Sonja Mensch

13 General introduction and outline of the thesis Chapter 1 General Introduction 1 Health condition: SMD* Activity* 2 Body Function & Body Structure* 1 Participation* 3 Personal factors * 5 Environment Factors* 4 Figure 1. The ICF-CY model (World Health Organization., 2008) *SMD= severe multiple disabilities *1 Body function “Psychomotor retardation” Presence of problems: Wakefulness, alertness and awareness of the child Respiration functions Eating and drinking functions Motor reflexes Muscle tone Spontaneous movements Postural, balance or threatening reactions *2 Activities and *3 Participation “Unable to participate in daily life situations” Presence of problems: Exploring, watching, learning Comprehending meaning of messages in spoken language, vocalizing Maintain a body position, change body position, using hands and arms, moving around Differentiation Playing *4 Environmental factors Availability of wheelchair, health-care and financial resources Surroundings: support of other persons such as care-givers and parents *5 Personal factors Coping ICF-CY: levels. ICF-CY: levels. Treatment goals of physiotherapists will usually address the levels ‘activities’ and ‘participation’. One of the main priorities of treatment is aimedat qualityof lifeof childrenwithSMD; inaddition, urgent problems tobeaddressed are mostly pain, sputum retention, dyspnoea, and establishing the best body position for example during mealtime to avoid dysphagia/aspiration or related to comfort and prev ntion of c ntractures. Motor abilities in themselves might be considered a less relevant treatment aim in this group. Nevertheless, much time and energy, both of the children and the physiotherapists, is spent on stimulating and training specific motor abilities. Performing physical activities independently is problematic and the children