Therapy aspect

According to statistics from the Real Patronato de Discapacidad (Spanish Royal Trust for Disability), "in Spain, one of the main groups requiring rehabilitation are children: children with development problems due to congenital defects or socio-environmental maladaptation, and children or young people who have suffered accidents".

The Convention on the Rights of the Child (1989) indicates that "mentally or physically impaired children have the right to receive care, education and special training, directed at achieving self-sufficiency and active integration within society". This integration within society is the main objective of the publication of the music books in this collection, directed at people with motor dysfunction - paresthesis - in the right hand, caused by changes in the development of the encephalon and congenital malformations, vascular alterations/defects (haemorrhage, ischemia or stroke), cranial-encephalic trauma, tumours or infections (encephalitis, meningitis, abscesses, or other bacterial or acute viral infections).

In hemiparesis there is often greater distal involvement, i.e. in the hand. In the most frequent case (spastic hemiparesis), the hand has a tendency to be "clenched", frequently including the thumb. There is also an increase in pressure reflexes, i.e. a stimulus which affects the palm of the hand provokes a reflected hyperflexion in that hand. In the upper extremity the flexor muscles of the hand and wrist dominate over the extensor muscles, as well as there being hypertonus in the pronator muscles of the forearm, which causes difficulty in lying down. The shoulder also tends to be in internal rotation and approximation, these muscles dominating over the external rotators and separators. Thus, their attitude will be: flexed elbow, forearm in pronation, wrist and fingers flexed, thumb frequently included or in approximation, with difficulty in "plucking"; little development of the hand's intrinsic musculature, with absence of the palm arch (flatter), and a certain degree of cubital deviation.

A child with hemiparesis must continue to be reviewed in rehabilitation until his or her development is complete. Although the lesion has stabilised, hemiparesis has not. For example, the need for orthesis during growth or change in these hemipareses must be assessed; the need or otherwise for treatment with botulinic toxin, since in periods of growth spurt hypertonus or muscular retractions may increase. The appearance of scoliotic posture, dismetries or shortening of the extremities must be monitored; also the use of the upper extremity as, on occasions, with growth a hand which has achieved good integration is progressively forgotten, since it is more useful to use the other faster extremity with normal, detailed motor ability.

In cases like this it is much more efficient to undertake tasks which are pleasant for the patient and which require the intervention of both hands. It has been borne out that in hospitals (such as the Hospital Niño Jesús in Madrid) where there is an arts workshop class for children (consisting of drawing, ceramics and learning to play a musical instrument), greater integration of the paretic upper extremity is achieved, as well as a greater wealth of movement. The stimulus or afferences of that paretic hand which reach the brain are much more complex and richer. And finally, it is much easier to integrate these movements within activities than through purely mechanical exercises, given that this provides a whole set of benefits: emotional, sensory-motor, visual, auditory and, above all, it improves the overall self-esteem of the patient.

Inés Folgado Toranzo
Medical Rehabilitator