Spina bifida is a congenital disorder affecting the formation of the spine. About 75% of cases are called ‘Myelomeningocele’. The backbone and spinal canal do not completely form before birth causing a decrease or lack of function of the parts of the body controlled from or below the defect. Most defects occur in the lower lumbar or sacral areas of the back (the lowest areas of the spine) because this area is normally the last part of the spine to close during inter-utero development.
Gait Problems:When children first start walking they will often walk on their toes or with their feet turned in. This is quite normal, but usually improves by the time they are 6 or 7. Sometimes, as children grow, they develop an uneven walking pattern which can be improved.
Flat feet :are feet with a flattened arch. Flat feet can contribute to other problems such as knee and hip pain and balance difficulties.
Torticollis :or ‘Wry Neck’, describes a condition where a tight sterno-mastoid muscle in one side of the neck limits a child’s neck movements.
Cerebral palsy (CP) is an ‘umbrella’ term used to describe a group of chronic movement or postural disorders. “Cerebral” refers to the brain and “palsy” refers to a physical disorder. Cerebral palsy is caused by faulty development of or damage to motor areas in the brain, causing disruption of the brain’s ability to control movement and posture.
Cerebral palsy affects approximately one in four hundred children and no two children are the same. A diagnosis of “Cerebral Palsy” covers a wide range of disability. The movement problems vary from barely noticeable to extremely severe.
The three main types of cerebral palsy correspond to injuries to different parts of the brain:
# Children with spastic cerebral palsy have increased muscle tone causing ‘stiff’ muscles. Because the stiffness is caused by problems in the brain, it tends to increase with effort or excitement.
# Children with athetoid cerebral palsy have difficulty controlling their muscles and posture. The limbs affected by athetoid cp often make unwanted movements.
# Children with ataxic cerebral palsy usually have problems with balance and the control and selectivity of movements.
Cerebral palsy can also be classified by the parts of the body affected:
# Children with quadriplegia have movement difficulties with all their limbs.
# Children with hemiplegia have problems with the movement of one side of their bodies.
# Children with diplegia have difficulties with the movements in their legs. Often they also have difficulty with fine, dextrous movements of their hands.
# Children with monoplegia have problems with just one limb.
Many children with CP are hardly affected, others have problems walking, feeding or talking. Some children manage all activities independently, whilst others are unable to sit up without support and need help with all aspects of daily living. Sometimes other parts of the brain are also affected, resulting in sight, hearing, perception, learning difficulties and epilepsy.
Co-ordination difficulties:There are many different terms used to describe co-ordination difficulties: developmental co-ordination disorder (DCD), dyspraxia, perceptual-motor dysfunction and clumsy child syndrome. Children with coordination problems often also have difficulty processing information from their sensory systems (eg vision, hearing, speech and balance). This is known as Sensory Integration Dysfunction (SID).
Mbr> Examine your child to establish the nature of their difficulties, which may include:
# delay in reaching their milestones such as sitting, crawling, standing and walking
# poor balance and a difficulty standing on one leg, hopping or jumping
# difficulty with ball activities such as throwing, catching, kicking
# an inability or difficulty riding a bicycle
# often bumping into people or falling or tripping
# an inability to sit still
# difficulty using a knife and fork or a messy eater
# difficulty organising dressing and undressing, often putting clothes on back-to-front
# immature writing and drawing ability, delay in developing hand dominance
# difficulty with copying text from a book or blackboard
# difficulty carrying out instructions
# difficulty with organising themselves
# poor concentration and easily distracted
# they may be a loner and have difficulty with social skills
# they may be disruptive in class
# they may appear to not try or make an effort with taskAssess your child’s ability to take in, sort out and process the information from the environment. Look at whether your child is/has:
# over or under sensitive to touch, movement, sights, or sounds
# under-reactive to sensory stimulation (body whirling or crashing)
# an activity level that is unusually high or unusually low
# poor organisation of behaviour (impulsive, distractible, frustrated, aggressive)
# poor self-concept (may appear lazy, bored, or unmotivated)
These are mostly sensory integration difficulties
Although dyspraxia is not curable, a child’s gross motor skills and confidence often improves dramatically with appropriate physiotherapy treatment.
Assessment your child’s abilities and difficulties before planning a treatment programme will be necessary. This may include exercises and games to strengthen weak muscles and improve motor skills. I will also recommend beneficial activities and clubs for your child to join.
The development of the ability to move the large muscles in a coordinated manner. Activties such as rolling over, sitting, crawling, walking and jumping are all examples of gross motor skills.As with “typical” children, in Down Syndrome gross motor development follows a pattern. Generally large muscles develop before smaller ones. Thus, gross motor development is the foundation for developing skills in other areas.Development also generally moves from top to bottom. The first thing a baby usually learns is to control his head. This is one reason why it is important the baby has supervised tummy time every day. Tummy time also helps strengthen back muscles for future sitting, crawling, and walking.
Children with Down’s Syndrome attempt to compensate for their hypotonia, ligamentous laxity, decreased strength and short limbs by developing compensatory movement patterns which, if allowed to persist, often develop into orthopedic and functional problems. The goal of physical therapy is to minimize the development of the compensatory movement patterns that children with Down Syndrome are prone to develop.
Each Child is different, and some need more treatments than others – its difficult to say without an assessment and the realistic goals
Erb’s Palsy, also known as brachial plexus paralysis, is a condition involving damage to the nerves that supply the arm in a baby. Damage to the nerves usually occurs as a result of trauma sustained during a difficult delivery and childbirth. The severity of symptoms may vary according to the amount of nerve damage sustained ranging from mild weakness to complete paralysis of movement and sensation in the arm. Potential for recovery will be dependent on the number of nerves affected and the level of damage sustained. Some children may recover fully whereas others may be left with permanent muscle weakness and loss of function.The presentation of Erb’s palsy will be individual to each child and before treatment begins a thorough assessment of the child’s range of movement, muscle strength, sensation and overall function will be required to establish appropriate treatment. This may include:
# Activities and exercises to promote recovery of movement and muscle strength
# Exercises to maintain range of movement in the joints to prevent stiffness and pain
# Exercises to promote increased awareness of the arm
# Provision of splints to prevent secondary complications and maximise function
# Advising parents on appropriate handling and positioning of the child and home exercises to maximise the child’s potential for recovery
There is no treatment, as such, that will cure cerebral palsy. The main goal of professionals who work with individuals affected by cerebral palsy is to foster as much independence for the individual as his or her impairment will allow. Individuals with seizure disorders may be effectively controlled with anticonvulsive medications. Physical therapy, speech therapy are frequently utilized to maximize participation and independence. For individuals who do not have intellectual involvement, accommodations can be made to living spaces, places of employment, and schools so that they may be included in the everyday world of business, education, and recreation. For many individuals with cerebral palsy, inclusion is more a matter or management of their disorder, rather than treatment or a cure.
Juvenile arthritis is the name given to describe arthritis which affects children. There are different types of juvenile arthritis including polyarthritis (five or more joints), pauci-articular arthritis (4 or less joints affected) and systemic juvenile arthritis (affects the internal organs as well as joints). The symptoms can develop in children at any time and may last for months or years, although most children are recovered by adulthood.
may vary in each child but are likely to include:
# Swollen, red or hot
# Joint stiffness especially in the morning
# Recurrent pain in one or more joints
# Movements of joints become more difficult
# In systemic cases rashes, fever and swollen glands
Flat feet (also known as pes planus or fallen arches), is a condition where the arch of the foot either fails to develop or collapses. This means that the sole of the foot is in contact with the floor when standing.
The arch in the foot normally develops by age 5 or 6 as the fat pad in babies is gradually absorbed and balance improves as skilled movements are acquired. In some children however, the arch fails to develop which may be a result of tightness in the calf muscles, laxity in the achille’s tendon or poor core stability in other areas such as around the hips.
Initially a child may not complain of any problems associated with their flat feet, however over time it may lead to an altered walking pattern, clumsiness, limping after long walks, and pain in the foot, knees or hips. It is therefore important that appropriate treatment commences as early as possible.
Growing pains is the term used to describe the aches and pains that children often experience during childhood. They are muscular in nature rather than affecting the joints, and usually affect the legs rather than the arms. The pain usually occurs later in the day or evening and may wake the child at night. The intensity of the pain varies but is usually resolved by the following day. It most commonly affects children between the ages of three to eight and early adolescence, particularly during a growth spurt.
The cause of growing pains is yet to be established; however it is thought to occur as a result of an imbalance between the rate of growth between bones and soft tissues.
Hypermobility syndrome is a term used to describe overly mobile joints which occurs as a result of the protein collagen being more flexible than usual due to a genetic abnormality. It is an inherited condition which varies on a spectrum of different severities, some with serious complications (e.g. Marfan syndrome) which can affect internal organs. The other end of the spectrum has milder consequences which are not life threatening such as benign hypermobility syndrome.
For some children the excessive laxity in joints and soft tissues presents with no problems, however in other cases it may lead to:
# Painful joints and muscles which may be acute or chronic # Difficulty with prolonged exercise # Swollen joints # Disturbed sleep # More prone to injury
Assessments are conducted at the clinic. A range of standardised and non-standardised assessments are used . A thorough assessment is always conducted before therapy can commence.
Hippotherapy in children —a condition caused by brain damage that effects posture and movement—is becoming increasingly popular in the U.S. Hippotherapy is both a physical therapy treatment that utilizes horseback riding to provide engaging, enjoyable, and challenging activities that can significantly improve muscle tone, posture, balance, walking abilities, and more.
The idea behind hippotherapy is that the horse’s movement provides a sense of rhythm to the rider as well as forces the rider’s torso and hips to align and move in the proper physical way. Hippotherapy for patients with cerebral palsy essentially improves rhythm and movement, encourages step spacing (horses step with approximately the same frequency as humans), and promotes normal off-horse movement by training natural motor responses.
Hippotherapy can help children with cerebral palsy on many levels. It contributes to a rider’s well being physically, psychologically, and emotionally. Some of the physical impairments that may be improved by hippotherapy in people with cerebral palsy are:
# Abnormal tone
# Impaired coordination
# Impaired communication
# Decreased mobility
# Poor posture
# Impaired balance
# Impaired limbic system function
Improvement in these areas can lead to improvement in gross motor skills (walking, standing, sitting, etc.), including motivation, attention, and arousal.
Hippotherapy is also very emotionally rewarding for children and their families. The bond that develops between a child and a horse during hippotherapy treatment is something that a child will both cherish and be motivated by. This therapeutic activity can also increase self-confidence and encourage a child’s success.
Theratogs are one of the most innovative ,versatile and progressive modalities available for physical therapy practices.Theratogs are a live in exo- muscular system for neuromotor,postural and sensory training.The system provides a versatile ,flexible approach to addressing and managing mobility, sensory input,and stability issues. Theratogs are available in India
Taping is one of the adjuncts that can be effectively to enhance Neuro developmental treatment in addressing impairments in several systems.Taping can improve range of motion , provide proprioceptive input , correct joint alignment problems , support weak muscles.
This splint was designed by Ann Mckie , an occupational therapist who worked with developmentally disabled children in northeastern Minnesota.The design for the splint was , she says divinely inspired by love for the children she served.It is made of 1.5 cm velcro -receptive ,washable neoprene .Splint is sewn rather than glued in its construction ,sized for children as young as 3 months old ,it supports more normal grasp development during the critical first year of life.