Children's Programs

This is an individual treatment program, addressed to infants up to 18 months and their families according to the needs of each child.

The interventions and services provided by ELEPAP include the following:

General Evaluation, Diagnosis, Physiotherapy, Biofeedback, Electrotherapy, Occupational Therapy, Ergonomics, Nutritional training, Speech Therapy, Alternative Means of Communication, Support Technology, Musical Therapy, Therapeutic Swimming, Adapted Sports Activities, Therapeutic Horse Riding, Child Counseling, Parental Counseling, Neuropsychological Assessment, Pre-School Special Training and School.
Therapeutic interventions aim at the optimal functional rehabilitation methods followed indicatively:
•   Bobath,
•   Baby Bobath,
•   PNF,
•   Vojta,
•   Sensory Integration,
•   Halliwick,
•   And assessment methods such as GMFM

ELEPAP provides daily medical support
•   Doctor of physical medicine and Rehabilitation
•   Orthopedic Doctor
•   Pediatrician
ELEPAP's children are attended regularly by the following medical experts:
•   Pediatric Neurologists
•   Opthalmologist
•   Child Psychiatrist
At the clinics, children and adults are seen in the following situations:
•   For first time evaluation before joining a treatment program.
•   For re-assessment after a treatment program or other intervention.
•   Motor or other orthopedic problems examination.

Before children are enrolled in ELEPAP’s integrated programs of intervention, there is an inter-disciplinary scientific evaluation, designed to suit the age of the child, by a health care team including Doctor of physical medicine and Rehabilitation, orthopedic doctor, pediatrician, pediatric neurologist, physiotherapist, occupational therapist, speech therapist, musical therapist, special needs teacher, psychologist and social worker.
For children who are already taking part in ELEPAP’s therapeutic programs, there is a Rehabilitation Team which meets at regular intervals with all the specialists and the parents in order to set short-term and long-term goals for each child’s rehabilitation.
There is close co-operation between the medical and the other therapeutic departments of ELEPAP, in order to assess and estimate the need for orthopedic aids and adaptations.

The responsibilities of Social Services include:

•    Family Counselling.
•   Organizing and coordinating the group of parents of children who participate in the Early Education and Therapeutic Intervention Program, in collaboration with the psychological and educational department. The aim of the group is to investigate the changes in the balance of the entire family system, after the birth of the child and simultaneously to support families to gradually adapt to the new situation.
•   Participating in the Rehabilitation Team
•    Facilitating parents to deal with the social welfare and health care organizations according to the particular needs of each family.
•   Cooperating with institutions of Social Policy and Education for the smooth adjustment of the family and the child's subsequent evolutionary course.

Mission and Tasks

1.   The psychological assessment of children with neurodevelopmental disorders. The evaluation process includes measures of cognitive level and examines children’s   socio-emotional development. The evaluation findings are taken into account by the multi-disciplinary team during the setting of intervention goals for each individual case. The validity of our assessment techniques is guaranteed by a high level of clinical expertise, the constant up-dating of scientific knowledge and the use of psychometrical instruments that are adapted to the specificities and constraints of children with disabilities. Child disability in the family life-circle is viewed through a conceptual perspective which incorporates elements from cognitive psychology, systemic thinking and developmental neuropsychology.

2.   Supporting the families of children with neurodevelopmental disorders.   Counseling services for parents and siblings.   Intervention programs for disabled children and for their parents using group dynamics (in association with ELEPAP’s social workers and special educators).

3.   Co-operation with ELEPAP’s resident child psychiatrist in a continuous effort to promote the mental health of disabled children and   to facilitate the management of family stress.

4.   Co-operation with state agencies (Ministry of Education) for the implementation of school inclusion programs concerning children with neurodevelopmental disorders.

Assessment instruments:

Baley Scales of Infant Development (2nd Edition)
Leiter International Performance Scale-Revised
Stanford- Binet Intelligence Scale (4th Edition)
Children’s Apperception Test (C.A.T.)

Physiotherapy Intervention is designed to develop and improve children’s mobility and function, to promote their functional independence and to increase their participation and social interaction.

Experienced, fully-qualified, specialized pediatric physiotherapists collaborate with the families and all medical, educational and therapeutic departments to support the children in reaching their maximum potential.

Physiotherapists use a variety of techniques, incorporating fun and innovative activities (e.g., Wii)in treatment, in order to enhance motor function, to promote quality and efficacy of motor performance and to prevent impairment.

Treatment focuses on optimizing the child’s:
•   muscle tone
•   balance and coordination
•   gross motor and functional skills
•   strength
•   flexibility
•   breathing function
•   endurance and fitness

Treatment includes inspecting, adjusting and teaching safe use of walking aids, assistive equipment ( e.g., standing frames and adapted sitting ) and orthoses.

The Intervention approaches applied are:
•   NDT Bobath
•   NDT Baby
•   Vojta
•   PNF
•   Sensory Integration
•   Electrotherapy

Physiotherapy Evaluation is an integral part of the intervention and consists of a dynamic process involving daily observation and examinations, composition of assessment reports, administration of special tests and measures (e.g.,Gross Motor Function Measure GMFM, Gross Motor Performance Measure GMPM) and videotape sessions for all children at appointed time intervals.
Physiotherapy Evaluation helps to identify impairments and functional limitations, to establish the plan of treatment and to monitor the progress of each child.

Each child is regarded in a holistic way, with respect to his/ her personality and understanding of his/ her problems; therefore, treatment is individualized and designed to meet the unique needs of each child and family.

Physiotherapists provide support and instructions to every child’s family, educating the parents / caregivers on handling techniques, positioning and ways of interaction with the child, ensuring the safe integration of therapeutic goals in everyday life.
The holistic physiotherapy services provided at ELEPAP, help our children enhance their independence and their physical and emotional well-being and prepare them for an improved quality of life in adolescence and adulthood.

Biofeedback is the dual process of monitoring and making a physiological response available for shaping. It involves the use of modern electromechanical devices that quantify an individual’s bodily processes in such a way that they can be fed back to the individual in an immediate, accurate and meaningful way.
EMG Biofeedback in Neuromuscular reeducation is a specialized psycho-physiological approach. Α trial and error approach that allows the use of learning techniques in the facilitation of motor behaviors. EMG Biofeedback has shown to be a successful mode of treatment and its utmost goal in neuromuscular reeducation is the establishment of voluntary and functional neuromotor behavioral patterns.
We evaluate the improved motor performance by applying the tests:
GMFM -66 & GMFM-88 (GROSS MOTOR FUNCTION MEASURE)

It helps children with motor and other accompanying problems to reach the highest level of their functional independence physically, spiritually, psychologically and socially. Taking into account the diagnosis, age and the seriousness of the environment of the child, we use various intentional activities, with value and meaning, as games and special aids (tables, chairs, standers, splints of upper extremities) adapted for each case.

TREATMENT GOALS:

1. Improvement of sensory-motor-perceptual functions

2. Improvement of gross-fine motor skills of body’s parts especially of upper limbs

3. Education in activities of daily living (feeding, dressing-undressing, personal hygiene, transportation, communication)

4. Finding of various adaptations and types of devices that facilitate the functionality of the child at home and school

5. Use of the electronic computer as a tool for communication, therapy and education in a specially equipped space (Assistive Technology)

6. Instructions to the parents for the continuation of treatment programs at home

The specialized techniques in Occupational Therapy are based on:
1. The method of Sensory Integration

2. The Neurodevelopment method of Treatment (Bobath)

3. The TEACCH method

Occupational Therapy Evaluation is an integral part of the intervention and consists of a dynamic process involving daily observation, composition of assessment reports and administration of special tests:

-DTVP-2 (Developmental test of visual perception, second edition)
-ABC (Movement assessment battery for children-2)
-PDMS-2 (Peabody developmental motor scales, second edition)
PEDI (Pediatric evaluation of disability inventory)

Therapeutic horseback riding is the use of horses and equine-assisted activities in order to achieve goals that enhance physical, emotional, social, cognitive, behavioral and educational skills for children who have disabilities. It not only focuses on the therapeutic riding skills, but also the development of a relationship between horse and rider. It uses a team approach in order to provide treatment for the individual with the guidance of riding instructor.
Horses provide a unique neuromuscular stimulation when being ridden through their one of a kind movement. Horses move in a rhythmic motion that mimics the human movement of walking. While riding, the horses stride acts to move the rider's pelvis in the same rotation and side-to-side movement that occurs when walking. The horses adjustable gait promotes riders to constantly adjust the speed to achieve the desired pelvic motion while promoting strength, balance, coordination, flexibility and confidence.

One does not have to ride to achieve the desired effects of therapy. Horses can act as an aid by giving those with disabilities a companion to care for. Grooming such as brushing, bathing, and currying aid in joint range of motion and have a relaxing and calming effect.
Benefits

The amount of benefit gained through therapeutic riding differs from person to person based on many factors such as the type of disability, severity of disability, motivation of the rider and connection between horse and rider. Unlike exercises machines that only focus on one muscle group at a time and do not use natural body movements, riding forces the rider to make use of the entire body to steer, control, adjust the horse and maintain balance. Because horses require not only physical skill but also cognitive skill for achievement, riding reveals the strengths and weaknesses of the rider. While most traditional therapeutic techniques often reach a plateau where the patient may lose motivation, the pleasure and excitement of riding acts to encourage patients to work through the pain and discomfort. The act of accomplishing something many able-bodied people are afraid to try is a benefit to those with disabilities in itself.

Benefits
Physical

Improved balance and muscle strength
Improved coordination and faster reflexes
Increased muscular control
Improved postural control
Decreased spasticity
Increased range of motion of joints
Stretching of tight or spastic muscles
Increased endurance and low-level cardiovascular conditioning
Stimulates Sensory integration
Improved visual-spatial perception
Improved gross and fine motor skills

Psychological

Improved self-confidence
Increased self-esteem and self image
Development of patience
Emotional control and self-discipline
Expansion of locus of control
Improved risk-taking abilities
Sense of normality
Socialization and improved interpersonal skills
Increased perception of quality of life and life satisfaction
Stress reduction

Τhe Halliwick Method (now Concept) was developed in 1949 by James and Phyl McMillan to teach swimming to disabled people.

Swimmers are taught on a one-to-one ratio of instructor to swimmer, until the time when complete independence is achieved. The swimmer instructor pair becomes a unit within a group activity, so that the swimmer gains the advantages of social interaction with his peers, whilst at the same time enjoying the unobtrusive but constant attention of an individual instructor. Through the medium of games appropriate to age and ability, groups are made aware of the properties and behaviour of water and of how to control their own imbalance problems.
The giving of correct support by the instructor enables the swimmer to experience mobility possibly not experienced on land. After the initial mental adjustments to water are made and balance control principles are learned, the swimmers reach a stage where they are prepared to disengage from instructor contact. Now, perhaps for the first time in their lives, they can experience complete independence of movement.
Swimmers are taught how to maintain a safe breathing position; how to regain such a position from any other position; and how to control exhalation whenever the face is immersed in water.
They are made familiar with all conceivable body rotations and learn how to initiate, control, and arrest such rotations at will.
The powers of upthrust, turbulence, and impedance to movement are studied, together with metacentric effects. The result is a secure swimmer whose confidence is based upon sound knowledge of water and the ability to control his / her own movements in water.

In the department of Assistive Technology, trained Occupational Therapists utilize to the maximum extent possible the modern technological equipment (switches) and special software (The Grid, series Blob, Press to play) for:
-The sensory-motor-perceptual development of children
-Training for independent handling of a computer in a manner tailored to the needs of each child
-The improvement of children’s communication ability
- The use of the computer as an alternative means of writing

In a specially designed area, the intervention is a valuable source of sensory experience, useful for a wide variety of ages and diagnoses of children, which leads to relaxation, pleasure and stimulation of senses. In addition, the area offers opportunities for the development of social, cognitive and motor-functional abilities as it is the ideal environment to encourage movement, expression, exploration, creative and imaginative play.

Music therapy is part of ELEPAP’s holistic approach to intervention in order to make the most of children’s full potential. Music therapy helps children to express their emotions and provides them with opportunities for relaxation and stress relief. It promotes children’s mental balance and ensures the development of imaginary thinking and the growth of communication skills.
The department of music therapy provides the following services:

* Individual sessions of music listening, improvisation and musical play, where children assume the double role of listener and creative artist.

* Group sessions where children cultivate their sense of "belonging" to a group, understand the meaning of communication, increase their self esteem and become aware of themselves as physical and social entities.

* Theatrical and musical improvisation games (according to the Orff system) in co-operation with the department of early therapeutic and educative intervention.

* Interdepartmental cooperation to assure a specific, individualized intervention program for each particular child.

*Combining means of artistic expression, where musical activities coexist with other types of aesthetic creativity (painting, collage or clay. )
This program is implemented in cooperation with the Social Services’ department).

We offer services to preschool and school age children with speech and/or language disorders of different etiology:

•   evaluation of the child’s communication skills with the use of formal and informal assessment procedures, diagnosis of any speech and/or language disorders and planning of individual therapeutic interventions.

•   evaluation and treatment of swallowing disorders and oral feeding difficulties

•   training children and their caregivers in the use of alternative and augmentative ways of communication. With the use of Alternative & Augmentative Communication (AAC) and the use of Assistive Technology, the individual acquires a new means of communication or he/she supports his/her verbal expression.

•   use of different therapeutic methods in order to treat speech and language problems and to facilitate the child’s communication skills.

•   therapeutic sessions in collaboration with other specialists from various clinical areas in order to achieve a holistic model of intervention.

•   counseling caregivers and encouraging them to participate in their child’s therapeutic program in order to achieve the best and quickest results.

Sport Activities can play a key role in the lives and communities of people with disabilities, the same as it can for people without a disability. The Physical activity and sport participation result in improved functional status and quality of life.
A great many sporting activities that can be used for rehabilitation and recreation have become possible for disabled people. Adapted sport is increasingly being used as treatment complementing the conventional methods of physiotherapy. Participating in adapted sports and games gives an individual the opportunity to become physically fit, develop hobbies, become more active, learn leisure time skills, and undergo positive social and group experiences.
Τhe following adapted sporting activities are included in the program of the department of Remedial Physical Education of ELEPAP.

BOCCIA

Boccia is a traditional recreational sport. In 1984 it became a Paralympic sport. It was originally designed to be played by people with cerebral palsy but now includes athletes with other severe disabilities affecting motor skills. Boccia originated in Greece. Originally, big stones were used to throw at a stone target. Boccia is derived from the Latin word for ball – bottia. Boccia is governed by the Cerebral Palsy International Sports and Recreation Association (CPISRA).

Boccia can be played by individuals, pairs, or teams of three and all events are mixed gender. The aim of the game is to throw leather balls – coloured red or blue (what each side gets is determined by a coin toss) - as close as they can to a white target ball, or jack.

BOWLING
Bowling is one of the most popular indoor sports for the handicapped because it can be enjoyed by almost everyone, regardless of the extent of physical disability. The sport is a lifetime sport with great therapeutic potential. It requires poise, balance, accuracy, synchronization of movements of the upper and lower parts of the body. It can be an interesting way to develop body awareness: to strengthen muscles in the arms, legs, and trunk and to improve coordination and body control.

WHEELCHAIR BASKETBALL

Wheelchair basketball is considered one of the major disabled sports practiced. Wheelchair basketball sees tremendous competition and interest on the international level and is included in the Paralympic Games.

Wheelchair basketball, based on the sport of basketball, introduces some adaptations to reflect the use of the wheelchair in the game, and to harmonize the different levels of disabilities players have. Wheelchair basketball is played by boys and girls and helps develop coordination as the disabled person has to propel the wheelchair and learn to pass, catch, and intercept the ball.

Following programs are addressed to recurrent visitors. Children and families residing in the province, far from the six branches of ELEPAP, are encouraged to visit any of the facilities to allow our staff to keep track of their progress. Families with their children visit ELEPAP regularly for medical follow-up and a integrated therapeutic program.

By the end of the school year, children of the Public Special Schools and Kindergartens, operating in ELEPAP’s facilities, attend a daily recreation program, musical performances and adapted sports. The transportation of children takes place either by the school –busses of ELEPAP, or by their parents.

All ELEPAP centres are hosting and supporting the operation of special needs schools of the Ministry of Education covering Kindergartens and Elementary Schools.