Integrated Physical Therapy Process
Home for Disabled Babies

The Problem

What was the Situation before the initiative began?

In 2007, National Statistic Organizations showed the data of disability survey, there were about 1.8 millions of people with disabilities or about 2.9 percent of total population across Thailand. Among these numbers, just only 1,278,239 persons who have registered for disabled identity which mean they would be able to get their rights and welfare from government organizations to enhance their quality of life. And also, there are involved government agencies that provide and protect for people with disabilities who still confront their problems especially children with disabilities who are abandon, homeless, no foster care or insufficient family, including children who are at risk of abuse and harassment.
Home for Disabled Babies (Bann Fueng Fah) is one of the government agencies, which belongs to the Department of Social Development and Welfare, Ministry of Social Development and Human Security that established on November 14, 2521. Their important mission is to properly take care of the children of all kinds of disabilities from birth to 7 year-old. The physical therapists and physical therapy assistant play an important role in order to give physical therapy and rehabilitation task including providing aid equipment, co-ordination to specific physician to correct the deformity. The difficult task to manage is to improve the ability are children with severe disabilities, psychological problems due to inadequate rehabilitation staff, treatment device, and assistive devices for children with disabilities.
As above-mentioned, all those problems become an inspiration and motivation to integrate physical therapy process to enhance ability and response both physical and psychological as to need in a holistic way since the young age to all types of disabilities. For the purpose that children could do their activities of daily living as much as they can and be able to participate community activities where ever possible.

Solution and Key Benefits

 What is the initiative about? (the solution)
What is the initiative about? (What was the solution?)
Creation of New profession work
The method details of integration all fields of knowledge to improve ability of each children which the highest goal is children helping themselves as much as they can with individual disabilities as follow:
2.1 Designed a pushcart for 4 children instead of picking children up one by one with normal wheelchair from their ward to physical therapy.
2.2 Physical Therapy divided to 2 groups
2.2.1 Dependent children with disabilities
Physical therapist and Physical Therapy staffs play a main role of treatment: massage, mobilization, heat, handling, and special techniques to decrease muscle spasm, increase flexibility, relax the body and also facilitate children development such as supine lying to side lying, prone lying with head control, creeping, crawling, sitting, standing and walking which doing again and again for children memorize and learning until they can do by themselves.
2.2.2 Almost independent children
Physical therapy treatment will focus on making children more movement by themselves for example locomotion by using assistive device, using prosthetic or orthotic and enhancing their ability to move by physical therapy equipment such as bicycles, treadmill by physical therapist and staff.

Creation of new service
To save time and staffs, Bann Feung Fah coordinates with special physicians to come to the home: pediatric, orthopedic and surgery from Queen Sirikit National Institute of Child Health and Sirindhorn National Medical Rehabilitation Centre for assessing and planning treatment of individual cases once per two months. Each time physicians can come they look at 10-15 children’s cases that mean they will have more time to assess and plan the treatment, also suggesting to physical therapist and involved staff directly.

Applying new technology for physical therapy service
Practicing in a pool known as hydrotherapy, where designed new modern, antique and proper swimming pool for children with disabilities. The pool has 3 steps to go down, jet stream to make waves under water and eddy current like a spa, more than buoyancy the pool also has parallel bars to help children standing and walking in water. In the corner of the pool has a place to sit and jet stream for massaging children back and lower limbs.

Stimulating brain function and neurology system with Snoezelen is a new standard technique which mostly accepted to be good for improving brain, neurological system, and all senses across the body such as tactile, proprioceptive, visual, vestibular, taste and smell to all types of disabilities.
Furthermore, all new technology also helps improving physical and psychological development in the better way. All these creation service and treatment will make equal improvement between body and mind.

Actors and Stakeholders

 Who proposed the solution, who implemented it and who were the stakeholders?
Who proposed the solution, who implemented it and who were the stakeholders?
The main mission of the Home for disabled babies (Bann Fueng Fah) is to foster and promote the development of the children in its care to better help themselves where their disabilities cause difficult. All staff at the Home provided a service which will lead to those tasks being achieved and goals met which will enhance quality of life of the young-aged children with disabilities in their care.
Integrated physical process innovation is used so that all staff such as administrator practitioners the superintendent, head of social work and welfare, physical therapy staff, caregiver and all children with disabilities work in collaboration and networks which mean that get best quality care. All staff tried to do their best in their role because each one has an individual character that can enhance the work; Chief executive manages deals with the budget to adjust location of funds and improve environments. The human resource manager plan’s with the head of social work office to find and provide physical therapy staff whose skill set is appropriate to assist the children in their needs including co-operation from caregiver to get children ready for going for physical therapy service. Moreover, there are very important external networks from doctors and nurses at Queen Sirikit National Institute of Child and Sirindhorn National Medical Rehabilitation Centre. Their efficient working practice and staff team have brought in more spirit and willing, to work and it brings about a better outcome of children’s development.

(a) Strategies

 Describe how and when the initiative was implemented by answering these questions
 a.      What were the strategies used to implement the initiative? In no more than 500 words, provide a summary of the main objectives and strategies of the initiative, how they were established and by whom.
What were the strategies used to implement the initiative?
Working Strategy
The physiotherapy team always has seminars to update physical therapists and staff in both theory and practical practice to get the greatest outcome for children with disabilities. For instance, when special physicians visit Bann Fueng Fah, they are always asked to advise how to improve the care of the children and are encouraged to offer ideas for effective treatment techniques to staff to engage with. This helps so that if then there are any problems or suspicion of issues, they can immediately ask the physicians how to improve the situation for that child.
Children strategy
After assessing the child’s difficulties we then try them with a piece of equipment we already have and see what adaption’s need to be made to the equipment in order to assist the child. Then a suitable devise is obtained for their needs so they can be more effective as they continue their life. This is because all the children’s needs are so different and one device will not work for all children.
Equipment, Facilities and Environment Strategy
We provide modern and useful facilities, equipment and device for the children. Some of the equipment was sourced or provided by foreign organizations and volunteers in support of our work because they were not available for sale in Thailand, nor could they be delivered worldwide. Having these resources make the therapy more professional and a better quality service for the children. Furthermore, Bann Fueng Fah always adjusts and improves the building to be warm, welcoming and with a feeling of home for all children. It is also prepared for increasing the numbers of children with disabilities in the future.

(b) Implementation

 b.      What were the key development and implementation steps and the chronology? No more than 500 words
What were the key development and implement steps and the Chronology ?
Before 2007, the physical therapy management focused on manual technique and occupational therapy
In 2007 – 2008
- Visiting special physician: orthopedic surgery and rehabilitation at Queen Sirikit National Institute of child health and Sirindhorn National Medical Rehabilitation Centre was introduced once per two months. This was done because it was so difficult to get enough staff available to take the children to appointments without leaving the ward short staffed or having to reduce the number of children assessed and assisted with treatment and surgery
- Dividing children with disabilities into 2 groups: maximum and moderate assisted groups that will be better to assess, evaluate and follow up.
- Building the more modern swimming pool and appropriate to all types of children
- Co-operating with foreign volunteer in order to find and provide assistive device and physical therapy equipment from other countries.
In 2010
- Purchasing active/passive/assistive exercise cycle device. This machine also decreasing spasticity and having biofeedback for children upper and lower extremities

In 2011
- Co-operating with volunteer to provide treadmill. This machine will develop and improve ambulation.
- Improving Adventure room to simulate the physical and sensitivity development. This room has a good atmosphere which stimulates children’s performance and learning throughout the whole body especially joints of limbs, major and minor muscles and also provides multi-sensory, cognitive experiences and improvement in physical performance, psychological awareness and behavior. The fun activities that go on help children’s brain function and thought processing.
In 2012
- Becoming a placement for practicing training in pediatric physical therapy for student from Huachiew Chalermprakiet Walailak and Khonkan University. This benefits them but also our service by including a public hearing for the students and professors to give their opinion for integrating, adjusting and improving the service at Bann Fueng Fah in the future.

(c) Overcoming Obstacles

 c.      What were the main obstacles encountered? How were they overcome? No more than 500 words
What were the main obstacles encountered? How were they overcome?
Most of the physical disabilities cases we see have cerebral palsy, but many of them also have other additional difficulties such as mental retardation, hearing difficulties, vision impairments, psychological difficulties, hyperactivity or learning disabilities. These complex conditions lead to standard ways of working being more difficult and we have to tailor rehabilitation to the child and have specific staff helping them with their therapy. To improve this situation to meet the needs, the human resource management of Bann Fueng Fah did provide funds for two more physical therapist and one occupation therapist positions. Also physical and occupational therapy volunteers were accepted to help the children because their qualifications were suited to help needs of the children improving physical problem. Their knowledge, skills and service minded natures were of assistance to the needs of the children.

(d) Use of Resources

 d.      What resources were used for the initiative and what were its key benefits? In no more than 500 words, specify what were the financial, technical and human resources’ costs associated with this initiative. Describe how resources were mobilized
What were the key benefits resulting from this initiative ?
Children with disabilities
At the end of the year we found (through observing individual children’s development and by evaluation) that the initiated physical therapy integration to children lead to their better development of skills and ability by staff spending less time before the therapy work commenced. At the same time the new children who come into the home with physical problems could get physical therapy earlier because old disabled child can move on to other group training such as special education or preparing to go to school.
Human Resource
Physical therapy staffs work more efficiency and proficiently because of their renewed understand of their role and duties. They have better co-operation systems in place to work as a team. These lead the service to the more effective and beneficial to the children. The quality that is now provided brings many visitors who come to observe their work. We also have those who come on a regular basis such as physical therapy students from Huachiew Chalermprekeat, Walailak and Khonkan University. They come to practice in the field of pediatric physical therapy. The university wished them to come to Bann Fueng Fah as its deemed to be a place where experts in pediatric physical therapy can share their knowledge with the students and give them a quality learning placement This brings about the opportunity for, experienced staff to keep up-to-date with new innovation and through the process of seminar or brainstorm sessions improve their knowledge, skills and from this the children benefit.
The adjustments to the old rehabilitation building made the building become much more useful. The use of the space was utilized better. We realized this from comments made by visitors and students. All their evaluations showed it was good changes.
Being the first home to apply for funds for new technology such as hydrotherapy and sensory stimulation room (called Snoezelen) to treat our children, we became a place to visit for both other government homes and departments and private organizations. They would come and see the technology and take those points back to improve their work to benefit their client. This makes our provision and inspiration to others and helps us be more professional.
- In 2011, received an award in ‘Development of innovation service of Department of Social Development and Welfare’.
- In 2011, received consolation prize for ‘Innovation service of Office of the Public Sector Development Commission Thailand’

Sustainability and Transferability

  Is the initiative sustainable and transferable?
Is the initiative sustainable and transferable?
Integrated physical therapy process of home for disabled babies response to the need of rehabilitation of the individual child and by evaluation of their abilities and difficulties sets in place a treatment plan for their physical ability, psychological, emotional development and sets a time scale and then re assesses. The service also has been noted as meeting the ‘standard work system’ and is accepted nationally as good practice, which brings people to visit. We have been told from the number of visitors and the physical therapy student that they see good points in what we do and how we do it. Those who work in the field of disability experience good practice in the therapy they see and take it back to apply at their work weather that is persons of different age with disabilities or people with different type of people needs.
Furthermore, our work also passed the knowledge to the community based rehabilitation (CBR) in Bangkrang district, Nontaburi. We pass on our knowledge and assist them to help those in the community. The CBR have set up physical therapy section to serve all people in that area especially elderly and disabilities persons which supported and managed by Bangkrang Subdistrict Administrative Organization.

Lessons Learned

 What are the impact of your initiative and the lessons learned?
What were the lessons learned?
A form of integrated physical therapy focused on the using of our hand, brain and heart altogether to bring about the ability of the children to reach towards their full potential. This can be done with or without the help of the assistive machine and devices. We aim to give all the children in our care ways to improve by the way we look after, assess, develop, stimulation, giving treatment, and evaluation. Our hope is that doing this can improve their performance as much as they can reach. We have been successful because of the co-operation from superintendent, head of management office, head of social work and welfare office, and the staffs of physical therapy, development stimulation workers, social work team, nursing staffs and volunteers. The children have not only improved in their physical skill but also cognitively and emotionally due to the fact that all staffs are giving their best effort for the children and warmth of interaction liked parents would give. Observing our children’s improvement will give more inspiration; lift spirit’s and increase willingness of staffs to work harder for the further children in the home.

Contact Information

Institution Name:   Home for Disabled Babies
Institution Type:   Government Agency  
Contact Person:   Ms.Cheewaporn Kumjorhor
Title:   Superintendent  
Telephone/ Fax:   +(66)2582-3978 , +(66)2583-4000
Institution's / Project's Website:
Address:   78/9 Moo.1 Tivanon Bangtalad Pakkred Nontaburi
Postal Code:   11120
City:   -
State/Province:   Nontaburi
Country:   Thailand

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