Pediatric physiotherapy is the specialized physiotherapy that helps children to achieve their optimal physical development in gross motor development field.
What is that? The main purpose of paediatric physiotherapy is to assist children in overcoming physical disabilities.
When I say disability that means a lack or impairment of a particular capability or skill.
So, Paediatric physiotherapy is concerned with the development and health of infants, children and adolescents.
It focuses on the reduction of pain and achievement of gross motor milestones in order to aid function and development throughout growth.
The main purpose of paediatric physiotherapy is to assist children in overcoming physical difficulties interfering with their ability to function at home, school or on the sporting field.
Treatments will vary depending on the age of the child and the goals of intervention.
Physiotherapists who are specialized in working with children are known as pediatric physiotherapists.
Pediatric physiotherapists have specialist knowledge in the movement, development and disabilities or deviations that are likely to affect a baby and growing child and treat from 1 day-old babies to abolescents.
Children are not small adults and they are built differently, move differently and think differently.
By this meaning pediatric therapists encourage children to move to the best of their abilities through play and age appropriate fun and instruction.
What does a pediatric physiotherapist do?
As I already mentioned, Paediatric Physiotherapists are movement specialists for babies, children and adolescents. Paediatric physiotherapists are experts in child development, particularly in relation to the development of movement.
Movement is a very important aspect of development for babies and children. Movement allows babies and children to explore their bodies and how they work.
movement gives the child the ability to explore their environment and all the things in their world because – being able to move easily and successfully– is essential for learning and growing.
Pediatric physiotherapy, aims to improve a child’s movement abilities through the use of methods such as movement training, strengthening, exercise, stretching, intensive therapy programmes, adapted equipment, motor learning and play as well as education.
Pediatric physical therapy differse from adults physiotherapy intervention from an anatomical, physiological and psycological point of view.
In pediatric rehabilitation its believed that to treat children efficiently we must consider all these parametres. Therefor pediatric physiotherapists are higly skilled proffesionals, who use the latest assesment tools and interventions to devise quality programs to achieve a child’s goals in every field that is required.
How pediatric physiotherapy help your child?
In pediatric rehabilitation field of physical therapy, an early intervention, concerns children with neurokinetic disabilities or neurodevelopmental delays, as well as sensory impairments related to hearing and vision.
Pediatric physiotherapy rehabilitation also helps children with biomechanical, positional and sports injuries and other multiple issues that can be helped from this type of intervention.
Chronic neurological deseases like syndromes, cerebral palsy, developmental coordination disorders, belongs in this field of physical therapy intervention.
Treatment may involve soft tissue massage, mobilisation, stretching, specific therapeutic exercises and posture education.
Your child’s treatment may include direct hands on physiotherapy and education about your child’s condition. Also treatment includes activities or exercises to do at home or school that will help your child’s progress.
In cases that concern neurokinetic disorders it might include trial and prescription of specialised orthotics, splints or equipment to support your child’s development. In these cases pediatric physiotherapists cooperate to other health professionals and support providers for the best results.
Pediatric physiotherapists, in common, must find ways to involve family to their children’s therapy. I have to tell you that, children don’t usually know what is wrong and why do they follow an intervention physiotherapeutic program.
One of our goal as pediatric therapists is that children have fun and play time during the session. In this way fun and motivational factors are incorporated into functional activities to make therapy enjoyable for the kids.
Pediatric physiotherapists are trained in orthotics, prosthetics, and adaptive equipment (as the wheel chair sitting system). In addition they have expert skills in the assesment, identification and diagnosis and treatment of child development process but also on movement and function difficulties.
Pediatric physiotherapists are knowledgeable of normal and abnormal development, so they develop individualized therapy program, depending on the deficits that they have found, in every case, of the child that they treat.
Therapeutic program aims to optimize the health of the children, the ability to function and participate in everyday activities and be part of a family and community. In any case it aims to improve quality of life in our little herows.
What is the role of physiotherapy in pediatrics?
As I already mentioned there is a wide variety of acute and chronic deseases in different fields.
Pediatric physiotherapy can be related to help neurological disorders, developmental deficits, cardiorespiratory conditions and orthopedic injuries or mulfunctions and even after chemotherapy in cases of pediatric cancer. In the neurodevelopment disorder field, there is a pertain to the syndrome mulfunctions.
In all of the cases the role of the pediatric physiotherapy is to evaluate and provide treatment for delays in gross motor function. This is accomblished by developing the strength and range of motion that children need to move through their environment easily and effectively. This will be determined by the development of muscle tone, flexibility, strength, postural control, gait ability, sensory processing, balance and coordination skills.
The pediatric therapist is trained to assess motor development using standardized testing for age equivalents.
The long-term goal includes gross motor skill development solid to age with good quality to both sides of the body.
Physiotherapy improves mobility, enabling greater opportunities for improvements in function and increasing independence in pediatric rehabilitation field. But the most important is that it can reduce the risk of pulmonary complications in postoperative pediatric cardiac sergury, that researches shown an absolute risk reduction of 18.3%.
Why do kids need physiotherapy?
People usually ask why do infants or children need physical therapy? what is that is needed to do to them?
The types of deficits and problems that we treat are varied. The most common disorders of badies and children are:
1.The deficits that concern when they are slower to achieve their motor milestones, such as clowling, sitting, walk etc.
2. children that are using unusual, not normal, motor patterns to move against gravity, like W sitting(that could lead to the hipps adduction on related to pelvis control), bottom shuffling(which leads sometime to mulfunction in hips and pelvis control or limited rotation between soulders and pelvis) and toe walking(that could be the cause of falls, unbalance walking and other deficits)
3. children who are having difficulties on motor skills, such as jumping, running or playing with others on a team or under specifically orders.
4. toddlers and babies who are clumsy or uncordinated
5. children with disabilities such as cerebral palsy, Down syndrome, autism, brain injuries, cancer, muscular dystriphies, brain surgery and other simillar disorders
6. babies and children with conditions affecting their bones, joints, muscles. In this area is plagiocephally(flattened head shape), clupfoot, flat feet, overly flexible or dislocating joints and other.
7. children with rheumatological and pain conditions such as arthritis, myositis, or chronic pain
8. children who had injury or trauma who require rehabilitation to get back to their best function
9. children with rumination
10. children with cronic respiratory conditions such as cystic fibrosis, bronchiectasis or primary dyskinesia
11. premature babies under 36 weeks generational age or low birth weight babies under 1500gr
12. Newborn babies having difficulty turning their heads or not tolerating tummy time
13.Babies having flat spots on the back or side of their heads, especially after 7 weeks old
14. Babies who have difficulty with rolling, sitting, crawling and walking.
15. skoliosis
what are the techniques and the main approaches for pediatric physiotherapy?
Physiotherapists who work with babies and children do use specialized techniques to treat a broad variety of musculoskeletal, respiratory, neurological and developmental conditions.
The main techniques of the pediatric rehabilitation are
NDT(neurodevelopmental treatment) A neurodevelopmental approach to the treatment of Cerebral Palsy was established in England in 1940s by Karel and Berta Bobath: the approach continues to evolve and is based on the principle of using techniques of handling and positioning in order to inhibit abnormal postures and movements and facilitate desirable normal motor patterns of movement.
PETO ‘Not because of, but in order to’. This is the inscription above the PETO institute in Budapest since 1960. Work is based on the principle that cerebral palsied children consciously learn movement by constant practice and repetition. This learning is reinforced by the use of voice and rhythmical intention.
Portage was developed in wisconsin and aiming to teach the family of how to be able to work with their disable child and teaching activities and records their work with their child.
Doman-Delacato approach extended the premise that children must develop through the evolutionary stages of reptilion squirming, amphibian creeping, mammalian crawling to attain the primate upright gait. To this they added elements of vestibular stimulation and techniques of re-breathing. The aim is to bombard and exploit the areas of the brain that the presumed to be undamaged.
SI sensory integration therapy is a physiological, neurobiological process where parts of the nervous system work together to collect input from our surroundings through the senses Sensory integration therapy, which was developed in the 1970s by an OT, A. Jean Ayres, is designed to help children with sensory-processing problems (including possibly those with ASDs) cope with the difficulties they have processing sensory input. Therapy sessions are play-oriented and may include using equipment such as swings, trampolines, and slides.
visceral manipulation (VM) therapy re-establishes the body’s ability to adapt and restore itself to health. VM is a soft hands-on manual therapy. Underneath the pain or diagnosis is a compensatory pattern created in the body with the initial source of the dysfunction often being far from where the pain is felt.
craniosacral therapy release is about the craniosacral rhythm and it concerns neuromuscular and orthopedic disorders even from birth. Craniosacral therapy (CST) is a form of bodywork or alternative therapy that uses gentle touch to palpate the synarthrodial joints of the cranium. It is based on fundamental misconceptions about the physiology of the human skull and is promoted as a cure-all for a variety of health conditions. CST was invented in the 1970s by John Upledger, an osteopathic physician.
The most common technique that we use in pediatric rehabilitation in kinesiotherapy. After that, in specialized form of kinesiotherapy approach is:
soft splints therapy, where soft splints are used to restrict a part of the body in order to achieve others body parts to move effectivelly
prism adaptation therapy, where the vision is the main sense that gives the vital information to tha brain so the activation of the body is adapting to more normal patterns
cimt therapy, constraint induced movement therapy, concerns hemiplegic children. This approach is a form of rehabilitation therapy that improves upper extremity function. CIMT is a specialized approach used to increase the use of a limb affected or weakened as the result of a stroke or brain injury and aims at decreasing the effects of learned non-use.
Mirror therapy is a type of therapy that uses vision to treat the function in hemiplegia or the pain that people with amputated limbs sometimes feel in their missing limbs. The principle of mirror therapy (MT) is the use of a mirror to create a reflective illusion of an affected limb in order to trick the brain into thinking movement has occurred without pain, or to create positive visual feedback of a limb movement. It involves placing the affected limb behind a mirror, which is sited so the reflection of the opposing limb appears in place of the hidden limb.
omt-manual therapy is a physical treatment that may include moving joints in specific directions and at different speeds to regain movement, muscle stretching, passive movements of the affected body part, or having the patient move the body part against the therapist’s resistance to improve muscle activation and timing.
clinical pilates, that is related with todllers rehabilitation and muscles coordination in daily life activities
which can be combined with eath other, or they can be apply individually.
What Will My Child Do in a Physical Therapy Session?
In almost any case, pediatric physical therapy sessions should look and feel like play. Pediatric physiotherapists engage children with fun, age-appropriate games and activities to keep them motivated and happy.
In the initial visit, the physical therapist will check the strength, development, physical condition of your child and whether they follow their age milestones.
It’s crucial to know that the treatment of children’s health problem requires different intervention depending on the variation of the deficit itself.
The most common childhood conditions depending on their age are the following.
Under 9 months of age
Positional Plagiocephaly (flattened spot on the back and side of the head)
Torticollis (Benign lump found in the neck)
Unusual foot posture
Delay in milestones e.g. rolling, holding the head up
Scoliosis
Developmental Hip Dysplasia
9 – 17 months of age
Unable to crawl
Unable to walk
Walking on tiptoes
Turned in feet
Pigeon toes or knock knees
Juvenile Arthritis
17 months – 5 years of age
Delay in gross motor milestones (not keeping up with peers)
Musculoskeletal injuries
Toe walking
Juvenile Arthritis
5 years and older
Sports injuries
Growth disorders (Severs Disease, Osgood-Schlatters Syndrome)
Scoliosis
Poor gross motor abilities
Rehabilitation post orthopedic surgery Intervention
There are many familiar childhood disorders and diseases like Cerebral Palsy, Autism, Down Syndrome, Muscular Dystrophy, Arthrogryposis, Cardio-Pulmonary Disorders, Cystic Fibrosis, Cancer and Traumatic Brain Injury.
In addition, many children present with hypotonia and developmental coordination disorder without a formal diagnosis.
Orthopedic conditions that can also be treated with PT include back pain, sports injuries, fractures, and orthopedic surgeries.
The treatment a child receives from a physiotherapist will be unique to the age of the child and the condition being treated.
Treatment for children under 17 months of age will typically involve parental education regarding positioning and purposeful play, to encourage appropriate movement patterns.
The Value of Pediatric Physiotherapy
The physical therapy in pediatrics has a significant impact on reduced utilization of health care services.
Physiotherapy increases the amount of positive health outcomes.
Pediatric physiotherapy has long term benefits to pediatric cases such as reduction in need for surgery and specialized physician services later in life, specifically for hip mobility in children with cerebral palsy. It could also reduce the burden on future use of care services.
Early intervention in pediatric physiotherapy has long-term positive input on motor development, mobility and health issues in order for children to increase their independence.
In addition, pediatric physical therapy plays a significant role in ensuring the continuation of treatment while transitioning from children to adult care.
