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GENERAL GUIDELINES. The following recommendations, based on Nancie Finnie's (1975, pp. 17-18) primer for parents of cerebral-palsied infants, contain clear elements of structure, engagement, nurture, and challenge and thus are made-to-order directives for Theraplay therapists working with children with cerebral palsy:
1. Impose your "talking face" in front of the baby in order to teach him "the vital skill of concentrating on one set of meaningful and associated stimuli, rather than vaguely scanning the world in general. In this way he learns to filter out confusing and irrelevant sensations and to pay attention to one problem at a time."
2. Play with the child in a way that is mutually pleasurable for both of you. "If the child is smiling and excited, he is playing and learning. Physical contact games (cuddling,.. . stroking, rubbing noses, kissing); visual games (approach and retreat of adult's face, movements of mouth, tongue, and head, hiding and reappearing); and vocal games (singing, gentle talking, lip and tongue noises, blowing and puffing air)" lead on to more active games such as clapping hands, wrestling, and rough-housing.
3. Always talk to the child. He should hear "the singsong rhythm of normal speech, and the flow of normal language." Avoid focusing on single words that he has to imitate.
4. Imitate every noise he makes-"even a burp or a chuckle." If you wait a little while and repeat the noise again, the child later on will listen for that response and smile when he hears it. "He is now playing with sounds! Still later he will make his noise in order to get you to copy, and then you are 'throwing' sounds back and forwards like a ball, with enjoyment. You can then vary the sound and he will try to follow you. . . (you are teaching him to enjoy learning to control his speech organs to make the sounds he wants). If he tries to imitate your play or your voice, repeat the procedure and wait again, so that he knows it is his turn?'
5. If the child is to be helped to complete tasks on his own, you must gauge carefully how long to let him struggle and when it is appropriate to step in. "He must be shown the task, and then helped to go through the movements with his own hands or body.. . . After he begins to move with you.. . gradually withdraw your effort, particularly at the end of a sequence so that he completes the task by himself."
6. Rather than back down for fear of a battle, maintain your position. The child with cerebral palsy both resents pressure for conformity and enjoys upsetting grown-ups. "Don't let him enjoy upsetting you (and don't relent). In the long run, it is kinder to be firm?'
7. You must be patient with the slow-to-respond child. Even though he may be unable to respond quickly, he still may be quite able to understand.
8. You must persevere even if improvement is very slow. Often signs of progress will be very small.
9. You must learn to concentrate on helping the child now rather than worrying about the future. "What is needed is a determination to help him develop to the maximum of his capabilities:' not a preoccupation with whether he will ever approximate the normal.
10. You must be firm and consistent in requiring reasonable conformity. "Disabled children must develop socially appropriate behavior like everybody else?'
11. As with any child, you must insistently make your presence felt. If the child with cerebral palsy receives "little attention, stimulation, or social contact he will tend to occupy himself with body manipulation, especially if he has partial or complete loss of vision or hearing or in some cases is severely mentally disabled?'
You should encourage interest in the environment through peek-a-boo games
and the hiding and finding of objects.
Reflection Exercise #12
Peer-Reviewed Journal Article References:
Online Continuing Education QUESTION
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