Principles of Paediatric Physiotherapy

Original Editor - Niha Mulla Top Contributors - Niha Mulla, Lauren Heydenrych and Kim Jackson

Introduction[edit | edit source]

Physiotherapists who work in the field of paediatrics provide support and treatment services to the paediatric 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.   [1] [2]

While paediatric 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.

Scope of Paediatric Physiotherapy[edit | edit source]

Who do paediatric physiotherapists treat?[edit | edit source]

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. [1] [2][5]

Where do paediatric physiotherapists treat?[edit | edit source]

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. [6]

Goals of treatment[edit | edit source]

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.[7][8]

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[edit | edit source]

  • Improves posture and integrates reflexes of child[9]
  • Makes movement easier by training more typical patterns of movements.
  • Improves gross motor skills.[10]
  • Improves functional mobility.
  • Improves muscle balance and muscle strength.[11][10]
  • 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.[12][13]

Common Treatment Approaches And General Principles of Treatment[edit | edit source]

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.[14]

Examples of Specific Treatments Approaches[edit | edit source]

  1. 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. [6][15]
  2. Motor Learning: Is beneficial in treating infants sufferings from cerebral palsy.[16]
  3. 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.[6]
  4. The Margaret Rood Technique: This approach uses superficial and deep stimulation and consists of manipulations for activation or inhibition of motor activity.
  5. The temple fay technique: Normal movements patterns are activated by sequential developmental movement.
  6. 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.
  7. The Kabat - Knott - Voss Technique: Proprioceptive neuromuscular facilitation using functional movement patterns. [6]
  8. 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.[17]

Where possible, play-based therapy is incorporated to motivate the child and improve functionality. [6]

Principles of Paediatric Physiotherapy Summary[edit | edit source]

  • 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.[11]
  • 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. [11]
  • 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.

References[edit | edit source]

  1. 1.0 1.1 Burslem J, McAtasney D, McGarrity K, Old S, Sellar J, Todd G. Working with Children - Guidance on good Practice. Chartered society of physiotherapy. 2016
  2. 2.0 2.1 Mistry K. Yonezawa E. Milne N. Paediatric Physiotherapy curriculum: an audit and survey of Australian entry-level Physiotherapy programs. BMC Med Educ. 2019: 19 (109): doi: 10.1186/s12909-019-1540-z
  3. Tina Duong. Paediatric Physiotherapy Available from: https://www.youtube.com/watch?v=Ock2HTMkP9w [last accessed 6/6/2009]
  4. Physical Therapist - A Day in The Life. Available from: https://www.youtube.com/watch?v=4ykElSXlReU [last accessed 26/04/2022]
  5. Topdoctors. What is paediatric physical therapy. Available from: https://www.topdoctors.co.uk/medical-dictionary/pediatric-physiotherapy-treatment (accessed 18 April 2022)
  6. 6.0 6.1 6.2 6.3 6.4 Stuart Porter, at al. Tidy’s Physiotherapy, Chapter 8 “Paediatric Physiotherapy". 2003 Edition 13
  7. Available from Movin' Mountains Therapy Services.Paediatric physiotherapy Services. 2019
  8. Jelsma J. Scott D. Impact of using the ICF framework as an assessment tool for students in paediatric physiotherapy: a preliminary study. Physiotherapy. 2011: 97 (1) 47-54: doi: 10.1016/j.physio.2010.09.004.
  9. [https://pregma.co.uk/the-benefits-of-paediatric-physiotherapy/ Faye, N. The benefits of paediatric physiotherapy.Pregma. 2021 Available from: https://pregma.co.uk/the-benefits-of-paediatric-physiotherapy/]
  10. 10.0 10.1 Team NAPA. Paediatric physiotherapy - benefits for kids: World-renowned Napa [Internet]. NAPA. 2021
  11. 11.0 11.1 11.2 Available from Physio Experts, Physiotherapy and Rehabilitation Centre. Principles of Paediatric Physiotherapy 2019
  12. Hartley H, Cassidy E, Bunn L, Kumar R, Pizer B, Lane S, Carter B. Exercise and physical therapy interventions for children with ataxia: a systematic review. The Cerebellum. 2019 Oct;18(5):951-68.
  13. Lucas BR, Elliott EJ, Coggan S, Pinto RZ, Jirikowic T, McCoy SW, Latimer J. Interventions to improve gross motor performance in children with neurodevelopmental disorders: a meta-analysis. BMC pediatrics. 2016 Dec;16(1):1-6.
  14. The Association of Paediatric Chartered Physiotherapists. Paediatric Physiotherapy. Available from: https://apcp.csp.org.uk/content/paediatric-physiotherapy-0 (accessed 18 April 2022)
  15. [https://www.physiotherapy-treatment.com/pediatric-physiotherapy.html Das P. Pediatric Physiotherapy. Physiotherapy Treatment. 2020 Available from: https://www.physiotherapy-treatment.com/pediatric-physiotherapy.html]
  16. Morgan C, Darrah J, Gordon AM, Harbourne R, Spittle A, Johnson R, Fetters L. Effectiveness of motor interventions in infants with cerebral palsy: a systematic review. Developmental Medicine & Child Neurology. 2016 Sep;58(9):900-9.
  17. Maternik M, Krzeminska K, Zurowska A. The management of childhood urinary incontinence. Pediatric Nephrology. 2015 Jan;30(1):41-50.