Upload
marion-hunt
View
213
Download
0
Tags:
Embed Size (px)
Citation preview
Normal knee anatomySymptoms and pathology of juvenile rheumatoid arthritis
Pain managementStages of development and psychosocial issues
Multidisciplinary approach
What is juvenile rheumatoid arthritis? Joint contracture
Joint inflammation
Joint damage Alteration or change in growth
Juvenile idiopathic arthritisPolyarticular JRA - typically affects 5 or more joints
Systemic onset JRA - high spiking fevers and rash
Oligoarticular JRA - typically affects 4 or fewer joints
Pauciarticular JRA - may cause eye inflammation
Jean Piaget (1896-1980)Piaget developed four stages to his theory of cognitive development:
Sensori-Motor StagePre-Operational StageConcrete Operational StageFormal Operational Stage
Pre-operational stageThe child’s thoughts become more
symbolic and they represent their world through images and words
However they do not have the skill of ‘reversibility’
They do not understand quantity, volume and number have not changed despite a change in its appearance
Concrete Operational StageChildren acquire internally
consistent (adult) logic but only in concrete situations such as problem solving
Children in this stage are able to conserve and decentrate, they may also be able to use reversibility
• Piaget’s theory has had an enormous impact on our understanding of cognitive development
CBT further developed in the 1970’s by Beck
Cognitive - Thinking and beliefs
Behavioural – Behaviours and actions
• (CBT) is tuning into emotions, challenging, negative automatic thoughts, and unlearning unhelpful habits of thinking that can leave us at the mercy of unwanted emotions
How does this relate to Tilly or her close family members?When therapists elicit and gracefully deal with
deeply felt emotional issues, treatment takes offEffective CBT reveals and deals with the tragedies
of young patients lives (Leahy 2007)Since CBT is so flexible it may be applied in a
variety of formats including individual, family and groups
The International Association of Study of Pain describe pain as “An unpleasant sensory and emotional experience which is due to actual or potential tissue damage, or which is expressed in terms of such damage”
Lev Vygotsky (1896-1934)Vygotsky felt the acquisition of
knowledge was active and socially constructed rather than a passive conditioning
He believed that social interaction played a vital role in cognitive development firstly on a social level (between child and the world) and then on a individual level (internally)
Culture teaches children both what and how to think, through the acquisition of knowledge via intellectual tools
Since much of what children learn is through interaction, Vygotsky believed isolation was inappropriate...guidance by a another is usually most beneficial
Woods et al described this process as scaffolding i.e. The support given by a significant other, e.g. teacher, parent or even peer
The stages of scaffoldingRECRUITMENT - gaining the child’s interestREDUCTION OF DEGREES OF FREEDOM –
breaking the task down into manageable stepsDIRECTION MAINTENANCE – encouraging and
motivating the child until they have become self-motivating
MARKING CRITICAL FEATURES – drawing attention to aspects of the problem that will help further progress
DEMONSTRATION - the tutor (parent) finishes the task off so that the learner can imitate this back in a better form
Applying the theoryLearning as collaboration- Learning together
rather than individuals...promotes critical thinking & interest
Zone of proximal Development (ZPD)- MKO (more knowledgeable other) i.e. teacher or friend. ZPD encompasses the tasks that learners cannot perform on their own but can with help from the MKO
Scaffolding- Begin with full support, gradually remove support as abilities and confidence increase
Multidisciplinary team GPConsultant paediatric rheumatologistPaediatric rheumatology nursePaediatric physiotherapistOccupational therapistPlay therapistPodiatristPharmacistPaediatric pain service