Expériences d’utilisation d’hyperinsufflation chez l’enfant polyhandicapé trachéotomisé et ventilé

Children with severe cerebral palsy requiring invasive mechanical ventilation need respiratory physiotherapy. Hyperinsufflation to improve respiratory drainage and reduce pulmonary restriction, appears relevant. Invasive mechanical ventilation by VIVO 50 allows to set an hyperinsufflation profile as well as to display insufflate volume.     

L’évaluation des bains thérapeutiques dans la prise en charge de la douleur des enfants polyhandicapés en SSR pédiatrique

Pain management for children who have severe neurological diseases (polyhandicap), in a pediatric post-acure care and rehabilitation, is daily and work frequently with palliative approach. Cares for these children, with complex illness are a multidisciplinary approach. Treatments establishment or equipment, intervention, adaptation take place with respect and comfort concern about child or adolescent dignity. For this, drug free techniques are more and more integrated in the pain management in hospitals. Balneotherapy is one of them, essentially used for orthopaedic, rhumatological or neurological diseases (hemiplegia for example). Caregivers doesn’t have specific bath for balneotherapy in our establishment, that why we put in place some bath, called “therapeutic bath” or “relaxation bath”. The impression was a better feeling of comfort and better-being on these children. This encourages us to pursue the study to evaluate the real benefits.     

Les personnes en situation de handicap complexe avec altérations des capacités de décision,d’action et de communication : retour sur la méthode

As a result of the collaborative national research on complex disability situations, which he conducted between 2010 and 2013, the author returns to method elements regarding the survey of people without access to a typical communication. The article discusses the conditions of a “semaphoric” approach (Delion, 2006) in meeting with a person with multiple disabilities with significant communicative limitations, and co-constructing possible “spaces” for discussion and observation of the shared experience of emotions.     

Health characteristics and health care trajectory of polyhandicaped person before and after 1990

IntroductionPolyhandicap is defined as the combination of severe mental impairment and severe motor deficit resulting in reduced mobility and an extreme reduction in autonomy. Over the last 20 years, care management for these patients has become more structured, however, their care pathway is not always optimal.ObjectiveTo describe/compare the health characteristics, treatment and history of the care pathways of subjects who received care before and after 1990.MethodMulticentre cross-sectional study, population studied: patients with polyhandicap: (i) causal brain damage < 3 years, (ii) severe mental impairment, (iii) motor disability, (iv) reduced mobility, (v) extreme restriction of autonomy. Data collected: clinical and medical, care procedures, treatments, history of care pathways.ResultsPatients are divided into 2 groups: 545 patients who received care after 1990 and 330 before 1990. Older patients present more recurrent urinary infections, slow transit, behavioural disorders and pain, and are prescribed a greater number of drugs. For those who received care before 1990, the age of admission to an establishment is lower, with one-third receiving a consultation dedicated to the transition from paediatric to adult teams.Discussion/ConclusionThe care sector for patients with polyhandicap makes it possible to meet their needs throughout their lives, however, there is still progress to be made in terms of formalisation and of coordinating the care pathway in order to facilitate the transition from paediatric to adult services/establishments.     

Apport de la transdisciplinarité sans perdre sa spécificité de kinésithérapeute dans la rééducation d’un enfant polyhandicapé : étude de cas

This paper presents the case study of Julie, a 5-year-old child presenting a cerebral palsy. Her motor function level is rated V on the Gross Motor Function Classification System for cerebral palsy (GMFCS) and her manual ability is rated V on the Manual Ability Classification Scale (MACS). Her communication level is rated IV on the Système de classification des fonction de communication (SCFC). Our work focuses on the major hypertonia observed with this child and which massively alter her voluntary motor skills. The analysis was led through an interdisciplinary re-education team and enabled us to consider the different roots for these contractions. Not only is the neuromotor function altered by the brain injury leading to an inflated basal state of contraction, but the sensory, psychological and emotional dimensions were also taken into account to understand Julie's behavior in relation to her exaggerated contractions. Based on this multidimensional diagnosis, a collective process led to a physiological and educative therapy in order to allow this young girl with multiple disabilities to achieve a certain level of control over her contractions. The installations, the organization of her environment and an adapted educational framework were the three areas chosen to answer the three identified dimensions of pathological contraction. Regulating her state of contraction appears as a necessary step towards optimizing her expression and accessing an improved state of relaxation and comfort – a key element to support her general development.     

Soins de la vie quotidienne dans le traitement du reflux gastro-œsophagien et prévention des fausses routes par régurgitation

The diagnostic and the treatment of the gastrooesophageal reflux are actually well codified. In people with profound neurological disabilities who cannot tell their symptoms, the evaluation of the efficiency of the treatment is difficult. The classic procedures for the medical follow up cannot be forgotten and have to take into account the troubles of the swallowing, the high intra-abdominal pressure in these population and the slow emptying of the stomach that they present. Several aids for the care of the daily living described in this article help the profound neurological disabled people to suffer less from their gastrooesophageal reflux and to avoid severe respiratory complications.     

Faire face aux situations d’urgence médicale de l’adulte polyhandicapé : un casse-tête permanent pour les équipes soignantes dans les établissements médicosociaux

Emergency, for a multi-handicapped person, is a critical situation in which the risk of adverse consequences could lead to a state of distress. In the medical-social sector, this is a recurring situation and a source of anxiety for caregivers. Managing urgent situations is even more difficult with the adult multi-handicapped than with the children. These episodes are energy draining and, when they occur again and again, especially in a smaller team, they can provoke burn out, a state that can quickly become infective, severe and long lasting. In order to avoid this disastrous development, an emergency in an adult multi-handicapped patient must be anticipated and managed, not just endured as a fatality.     

Pathologies ophtalmologiques de l’enfant cérébrolésé et du polyhandicapé

For a long time, ophthalmologic and neuro-ophthalmologic pathologies have not been explored enough in polyhandicapped children. However, vision makes up for an important part in cerebral activity and in child construction. After having located the ophthalmologist and orthoptist contribution, we tried, following the anatomophysiological way of the visual impulse, to describe any pathologies and practical therapeutic behaviors. Those are described concerning eyes, optical pathways, cerebral visual functions, ocular motility and some specific situations of the disabled child. The best possible knowledge of these pathologies is essential to a therapeutic and educative intervention, respecting the child as a whole.     

Faut-il s’intéresser au sommeil des patients polyhandicapés ?

Far from superfluous, sleep recording is useful for diagnosing mechanical respiratory disorders such as Sleep Apneas. Those have an important impact on diurnal quality of life for patients with multiple disabilities: behaviour disorders, sleepiness, increased difficulty of concentration. Directed clinical examination and questioning are useful to decide whether to continue or not further investigations. Nocturnal pulse oxymetry recording is a good approach to the diagnosis. Confirmation can be achieved by sleep polygraphy. Only when doubt remains will polysomnography be considered. For the set-up of a ventilatory treatment, noninvasive PCO₂ monitoring is useful to differentiate pure OSA from global alveolar hypoventilation-associated OSA. Before setting-up a ventilatory treatment, a risk-benefit evaluation should be done: the OSA or alveolar hypoventilation treatment must improve enough quality of life sufficiently to balance the constraint of being ventilated every night.