Introduction to Paediatric Physiotherapy

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

Intro[edit | edit source]

Physiotherapists emphasise maintaining and improving function and movement.[1] 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.[2]

he overarching habilitation and rehabilitation goals for children with disabilities are to help the child achieve developmentally appropriate functional skills, regardless of whether these skills existed previously for the child (rehabilitative) or are to be newly developed (habilitative); prevent maladaptive consequences; mitigate the impact of impairments of the body part or structure on the child’s activities and participation; provide adaptive strategies to minimize the impacts of functional deficits; and ensure carryover into other settings through family training, support, and community integration strategies.17 Adaptive strategies can include making environmental modifications to accommodate the child, training the child to use assistive technologies and other durable medical equipment such as walkers and wheelchairs, and helping the child develop compensatory techniques. Greater access to the physical and social worlds through adaptations provides children with disabilities greater opportunities for participation and connectedness with others and can enhance their well-being.18 [3][edit | edit source]

Family Centered Care[edit | edit source]

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.[4][5]

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.[6] 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.[4] [7] [8][5]This process provides opportunities for the families to feel empowered and increase their self-confidence as they face daily challenges.[6]

Aims of Pediatric PTs[edit | edit source]

Goals of pediatric physical therapy are:

  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[9]

Where do they work[edit | edit source]

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[10][3]

Team[edit | edit source]

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.[11]

Resources[edit | edit source]

References[edit | edit source]

  1. ↑ Pagliarulo MA. Introduction to Physical Therapy-E-Book. Elsevier Health Sciences; 2021 Jan 12.
  2. ↑ Long T. Handbook of pediatric physical therapy. Lippincott Williams & Wilkins; 2018 May 17.
  3. ↑ 3.0 3.1 Houtrow A, Murphy N, Kuo DZ, Apkon S, Brei TJ, Davidson LF, Davis BE, Ellerbeck KA, Hyman SL, Leppert MO, Noritz GH. Prescribing physical, occupational, and speech therapy services for children with disabilities. Pediatrics. 2019 Apr 1;143(4).
  4. ↑ 4.0 4.1 Hielkema T, Toonen RF, Hooijsma SJ, Dirks T, Reinders-Messelink HA, Maathuis CG, Geertzen JH, Hadders-Algra M. Changes in the content of pediatric physical therapy for infants: a quantitative, observational study. Physical & occupational therapy in pediatrics. 2018 Oct 20;38(5):457-88.
  5. ↑ 5.0 5.1 Longo E, de Campos AC, Palisano RJ. Let's make pediatric physical therapy a true evidence-based field! Can we count on you?. Brazilian journal of physical therapy. 2019 May;23(3):187.
  6. ↑ 6.0 6.1 Cunha RF, Costa KB, Morais RL. Family-centered care on a physiotherapy course. Fisioterapia em Movimento. 2022 Mar 25;35.
  7. ↑ Hornby G, Lafaele R. Barriers to parental involvement in education: An explanatory model. Educational review. 2011 Feb 1;63(1):37-52.
  8. ↑ Kokorelias KM, Gignac MA, Naglie G, Cameron JI. Towards a universal model of family centered care: a scoping review. BMC health services research. 2019 Dec;19(1):1-1.
  9. ↑ Eskay, K. Introduction to Pediatric Course. Physioplus. 2022
  10. ↑ Innerbody Research. Available from: https://www.innerbody.com/careers-in-health/how-to-become-a-childrens-physical-therapist.html#:~:text=Pediatric%20physical%20therapists%20work%20in,directly%20in%20the%20child's%20home.
  11. ↑ APTA Pediatrics: Facts Sheets and Resources: Available from: https://pediatricapta.org/includes/fact-sheets/pdfs/12%20Ped%20PT%20as%20Practioner%20of%20Choice.pdf. 2012.
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