Principles of Pediatric Physiotherapy

[Dr. Sushanta Kumar Ghose]

Introduction
Physiotherapists who work in the field of pediatrics provide support and treatment services to the pediatric population. They understand well that children are very different from adults. These health professionals have a good understanding of typical Child Development and how this relates to body systems and functions.   



While pediatric physiotherapists use many of the generic skills of physiotherapy, they use further skills and training within the field of development and growth to treat infants through to teenagers.

Who do paediatric physiotherapists treat?
Paediatric physiotherapists are specialists in the assessment, identification, diagnosis, and treatment of disorders of movement and physiological issues. They treat children (infants up until the age of 19 years) in the areas of orthopedics, congenital malformations, neurology, neuropsychiatry, breathing and prematurity. This includes developmental delay, neuromotor and/ or neuromotor problems.

Where do paediatric physiotherapists treat?
Domains of treatment can include in-hospital, rehabilitation centers, outpatient clinics, and within the home environment.



Physiotherapy treatment is vast and extensive and can go along the life of the child as the child grows. The needs of the child change as they grow and so does the treatment plan. A physiotherapist has to access the child's home, school or community area for any modifications to be done/advised for the community area or treatment plan, in order to achieve maximal daily living activity independence in accordance with the child's educational, social and cultural needs.

Goals of treatment
Goals of treatment focus on components of the International Classification of Functioning, Disability and Health (ICF). In particular that of participation and activity performance. This is done through addressing pain management, improving strength and endurance, as well as providing the learning opportunities needed for skill acquisition.



Following the Family Centered Intervention and Early Diagnosis model, a paediatric physiotherapist will work in a team in order to treat a child. This team will comprise the family, as well as other health professionals. These professionals may include a paediatrician, neurologist, nurse, occupational therapist, psychologist, play therapist, pharmacist, nutritionist, teachers, etc.

Some benefits of Paediatric Physiotherapy

• Improves posture and integrates reflexes of child.
• Makes movement easier by training more typical patterns of movements.
• Improves gross motor skills.
• Improves functional mobility.
• Improves muscle balance and muscle strength.
• Improves balance and coordination.
• Improves range of motion.
• Improves muscle tone.
• Improved gait/gait training.
• Addresses respiratory difficulties.
• Assists in addressing learning difficulties.

While it must be noted that the benefits of physiotherapy are many, there is little high level sustaining evidence for this.

Common Treatment Approaches And General Principles of Treatment
An extensive span of treatment approaches is used by physiotherapists in the paediatric field. In each case, careful assessment determines the treatment approach and program.



Examples of Specific Treatments Approaches

• Bobath Approach: This is a neurodevelopmental treatment approach used to improve Developmental Sequences, Inhibition of abnormal patterns, facilitation of normal postural control, and use of sensory stimuli for inhibition or activation of muscle movement.
• Motor Learning: Is beneficial in treating infants' sufferings from cerebral palsy.
• Conductive education approach: A very rigorous treatment model that concentrates on all aspects of life. This is done by a 'conductor' who constantly oversees the child's activity.
• The Margaret Rood Technique: This approach uses superficial and deep stimulation and consists of manipulations for activation or inhibition of motor activity.
• The temple fay technique: Normal movements patterns are activated by sequential developmental movement.
• The Doman-Delecto technique: This technique facilitates the dormant central nervous system pathways of the brain by using consistent - repetitive movements of patterns of normal sequential developmental movement.
• The Kabat - Knott - Voss Technique: Proprioceptive neuromuscular facilitation using functional movement patterns.
• Urotherapy: Provided by a physiotherapist specializing in continence issues. These therapists concentrate on treating bowel and bladder issues through pelvic floor muscle training, neuromodulation, lifestyle changes, and behavioral modification.

Where possible, play-based therapy is incorporated to motivate the child and improve functionality.

Principles of Paediatric Physiotherapy Summary

• Children, infants to teenagers, are treated by a paediatric physiotherapist.
• Paediatric physiotherapists possess specialized knowledge and training related to growth and development, syndromes as well as diagnoses within the paediatric filed.
• A paediatric physiotherapist is able to assess, identify, diagnose and treat physiological impairments within the paediatric population.
• Peadiatric physiotherapy treatment is based on a number of hands-on techniques, exercises and interventions with the goal of addressing functional impairments including muscle tone, strength, coordination, balance and posture, mobility and achieving an optimal range of motion.
• Treatment is always performed with the ICF model in mind so that activity limitations and participation are addressed. To this end paediatric physiotherapists treat as part of a team, with the child and family as central components.

Author: Sushanta Kumar Ghosh, Physiotherapy Specialist, DIU Medical Center