At my current placement I help run a childrens play group for developmentally delayed children. In this group there is one child who has a fairly severe intellectual disability and is very hard to control. Even with the parents taking part in the class he often does not follow instructions and will instead run of to do his own thing. Trying to get tis child to do want the rest of the class is takes alot of time and some things he will just never do. I had to ask myself was this patient suitable for the group treatment scenerio? In order to get him working we would have to somewhat neglect the other children who were doing the right thing, meaning that they didnt get as much benefit from the class. At the same time the group scenerio is benefitting the child through the team work and positive role models he is witnessing.
I would guess that in an individual treatment session this child would not get any more benefit as he will not like the added attention and will still refuse to do the tasks that he doesn't like. Maybe instead if an extra physio was involved in the group to work with that child in particular so the other children are not disadvantaged in anyway everyone would be happier. Otherwise we also noticed that the child preferred gross motor activities especially jumping on a trampoline, over fine motor activites. After being allowed to jump on the tramp ie during the obstacle course, the child was much more compliant with any following activites. As a result maybe changing the structure of the session by having this obstacle course just before the fine motor tasks would increase compliance? I guess the question is how much should you modify a class or the benefit of one person and when do you have to draw the line in saying that they are simply too disruptive to be in the class? Next week we will be trying the trampoline idea.
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There has been a similar situation on my current placement where a class is run regularly for NOF fracture patients. Some of these patients suffer form dementia and disrupt the class preventing it from running smoothly and making things difficult for other patients who are trying to participate. It is hard to judge whether they are benefiting from the group experience and if it is worth involving them in it. A lot of these patients do not even partake in a single exercise during the class therefore they will probably not be brought back but instead we might try doing exercises with them where they have one-on-one support.
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