Beckons the Dragon - Part 4

I worked with a five year old boy suffering from spastic hemiplegic cerebral palsy. He was a boy with a dense left hemiplegia. Both his left upper and lower limbs were in a flexor pattern and had increase tone when I tried to extend them.

He has only been in the Centre for about six months. The staff reported that when he first came in, he did not speak a single word, kept wetting his pants because he did not know how to say he needed the toilet, had no voluntary control of his left upper and lower limbs and even has an incidence of epilepsy and was foaming at his mouth. The staff thought they may have pushed him over his limit and overworked him. This is something that they do with all their children to help them reach their full capabilities.

When I learnt about all this that was happening, I felt worried for the children. The staff at the Centre work the children really hard. When stretching, they tend to stretch past normal range! They sometimes stretch the knee into hyperextension and the elbow into hyperextension. This was a sight that sent shivers down my spine. These poor children, most who could not express themselves, were not able to say if they were in pain. The staff also made the children stand for extended times in wooden standing frames. While in these frames, the children had lower limb splints on. They were then strapped at the ankles and knees, to the standing frame. This promoted knee hyperextension and was again another scene that required change! Finally, the children also had upper limb splints on and were made to remain in a 4-point kneeling position for at least 30mins. Support was given at the shoulders but some of these children did not even have the strength to maintain the weight of their body. If not careful, the children’s shoulders may sublux. Again, these poor children were not able to express themselves. The children sometimes cry and the staff took crying as a form of disobedience, and punished them further by extending the therapy time.

All the children in this room, regardless of their diagnosis, went through the same schedule daily. Even if a child had low tone, the staff would still be stretching them, and stretching pass neutral! This was something that was unacceptable back home. I noted all these down and during our handover session in the final week, told the staff that they should be careful with the exercises that they prescribe to the children. I even demonstrated the different exercises and stretching to show them where they should have their hands placed to give maximum support and how far they should go when stretching (never to go beyond neutral!!!).

These are just a few of the unacceptable practices I saw while on placement in Shanghai, China. What would you have done different to me if you were on the same placement?