Alain Jouve.
Cerebral motricity. 44 (2023) 153-158. https://doi.org/10.1016/j.motcer.2023.10.001
Mediation/Education :
The multihandicapped child, suffering from brain damage, presents two types of anomalies affecting motor control: poor regulation of muscle contractions and altered postural tone. These two motor deficits interact with each other and favor the development of orthopedic deformities. To prevent this, we must constantly seek to relax our muscles through automatic relaxation manoeuvres, the recruitment of active movements, and the use of alternating postures. In addition to these classic techniques, new therapeutic proposals are now available for children and adolescents with multiple disabilities (broader indications for botulinum toxin injections, thermoformed orthoses, etc.). These therapeutic innovations help to broaden the range of treatments available, but sometimes suffer from a lack of scientific evidence and reimbursement.
Orthopedic care for multihandicapped children in specialized establishments relies on motivated, skilled professionals. However, recruitment difficulties leading to team instability can weaken the therapeutic follow-up of children. Possible avenues for improvement include pooling the know-how of different professionals in the course of daily life (living situations that encourage expression, movement, etc.), developing specialized pediatric rehabilitation practices, and simplifying collaboration between establishments and private practitioners.
Taking into account parents’ expectations and willingness to get involved must also enrich the therapeutic follow-up of multihandicapped children. In addition to the annual individualized project, new initiatives are emerging (shared rehabilitation time, systematic consultation with parents on fitting, easier parental presence at sessions, etc.), enabling us to move from “contract” to “partnership”.
Despite the difficulties associated with medical demographics, certain treatments are becoming increasingly accessible to this population (dental care, non-invasive ventilation, etc.). The increase in the number of medical examinations offered has in turn led to the development of knowledge about multiple disabilities, as reflected in the numerous reference texts published in recent years (HAS recommendations, Espace survey, etc.).
In conclusion, some major principles can be identified: developing new partnerships and a global vision, co-constructing content and integrating new knowledge. In this respect, the conceptual framework proposed by the International Classification of Functioning, Disability and Health (ICF) can be a valuable aid.