Pediatric Physical Therapy

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Pediatric Physical Therapy

• Curt Phillips, MPT

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Objectives

• Identify common pediatric conditions
• Describe states of tone and one pediatric
  condition associated with each type of tone
• Describe how pediatric physical therapy differs
  from adult physical therapy
• Understand that disability does not define a
  person

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Unique Challenges of Pediatric Physical Therapy

• Tone issues
• Childrens ability to understand how physical
  therapy benefits them
• Family/Caregiver compliance and interaction with
  the family
• Grieving process

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Muscle Tone

• What is tone?
• What is high tone?
• What is low tone?
• What is fluctuating tone?
• How do you test for increased tone?

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Grieving Process

• THE STAGES OF GRIEF
• Denial and Isolation
• Anger
• Bargaining
• Depression
• Acceptance
• Why is it important to understand the grieving
  process?

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Common Pediatric Disorders/Syndromes

• Down Syndrome
• Cerebral Palsy
• Spina Bifida
• Torticollis/Plagiocephaly
• Developmental Delay

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Down Syndrome

• Special Olympics www.specialolympics.org
• Incidence 1 / 800-1000 live births
• AKA Trisomy 21
• Associated with LOW TONE (hint)
• Developmental rate approximately twice as long
• Affects cognition

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Down Syndrome (Cont)

• Physical therapy treatment
• Parent education for positioning
• Core stability
• Compression of joints
• Patience stubborn little guys/gals

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Cerebral Palsy

• Team Hoyt www.teamhoyt.com
• Incidence 2 / 1000 live births
• Junk term for any pre-birth or during birth brain
  trauma similar to stroke in adults
• Associated primarily with HIGH TONE, but can be
  associated with low tone or fluctuating tone
• Widely varied developmental rate

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Cerebral Palsy (cont)

• Can affect cognition
• Widely varied demeanor possibly due to pain or
  lack thereof
• Physical therapy treatment
• Parent education
• Stretching of tight muscles (hamstrings, hip
  flexors, hip adductors, heel cords)
• Core strengthening
• Functional positioning

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Spina Bifida

• Sledge hockey team / paralympics
• Incidence 1-2 / 1000 births
• Spinal cord not fully developed
• No tone in affected neural pathways incomplete
  lesions

Spinal lesion
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Spina Bifida (cont)

• Can affect cognition in math and other concrete
  subjects
• Difficult adjustment for youth
• Physical therapy treatment
• Parent education
• Assistive technology
• Core strength
• Usually will use assistive device for life

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Torticollis/Plagiocephaly

• Incidence Not listed, but appears to be on the
  rise.
• TorticollisIncreased tension in the SCM
  (sternocleidomastoid) muscle in the neck
• Causes a tilt to one side and a rotation to the
  other
• Not sure of cause could be birth trauma or
  congenital

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Torticollis/Plagiocephaly (cont)

• Usually resolves with physical therapy at a young
  age
• Plagiocephaly Mis-shapen head
• Physical therapy treatment
• Parent education
• Stretching
• Positioning
• Possible TOT collar or helmet

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Developmental Delay

• Incidence Because of the lack of true
  definition, difficult to assess
• Catch all term for dont know what causes the
  delay
• Causes could be tone, neuromuscular coordination
  issues, weakness, tightness, or balance

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Assistive Technology

• What is assistive technology?
• AT lab here on campus/classes in AT
• Common assistive devices
• Braces
• Walkers
• Crutches
• Seating/Positioning devices
• Scooters

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Take Home Messages

• Parent Education is the key
• Core strengthening is primary goal
• Be sensitive to parental grieving
• Treat the child/symptoms, not the disease
• Every child is unique and should be treated so
  even if have same diagnosis