Principles of Paediatric Physiotherapy

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

Introduction

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.  

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

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 orthopaedics, congenital malformations, neurology, neuropsychiatry, breathing and prematurity. This includes developmental delay, neuromotor and/ or neuromotor problems.

Domains of treatment can include in-hospital, rehabilitation centers, outpatient clinics, and within the home environment.

Goals of treatment focus on components of the International Classification of Function, Health and Disability (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.

Following a ‘family-centered care’ (FCC) approach, 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.

Benefits of Paediatric Physiotherapy

• Improves posture and integrates reflexes of child
• Makes movement easier by training more typical pattern of movements.
• Improves gross motor skills.
• Improves functional mobility.
• Improves muscle balance and muscle strength.
• Improves balance and coordination.
• Improves range of motion.
• Improves muscle tone.
• Improved gait/gait training.
• Addresses respiratory difficulties.
• Assists in addressing learning difficulties.

Common Treatment Approaches And General Principles of Treatment

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.

Examples of Specific Treatments Approaches

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.
2. Motor Learning: Is beneficial in treating infants sufferings from cerebral palsy.
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.
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.
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.

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

Psychological aspect of Children

Child psychology knowledge, plays a vital role in treating children. A child may have lack of understanding due to mental impairment which can pose a huge challenge on a physiotherapist while creating a treatment regime.

Parent Support Groups

Parents should be instructed to join parent support groups so they can meet other parents and special need children with the specific condition of their child. The shared experiences help the parents in coping with their child's condition as they feel understood by other parents dealing with same difficulties as the group provides a safe place to talk. These groups can help the physiotherapist to direct the treatment as a larger picture can be drawn from group information accumulation.

Community Paediatric Physiotherapy

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 accesses the child's home, school or community area for any modifications to be done/advised for community area or treatment plan, in order to achieve maximal daily living activity independence in accordance to the child's educational, social and cultural needs.

Ethics And Consent in Paediatric Physiotherapy

The concept of consent in firstly, based on the respect for patient autonomy and the notion of patient being involved in the plan of treatment only after elaborate understanding of the treatment plan. A physiotherapist is required to ensure, all information is passed on to the patient without assuming, that patient has any information at all.

It is mandatory to provide all information to the patient without any bias that can influence patients decision making.

Duty of Care by Physiotherapist

Health care professional/ Physiotherapist is abide by the law to make informed clinical decision, in the best interest of the patient. A therapist must also answer all patients questions on the basis of latest scientific evidence.

Principles of Paediatric Physiotherapy Summary

• Child/ Children disorders are treated by the physiotherapist, with correct comprehensive assessment, followed by diagnosis and an efficient treatment plan.
• Assessment is conducted in the presence of parent or guardian with their informed consent.
• Peadiatric physiotherapy treatment is based on a number of hands on techniques and exercises with a goal of normalizing muscle tone, achieving normal range of motion, strength, coordination and balance. Improving posture and mobility is vital with precise understanding of child psychology.