Introduction to Paediatric Physiotherapy

Original Editor - Robin Tacchetti Top Contributors - Robin Tacchetti, Jess Bell and Kim Jackson

Introduction[edit | edit source]

Physiotherapists / physical therapists work to maintain and improve their patients' or clients' function and movement.[1] Paediatric physiotherapists work with children who experience some disruption in their development and their families. Typically paediatric physiotherapists will address motor issues, but their patients may also present with other impairments that affect cognition, language and psychosocial issues. Developmentally, children typically follow a predictable pattern of motor skills attainment, although timelines can vary. Genetic makeup, cultural expectations, caregiver practices, and interactions within the environment all have an impact on how children learn functional skills.[2]

Aims of Paediatric Physiotherapy[edit | edit source]

When working with children with physical impairments or disabilities, the overall goal of the paediatric physiotherapist is to promote independence. Physiotherapists aim to help their clients / patients achieve developmentally appropriate functional skills, decrease the impact of an impairment, impart adaptive strategies, and educate the family and caregiver to ensure carryover.[3]

Goals during paediatric physiotherapy sessions include:

  1. Promote independence
  2. Increase participation
  3. Facilitate motor development and function
  4. Improve strength and endurance
  5. Enhance learning opportunities
  6. Ease challenges associated with daily caregiving[4]

Common Paediatric Impairments[edit | edit source]

Neurodevelopmental conditions among children are on the rise. These disabilities can be related to congenital or acquired health conditions which result in temporary, permanent or progressive impairments. Depending on the disability, all or different aspects of a child's life can be affected. Some examples of childhood disabilities include:

Where Do Paediatric Physiotherapists Work?[edit | edit source]

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

  • Schools
  • Outpatient centres
  • Hospitals
  • Rehabilitation centres
  • The child's home
  • Neonatal intensive care units[5][3]

Family-Centered Care[edit | edit source]

Previously, interventions for children were based on structures and body function impairments. Recently, there has been a shift to focus on the child's participation and activities with their family. In addition, interventions have shifted from what the child cannot do to what the child can do.[6][7]

Atypical development of a child can impact the entire family. Caregivers and family members may develop feelings of vulnerability and guilt, or feel unable to care for their child.[8] However, this new model of care shifts the decision-making from the clinician to the caregivers as they are considered the experts in their child's needs and abilities.[6] [9] [10][7] Acknowledging the family's interest and values is, therefore, critical. This process provides opportunities for the families to feel empowered and increase their self-confidence as they face daily challenges.[8]

Team[edit | edit source]

In most paediatric settings, the physiotherapist will work collaboratively with other members of their team. 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 specialised medical personnel such as speech-language pathologists / therapists, occupational therapists, psychologists, social workers, teachers and physicians. The child is considered the most important member of the team.

Paediatric physiotherapists may work in the following types of teams:

  1. Multidisciplinary:
    • professionals work independently providing separate evaluations, goals and interventions specific to their discipline
    • there is generally less communication between team members
  2. Interdisciplinary:
    • team members interact with each other in relation to the evaluation and development of an intervention plan
    • interventions are typically provided by the individual provider but occasionally co-treatments occur
    • there is more communication amongst team members than in a multidisciplinary team
  3. Transdisciplinary:
    • team members provide joint evaluations, collaborate on goal development and interventions
    • one provider is the primary provider who works with family on a regular basis (they implement the intervention plan for all disciplines while consulting with other providers)
    • the primary provider is chosen based on the discipline needed the most by the child and family

** Despite which team approach is used, coordination, communication and documentation are all essential .[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 3.2 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. Eskay, K. Introduction to Pediatric Course. Plus. 2022
  5. 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.
  6. 6.0 6.1 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.
  7. 7.0 7.1 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.
  8. 8.0 8.1 Cunha RF, Costa KB, Morais RL. Family-centered care on a physiotherapy course. Fisioterapia em Movimento. 2022 Mar 25;35.
  9. Hornby G, Lafaele R. Barriers to parental involvement in education: An explanatory model. Educational review. 2011 Feb 1;63(1):37-52.
  10. 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.
  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.