In speech therapy for stimulation of communication and development of speech and language.
In occupational therapy for perceptual training, for play involving perceptual motor function, for recreation, social interaction and learning to play a game involving rules and taking turns and so on.
In physiotherapy for training children with a specific diagnosis to carry out a set of exercises, for games involving gross motor activity, for swimming and activities in water, and various sports for disabled people. Circuit training groups have benefits (Blundell et al. 2003).As the aims of these different therapy groups overlap, it is possible to carry out interdisciplinary groups of two kinds:
Playgroups, including toy libraries, adventure playgrounds, special or ordinary nursery schools, opportunity groups or nurseries, are orientated to each child’s developmental levels and special problems. The therapists may advise or themselves work in the group setting, stimulating a few or occasionally all the children with play activities which involve gross motor, fine motor, perceptual and speech and language activities. The therapist may be in the playroom or nursery, relating to one child with specific problems and may or may not also bring in other children in the same activity. Classroom assistants are trained to position and handle children appropriately.
The children may all be in the same room and may or may not feel themselves to belong to the same group in all activities.
Songs, storytime, percussion band, games and music are well-known sessions when all the children carry out the same activity. Therapists are, therefore, working closely with teachers, psychologists, childcare staff, nursery nurses and nurses in the therapeutic playgroups and classrooms. Parents are often present in playgroups including therapeutic goals for their children. Children’s siblings may also participate in playgroups or games with them.
The structured group works to treat or train a specific area of function. These groups integrate the gross motor, fine motor, perceptual, speech and language activities, but with more focus on any one of these areas. This focus may be on the major disability of the children in the group, for example motor problems in cerebral palsied children. The focus may be on a specific area of function in one group session, whereas the focus will be on another area for that same group in other group sessions.
These structured interdisciplinary groups in Britain have been influenced by the ideas of Petö, Hari and the work of physiotherapist Ester Cotton (1970, 1974, 1975). Dorothy Seglow (1984), a physiotherapist, introduced mother–child groups and a teacher Titchener (1983) evaluated such a group. Many others have developed ‘Peto Groups’ in Britain (Russell & Cotton 1994). See section ‘Conductive education’ in Chapter 3 (Hari & Tille-mans 1984; Cottam & Sutton 1988; Hari & Akos 1988).
These groups may not follow the full system of the Petö approach, which involves very much more than a group session or group sessions. From studies with the staff of The Cheyne Centre for Children with Cerebral Palsy, these structured interdisciplinary group sessions for multiply disabled children were invaluable and often essential for such children (1969–1979).
Some of the main observations are:
General management of groups
Number of children. This varies according to the numbers of children in each centre, school or unit, from whom selections may be made. No matter how many children are in a group, they must be involved and preferably participating.
Staff. One staff member leads the group with another assisting her. The assistant should be from another discipline. If the children are all severely disabled, more help may be indicated. However, the adults present must be kept to a minimum, or their one-to-child relationship rather than a child-to-child relationship may occur. The leader may alternate with her assistant each week or alternate days in conducting the group.
All assistants need to work according to the leader’s action and not divert the child’s attention away from the group by private conversation with them or with each other.
Venue. The group is best done in the child’s own classroom or where there are no unfamiliar distractions and a coming and going of adults or other children.
Arrange children during the group session so that they can see the leader of the group at all times and also so that the children see each other. Semicircles or L-shaped seating arrangements are best, but the positions will change in a class with particular motor activities and walking exercises.
Length of sessions should be planned for 1–2 hours depending on the children’s ability to continue participating and the programme of work.
Frequency. Group sessions are best done daily or three times a week depending on the aims of the group programme. Some aims only require twice a week. The main object is that the children work together for not less than two or three times a week so that they know each other and develop a group dynamic.
Behaviour. If a child refuses to join in, make sure that the programme is not too difficult for him. If it is not, let him watch for a while, ignoring him. The other children may be given a particularly pleasant activity, or they may occasionally be told ‘Let’s do that again for so-and-so to try as well’. Other ideas may be offered by the parent or team members who know the child. However, if non-participation continues or if the child seems oblivious to other children and cannot imitate others, the group cannot ‘carry’ him indefinitely. He may not be ready or not suitable for group treatments, and this is not always obvious in the beginning.
Children with behaviour problems may become disruptive to the group. Hyperkinetic children may be particularly difficult. However, try a trial period of partial sessions with the group, increase to full sessions and the techniques above. Restless children may settle down and join in with the others. Finally, good selection of children and programme planning makes organised management easier.
Selection of children
The basis for selection varies and ideas are still developing. The early days of group treatment both for staff and children seem to be easier if the disparity between the children is not great. A group with children who have hemiplegia and are at the walking level and at approximately the same chronological age and have intelligence forms a group which works well. Such a group is best for inexperienced staff and for those professionals beginning group work. The hemiplegic group might enlarge itself to encompass other diagnostic types of cerebral palsies who have asymmetry. Mental levels of children may be varied. A variety of developmental levels among motor developmentally delayed children may be contained in one group. The following points influencing selection may be helpful.
Problems of children
Motor problems
Selection of children according to diagnosis is not usually helpful. Select the children according to their problems. Although it is difficult to generalise them, motor problems are usually some or all the following:
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