The ARCOS approach is designed to be comprehensive in a way that enables people to acquire understanding, skills and confidence in managing their disabilities and exploiting their ability. This entails taking sufficient time to discover the underlying causes of symptoms and trial intervention. Some of the most useful diagnostic information is provided by the client’s response to intervention. All intervention is provided by specialists.
The principles underlying treatment provided by ARCOS are made as clear as possible to the client, family and others working with them. Written recommendations and home programmes are provided, with videotape and/or photographic illustration. Carers, including relatives as appropriate, participate in therapy and training that includes supervised practice in handling.
Patients with impaired language often have concurrent disorders of sensation and movement. The most useful way to improve language and communication may be to attend first to their sensori-motor difficulties. This is certainly true for clients with a combination of physical disability, language and communication disorders caused by developmental and acquired brain injury. This may be self evident in those with conditions such as hemiplegia following stroke, tetraplegia caused by brain injury and muscle wasting and weakness arising from motor neurone disease. However, while it may be less obvious, sensory feedback is likely to be disturbed in those with learning disabilities including Autistic Spectrum Disorders (ASD) and Dyspraxia.
Assessment and treatment carried out by ARCOS explore sensory modalities available to the client and uses various modes of learning in a carefully organised and evaluated way.
Many ARCOS clients do not benefit from multi sensory input or verbal direction.
There are practical steps that can be taken to tackle eating, drinking and communication problems and the feelings of helplessness experienced by individuals and their families.
ARCOS aims to help develop function or in the case of progressive disease, maintain function for as long as possible. In both developmental conditions such as cerebral palsy and acquired disabilities e.g. traumatic brain injury (head injury), stroke or progressive conditions, it is important to delay or prevent common secondary symptoms. These include anxiety, choking and contractures caused by lack of movement.
Patients need to learn strategies to help themselves as far as possible. In the case of someone with reduced oral movement and swallowing impairment, this might include ways to keep the mouth comfortable and wet.
Adequate nutrition and hydration are important. ARCOS can provide advice on nutrition and we aim to enable individuals to enjoy eating and drinking safely. Practical guidance is provided on ways to prevent choking and deal with choking episodes should they occur. Diet management such as calorie enhancement, modified food consistency and thickening for liquids may be required. In progressive conditions, the introduction of gastrostomy (PEG) feeding that may be necessary, is discussed before it becomes a necessity.
Too often, rehabilitation begins too late, finishes early and is too little integrated into real life. It is important that all therapeutic routines and interventions are carried out in a way that reinforces beneficial experience of the patient. In order to be really effective, therapy must be integrated in to everyday life. This means not only ensuring the most appropriate posture and movement of the individual but also carefully managing their environment. For example hectic and noisy environments should usually be avoided.
The risk of aspiration pneumonia is reduced by facilitating the most normal muscle tone possible, promoting sensory feedback, physiologically normal alignment of the body for function, swallowing breathing, and voice production.
ARCOS policy is to provide information and equipment ahead of “crisis time” so the individual and their family can become accustomed to the device before they are unable to speak and have to rely on it for their communication.
|Ann’s physical disability was caused by severe brain injury. She needs a combination of handling to improve her mobility and sensation to help her swallow her own saliva. She receives therapy at the ARCOS Centre where her carers also participate in the treatment.|