Introduction to Paediatric Physiotherapy

Original Editor - Robin Tacchetti Top Contributors - Robin Tacchetti, Jess Bell, Kim Jackson and Naomi O'Reilly

Introduction

Physiotherapists emphasise maintaining and improving function and movement. Pediatric physiotherapists work with children and their families who have some disruption in the normal flow of development. Typically physiotherapists will address motor issues, however, other impairments that affect cognition, language and psychosocial issues may also be present. Developmentally, children follow a predictable pattern of motor skills attainment, although timelines can vary. Genetic makeup, cultural expectations, caregiver practices, and interactions within the environment all play a role in how children learn functional skills.

Aims of Pediatric PTs

Pediatric physiotherapists overall goals when working with children with physical impairments or disabilities are to attain developmentally appropriate functional skills, decrease the impact of the impairment, impart adaptive strategies, and educate family and caregiver to ensure carryover.

Goals during pediatric physiotherapy sessions include:

1. promote independence
2. increase participation
3. facilitate motor development and function
4. improve strength and endurance
5. enhance learning opportunities, and
6. ease challenges with daily care giving

Common Paediatric Impairments

Neurodevelopmental conditions among children is on the rise. Thi disabilities can be related to congential or acquired health conditions resulting in temporary, permanent or progressive impairments. Depending on the disability, all aspects or certain settings in in their life can be affected. Some of the common examples of childhood disabilities are the following:

• cerebral palsy
• spina bifada
• traumatic grain injury
• autism spectrum disorder
• intellectual disability
• juvenile idiopathic arthritis

Where do they work

Pediatric physiotherapists can work in a diverse group of settings including:

• schools
• outpatient centers
• hospitals
• rehabilitation centers
• the child's home
• neonatal intensive care units

Family Centered Care

Previously, interventions for children were based on structures and body function impairments. The shift in therapy is to focus on the child's participation and activities with their family. In addition, interventions are shifted from what the child can not do to what the child can do.

Atypical development of a child can directly impact the entire family. Caregivers and family members may develop feelings of vulnerability, guilt and incapacity in caring for their child. Acknowledging the family's interest and values for their child is critical as they are considered the experts for their child's abilities and needs. This new model shifts the decision from the clinician to the caregivers as they are considered the experts in their child's needs and abilities. This process provides opportunities for the families to feel empowered and increase their self-confidence as they face daily challenges.

Team

In most pediatric settings, the physiotherapist will work collaboratively as a team member. Each team is different depending on the needs and wants of the family and the child. In general, the team will include the child, parent/caregiver and other specialized medical personal such as speech-language pathologists, occupational therapists, psychologists, social workers, teacher and physicians.

There are three types of team approaches that a pediatric physiotherapist can participate in.

1. Multidisciplinary: professionals work independently providing separate evaluations, goals and interventions specific to their discipline; generally less communication between team members
2. Interdisciplinary: team members interact in regards to the evaluation and development of intervention plan; interventions typically provided by individual provider but occasional co-treatments occur; more communication amongst team
3. Transdisciplinary: team members provide joint evaluations and collaborate on goal development goals and carrying out interventions; one provider is the primary provider who works with family on a regular basis , implements intervention plan, receives consultation from other providers; primary provider based on highest need of family

** Despite which team approach is used, coordination, communication and documentation are all necessary between teams.

Resources

• Family Centred Intervention and Early Diagnosis

• Best Practice in Developmental Skills Training in Early Intervention