Movement Physical Therapy (Stacey Braun)

 The earliest documented origins of actual physical therapy as a professional trade date back to a man by the name of Per Henrik Ling (Chartered Society of Physical Therapy). Through the years, this practice has morphed and changed until its current form in the 21st century. It is this form that is instructed at Chiang Mai University's Faculty of Associated Medical Science Physical Therapy Department to their students. And it is these students that implement their new knowledge on Hope Home's children with cerebral palsy weekly.

As illustrated by children with cerebral palsy, neurological disorders often cause increased muscle tone - or too much tightness. In the muscles of the arms and legs, spasticity results from increased muscle tone, limiting movement and joint mobility (Verschuren et al.).Therefore, the therapeutic goal of physical therapy for children with cerebral palsy is largely focused around "improving ones ability to walk or perform other functional activities" (Verschuren et al.).

Chiefly, passive stretching is the major component of the children's program at CMU. By definition, passive stretching is when "the stretch is performed by another person and the child does not actively participate"
 (Wiart et al.). Notably, this type of stretching is integral to the physical therapy for Hope Home's children. This is because the children who have cerebral palsy at the home, have severe cerebral palsy. The number of controlled muscle movements they are able to perform is extremely limited. Ergo, applied external force is required to complete any stretch.

Foremost, after arriving for our weekly session the physical therapy students started with each child's upper extremities. Initially, a gentle soft tissue massage was completed by each therapist. This was performed to loosen up the desired muscle group and to promote a convivial connection with the child.

Subsequently, each therapist then moved to performing palm extension exercises. These exercises are salient for children with cerebral palsy. For these children, the clenched fists come from the damaged brain sending improper impulses to muscles causing "excess flexion" (Soon et al.). Accordingly, the physical stretching of the palm helps relieve this tension.

Following several minutes of these types of exercises, the students shifted to bicep flexion and shoulder rotation. Overall, in our group this is commonly met with a rousing chorus of grunts, groans and tears. Due to the children's inability to communicate verbally, the reason for the crying cannot be completely understood. The child could be feeling pain resulting from their stuff muscles being elongated. Or if the child has experienced damage to their cerebral cortex, their ability to perceive  their world could be hampered (Gerztiman et al) . Therefore, the child could be perceiving a fearful situation.

Following the choir of cries, the physical therapy students focus shifted to the lower limbs. Largely, a similar routine was performed as on the upper extremities. However, the physical therapy students did preform a new type of exercise to each child's legs that was not performed on the child's arms.

Accordingly, prolonged stretching is when "positioning is used to achieve a longer duration stretch of a muscle group (Wiart et al.). Often this type of therapy is completed with the assistance of splints or braces. In respect to our physical therapy session, 3/4 leg braces allowed the physical therapy students to stretch the major lower extremity muscle groups while simultaneously assisting the child with sitting or standing. Overall, there is something exceptional about seeing a child stand who cannot do it individually. It is almost as if you can see the pride fill their eyes and confidence seep out of their pores. I do not believe there is a better education for the students than that image right there.

Not only are these children living models for the students to practice their craft on, but they are also tangible models of life lessons. Walking should not be taken for granted. Siting should not be taken for granted. Life un-assisted should not be taken for granted. Though confined by their disability - they are not defined by their disability. And that in itself may be a lesson for more than just this small student  sector of Thailand.