous
system through, mainly, greater awareness and non-verbal movements,
kinesthetic experiences.
With ABM, the brain of a child with cerebral palsy or any other brain injury regains
its ability to function in a healthy way. That's when the brain-damaged child can
start doing what healthy children do. We have countless examples of success
with our work.
It is very important to understand that only when we create the conditions for the
child's brain to function at high quality in a healthy way will it be able to overcome
limitations, in ways that can be surprising and inspiring.
More information and testimony at www.anatbanielmethod.com
2
74
PILATES
method
The Pilates method is a physical and mental training system created at the
beginning of the 20th century by the German Joseph Hubertus Pilates, who
devised it based on his knowledge of different specialties such as gymnastics,
traumatology, ballet or yoga, uniting dynamism and muscle strength with mental
control, breathing and relaxation.
There are many applications, and one of the most pioneering is its use as a tool
to improve the ability to move and feel in people with disabilities.
The Pilates method facilitates the motor sensitivity of people with reduced mobility
and also serves to improve the balance of people with cerebral palsy or to
stabilize those who suffer from spinal cord injuries when moving.
It is a discipline that seeks to rebalance the body by correcting postural errors and
strengthening internal and external muscles. This is achieved by working first the
internal muscles of the abdomen and the pelvic floor, considered “the core” of the
body by specialists, and, from there, everything else.
The tools to reach this seemingly intangible goal are muscle contraction and
breathing.
2
The final result is that all the muscles are strengthened in a much deeper and
more stable way, which in a healthy person prevents the appearance of injuries
and in one with a pathology it improves many aspects. In the case of
rehabilitation, for example, the results are much better and faster. In other areas,
taking into account that Pilates improves circulation throughout the body, calcium
absorption is also improved and pain due to postural defects is reduced.
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 the ground, 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 particular situations.
However, it is not a relaxing exercise like yoga can be.
A pilates center will offer a discipline course for people with disabilities with
the support of several foundations
http://www.europapress.es/epsocial/noticia-centro-pilates-ofrecera-curso-
disciplina-personas-discapacidad-apoyo-varias-fundaciones-
20100421135304.html
2
7
5
therapy
RESTRICTION-INDUCED
MOVEMENT (CIMT)
Restriction Induced Movement therapy is an alternative physiotherapy treatment

and its objective is the functional restoration of the hand of the affected upper
limb. It consists of restricting the movements of the undamaged upper limb and
intensively performing exercises and various activities with the paretic upper limb.
To develop this therapy it is necessary that the affected upper limb is not totally
paralyzed (plegic), but rather has some movement, although these are carried out
through a synergistic pattern and it is proposed that the greater the mobility, the
better the results. functional results.
Restriction Induced Movement Therapy has been designed to solve the problem
of “learned non-use” in patients with brain injuries and to promote great advances
in the use of the paretic upper extremities in different pathologies. It is estimated
that at least 50% of the population that has suffered a Cerebral Vascular Accident
could benefit from such therapy. The clinical efficacy of Constraint Induced
Movement Therapy has been demonstrated and documented with positive effects
on motor outcomes and the therapeutic results are considered capable of being
transferred from the clinic to the “real world,” as well as from patients to society.
Research over the past decade has demonstrated the effectiveness of Constraint-
Induced Movement Therapy in individuals who had upper extremity weakness as
a result of an upper motor neuron injury. The basic component of Movement
Therapy
21
0
Restriction-Induced involves restriction of the uninjured upper extremity during
90% of waking hours, in conjunction with a period where repetitive training of the
most affected upper extremity is performed. The less affected upper extremity is
restrained with a mitt, sling, or glove. Subjects generally underwent 6 or 7 hours
of therapy focused on home and daily living activities. The individual also
maintains a daily treatment to use on the affected limb when not in the clinic.
Restriction Induced Movement Therapy (CIMT), also known as forced use

therapy, is a therapeutic approach to the rehabilitation of the patient who has
suffered a brain injury with topographic involvement of one hemibody. The
intensity and schedule of therapy are different from traditional physical
rehabilitation treatments.
TMIR requires a range of rehabilitation techniques with a common goal: to induce

individuals with hemiparesis to increase the use of their affected limb.
TMIR has its origin in experimental work carried out on monkeys. Tabú and
collaborators revealed that by retraining the denervated upper limb for more than
three days using TMIR, the monkeys could learn to use the limb in question and
in turn the use is reinforced in the long term. of said limb in activities of daily
living.
Two clinical trials showed positive trends in favor of constraint-induced movement

therapy (CIMT) and forced use, while another showed a positive treatment effect
in favor of modified CIMT as a treatment for children with spastic hemiplegic
cerebral palsy. This evidence is based on a trial with ambiguous methodology and
reporting and a controlled clinical trial. Additional high-quality research is needed
to adequately support the use of this therapy.
2
7
6
REFLEXOLOGY
76.1 Introduction
It is a therapeutic technique that is based on the manual stimulation of the so-

called reflex points and areas, which achieves an indirect action on different
organs, tissues and conditions of our entire being, obtaining from this self-
regulation in functions and therefore an improvement in our sufferings. With this
technique, health problems can be detected at their earliest stage, making it an
effective way to prevent more serious problems.
76.2 What is the purpose?
The purpose of foot reflexology is:
1. Relieve stress and tension.

2. Improve blood supply and promote the unblocking of nerve impulses.
3. Help nature achieve homeostasis.
Foot reflexology alters the body's energy flow, eliminating blockages.
Blood and lymph flow in certain regions of the body can also be normalized.
The feet are the final end of the body. Far from the heart, the blood and lymph in
the feet must fight against gravity. The movement of these vital fluids is essential.
Like any stream, heavy particles will tend to settle as sediment, especially when
the stream is not fluid.
21
2
On the other hand, slow flow can cause poor tissue oxygenation and inadequate
waste removal. Blood flow may slow, then become clogged. Crystals may form in
tissues. There are 7,200 nerve endings in each foot.
Research is being done on the effects of massage on cerebral palsy (to help
children have greater muscle flexibility).
2
7
7
SPHERODYNAMICS
THERAPEUTICS (TECH.
VOGELBACH)
77.1 Introduction
The use of Kinesic spheres as a complement to therapeutic treatments dates

back to the beginning of the century. Dr. Susanne KleinVogelbach used them in
Switzerland starting in 1909 in the treatment of joint problems and for the
rehabilitation of neurological patients. They have been used since then in that
country with young patients affected by cerebral palsy, to help them regain
balance and improve reflex responses.
The German physiotherapist Berta Bobath also used spheres as a complement to

the work she developed since her arrival in England in 1930, treating patients with
spasticity and different types of brain injuries.
The balls were introduced by a disciple of Dr. Klein-Vogelbach in the United

States in 1970, where they were used during the 1970s and 1980s to treat spinal
cord injuries and other bone structure disorders, and from 1990 as a complement
to sports training. Occupational therapist and dancer Bonnie Bainbridge Cohen,
disciple of the Bobaths and creator of the experiential anatomy method called
Body-Mind Centering, has also used them since the 1980s to investigate the
reflexes, righting reactions, and balance responses that make up our basic
movement patterns.
21
4
77.2 What are they?
Over time, the spheres have been identified with various names, but generically
they are called “stability balls,” since their 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 shape the body, but they are useful above all to increase
the registration of joint and muscle areas that are especially compressed or tense.
Once we achieve that, it is much easier to rearrange the posture, adjust the
muscle tone and train the body. Using the ball correctly, it is much easier to
rearrange your posture, adjust muscle tone and train the body. By using the ball
correctly, we can isolate, strengthen and stretch each muscle effectively and
efficiently. The unstable balance position on the ball allows you to maintain
correct alignment using the body integrally in each exercise.
They are also a valuable therapeutic element to

treat painful or tense areas, and to regulate stress
levels. Pain in the lumbar or cervical areas can be
caused by incorrect posture, an imbalance in
muscle tone or areas of poor mobility in the spine,
among other reasons. Through
With adequate training, we can relieve these
discomforts, balance muscle tone and improve the mobility of the spine and body
in general, promoting health and well-being.
The size and material of the ball to use will depend on the type of work to be done
and the characteristics of the person: the softer ones are suitable for reducing
muscle tone and the harder ones for increasing it.
In a small ball the work is more localized; In a large one, however, it is more
global, and the stretches can be sustained for longer.
Likewise, a hard or highly inflated ball offers greater resistance, the support
surface on the floor is smaller, it moves faster and requires more control of
reflexes than a soft or less inflated ball, which has a larger contact area with the
ball. floor, moves more slowly and requires less effort to maintain balance.
77.3 Educate the body
Spherodynamics is found within the field of Somatic Education, which groups

together disciplines that emphasize learning through the body in movement, its
internal record and its relationships with the environment as a basis for perception
and for action in everyday reality.
2
The therapeutic aspects are present, but the emphasis is placed on the education
or re-education of the body in movement, with the consequent transformations
that occur in the complex body-mind unity.
In Therapeutic Spherodynamics we work on function and structure. Structure

limits function to the extent that the body, due to muscle shortening, is not able to
execute movements in its greatest range of amplitude. On the other hand, it is
functional learning that will allow us to use that structural capacity to the
maximum through a more efficient use of the body with economy of muscular
effort.
Depending on this, ball practice may emphasize one of the two aspects, or both
at the same time.
In functional learning exercises we train the proprioceptive capacity, that is, the
body's ability to perceive itself internally and in relation to space, in stillness and
speed, using or consciously inhibiting reflexes, righting reactions, responses of
balance and the basic neurological patterns (cellular respiration, pulsation,
umbilical, oral, pre-vertebral, spinal radiation, etc.) that form the basis of the
body's ability to move in space. In addition, it acts on muscle tone.
From a neurological point of view, muscle tone is the tonic contraction of muscles
maintained over time. It is based on the myotatic reflex, and is caused by stimuli
coming from the same muscle (autogenous regulation of tone) and 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 expresses the capacity that 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 to the
environment and to 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 pull of gravity; A balanced and
uniform tone shows us that we have a comfortable or balanced relationship with
the attractive force of the earth.
This work allows us to perceive muscle tone and learn to regulate it by training
the tension capacity of the muscles in relation to the surface of the ball and the
unloading of weight on it.
In the structural alignment and elongation exercises of the different muscle chains
(whose shortening is responsible for poor posture or deviations from the ideal
model), we work to increase the mobility of the joints.
Unstable support on the ball requires gentle stretching, prolonged over time,
2
which is more effective for correction than sudden tractions, since they reduce to
a minimum the risk of injury and the compensations that short muscles produce in
the body to avoid stretching. The possibility of maintaining gentle traction for as
long as possible allows the shortened muscles to be gradually stretched, and this
stretching to be maintained after the exercise has finished. To optimize the work,
these stretches are combined with pushes, in order to perform lengthening
contractions. In this way, bodybuilding and flexibility are combined, thus achieving
long and strong muscles. In their relationship with space, 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 Therapeutic Spherodynamics
will have to do with the way in which learning is accompanied. All work must be
based on respect for diversity, for the differences that determine the meaning,
rhythm and quality of individual processes.
A round exercise
http://www.abc.com.py/nota/un-ejercicio-redondo/
78
Method
BRUNKOW
This method induces a reflex mechanism with extension movements that are
used for the facilitation of physiological motor sequences. Through the “pushing”
movement of the hands and feet in different positions, an overflow of energy
(muscle irradiation) occurs to the muscles of the trunk, which causes reflex
2
straightening of the trunk. Tension is induced from the extremities towards the
body.
This Brunkow facilitation technique causes tension in the anterior and posterior
muscle chain.
2
7
9
INTEGRATION
SENSORY
79.1 What is sensory integration?
Sensory integration could be defined as the ability of the central nervous system
(CNS) to interpret and organize the information captured by the various sensory
organs of the body. This information, received by the brain, is analyzed and used
to allow us to come into contact with our environment and respond appropriately.
Sensory integration theory was created to address learning problems in children.

It is, more than a specific technique, a therapeutic approach. Its creator was Jean
Ayres, an American occupational therapist, who formulated this theory of sensory
integration based on his own research and also established the evaluation and
treatment of sensory integration dysfunctions.
Ayres was initially interested in perceptual problems whose origin was found in
cranial trauma, cerebrovascular accidents and cerebral palsy. In the sixties of the
last century, after having completed doctoral and post-doctoral studies in
neurophysiology, he began to formulate hypotheses about the neurobiological
processes that could be associated with learning problems in children, and
created a systematic evaluation to be able to measure perceptual-motor
functions.
His first theoretical concepts were based on neuroanatomy, neurobiology and

neurophysiology studies. For more than twenty years he carried out numerous
clinical investigations, both with normal children and with children affected by
learning problems, for which he used the evaluations he had created.
21
9
These evaluations were perfected by Ayres herself throughout her research and
currently serve to measure the different neurological processes that contribute to
the ability to learn. The results of the evaluations of normal children allowed the
development of average performance scales according to age. The analysis of
these results allowed several types of sensory integration dysfunctions to be
identified.
Jean Ayres established very rigorous criteria for the administration and analysis of
his evaluations. Therefore, specific training is needed to be able to evaluate and
treat sensory integration dysfunctions.
79.2 The process of sensory integration
Sensory integration is a neurological process and Ayres' theory establishes the

relationship between said neurological process and behavior. Ayres developed
his sensory integration theory with the goal of describing, explaining, and
predicting the specific relationships between neurological functioning,
sensorimotor behavior, and academic learning.
He hoped to identify patterns of dysfunction among children with learning

disabilities and to develop specific treatments. I sought, 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

that currently serves as the basis for his entire approach. It allows us to
understand the process of sensory integration, from the senses to the final
products, that is, from the basic perception of our environment to active
participation through more specialized skills such as language, visual perception
and motor coordination.
In a normal individual, the development of sensory integration occurs

automatically following a series of successive stages, the first of which prepare
the following. The development of sensory integration would begin during fetal life
to reach maturity around 10 or 12 years of age. Afterwards, sensory integration
continues to be perfected throughout life.
At the first level of development, tactile, vestibular and proprioceptive experiences

would exert a fundamental influence on the development of control of body
movements.
At the second level, the child develops more refined skills. Thanks to the
development of his body image, the child improves the planning of his
movements. A good integration of different sensory information would allow the
child to acquire better emotional stability with a better attention capacity.
At the third level of sensory integration development, purposeful activity becomes
2
increasingly important. Everything the child does has a beginning, a middle and
an end, and he does not lose sight of his objective. The visual, vestibular, and
proprioceptive systems collaborate to enable hand-eye coordination. The
previous levels of integration would serve as foundations for the development of
the perception of form and space. Visual perception allows us to interpret what we
see, while vision is simply the recognition of what we see. Vestibular stimulation
would be necessary for the proper development of depth perception, while the
tactile and proprioceptive systems would be more related to object manipulation
activities.
Finally, the fourth level is the result of a good development of sensory integration
in the previous levels. The integration of numerous sensory information is
necessary for the development of good abstract reasoning. Good self-concept,
self-control, and self-confidence come from the feeling that one's body is a
competent sensory-motor being capable of responding to environmental
demands. The development of good sensory integration allows the child to
function well both academically and socially.
Sensory integration theory attempts to explain learning and behavioral problems

unrelated to a neurological injury or abnormality. Likewise, it particularly evaluates
and treats deficiencies associated with clumsiness and the integration of sensory
stimuli. Sensory integration theory, however, cannot explain neurodeficits. motor
disorders associated with problems such as the spasticity of cerebral palsy, the
hypotonia of Down syndrome or decreased tactile perception in people who have
suffered a head injury or a cerebrovascular accident. If the deficiencies observed
are related to cortical or peripheral nervous system problems, then we cannot
speak of a sensory integration dysfunction . It is believed that in children with
cerebral palsy, motor planning problems and tactile perception deficiencies are
more related to cortical damage and not to sensory integration problems.
However, some children with cerebral palsy demonstrate sensory modulation
problems, without these being the main cause of their motor difficulties, and
respond positively to treatment based on the sensory integration approach.
If every theory is a set of postulates and hypotheses that serve to relate a certain
order of phenomena, in the case of sensory integration it is 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 in interpreting sensory information from
the body and the environment and difficulties in academic learning in individuals
who show general learning problems or clumsiness.
2
80
MECHANOTHERAPY
80.1 What is it?

Mechanotherapy is the therapeutic use of mechanical devices used in physical
rehabilitation, the purpose of which is to perform exercises regulated in their
strength, trajectory and amplitude, avoiding joint contractures. Improving flexibility
and muscle strength.
80.2 Effects
• Increases arcs of movement
• Increase flexibility
• Increase muscle strength
• Improve the muscle trophism
• Improve the balance and coordination
• Gait re-education
This therapy is mainly applied in patients with infantile cerebral palsy.
The devices used in the mechanotherapy area are:
1. Fixed ladderwith high and low step
2. Ramp
3. Electric tape
4. bikes
2
5. Bars parallel
6. Bars swedish
7. Mats
8. Mirror mobile
Mechanotherapy is a medical prescription and must be exclusively indicated by a

Doctor with a specialty in Physical Medicine to guarantee the effectiveness of the
treatment.
Mechanotherapy room.
2
81
MAGNETOTHERAPY
Magnetotherapy (MT) consists of treatment using magnetic fields. These can be

produced by electric current (magnetotherapy) or by means of magnets (magnet
therapy).
Magnets or magnets, also called permanent magnets to differentiate them from

the electromagnet that maintains its magnetic properties only when connected to
current, have proven to be highly beneficial for certain ailments, and since time
immemorial (China, Egypt) were used to mitigate the body aches and relieve the
“stiffness” of muscles and joints.
The magnetic field (CM) is established between a north pole (N+) and a south
pole (S-), in the form of CM lines that circulate from south to north. These poles
do not act in the same way and have different therapeutic actions.
The properties of a magnetic field differ according to its orientation. When it

comes to pain, the north pole is known to be relaxing, while the south pole is anti-
inflammatory.
In case of pain due to muscle spasm, the N pole should be applied to the sore
region and if there is inflammatory pain, the S pole should be applied to said
region.
Magnetotherapy (MT) constitutes a safe physiatric method in the treatment of

multiple diseases, being used as a standard procedure in Rehabilitation Centers
and SPAs.
The magnetic fields used in Medicine are low frequency (less than 100 Hz) and
low intensity (up to 100 Gauss); They can be static or pulsating.
Recently, the magnetotherapy modality called “Pulsed Low Frequency

Electromagnetic Field Therapy” is being used, known as PEMF (Pulsed
2
ElectroMagnetic).
The pulsating application makes it possible to take advantage of the biological

effect of the magnetic component, with minimal action of the thermal effect
produced by the electric field.
Modern PMF devices allow generating various frequencies (1 100Hz), intensities

(1-100 gauss), pulse shapes (sinusoidal, rectangular, etc.), exposure duration
(timer).
Magnetotherapy devices consist of a console (control panel) and a solenoid

(applicator). This is included in a plastic cylinder, 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 entire body.
In addition, there are various biomedical devices, necklaces, bracelets, belts,

pillows, insoles, etc., that base their therapeutic effects on the use of magnetic
fields (magnetotherapy).
81.2 Basics
There are three established mechanisms through which pulsating magnetic fields
interact with living matter:
1. Magnetic induction
2. Magnetomechanical effects
2
3. Electronic interactions
Summarizing the data on research about the physiological and pathophysiological

responses to the application of magnetic fields (CM), it is postulated that CM
present the following effects or biological actions:
1. Local vasodilation
2. analgesic effect
3. Anti-inflammatory action
4. Spasmolytic/myrelaxant activity
5. Acceleration of healing
6. Stimulation of ossification
7. Anti-edema effect
8. Trophic-tissue effect
The proposed mechanisms for said biological effects or actions are described in:
http://www.magnetotherapy.com/action.htm
As is known, MT acts at the cellular level, producing the activation of enzymatic

processes, induction of metabolic systems and functions of the cell membrane.
Cellular respiration is activated in the area exposed to these fields. PMC

(―Pulsating Magnetic Fields‖) therapy induces positive changes in the patient's
immunological condition, vasodilation of the arterial portion of the capillaries and
reduction of blood coagulation.
Its capacity to stimulate trophic bone and collagen is notable, an effect linked to
the local production of current of very weak intensity, due to the piezoelectric
effect. Magnetotherapy helps calcium fixation, which is why it is used in
Osteoporosis, Sudek's Disease, ossification delays and pseudoarthrosis.
81.3 Indications
Rehabilitation
• Osteoarthrosis (coxatrosis/gonarthrosis)
2
• Spondylosis (cervical/lumbar)
• Ankylosing spondylitis
• Osteochondritis
• Osteoporosis
• tennis elbow
• frozen shoulder
• Post-traumatic soft tissue processes.
• Algoneurodystrophy
• Aseptic necrosis
Pediatrics
• myopathies
• Rheumatoid arthritis
• spinal muscular atrophy
• Cerebral palsy
Neurology
• Migraines
• Peripheral neuropathies
• Low back pain/Lumbosciatalgia
• Trigeminal neuralgia
• Post-herpetic neuralgia
Dermatology and Orthopedics
2
82
QUANTUM SCLO
FEEDBACK
As is typical in children with neurological brain pathologies, their evolution is

erratic in certain areas, sometimes they tend to have greater progress in certain
areas and less in others. The Quantum ScIo Biofeedback is a device designed to
strengthen the control functions of the brain towards the muscles, organs and
systems of the body that are defective.
With this equipment we work on: Cerebral Palsy, Neurodevelopment, Optic

Nerves, Auditory System, Respiratory System, Blood Circulation, Lymphatic
System, Immune System, Intestines, Liver, Kidneys, Intelligence, DNA, Genes,
Etc.
With this device we manage to stimulate the brain towards the greatest possible
normality to achieve over time. The treatment is completely non-invasive, no
medications of any kind are ingested, the child is not bothered or harmed in any
way; The therapy is totally external and achieves great improvements in the
aspects described above.
2
83
Therapy
with BACLOFENE
INTRATHECAL
Using a baclofen infusion pump can help you move and walk more easily, loosen
excessively stiff muscles, and minimize pain related to spasticity. The implantable
pump delivers medication continuously into the spinal cord fluid.
83.1 What is it?
A baclofen infusion pump (ITB Therapy) is a precise, targeted therapy used to

reduce severe spasticity caused by cerebral palsy. The treatment may be even
more effective if used in combination with physical therapy, speech therapy, or
occupational therapy.
It uses a programmable, battery-powered medical device that stores and delivers

a medication called baclofen. The device is surgically implanted in the abdomen
and a thin, flexible silicone tube called a catheter is inserted into the spine and
connected to the pump.
2
The medication consists of a baclofen solution that enters directly into the
intrathecal space where there is a fluid (cerebrospinal fluid) that circulates around
the spinal cord.
Because baclofen is administered directly where it is needed most, in the

intrathecal space, it relieves spasticity with lower amounts of medication than
required when taken orally. This method of administration may help minimize the
side effects caused by oral baclofen.
83.2 Components of therapy
The system is made up of:
• Pump: A programmable, implantable, battery-powered pump with a reservoir

from which the drug is delivered, at a programmed rate, through the catheter.
• Catheter: A flexible silicone tube that carries medication from the pump 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 root cause of your condition or severe
spasticity, it can help you relieve tight and stiff muscles that make your daily life
difficult.
2
BENEFITS
It has been shown to be beneficial for people who have been affected by cerebral palsy, brain
injury, stroke, multiple sclerosis and spinal cord injury in the following ways:
• Several studies show that it significantly reduces spasticity and spasms.
• In at least seven studies, the therapy has helped people become more independent,
allowing them to carry out everyday activities such as eating or dressing themselves,
sitting more comfortably or moving more easily.
• A study has shown that this therapy can provide long-lasting control of spasticity in people
living with cerebral palsy or brain injury.
• Several studies have determined that this therapy also reduces spasticity in the upper and
lower limbs of patients living with cerebral palsy, brain injury, and stroke.
A study of people suffering from cerebral palsy showed that reducing muscle tone with this
therapy can slow or prevent the development of hip problems. Another study found that if
therapy is offered at the right time to those suffering from cerebral palsy, orthopedic surgery
can be delayed or avoided altogether.
RISKS
Always follow your doctor's instructions carefully because suddenly stopping therapy can
cause serious problems (withdrawal syndrome) such as high fever, mental status changes,
muscle stiffness, 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 scheduled visits are met so that you do not run out of medication and thus
avoid withdrawal symptoms. Some people are more at risk for withdrawal than others.
The side effects associated with this therapy are usually temporary and can be resolved by
adjusting the dose of the drug contained in the pump.
The most common side effects include:
• lax muscles
• Drowsiness
• Pain stomach
• Nausea and vomit
• Pain head
• Dizziness
2
Pump failure can cause an over or under dose. Signs and symptoms of excessive dosage
include:
• Drowsiness
• Vertigo
• Difficulty breathing
• stroke attacks
• Loss of consciousness or coma
Signs and symptoms of an underdose include:
• Increase or return of spasticity
• Itching
• Low blood pressure
• Vertigo
• Tingling sensation
Possible complications of the device are:
• The catheter or pump may move inside the body or move through the skin.
• The pump may stop because the battery has run out or due to component failure.
• The catheter could leak, tear, kink, or become disconnected resulting in an insufficient
dose or abrupt cessation of drug delivery. Abrupt discontinuation of antispasticity
medication can lead to: high fever, altered mental status, return of spasticity, muscle
rigidity, death (in rare cases).
It is important to know that the pump sounds an alarm when it needs to be replaced, or
medication needs to be refilled, or if there is a problem with the pump.
Healthcare personnel should always be notified that this system is in place before performing
any medical procedure or diagnosis.
83.4 Contact
For more information about this therapy at: www.medtronic.es or at the following address:
Medtronic Ibérica SA
2
C/ María de Portugal, 11. 28050. Madrid.
2
84
BACH FLOWERS
84.1 Introduction
Bach flowers are a series of natural essences used to treat

various emotional situations, such as fears, loneliness,
despair, stress, depression and obsessions. They were
discovered by Edward Bach between 1926 and 1934.
Dr. Bach was a great researcher, as well as a doctor and

homeopath. He experimented with various wildflowers native
to the region of Wales, in Great Britain, until he found 38
natural remedies, each with healing properties for different
emotional problems. These 38 flowers are called Bach flowers.
Bach flowers are also called Bach flower essences and Bach flower elixirs.
His theory was that physical illnesses have an emotional origin, and that if
emotional conflicts persist for a long time, the illness of the body begins to
appear; however, by restoring emotional balance, the physical illness is resolved.
It was in this way that he developed Emotion Therapy.
After more than 70 years, Bach flowers have been proven as a magnificent
system to treat 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.

• Pregnant and breastfeeding women
• Seniors
• Animals
2
• Floors
• People taking other medications
• Sick or convalescent people
• Unconscious or comatose people.
They have no side effects nor are they contraindicated for any person or
condition. They can even be taken along with other medications and therapies.
Unconscious or comatose people can take Bach flowers through the skin, using a
cream to which Bach flower tincture has been added.
People with serious mental illnesses can also take Bach flowers, but in these
cases their therapist, whether a psychiatrist or psychologist, must assess whether
they take them in conjunction with other medications or if it is the only thing they
take.
2
8
5
Therapy
DEEP MUSCLE (TMP)
85.1 Introduction
Deep muscle therapy (DMT) is a technique that focuses on the deepest layers of
muscle tissue. Its primary goal is to release chronic patterns of tension in the body
through slow manipulations and deep pressure on contracted areas, either in the
same direction or opposite to the fibers of the muscles, tendons and fascia.
The purpose of TMP is to “unstick” the muscle fibers, release the patterns that
reproduce deep tension in it, remove toxins, and relax the muscle. Deep tissue
therapy can be used to eliminate fibrosis, realign muscle fibers, help eliminate
myofascial trigger points and muscle adhesions, ensuring that all muscles in the
body are worked to prevent possible injuries. So deep muscle therapy is both
corrective and therapeutic.
It is necessary to highlight that for the treatment to be well founded, the analysis
of the origin of the pathologies is essential.
In this way, TMP is revealed as the new cutting-edge technology in the treatment
of mechanical pathologies. The union of therapeutic chiromassage with the vision
and treatment of muscle chains makes these techniques one of the most
advanced of our times.
23
6
85.2 Goals
Locate the cause of the pathologies and inform the patient that the symptom or
pain is not where the problem arises, but most of the time it is a cause distal to
where the pain is felt.
Treatment of muscle chains, with instant improvements in the range of motion,

and reduction in pain, up to 50% in most pathologies in a single session.
Natural treatment (without medications).
Indicated for: Cerebral palsy, amyotrophy lateral sclerosis, multiple sclerosis,

muscular dystrophy, Parkinson's, sports injuries, trauma, arthritis, fibrosis, back
pain, neck tension, chronic fatigue syndrome and circulatory problems, to name a
few.
2
8
6
THERAPEUTIC TOUCH
(PRANOTHERAPY)
86.1 Introduction
It is a type of non-contact massage that is applied using the energy of the

physiotherapist, nurse or parents, it is known as pranotherapy. This type of
therapy may seem somewhat strange but it has been widely accepted among
staff who work with these types of children. Its beneficial effects are supported by
many clinical research tests.
86.2 Method
• Sit next to the baby, preferably when he is calm. Let's look at it and focus our
attention on it. We will do it for as long as we see fit.
• Next, place one hand with the palm facing down on top of the baby's head at a
distance of 5-10 cm, and with the other hand we do the same but on top of the
baby's feet. If we have very big hands we can do it with our fingers. We will try
to transmit our energy with our hands.
• If we want to do a little more, we lower our hand from head to toe, imagining
that we are caressing the baby, but always without touching it, keeping it at a
distance of 5-10 cm from the body. Let's do it as many times as we see fit
(normally one or two minutes).
• To finish, we return to place our hands in the initial position, on top of the
baby's head and feet. We keep them like this for a few seconds and we will be
done.
23
8
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 stimulation for the child in the environment
2
87
CRYOTHERAPY
87.1 Introduction
The use of cold as a therapeutic technique is nothing new and there is evidence
that the Egyptians used low temperature water to cure various diseases and
ailments. However, it was not until the 19th century when the German Sebastian
Kneipp discovered the healing properties of cold and its applications.
A very low temperature (cryotherapy uses temperatures up to 165 degrees below

zero) applied locally and continuously produces vasoconstriction, which reduces
blood flow; This also reduces inflammation and bleeding. Furthermore, with the
cold the respiratory rate decreases and the sensitivity of the skin is also less. It is
also used as an anesthetic.
Cryotherapy, when applied at such a low temperature throughout the body, acts
especially energetically on the muscle, reducing its hypertonia and spasticity.
87.2 Recipients
Extreme cold is used as a therapy to treat a series of chronic diseases such as

fibromyalgia, osteoporosis, osteoarthritis or arthritis. Cold can also be used in the
treatment of bipolar disorders in children or in patients with cerebral palsy, as they
often suffer from muscle contractures.
The cryotherapy treatment is planned in about 15 chamber sessions. Previously,

patients undergo a medical check-up to rule out a
2
series of contraindications since there are people who cannot use this therapy,
such as hypertensive or decompensated diabetics, patients who are allergic to
cold or who suffer from claustrophobia. Once it is proven that the indication for
cryotherapy is valid, the patient must dress appropriately to enter the chamber.
He puts on towel pants, high socks above the knee, a wool hat, a surgical mask
so he doesn't breathe in air at that temperature, some clogs and ski gloves.
Before entering the chamber itself, one
goes to an antechamber where the
patients remain for approximately one
minute at a temperature of 60 degrees
below zero, accompanied by control
personnel. They then go to the
cryochamber, where the temperature is
already 140 degrees below zero. Groups
of four or five people usually go inside the
chamber with a professional who explains
to them what they have to do inside. There are three minutes, during which they
move in circles and after this time they return to the antechamber and from there
to the outside (these temperatures are tolerated because the degree of humidity
is very low, below 20%. The sensation is of intense thermal shock and when they
finish the sensation is of having exercised for 40 or 45 minutes, you notice
relaxation in the legs and a certain sedation.
Each cryotherapy session (usually three a week) is followed by physiotherapy or

rehabilitation appropriate to the disease in question.
87.4 Centers
In Spain, there is only one cryochamber at the Activa Club de Jérez Center (and it
is not applicable for all the diseases mentioned above).
The distributor in Spain is the Dironte Group located in Palma de Mallorca.

Information: info@dironte.com
Where this therapy is applied regularly and included in its healthcare network is
Warsaw, which is implemented in both public and private hospitals.
2
88
TAI
CHI
88.1 Origin and philosophy of Tai Chi
Tai Chi is the ideal martial art for improving and restoring
health and thereby improves our physical condition. It builds
on the heritage bequeathed by the Taoists of ancient China
and consists of a series of gymnastic exercises based on
ancient traditional medicine and the experience of the
daoyin, which was transmitted within the Huashan sect.
They are body movements designed to channel vital energy in order to maintain
good health and achieve longevity. It is a gymnastics aimed at channeling the
meridians, the circulation of energy, the Chi.
Its particularity consists in 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 may be inclined to
practice one style or another. In the Yang style, long, smooth movements
predominate, without alteration of breathing or strength. In the Chen style, you
work from relaxation to explosion in the same continuous movement.
This is why the first style, the Yang, is one of the most suitable for the principals of
our second or third youth. This does not mean that it is easy to practice, since any
extension movement of an arm can take hours of practice to achieve the fluidity of
the relaxed movement.
2
88.2 The movement
• Mind and concentration. Tai Chi should never be practiced, according to

Chinese masters, automatically, as if we were reciting the alphabet while
thinking about anything. This is a very complex composition of different
exercises. The activity passes from one part of the body to another without
any area making excessive effort and the mind is completely active.
• Softness and lightness . In Tai Chi, the movements are smooth, continuous,
light and fluid; It feels like no effort is needed to do them. However, to be able
to practice them, the body must be firm, stable and strong. The mind has to be
alert and active. Tai Chi movements are circular, forming arcs and spirals.
According to Tai Chi masters, moving in circles helps conserve energy,
creates security and relaxes the nerves.
• Strength and movement. During the exercise process, the muscles never
become maximally tense. The amount of effort and tension used depends
entirely on what the position or movement itself requires. The muscles behave
in a natural way. Force is never added to the movement, as much force is
applied as necessary to perform the movement.
• Balance. Balance is an essential element in the practice of Tai Chi. Through

the control of each movement, muscles and joints are strengthened. A body
balance naturally produces correct posture and facilitates movements.
Physical balance also contributes to mental and emotional stability.
• Fluency. Tai Chi is continuous and fluid. Each movement, each unit of
exercise, is chained to the next without a visible pause. Calm and lightness
are manifested in that fluidity. Resistance increases as the ability to maintain
that continuity develops.
• Slowness. This is a slow exercise. Breathing should be natural. Slowness

helps develop patience and strength. But this does not mean that Tai Chi has
no changes or is dynamic. Delicate changes in strength, stillness, and activity
alternate constantly throughout the exercise. The variation in dynamic flow
produces flexibility and resistance in those who practice it.
• Diversity. The energies dispersed in the body cause diseases when they
circulate in a disorderly and chaotic manner. Tai Chi helps to feel, unify and
guide these energies. Traditional Chinese medicine attributes diseases to an
imbalance between Yin and Yan, to remedy it it is necessary to reduce the
excess of one and avoid the insufficiency of the other. The exercise was
designed to generate what they believed to be the two vital energies of life, yin
and yan. Yin represents all things receptive and calm. He yan all active and
energetic things. The various forms contrast yin and yang in the exercise of
Tai Chi.
2
88.3 Tai Chi and its therapeutic effects
In the treatment of people with motor disabilities, the contribution of Tai Chi can
be very beneficial. Two important aspects appear related to this topic: the
globality of movement and postures help the person to feel a part of the body in
relation to their entire body. On the other hand, the practice awakens a sensitivity
that contributes to integrating the diminished body part. In the case of long-term
injuries that are difficult to heal, Tai Chi exercises can develop a more unified
perception and at the same time contribute to improvement. Awakens body
awareness and facilitates body exploration, thus benefiting joint mobility and
flexibility, muscle strength and endurance, coordination and balance.
Circular movements performed without breaks activate blood circulation and

regulate blood pressure. Abdominal breathing keeps the abdomen flexible and
the chest relaxed, making it a deep, slow, uniform and soft breath, providing
greater balance in the functioning of the respiratory system.
Likewise, Tai Chi promotes digestion, since its movements activate 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 the unified performance of the
movements has an extremely beneficial effect on the entire body, promoting the
capacity for attention and calm.
Inhibition of the body can express grief, anguish and distrust of oneself, etc. The
practice of Tai Chi can help promote harmonization, the progressive liberation of
movement, breathing and attention. Practice teaches to feel the fluidity of
gestures and to discover the
smoothness in activity. Influence our mind and we will discover how we become
less rigid and more flexible.
Attention to breathing allows images and thoughts to be expressed little by little

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. It develops the ability to perceive unconscious images and
feelings that also correspond to the principle of attention and not fighting that is
the basis of Tai Chi. It has a therapeutic benefit when one practices it
consistently. Its practice progressively guarantees greater harmony with oneself
and with the environment, allowing us to remedy the imbalances in the conditions
in which we live, a product of agitated and rigid walking, externally and internally.
2
89
SHANTALA
Ayurvedic Massage
Shantala or Ayurvedic massage, is an ancient technique

developed in India for babies and children. Massages are an
important pillar in many pediatric treatments from Ayurveda.
89.1 Who can you help?
Shantala or Ayurvedic Infant Massage is used in India for all newborns, with the
aim of affectionately welcoming the newborn child, strengthening the
mother/father-child relationship and helping in the sensorimotor development of
the newborn. All newborns and their parents benefit from this massage, especially
those who are premature or underweight, since massage has been shown to help
with weight gain.
On the other hand, massage has also been developed for the childhood stage.
During this period, the goal is to correct conditions that are affecting the child's
overall health and development. Patients with the following conditions would
especially benefit from Shantala therapy:
• Attention deficit
• Growth retardation
• Dermatological pathologies such as atopy and psoriasis
• Endocrine pathologies such as type I diabetes
• Neurological pathologies such as cerebral palsy, mental retardation,

myopathies, etc.
2
• Joint pathologies
• Obesity
• Also children with special abilities that require stimulation can greatly benefit
from massages, since it helps strengthen the body, integrating body
perceptions with feelings and emotions.
89.2 What are the benefits?
Massage is an ancient technique that allows you to provide affection and well-
being to both those who receive it and those who give it. It is a natural alternative
to increase well-being in healthy children and restore health in children with some
type of condition. In some conditions, Ayurvedic Children's massage is useful as
an adjuvant therapy in patients who are undergoing prolonged or aggressive
treatments, or in those with chronic pathologies. The most important benefits are:
• Helps sensorimotor and psychological development
• Increases tone, strength and flexibility of muscles and joints
• Regulates metabolism
• Allows for greater attention
89.3 How does this work?
The Ayurvedic Children's massage uses natural resources to increase the state of
health and vitality of the person who receives it. 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 neurological pathologies such as spasticity
due to cerebral palsy, special preparations are used with the aim of revitalizing
damaged tissues. Massages are always performed with an adult (mother, father
or guardian) inside the room, who accompanies the child during the session.
2
90
Method
ESSENTIS
The Essentis method is an intensive and multi-disciplinary neurorehabilitation

program.
The method does not follow a protocol, but is adapted to the individuality of each
child.
An “intensive treatment” lasts 2 to 4 weeks, lasting 4 hours a day, 5 days a week.
During the intensive the following will be done:
• Evaluate the child and emphasize his or her abilities in the physical and
cognitive areas.
• Test the different tracks that will allow 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 so they can follow the work undertaken at home.
The results are optimized if the child attends several intensives a year and works
at home regularly.
The objectives of the program:
• Develop functional motor skills to the maximum. Repeated stimulation of

peripheral joints during functional activities to feed back the central nervous
system with correct sensory information.
• Improve self-confidence and fear management (of falling, failing...).
• Promote the child's autonomy.
• Improve the child's comfort of life: care for functional disorders such as
2
dysphagia (difficulty swallowing), constipation, excessive salivation, breathing
difficulties, etc.
• Give the child the possibility of developing his or her abilities to the maximum:
improving the functions affected by Cerebral Palsy and developing other
potentials .
During the sessions, the patient goes through different workshops in which their
posture, disability and symptoms are evaluated by the different members of the
team (osteopaths, acupuncturists, physiotherapists) with the aim of creating a
program adapted to the needs.
It has a holistic approach to treatment, that is, the patient is evaluated as a whole.
We carefully analyze all factors to establish a diagnosis and an appropriate
treatment strategy for the patient (physical, emotional and social factors, current
symptoms and medical history).
In this method, great importance is given to the preparation of the tissues to

optimize the exercises done later.
In parallel with the physical treatment, the patient will go through numerous
rehabilitation workshops with the aim of maximally developing functional motor
skills. The center of the essentis method has a variety of material allowing it to be
adapted to the patient's needs and progress: work on the floor, parallel bars,
against the wall, walker, orthopedic crutches, Spider, Therasuit, Biodetox... All of
these tools used in the Appropriate timing will allow optimization of the patient's
progression.
90.1 Workshops and therapies of the method.

In this method they are the following:
• Osteopathy
• Acupuncture, Chinese Medicine and Cranial Electro-acupuncture
• Work on the ground
• Therasuit
• Spider Therapy
OSTEOPATHY:
It is a holistic manual therapy that aims to restore homeostasis in the body (the
body's ability to self-regulate).
According to the osteopathic concept, the structure and function of each tissue
2
(muscles, bone, joint, viscera...) are closely linked. By acting on the different
structures of the body, the osteopath tries to restore their normal function.
Osteopathic treatment aims to improve the vascularization of the structures and

thus promote their function and “self-healing.”
To carry out your treatment, the osteopath uses several types of techniques:
muscle inhibition, joint manipulations,
visceral manipulations,
fascial uncoiling, cranio-sacral work…
Craniosacral osteopathy is made up of a system of membranes that extend from

the skull to the base of the spine (sacrum). The fluid that circulates between these
membranes (cecephalo-spinal 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 good function of a viscus depends on its physiological

mobility, and correct vascularization and innervation.
A restriction of mobility, a lack of veno-lymphatic drainage or an alteration of

innervation and peristalsis (involuntary visceral movement) impairs the good
function of the viscera.
Osteopathic work ensures that the path of the arteries, veins and nerves is free of
restriction or adhesion.
The organs are attached to bony and muscular structures, and held together by
ligaments.
ACUPUNCTURE:
It is one of the five branches of Traditional Chinese Medicine. This therapy is

based on an energetic and holistic approach.
According to Eastern medicine, it acts on the “Qi” (pronounce chi) that circulates
in the body via the meridians.
Precise acupuncture points are stimulated with needles to regulate Qi and

balance physiological, organic and psychic functions.
From a Western point of view, it could be said that it allows us to reinforce the
self-regulation and healing processes that are activated when the body faces
aggression (caused by a virus, stress, an injury, etc.).
There is a detailed mapping of the acupuncture points, meridians and their roles
2
in re-establishing the patient's health and balance.
Acupuncture can treat, often in conjunction with other therapies, a variety of

imbalances in the musculoskeletal, respiratory, gastro-intestinal, nervous
systems, etc.
THERASUIT:
It is presented as a "suit", which, through a system of elastic bands, allows the

patient's body to align itself in a more "normal" way.
This restructuring of optimal posture and proper muscle function allows the
patient to learn or relearn correct movement patterns (sensory integration).
The tensions exerted by the elastics (which can be moved according to needs)
stimulate the appropriate muscle groups to stabilize the posture.
Therasuir is particularly adapted in the case of passive muscle stiffness: it acts as

a flexible orthosis, guiding the joint without blocking it.
SPIDER:
It is a verticalization tool that gives excellent results and can be adapted at home.
It is a very playful work instrument that allows the child to let off steam freely and
in complete safety.
The patient stands in the center of a room, restrained by elastic cables attached
to the walls. This type of support is dynamic and allows the patient to train by
practicing any type of movement independently, improving their sensory
integration.
The child discovers sensations of verticality and can practice any movement
without the fear of falling (staying standing, pushing on the legs, straightening the
head, moving the arms, raising a leg, jumping...).
The verticalization of the spine is an essential step in the development of walking.
Working in Spider allows you to improve coordination, balance and muscular

endurance.
It is excellent for the development of head and trunk control and also allows the
child to develop sociability so that he can interact with his environment.
The higher the elastics, the less the child has to support their own weight. This
way we can control the level of difficulty and muscular effort to be produced.
2
This controlled loading of the joints stimulates correct ossification and thus allows
prevention of osteoporosis and hip dislocations.
90.2 Centers and contact
The center of the Essentis method is located in Barcelona, for information there
are the following links:
www.metodoessentis.com
info@metodoessentis.com
Official website of the ROE (Registry of Osteopaths of Spain)

www.osteopaths.org
2
9
1
Treatment
with TIZANIDINE
Tizanidine is an imidazole derivative that acts centrally as an agonist, inhibiting

the release of excitatory amino acids in spinal interneurons, and which could
facilitate the action of glycine. The antispastic effect has been studied in
experimental animals; Tizanidine has been shown to suppress reflexes in cats
with spinal cord transection, stimulate inhibition of the H reflex in humans and
reduce abnormal contraction, and this is also due to an adrenergic effect. The
potency of the effect on tone is similar to baclofen but, in addition, it facilitates
spastic muscle torque by increasing the amplitude of the agonist contraction. The
tone-reducing effect, spasms, begins to be noticed after 3 hours.
The most common side effects are sedation, non-specific dizziness, asthenia and
dry mouth, and other rarer effects have been reported 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 decreased tone (especially in
extensor muscles) and hyperreflexia, improved posture, antinociceptive, and
consequently facilitator of activities of daily living and hygiene. Other effects that
have been used are the induction of sleep in quadriplegic patients with a sleep
disorder refractory to other treatments or the supposed improvement of language
disorders.
In general, it is recommended to start with a low nocturnal dose, ranging between

1 and 4 mg, and then gradually increase to a maximum amount of 9-12 mg.
Differentiation of doses according to age is rarely specified, but the usual cut-off
point for converting almost all drugs to adult doses
25
2
It is at 12-13 years. Other ages used to make dose changes are 7 or 10 years.
It is a medication that produces relatively few side effects, which is why it is better
tolerated by patients than other anti-spastic drugs, which means that both children
and their parents rate it highly.
Therefore, tizanidine is presented as a drug with a potency against spasticity

similar to that of the others but with the ability to cross the blood-brain barrier, it
does not cause muscle weakness like baclofen and benzodiazepines, it is better
tolerated and shows better results on function and activities of daily living, and yet
it is often proposed as an alternative to baclofen even in lesions of cerebral origin.
The usefulness of tizanidine in the treatment of childhood spasticity is explained,

especially as an initial measure in the event of generalized or harmful hypertonia,
to be able to apply other global (physiotherapy) or focal (botulinum toxin)
treatments.
2
9
2
cerebral palsy and
SCOLIOSIS
Most children with severe cerebral palsy have significant spinal curvatures
(SCOLIOSIS), which often require surgery. Because the pelvis and spine are
connected, any surgical procedure to correct scoliosis must take into account the
possibility of a misaligned pelvis. The degree of asymmetry, they add, should
dictate the size, type and location of surgical screws and rods to stabilize the
spine and pelvis in such corrective procedures. Among the treatments it is worth
highlighting:
It depends on the cause of the 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 brace (corset) is usually recommended to slow the
progression. Many different types of such devices are used and have names such
as the Boston, Wilmington, Milwaukee, and Charleston corsets.
Each corset or brace looks different and there are different ways to apply it. The
selection of a corset is determined by the specific characteristics of the curvature.
Back corsets do not stop the growth of the curve, but rather apply pressure to
straighten the spine and can be adjusted during growth. These devices do not
work for congenital or neuromuscular scoliosis and are less effective in infantile or
juvenile idiopathic scoliosis.
A curvature of the spine of 40 g or more requires surgery to correct it, due to the
patient's high risk of deterioration even after bone growth stops.
25
4
Surgery involves correcting the curve (although not all of it) and fusing the bones
at the curve. The bones are held in place with one or two metal rods held in place
with hooks and screws until the bone heals. Sometimes surgery is done through a
cut in the back, abdomen, or below the ribs.
A corset or brace may be necessary after surgery to stabilize the spine.
The limitations imposed by treatments tend to be emotionally difficult, especially in

adolescents, by damaging self-image. Therefore, emotional support to adjust to
these restrictions is important.
Among the methods to treat SCOLIOSIS, it is worth highlighting:
• NIEDERHÖFFER METHOD
An exercise system for scoliosis and vertebral deviation. It consists mainly of the
consolidation, by 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 co-worker, the physical therapist Luise von Egidy (1873-1946).
To treat scoliosis, apart from the Niederhölffer Method, there are other methods
and techniques that are:
• RUDOLF KLAPP ASYMMETRIC METHOD (it is the oldest)
Method that is based on unloading the spinal column. The variations of the
quadruped position allow the corrective action to be placed on a delimited level.
KLAPP was a German surgeon at the beginning of the century who based his
treatment for spinal deformities on his observation of animals.
2
He proposed that quadruped animals, which initially included man, never had
spinal problems in their frontal plane, since lateral deviations when on 4 legs were
almost zero. Therefore, its method is based on placing the patient in a crawling
position and the subsequent development of specific exercises for their deformity.
Of course, although some exercises are explained for the treatment of deformities
in the lateral plane, such as dorsal hyperkyphosis and lumbar hyperlordosis, their
results are not very good compared to scoliosis treatments using this method.
Thus Klapp places the patient on all fours (in a crawling position) leaving the
spine suspended from four support points as if it were a hammock. There are four
crawling positions that vary depending on the vertebral segment that we want to
mobilize.
Two types of exercises are associated with these initial positions, walking and
stretching.
To do this, Klapp uses six positions that can be adopted in kyphosis and lordosis.
The Positions are shown below through the following drawings: Low, Semi-low,
Horizontal, Semi-erect, Upright and Inverted.
2
And the three forms of movement that are used:
1. Ambulation must have the opposite arm and leg habitual.
2. Amble ambulation: walking is performed with the arm and leg on the same
side.
3. Alternate movement of the homologous members: it is done

advance the two upper limbs and behind them the two lower ones
After learning the positions and gestures that must be made, the movements are
carried out at a pace, forcing the amplitude. In this way, you obtain both an elastic
and muscular spine and quick and intense general effects, increasing heart rate,
increased breathing and sweating. Klapp initially did not present his method as
therapeutic, but rather as prophylactic gymnastics.
2
93
OTHER THERAPIES
• TREATMENT OF DROOLING
Drooling can be reduced through certain medications, surgery, or biofeedback.

Various surgical techniques have been developed to alleviate drooling with
varying degrees of success. In general, the main objective of these operations is
to reduce salivary secretion rather than to improve saliva circulation in the back of
the mouth. These surgeries are mainly dedicated to the extraction of the
submandibular glands, the relocation of the salivary canals, the section of the
parasympathetic efferent nerves that serve the salivary glands, as well as
numerous modifications or combinations of these techniques.
With this series of surgical interventions the subject is frequently affected by

undesirable side effects. For example, Torelmalm and Bjerre (1976) confirmed
the temporary loss of gustatory functions as well as a decrease in internal oral
sensitivity. According to Green in 1977, pain and edema frequently appear on the
face. An increase in the number of dental caries in certain subjects and the
formation of cysts occasionally occur (Ericson, et al, 1973). Even when surgery
manages to reduce drooling, they question the success of this type of treatment.
It is also necessary to remember that drooling is not due to increased salivary
secretion. A decrease in saliva secretion due to surgery is even contraindicated
since normal swallowing depends on adequate saliva stimulation.
Surgical treatment may be accompanied by complications, aggravating

swallowing difficulties. Biofeedback is a technique that warns when drooling
begins so that the person can control it. It consists of a device that emits a light
and/or auditory signal (light/sound) when the person begins to drool and, thus,
can swallow saliva when they perceive this signal.
How to reduce uncontrolled drooling in children with cerebral palsy?

http://www.intramed.net/contenidover.asp?contenidoID=67717
• TREATMENT OF BLADDER INCONTINENCE
To treat incontinence, there are a number of possible interventions including

special exercises, biofeedback, drugs or surgical implantation of devices that help
2
control the affected muscles.
• TREATMENTS FOR EATING PROBLEMS
Difficulties chewing and swallowing can cause choking and/or malnutrition

problems. To alleviate them, the doctor or occupational therapist sometimes
recommends specific diets and training the person with CP in new ways of eating.
In more serious cases, they may recommend a gastric tube that takes food from
the throat to the stomach, or its surgical implantation after making an opening
through a gastrostomy.
An expert advises families on nutrition for people with autism and other
pervasive developmental disorders
http://www.murcia.com/region/noticias/2011/02/25-experta-asesora-a-familias-
sobre.asp
• PATTERN THERAPY
It seeks to teach motor skills in the same sequence in which they normally
develop and evolve, that is, the therapist guides the child to follow the same
learning sequence that a child without CP follows when going through the
different stages of development. motor, regardless of the patient's age. This
therapy is involved in a lot of controversy and arouses reluctance among those
who believe that there is a lack of studies that demonstrate its effectiveness.
• SURGERY TO LENGTHEN THE MUSCLES
It is especially recommended in cases of severe contractures that reduce the

person's mobility possibilities. Its purpose is to detect muscles and tendons that
are contracted (short) and then lengthen them. Identifying defective muscles is
not an easy task. For example, taking just two steps with a normal gait requires
thirty muscles, but a problem in just one of them is enough to cause gait
abnormalities.
To detect the origin of walking problems, a technique called gait analysis is

available that combines information obtained through video tape recording,
computer analysis of gait sections, force plates that detect when they touch the
ground the feet and electromyography, which records muscle activity.
2
Disadvantages of surgery include the possibility of muscle weakness and the
need for a long recovery period.
• BEHAVIOR THERAPY
Behavioral Therapy aims to increase the skills of the child with CP, through
psychological learning techniques. It constitutes, therefore, 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 an occupational therapy goal, he or she is given a balloon)
while they are extinguished, ignoring, inappropriate behaviors (p. Ex: attention is
withdrawn when he has tantrums because he does not want to undergo
rehabilitation).
• BRUNNSTROM METHOD
It is one of the classic treatment methods in neurology. Brunnstrom uses primitive

movement schemes (especially flexion and extension synergies) through self-
and exteroceptive stimulations. Progressing towards voluntary control by the
patient under maximum resistance, the evolution of hypertone develops
throughout the seven phases of motor recovery, in the fourth phase hypertone
decreases, parallel to the beginning of the basic combinations of movements,
towards the sixth phase, hypertone disappears, and motor coordination is quite
good, Remy-Néris and Chauviers cite it as effective in treating spasticity, although
other authors reflect the controversy alleging that the use of primitive movement
schemes and their repetition can increase the hypertone.
• HIPPS METHOD
Restriction of movements. 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 later
access to intellectual and moral education. She considered herself absolutely in
2
favor of pedagogy with disabled people, she worked directly with children for two
years. He stated that the object of the method is to lead the child by the hand to
educate from his muscular system to his nervous and sensory system; from
notions to ideas; from ideas to morality.
Combined education of sensory reactions and movements.
• LUNNING, PLUM
Intensive application of different selected methods.
• THOM
Complete individually adapted therapy using all conservative and surgical

methods to obtain certain purposes.
• STEINER, KONING
Education of the motor system from relaxed positions.
Place the patient in a calm environment, placing him in the fetal position. You
begin learning to control the head, and then work on the different parts of the
body.
• BEAMAN and OBHOLZER METHOD
It is a method that has been used in athetotic patients, it focuses on repeating the
exercises until fatigue prevents further exercises, at which point relaxation occurs
and the patients' incorrect or involuntary movements disappear.
More concretely:
Beaman: relaxation through fatigue during intensive exercises.
Obholzer: relaxation through exercises despite fatigue.
• DANE and NEUMANN METHOD – NEURODE
The method is based on gymnastics exercises for babies and adapts and applies
them to children with motor deficiency.
2
• MIOELECTRIC FEEDBACK
The method consists of making the patient aware of the variations in the electrical
activity of certain muscles that he must control voluntarily, after the relevant
training.
The device requires surface electrodes. The effectiveness of this method has
been demonstrated in hemiplegics by authors such as Schleenbacker et al.
• PLUM
Supports the strengthening of spastic muscles and their antagonists. However, it

exercises the spastic muscles in their external ranges, since these muscles are
normally shortened, while it exercises the antagonists in the middle and internal
ranges.
• COUNTER STIMULUS TECHNIQUE

It consists of the passive provocation of certain stimuli on joints in the spastic
areas. It also has its greatest indication in the upper extremity, thus, passive
stretching of the extrinsic flexor muscles of the spastic hand facilitates the function
of the extensor muscles, according to Carey's experience.
• CARLSSON METHOD
Therapeutics based on motivations to achieve goals.
• FUNCTIONAL ELECTRICAL STIMULATION
Studies have shown it to be an effective way to target and strengthen spastic

muscles, but the method of delivering electrical pulses requires bulky, expensive
devices implanted by a surgeon, or stimulation of the skin surface by a trained
therapist. . Researchers have developed a high-tech method that eliminates the
bulky apparatus and electrodes, using a hypodermic needle to inject microscopic
wireless devices into specific muscles or nerves. The devices are guided by a
telemetry wand that can direct the number and strength of their pulses by remote
control. The device has been used to activate and strengthen hand, shoulder and
ankle muscles in people with cerebral palsy as well as stroke survivors.
2
• SPINAL CORD STIMULATION
It was developed in the 1980s to treat spinal cord injuries and other neurological
conditions involving motor neurons. An implanted electrode selectively stimulates
nerves at the base of the spinal cord to inhibit and decrease nerve activity. The
effectiveness of spinal cord stimulation for the treatment of cerebral palsy has yet
to be proven in clinical studies. It is considered an alternative treatment only when
other conservative or surgical treatments have not been successful in relaxing
muscles or relieving pain.
• REIKI THERAPY
Reiki is a Sanskrit word that means REI, universal energy and KI, life energy.
It is a technique for channeling and transmitting vital energy through the laying on
of hands, which is used to obtain peace and balance at all levels:
Physical: improvement in ailments, injuries, metabolism, etc.
Emotional: sentimental problems, aggression, unhappiness, etc.
Mental: harmful habits, stress, insomnia, etc.
Spiritual : harmony, peace, balance, etc.
Reiki works in depth by going to the root of the physical or emotional problem,
allowing the emotion or behavior pattern that has created the imbalance to
manifest and be healed.
Reiki therapy can be received by all human beings (healthy adults, sick people,
pregnant women, children and babies), even animals and plants. It is a
complementary therapy to conventional medicine and psychological therapies
recognized by the World Health Organization (WHO).
The Reiki method is based on the Hindu belief about the Chakras, which would
explain the health conditions of human beings. According to this belief, the
malfunction or blockage of one or more Chakras would be what causes or
aggravates the poor state of health, giving rise to diseases and disorders.
The reikist acts as a channeler of universal energy and his objective is to

reharmonize the physical, emotional, mental and spiritual planes that have
become ill. It has been officially recognized and recommended by WHO for its
positive results. Currently there are many Reiki currents and in each of them it is
taught in a different way, however in all of them the same Universal Energy is
channeled, which is why these Reiki currents act under the same principle.
Through this method, we make our body healthier, our thoughts become calmer,
2
and we increase the joy of living.
2
~3V 3
Positions of treatment to another person (Front)
Ñau»— from -u owamumaa emi
ng0R ?
AAAAn
: i- 33 --e
aa aa n
» to F1de
—-z --a e
• RPG (GLOBAL POSTURAL REEDUCATION)
It is a treatment method for restructuring the musculoskeletal system with

beneficial effects on the locomotor, aesthetic, organic, functional and
psychological level. Based on active, progressive and global postures, it tries to
stretch the muscle chains. Corrects 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 in
coordination.
Currently there are more than 1,00 RPGistas in Spain (physiotherapists and
doctors) and more than 10,000 around the world.
• MATROGYMNASTICS
It is a technique that involves exercises only between the mother and the child.
Matrogymnastics is an important element that must be introduced in early

intervention to inhibit primitive reflexes and stimulate righting reactions facilitated
by the mother-child pairing; This requires guidance and participation from the
mother and the need for adequate stimulation in maintaining postures. It is
important to mention that the active participation of both the mother or father or
both is also integrated, through various forms of exercise such as gymnastics,
2
dance, games, body expression, etc., aimed at development and learning. of
basic motor patterns and the consolidation of others.
With the practice of Matrogymnasia many aspects of the child and their parents
can be stimulated, the most important in addition to the physical aspects are:
• Strengthen the emotional bond between the mother or father and the child
• The socialization
• The integration
• The values
• The hygiene
• The physical Culture
Matrogymnastics turns out to be a very powerful tool in the preschool stage, but it
can be applied at higher levels with good results. This is applied in sessions of 30
to 50 minutes, structured in an initial part, a spinal part and a final part, with a
physical education class, in which different aspects can be stimulated, both
physical and cognitive.
Visual contact between mother and child favors visual, auditory, labyrinthine and
cervical stimulation.
A patient with infantile cerebral palsy and persistence of TAC can hardly establish
visual contact with the mother, which is why the stimulation we perform on the
child is very important.
TREATMENTS WITH Ex N´ Flex APPLIANCES
The Ex N'Flex therapeutic exercise machines, name of a group of electrical

devices that allow combining active exercise - in which the person makes part of
2
the effort - and passive exercise - which is characterized because it is the
machine that does all the ― effort‖ through a motor- thanks to which people with
damaged limbs have greater possibilities of doing daily exercises and thus
improving their quality of life. With especially notable results in the treatment of
patients with hemiplegia, multiple sclerosis, Parkinson's, Alzheimer's, muscular
dystrophy or cerebral palsy but also in cases of disabling diabetes, arthritis, back
injuries and overweight. The periodic use of these machines allows you to
increase the strength, resistance, flexibility and movement of the limbs, promote
blood circulation and oxygenation, reduce spasms, edema, pain and stiffness in
the extremities, improve the functioning and control of the bowel and bladder,
increase energy and aerobic capacity, and improve balance in ambulatory
patients. It should be added that these machines incorporate an automatic system
by which they turn off immediately if the degree of resistance to movement of the
patient's arm or leg is excessive due to, for example, a muscle spasm. This way
the patient has the peace of mind of exercising safely.
• THE NEURALTER
The Neuralter is a Spanish device that, using non-ionizing and very low-power
electromagnetic waves, exerts proven therapeutic action on bone tissues - it
accelerates calcification, improves osteogenesis and increases the production
and fixation of collagen as well as bone vascularization and mineralization. , in the
epidermal tissues - it acts on collagen and has antioxidant action -, in the nervous
system - it calms pain -, in the digestive system - it regulates intestinal motility -
and in the circulatory system - it increases peripheral blood flow and promotes
defenses by stimulating the reticulum – endothelic system – in addition to
eliminating muscle spasm. And it achieves this because it is capable of
transmitting to the patient nearly 300 million very low-power frequencies that
manage to raise cellular biopotential and normalize the area in which it is applied,
facilitating its energy rebalance. In summary, it is an effective device in the
treatment of multiple pathologies that does not produce serious side effects, in
many cases allows the patient to reduce the amount of drugs they take daily and
that reduces pain and inflammation, accelerates the healing processes. and, in
general, improves metabolism since although the greatest contribution of the
signal occurs in the treated area, its beneficial effects can be perceived in distant
areas thanks to the good conductivity of the human organism to the waves
emitted by the equipment.
• ELECTROMAGNETIC POLAR BALANCE
Electromagnetic Polar Balance (EPB) is a medical-therapeutic system based on

the laws of quantum physics, which seeks to rebalance the electrical and
magnetic polarities of the body to comprehensively restore the health of the
2
person at its different levels of manifestation.
Every electromagnetic field is made up of an electrical and a magnetic aspect that

are manifested by electrical polarities - negative and positive - and by magnetic
poles - north and south - that have the same representation of yang and yin, of
the masculine. and the feminine, the active and the passive, the structural and the
functional.
In this therapeutic process, the body works as an electromagnetic field in which

the electrical is expressed, fundamentally, in the physical aspect and the
magnetic in the emotional, mental and non-physical aspects. The alterations that
occur in it, either because they originate from within or because they come from
the outside (environment), generate changes in the polarities of the organism that
are expressed as a disease.
Polar Balance therapy was developed by Doctor Francisco Ríos Álvarez, a

Colombian acupuncturist and psychologist, based on the principles of quantum
physics, the synthesis of several disciplines and the conscientious observation of
a large number of patients' processes. physiological, biochemical, emotional,
mental, etc., and its relationship with the environment that surrounds it.
The interaction between the therapist and the patient allows them to obtain the
necessary information about the alterations of their electromagnetic field at the
different levels of manifestation of their body, thus obtaining knowledge of their
state of health.
The normalization of polarities is done with acetate filters that exert their action
based on the photoelectric effect. These are small electromagnetic fields with a
specific vibratory frequency that, placed on the patient, contribute to the
rebalancing of the organism, giving the person elements that help them integrate
their individual processes and the relationship with their environment, so that they
can find the reason for being in your life.
To the extent that the Electromagnetic Polar Balance is an information

management process, the more complete the patient's medical history is and the
more knowledge the therapist has, the greater the possibilities of giving that
patient everything he needs and only what he needs. what do you need. That is
why handling a homeopathic medicine, an acupuncture needle or an allopathic
medicine, with the same criteria as working with filters, allows us to expand the
possibilities of helping patients.
Information about this at www.fundacionvanesa.org
• GINDLER METHOD
Body education system that aims to develop the sense of posture, muscle tone,
2
and movement as well as sensory acuity. It includes breathing and relaxation
practice, self-massage techniques, and mutual massage in group sessions. It is
probably the most profound of the modern systems to develop knowledge of the
body, "to be in touch with oneself" and to express oneself in a natural and true
way. Created in the 1920s by Kinesitherapist Elsa Gindler (1885-1961) from
Berlin. None of his writings have been published.
2
NEWS
News published on April 29, 2010 by universy:
THEY USE XENON GAS TO PREVENT BRAIN DAMAGE IN BABIES FOR THE
FIRST OCCASION.
― Xenon gas was successfully given to a newborn baby in an attempt to prevent

brain injury from a lack of oxygen at birth. This pioneering technique has been
developed by Professor Marianne Thoresen from the University of Bristol and
carried out at Michael's Hospital St, part of Bristol University Hospitals NHS
Foundation Trust.
They have pioneered new treatments for brain injury in babies starting in 1998
when Professor Thoresen used cooling on babies after a lack of oxygen and
showed that this technique could reduce damage to the newborn's brain.
Professor Thoresen, starting in 1995, has shown that cooling after oxygen
deprivation reduces brain injury in animal models. Clinical trials in humans have
shown that mild cooling by just a few degrees for 72 hours is a safe and beneficial
treatment. However, cooling only partially reduces disability and does not prevent
it in all babies. The search thus began for a second treatment that could be added
to cooling to further reduce disability.
Following rigorous scrutiny by the Medicines and Healthcare Authority and

regulatory approvals and other regulatory issues, the device is now cleared for
clinical trials and will be used on a minimum of 12 babies in the coming months.
Approval of this feasibility trial is the first necessary step before larger trials that
can be done in baby units on a larger scale .”
News published on May 20, 2009
ROBOTIC THERAPY FOR CHILDREN WITH CEREBRAL PALSY
MIT robotics engineers have spent decades developing robots capable of

assisting people recovering from a stroke. Lately, however, researchers are using
this knowledge to help children with cerebral palsy and other neuromuscular
disorders.
2
The devices are based on the same principle: that it is possible to reconstruct
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 be successful
because their developing brains are more malleable than those of adults and
therefore better suited to establish new connections.
The MIT team focused on improving cerebral palsy patients' ability to reach and
grasp objects. Patients shake hands with the robot through a handle, which is
connected to a computer monitor that displays functions similar to those in simple
video games.
In a typical task, the young person attempts to move the robot's handle toward a
moving or stationary target that appears on the computer screen. If the child
moves in the wrong direction or does not move at all, the robotic arm gently
guides the child's arm in the correct direction.
Krebs began his work in robotic therapy as a graduate student at MIT almost 20
years ago. In his initial studies, he and his colleagues found that it was important
for stroke patients to make a conscious effort during physical therapy. When
signals from the brain are paired with the robot's assistive movements, this helps
the brain create new connections and relearn how to move the limb on its own.
According to Krebs, although strokes kill many neurons, those remaining quickly
establish new synapses or reinforce latent synapses.
For this type of therapy to be more effective, many repetitions are required, at
least 400 in a one-hour session.
Published results from three pilot studies conducted on 36 children suggest that
patients with cerebral palsy may also benefit from robotic therapy. Studies
indicate that these therapies helped children reduce their impairments and
improve the continuity and speed of their movements.
One of these robotic machines is the LOKOMAT, it consists of a robotic walking

orthosis and a modern body weight unloading system, combined with a treadmill.
Automated operation reduces physical effort on therapists and allows for longer,
more efficient therapy sessions.
The LOKOMAT helps disabled patients to perform walking movements on a

treadmill and combines functional therapy of intensive locomotion with evaluation
and patient tools. In Galicia there are three in:
• La Merced Clinic in Pontevedra.
• FUDACE Brain Injury Foundation in Lugo.
2
• Juan Canalejo Hospital in A Coruña.
They create a robot with arms that helps disabled people imitate their
movements
http://www.lavozdegalicia.es/sociedad/2011/01/13/00031294941237629708262.
htm
Robots that give life
http://www.diariodeleon.es/noticias/noticia.asp?pkid=579190
A robot that teaches how to drive a wheelchair
http://www.elmundo.es/elmundosalud/2010/08/16/tecnologiamedica/
1281955712.html
A physiotherapist robot
http://www.hoy.es/20110303/local/caceres/robot-fisioterapeuta-
201103031337.html
News published on Saturday, November 6, 2010
IN VITRO CHILDREN PRESENT MORE RISK OF CEREBRAL PALSY. Source:

BBC World
Danish scientists say that fertility problems in parents cannot explain the risk of
cerebral palsy in children born after in vitro procedures.
Aarhus University found that couples who had trouble conceiving naturally had
similar risks to those who succeeded quickly.
However, what Danish scientists discovered is that the risk of cerebral palsy is
2
higher in babies born with the help of in vitro fertilization.
Other potential causes, such as the treatment itself, should be investigated, the
scientists say.
UK experts say that despite the low risk, the matter must be taken seriously.
The safety of the in vitro procedure, and other fertility treatments, has been
closely monitored since the birth of the first “test tube baby” in the 1970s.
As the number of in vitro babies increases, initial concerns about developmental

problems have disappeared; However, what remains high are the rates of
cerebral palsy.
There are several possible reasons, including a higher risk of complications in

multiple pregnancies, which until recently have been much more common when
the pregnancy is the product of a test-tube embryo.
Doctors had assumed that the reasons underlying infertility could play a role, but
recent studies cast doubt on this.
It's not a matter of time
The team examined a nationwide database of medical information containing

thousands of pregnancies and births, the journal Human Reproduction reported.
They compared rates of cerebral palsy in babies grouped by how long it took their
mothers to get pregnant after trying to conceive.
This period is used as a way to evaluate fertility. If the period is one year, this may
imply some type of problem, although not serious enough to prevent pregnancy.
When those who ―quickly fathered‖ were compared to those who delayed 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 the technique in

which sperm is injected directly into the egg, had nearly double the risk of cerebral
palsy compared to those parents who managed to conceive quickly.
Multiple pregnancies
As the number of in vitro babies increases, initial concerns about developmental
problems have disappeared; However, what remains high are the rates of
cerebral palsy.
The average risk was not high, approximately 1 in every 176 babies born,
although the figure represents a significant number when compared to the 12,000
2
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 allowed us to examine
whether untreated low fertility, measured by time to pregnancy, could be the
reason for an increased risk of cerebral palsy after the indicated techniques.
"Our results showed that this was not the case as, even for couples who took
more than a year to conceive, there was no statistically significant increased risk."
The researcher says parents should remember that the increased risk remains
very low.
The other suspected factor in the increase in cerebral palsy is multiple

pregnancies, which cause a greater number of problems for both the mother and
the babies, and very frequently involve premature birth.
a single embryo
The other suspected factor in the increase in cerebral palsy is multiple

pregnancies. A recent study carried out in Sweden indicates that the trend, in
recent years, of implanting a woman with one embryo instead of two as part of the
in vitro fertilization process, was reducing the number of children born with
cerebral palsy.
Professor Karl Nygren, one of the authors of that study, said the extra risk "may
have disappeared" in countries that implant a single embryo.
However, Professor Richard Fleming, of the Glasgow Center for Reproductive

Medicine, said the difficulty remained.
"It is clear that the issue persists. Although the risks are very low for babies, they
are high enough to warrant further study.
"The implantation of the single embryo will improve things, but it will not entirely
solve the problem"
2
News published on November 24, 2010.
ASPACE NOW HAS NEW ELECTROTHERAPY AND HYDROTHERAPY

EQUIPMENT FOR CEREBRAL PALSY AFFECTED.
It is the first center of its kind in Spain to have this rehabilitation system.
The Aspace Cantabria association, which cares for people with cerebral palsy,
has put into operation the new electrotherapy equipment with cutting-edge
TECAR technology and the new hydrotherapy room, to treat those affected by this
type of pathology.
The facilities, financed with 30,000 euros by the Caja Cantabria Social Projects
and which already provide service to the association's users, were officially
inaugurated this Wednesday. In this way, Aspace Cantabria becomes the first
center of its kind in Spain that has a TECAR team, a system used in the recovery
of injuries of elite athletes.
The opening ceremony was attended by the president and director of Obra Social,
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 teams develop a technology that allows local elevation of the temperature
of human tissue through the circulation of high-frequency currents.
As explained by those responsible for Aspace, the main therapeutic applications

of this equipment for the center's users are related to treatments for painful
processes of muscular and joint origin, muscle shortening, circulatory and
respiratory problems, constipation, regeneration of postoperative scars or muscle
injuries. -skeletal that present with inflammation and/or pain.
2
Aspace estimates that, with prior prescription, around 65 users treated in the
association's centers and services in Cantabria will benefit from the application of
this new therapy.
In general, this therapy is indicated in rehabilitation treatments in adults, such as

musculoskeletal injuries, joint pathologies and inflammatory processes that cause
pain in the extremities and spine.
The opening ceremony was attended by the president and director of Obra Social,
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 teams develop a technology that allows local elevation of the temperature
of human tissue through the circulation of high-frequency currents.
As explained by those responsible for Aspace, the main therapeutic applications

of this equipment for the center's users are related to treatments for painful
processes of muscular and joint origin, muscle shortening, circulatory and
respiratory problems, constipation, regeneration of postoperative scars or muscle
injuries. -skeletal that present with inflammation and/or pain.
Aspace estimates that, with prior prescription, around 65 users treated in the
association's centers and services in Cantabria will benefit from the application of
this new therapy.
In general, this therapy is indicated in rehabilitation treatments in adults, such as

musculoskeletal injuries, joint pathologies and inflammatory processes that cause
pain in the extremities and spine.
2
IN OTHER NEWS
Cold therapy prevents brain damage in babies born with little oxygen
http://www.cope.es/sociedad/24-03-10--una-terapia-frio-evita-danos-cerebro-
nuevos-poco-oxigeno-152399-1
Magnesium sulfate prevents childhood cerebral palsy
http://www.elmundo.es/elmundosalud/2009/01/20/mujer/1232456918.html
New technique to save premature babies
http://noticias.terra.com/noticias/nueva_tecnica_para_salvar_a_prematuros/act22
30422
La Fe begins hypothermia treatment for neonates
http://www.diariocriticocv.com/noticias/not331279.html
They develop a technique for babies who suffered asphyxiation during birth
http://www.diariodecadiz.es/article/cadiz/738886/desarrollan/una/tecnica/para/be
bes/suffered/asphyxia/childbirth.html
Torrecárdenas develops a program for the detection of cerebral palsy
http://www.ideal.es/almeria/20090926/almeria/torrecardenas-desarrolla-
program-for-20090926.html
Arrive early
http://www.magazinedigital.com/reportajes/sociedad/reportaje/cnt_id/4123
When life is overcoming
http://www.leonoticias.com/frontend/leonoticias/When-La-Vida-Es-Superacion-
vn60624-vst216
The Wii becomes a useful tool to treat children with cerebral palsy
http://www.levante-emv.com/salud-vida/2010/11/21/convierte-herramienta-util-
2
treat-cerebral-palsy/757379.html
Games with movement serve more than just exercise
http://www.abc.com.py/nota/148626-juegos-con-movimiento-sirven-para-algo-
mas-que-el-ejercicio/
They praise virtual therapy
http://www.vanguardia.com.mx/alaban_terapia_virtual-381678.html
Health centers incorporate virtual reality as therapy for mental health

patients
http://www.que.es/barcelona/200912151925-centros-sanitarios-incorporan-reality-
virtual.html
The minibus arrives to relieve the caregiver's tensions
http://www.laopiniondemalaga.es/malaga/2009/09/30/llega-cuidabus-remedio-
tensions-caregiver/292555.html
A new technique lengthens bones up to 15 centimeters
http://www.la Verdad.es/murcia/v/20110224/comarcas/nueva-tecnica-alarga-
bones-20110224.html
Intras organizes a course to improve a system that helps recover memory
http://www.nortecastilla.es/20090226/zamora/intras-organiza-curso-para-
20090226.html
New devices to improve the quality of life of the elderly and disabled
http://www.elmundo.es/elmundosalud/2009/07/07/tecnologiamedica/
1246982758.html
Félix wants colored crutches
http://www.ideal.es/granada/20100421/costa/felix-quiere-muletas-colores-
20100421.html
The Generalitat collaborates with FUVANE in the neurorehabilitation
treatment of minors with cerebral palsy and related pathologies
http://www.elperiodic.com/noticias/80612_generalitat-colabora-fuvane-
neurorehabilitative-treatment-minors-cerebral-paralysis-related-pathologies.html
2
Operation in the Maternal so that certain cerebral paralytics can walk
http://www.malagahoy.es/article/malaga/913495/operacion/materno/para/puedan
/caminar/viertes/paraliticos/cerebrales.html
“My son asks me: Mom, when are we going to go surfing?”
http://www.lavozdigital.es/cadiz/v/20110227/cadiz/hijo-pregunta-mama-when-
20110227.html
Electrical stimulation could restore voice to mutes and improve the quality
of communication for people with cerebral palsy and other disorders
http://www.tendencias21.net/La-estimulacion-electrica-podria-devolver-la-voz-a-
los-mudos_a5900.html
New technologies are a “priority” in cerebral palsy
http://www.europapress.es/salud/asistencia-00670/noticia-confederacion-aspace-
segura-nuevas-tecnologias-son-prioridad-paralisis-cerebral-
20110301181750.html
The practice of strength exercise delays functional deterioration in children

with cerebral palsy
http://www.europapress.es/salud/asistencia-00670/noticia-ninos-paralisis-
cerebral-logran-retrasar-deterioro-funccional-practica-ejercicios-fuerza-
20110317122203.html
Therapeutic massages: “Heal” with your hands
http://www.elmundo.es/elmundosalud/2011/03/18/noticias/1300460165.html
2
ANNEXES
Article from Growth Hormone in 2010, prepared by Jesús Devesa, founder

of the Foltra Project (entire).
Introduction
Growth hormone (GH) has classically been considered a hormone with

fundamentally metabolic actions, responsible for the longitudinal growth of the
organism before sexual maturation is complete. Likewise, this hormone is
classically considered to be a product of adinohypophyseal secretion, subject to
hypothalamic regulation by GHRH and somatostatin and partially gastric
regulation (depending on intake), by Ghrelin.
In light of the data that has appeared in recent years, these concepts, although
current, must be widely reviewed since today we consider GH as a pleiotropic
hormone that plays very diverse roles in the body, which go far beyond those up
to now established.
The present article is aimed at delineating these multiple actions of GH, different
from the merely metabolic ones and those exerted at the level of the longitudinal
growth of the organism.
1 Peripheral GH system.
At present, it is perfectly known that there are very numerous tissues in which
there is GH expression, to the point that we can speak of an authentic peripheral
GH system, as our group postulated in 1999, different from the classic
somatotropic system, functional both in physiological and pathological conditions,
although the mechanisms by which this system is regulated at the tissue level are
still unknown. Its local role would be to act in an auto/paracrine manner, attending
to specific needs for cell proliferation or survival.
2
Neurotrophic effects of GH
2.1 Effects of GH on adult neurogenesis
Currently, the effects that the hormone plays as a neurotrophic factor are already
clear, either directly or via IGF-I, at least at a central level, although the
mechanism(s) by which they act in vivo are far from clear.
Recently, GH production has been demonstrated in the hippocampus, the source,

with the Subventricular Zone, of continuous Neurogenesis in the first adult, and at
this level the hormone appears in the cytoplasm of neoformed neural precursors
after brain damage induced in rats. Also at this level it has been seen that IGF-I
increases the proliferation of neural progenitors through MAPK-mediated
signaling. It seems clear then that the GH—IGF-I axis has a special significance
in the processes of adult Neurogenesis, both physiologically and in response to
brain damage. This assumption has been evidenced, indirectly, by the work of the
Katakowski group, who demonstrate that the activation of the PI3K/Akt pathway,
one of the main pathways in GH signaling through its receptor, is responsible. of
the migration of neuroblasts to damaged brain areas, probably to act in
regeneration. In fact, 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 of a central
neuroprotection system. On the other hand, there is increasing evidence that the
GH—IGF-I axis is directly involved in the regulation of brain growth, development
and myelination, so that plasticity in the CNS, considered as the set of functional
interrelationships between The three main cell types, neurons, astrocytes and
oligodendrocytes, can be modulated by GH—IGF-I, which affects these three cell
types in very diverse ways. Aberg et al. have shown that after 5 days of
administration of GH to adult hypophysectomized rats, the production of neural
precursors in the hippocampus, parietal cortex, striatum and piriform cortex
increases very markedly, while the administration of the hormone to cell lines
neural cells produce a very rapid proliferation response of these precursors...
Data from our group in rats with induced brain damage clearly demonstrate that
GH treatment clearly enhances the proliferative response triggered by the
damage. The number of neural precursors in the Dentate Gyrus significantly
increases and a marked irGH appears in their cytoplasm. This data of increased
proliferation of neural precursors is also evident by the greater irGFAP detected in
this territory after damage and administration of GH. GFAP is an astrocytic
marker, which is expressed very early in neural proliferation. All of this agrees
with Christophidis' data: marked increase in the GH receptor in the suventricular
zone of the damaged hemisphere. On the other hand, the presence of irGH in
cells in the CA3 area constitutes clear evidence in favor of the important role that
the hormone can play in these processes of neurogenesis and neural repair. It is
to this area of the hippocampus that the newly formed neurons in the subgranular
2
zone of the dentate gyrus migrate, after having begun their maturation process in
the gradular zone and emitting axonal extensions towards the CA3 zone. During
their migration they are accompanied by networks of astrocytes that provide them
with the trophic factors necessary for their survival and maturation. It is, therefore,
perfectly feasible that the presence of irGH in those cells detected in CA3 is
related to this trophic role and survival. The detection of irGH in post-mitotic cells
(irBrdu+ in CA3, with morphology of neurons, but also astrocytes, supports this
assumption.
It seems clear then the positive effect that GH plays on adult Neurogenesis, both
physiological and reparative, at least in animals. Our data in patients with
acquired brain damage show that this assumption also occurs among our
species.
Experiments are not new in which it has been observed that after brain damage of
various types, changes occur in the interaction between the axons of the
damaged area and the glia cells. These mechanisms would prevent excessive
neuronal death and scar formation, while stimulating remyelination and reforming
compensatory circuits and synapses. In this sense, it must be noted that in
Neurogenesis, Astrocytes form a network in which neurons grow, but they also
release a series of key neutrotrophic factors for regeneration processes. From the
damaged brain areas, cascades of chemoattractant cytokines would be released
that would activate the migration and neural differentiation of adult progenitor
cells. The release of cytokines is one of the characteristics of the inflammatory
response, and among them are neurotrophic factors that are as important in
neurogenesis as BDNF, NGF, NT3 and NT4, also a product of secretion from the
lymphocytes themselves that go to the damaged territory.
At this point it is worth remembering, first of all, the effect that GH plays on the
processes of spinal hematopoiesis, directly and through Erythropoietin, but also
that it is a powerful cytokine capable of inducing marked neutrophilia and
activating the cascade of massive release of other cytokines in inflammatory
response processes.
Aside from everything mentioned, there is already much data indicating that GH
and IGF-I modulate a series of biochemical processes at a central level, related,
among other aspects, to the acquisition of knowledge. Data from Mora's group, in
old rats treated with GH, show that a series of amino acids involved in
neurotransmission modify their levels upward towards values of young animals:
this is the case of glutamine and arginine in the hypothalamus, diencephalon and
parieto-temporal cortex. , the same occurs with hypothalamic aspartate. On the
contrary, citrulline, a degradation product of arginine after NO synthesis,
increased in the aforementioned areas and decreased when animals were treated
with GH.
Some(s) of these GH effects may be attributed to IGF-I, either taken up from the
2
periphery or produced locally in the brain itself. Other effects shared with GH and
IGF-I can be explained by the crossing of actions between the transduction
pathways of both hormones; However, there is also much data that suggests that
the brain action of GH can be exerted directly without the participation of IGF-I,
since it acts in territories where the receptor for IGF-I is not found but the receptor
for GH is found. .
It is clear that to attribute a certain action to a factor in a certain territory, it is

essential to demonstrate that the GH receptor (GH-R) is expressed in neurons,
astrocytes and oligodendrocytes, but also in areas as significant as the choroid
plexus and hippocampus. A marked expression of this receptor has been seen in
both rodents and humans. GH-R and GH are 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 stressful stimuli, although it is unknown whether the presence of
the hormone is a product of expression of precursors and/or cells in the process
of differentiation and maturation, or a product of uptake of GH. that produced by
other cell types. In this sense, brain damage is accompanied by a significant
inflammatory response, with the massive presence of white blood cell cells that
release large quantities of all types of cytokines. Many of these play an important
role in the neural proliferative response, but among them may be GH itself,
manufactured by blood cells.
Regardless of whether the GH present at the neural level is a product of cellular

self-expression or of uptake of that produced in other brain territories, there is
clear evidence that circulating GH at the systemic level can reach the brain
parenchyma by different mechanisms. In relation to this fact, the presence of the
GH receptor in the choroid plexus suggests that it plays a role in the transport of
the hormone from the blood through the blood-brain barrier, although other
studies indicate that the entry mechanism may not be dependent on the receiver
and occur by simple diffusion. In any case, the administration of the hormone to
GH-deficient patients leads to GH levels in the cerebrospinal fluid multiplying by
up to 10, which clearly indicates that the hormone passes the blood-brain barrier.
3 What is the real role that the hormone plays at the central level?
3.1 Effects of GH on cell survival.
It was our group that for the first time demonstrated that GH is a potent cell
survival factor, at the expense of the induction of the antiapoptotic enzyme Akt.
Numerous subsequent studies have validated this mechanism of action in very
diverse cell types.
Unlike the previous approach, other authors suggest that the neurotrophic effect
of the hormone may be related to its role as a cell survival factor rather than as an
inducer of neurogenesis.
2
In several animal models of nerve degeneration, it has been proven that 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 these
data, it is feasible that the decrease in GH associated with aging may affect the
brain and contribute to its deterioration.
The hippocampus is a brain area related to episodic and spatial memory that
deteriorates with age in parallel with cognitive abilities. In this area it has been
seen 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 Wistar
rats of both sexes, while treatment with GH at doses that restore plasma IGF-I
levels to levels similar to those found in young adults is capable of avoiding this
neuronal decline.
At the present time, and in light of the data presented, we can affirm that the
important neurotrophic role that GH plays, at least at a central level, depends on
both its Neurogenesis-inducing effect and its role as a Cell Survival Factor. The
question to be resolved is: is it a direct effect of GH or a consequence of its
induction of other neurotrophic factors?
3.2 Neurotrophic effects of GH at the peripheral level
Unlike what occurs at the central level, the neurotrophic effects of GH at the
peripheral level have been less studied. Very recent data from Baudet 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 demonstrate that the
administration of the hormone is capable of inducing complete anatomical,
histological and functional regeneration of the sciatic nerve after its section in rats.
Likewise, our group has demonstrated, in humans, that GH treatment is capable
of restoring oropharyngeal innervation 15 years after it was lost after surgical
excision of a bulbar Astrocytoma.
In principle, it is reasonable to think that the hormone can play a role at the
peripheral level similar to that which we have described at the central level,
proliferation and survival. Support for this assumption is provided by the Winkler
data in a rat model with spinal cord injury, as well as by our group's data in
quadriplegic patients.
4 Other positive effects of GH
Based on the work of Rudman et al., GH replacement therapy has been proposed
in the elderly, and most of the studies carried out demonstrate the beneficial
effects of the hormone. But this therapy is not free of side effects that must be
2
taken into account: decreased insulin sensitivity and glucose intolerance, carpal
tunnel syndrome and fluid retention, although these symptoms are rare and
minor. .
4.1 Benefits at the metabolic level and on body composition
As occurs in adults with GH deficiency, in the elderly, GH replacement therapy

increases the proportion of lean mass and reduces body fat, improving muscle
strength. Experiments on animals corroborate these data.
GH replacement treatment also has beneficial effects on plasma lipid levels in old
age, since it reduces cholesterol levels and improves the HDL/LDL ratio.
Because they are already sufficiently known, we are not going to stop in this
review, in the analysis of the effect that the hormone plays 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. In fact, these
patients have a higher risk of premature cardiovascular pathology and mortality.
Numerous studies have shown that patients with GH deficiency present
endothelial dysfunction, even before the onset of frank atherosclerotic disease.
This dysfunction is reflected in a lower endothelium-dependent vasodilation, and
is possibly due to a lower production of endothelial NO, since the levels of nitrites
and cGMP in the urine are decreased.
Today it is known that the main effects of GH on the cardiovascular system are
the stimulation of cardiomyocyte growth and the production of nitric oxide (NO), a
fundamental molecule for vascular homeostasis, induced by IGF-I. GH
replacement treatment restores endothelial function, and at the same time
reduces oxidative stress, a phenomenon closely linked to endothelial dysfunction.
This improvement in endothelial function occurs regardless of the lipid profile of
the individuals. Likewise, the administration of the hormone is capable of
reversing incipient structural vascular lesions, such as thickening of the intimal
media.
The role of GH and IGF-I as modulators of myocardial structure and function is

therefore well established. In GH-deficient patients, replacement treatment is
capable of improving cardiac function, increasing left ventricular muscle mass.
Various experimental studies show the beneficial effects of GH in the treatment of
myocardial infarction in experimental animals. Thus, post-infarction GH treatment
2
in rats decreases end-systolic and end-diastolic volumes, and prevents the
decrease in ejection fraction that occurs after a myocardial infarction. Therefore, it
seems that the administration of GH after it 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

aforementioned improvement in myocardial function. The hormone is capable,
probably via induction of vascular growth factor (VEGF), of enhancing the
revascularization of a territory in which it has been lost, at the expense of
launching a powerful angiogenic effect .
5 Is GH an oncogenic risk factor?
Taken together, all the data presented point to the fact that the administration of
GH, in patients who require it, even if there is no hormone deficiency, including
that of adults, has more beneficial effects on the body than potential risk effects.
In fact, the main risk factor that has been invoked in relation to the hormone has
been its possible role as an inducer of the development of a series of tumors, an
effect that has not been demonstrated despite the hundreds of thousands of
subjects They have been treated with it for years. 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 that demonstrated that GH was
a proliferation and survival factor in human myeloid leukemia cells. This does not
mean, however, that the hormone promotes tumor development, although it could
favor it in a way consistent with its proliferative and anti-apoptotic effects and the
fact that it is practically expressed, physiologically, in all tissues. However, even
this assumption is questionable. The case of GH expressed in the periphery is
different. According to Lobi, the oncogenic properties of GH are exclusive to the
locally produced hormone which acts in an autocrine manner, since exogenously
administered GH, mimicking the effects of that secreted by the pituitary gland,
does not induce oncogenic transformations. Perhaps this is due to the fact that
exogenous and autocrine GH regulate the expression of a series of genes
differently, probably due to the different pattern with which one and the other
reach the cells: pulsatile and secreted at high concentrations in the former, and
tonic form and at low levels the second.
While exogenous GH induces a transient activation of the MAP Kinase p44/42,

the hormone produced in an autocrine manner leads to a sustained activation of
this mitogen, for at least 48 hours. These very different effects, at the oncogenic
level, of exogenous and autocrine GH are fully consistent with the large number of
neoplasms in relation to the normal population.
Very different is the effect that IGF-I, like insulin, has on the induction of abnormal
proliferations, something that currently seems to be perfectly contrasted, when
both hormones are found in high concentrations in plasma. The administration of
2
GH, due to its induction of IGF-I expression, must therefore be carried out at
doses that do not raise the rate of circulating IGF-I to levels greater than 2 SD of
the normal mean for the age group at which that belongs to the treated patient.
Conclusions
Although at the present time the administration of GH is fundamentally restricted

to patients with deficiency, in view of the data presented we believe that in the not
too distant future, the spectrum of applications will expand considerably, and
presumably the high price that currently a treatment entails will decrease
substantially, but health expenditure would also decrease by reducing sequelae
and hospitalization time.
6 What could those applications be?
Acute treatment of brain damage (whether of traumatic or hypoxic-ischemic

origin), due to its antiapoptotic effect; revascularization of territories in which blood
flow has been affected; central or peripheral nerve regeneration; acute treatment
of perinatal anoxia for prevention of cerebral palsy, reduction of bone callus
formation time in fractures, healing of torpid ulcers, etc. These would undoubtedly
be the most susceptible, and frequent, processes to be treated effectively with the
hormone. Time will tell if our approach is correct or not, although the data we
currently have rather indicates the former.
Finally, an important aspect, when starting treatment with GH, is to consider its
immediate suppression at the moment in which there is, or is suspected, an
infectious process that compromises the patient's life, such as pneumonia. .
The marked neutrophilia that the hormone induces, together with the response to
the infectious process, can set in motion a fatal cascade of massive release of
cytokines, leading to death due to multisystem failure, an exacerbated response
of the defense mechanisms against the infection. .
Summary
Growth hormone (GH) is a pleiotropic hormone, expressed at the pituitary and
peripheral level and that plays a multitude of roles in the body beyond those
known at the metabolic level and on longitudinal growth.
Among its actions, the neurotrophic effects stand out: increased proliferation of
neural precursors in response to neurological damage and increased survival,
probably in relation to a reparative response. At the cardiovascular level, the
hormone improves the lipid profile and reduces risk factors, restores endothelial
function, improves cardiac function and enhances revascularization in ischemic
2
territories. The administration of GH does not seem to be related to tumor
development, unlike what occurs with that produced in an autocrine manner.
Based on its actions, there are multiple possible preventive and therapeutic
applications of GH: acute treatment of brain damage, due to its antiapoptotic
effect; central or peripheral nerve regeneration; acute treatment of perinatal
anoxia, for prevention of cerebral palsy; revascularization of ischemic territories;
reduction of bone callus formation time in fractures; healing of torpid ulcers, as
more significant.
2
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specials. Madrid. Santillana
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treatment. Madrid. Atam-Paideia Publishing House
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locomotion and motor ontogenesis. Barcelona. Springer Publishing Verlag
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rehabilitative perspectives. Madrid: 21st century of Spain Editores
3
INTERNET ADDRESSES
HIGHLIGHTS:
Institute for the Achievement of Human Potential www.iahp.org
www.suittherapy.com
www.blyum.com / www.abrtherapy.com / www.abrhispano.blogspot.com
Nazarov www.insmicort.com
Tomatis Student Association: www.atomtomatis.com
www.votja.es
www.fundacionbobath.org
www.aspace.org/Aspace/fotos/guiapadres.pdf
www.asociacionbobath.es
www.stepofmind.com
www.sefip.org . Spanish Society of Physiotherapy in Pediatrics
www.efisioterapia.net
Peto Method or conductive education, www.aspacenavarra.org
www.alanspider.com and in Spain info@metodoessentis.com
www.theratogs.com
www.dafo.com
www.anatbanielmethod.com
www.magnetotherapy.com
www.medtronic.es
3
- www.halliwicktherapybcn.com
- www.proyectofoltra.com
- www.vegakids.es
- www.aetb.net
- http://padresconalterntivas.blogspot.com
- http://www.neurorehabilitacion.com/recursosrizotomia.htm
Likewise, information was taken from PARENT AND PROFESSIONAL BLOGS

:
www.mamaterapeuta.cl
http://brunosol.blogspot.com
http://lasonrisadenerea.blogspot.com
www.martinunproyectodevida.com
http://unblogparadaniel.blogspot.com/2008/02/parlisi-cerebral.html
www.con-esperanza.com.ar
www.convivirconespasticidad.blogspot.com
www.association-charlotte.org
http://rehabilitacionyfisioterapiaortotec.blogspot.com
http://estimulacionydesarrollo.blogspot.com
http://menudos-genios.blogspot.com

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Alternative therapies applied to

Cerebral Palsy Research study Year

2.1. Neurodevelopmental Profile

3. Therasuit- Pediatric intensive therapy

5. Tomatis Technician (Psychoaudiophonology)

5.1. What is it?

7. The NF-Walker walker/stander

7.1. What is it?

10. Katone therapy

12. Dolphin therapy.

14. Padovan Method

15. Cranio-sacral therapy

17. Sensory stimulation rooms

18. Subthreshold, threshold therapeutic electrical stimulation and

19. Selective dorsal rhizotomy

19.1. What does it consist of?

20. Rhythmic movement therapy and primitive reflexes

20.2. What is rhythmic movement therapy?

22. Neurofeedback and Biofeedback

23. Kabat Method

23.1. What does it consist of?

25. X-cell-Center Treatment for Cerebral Palsy

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

27.1. What does it consist of?

28. Israel's shoes (Step of mind)

30.1. What is it?

31. Pharmaceutical therapy

31.1. Drug for check seizures

32. Music therapy

33.1. What is it?

35. Le Métayer method

36. Schwartz Method

37. MOVE Program

38. Physiatric Treatment

38.1. Ease psychomotor development

39. Pohl method

41. Phelps method

40. Collis Method

42. Temple Fay Method

43. Deaver Method

44. Brushstroke technique – Rood Method

45. Castillo Morales Method

46. Guy Bérard method

47. Speech therapy treatments

48. occupational therapy

49. Conductive education

50. Artistic therapies: dance, theater, etc.

50.1. Therapy example artistic: Dance Ability Method

51. Jacobson method

52. Perfetti Method

54. Vestibular stimulation

55. Orofacial therapy

56. Tardieu Method

57. DEMEK method (dynamic kinesic stimulation method)

58. The Carolina Curriculum (Early Attention)

59.1. Application of colors.

60. Spider Therapy

60.1. What is it?

61. ABA method

62. PROMPT method

63. Sensory integration therapy

64. Hearing disorder treatment

65. Treatment of visual disorder