Home | Physio Dr.Shivom Singh & Akhileshwar Sahaye child development and physiotherapy Centre

Paediatric therapists play a key role in the management of movement problems. Physiotherapy, and sometimes occupational therapy, is essential to provide a program to encourage motor development. Therapy is also necessary to implement the other strategies discussed below.

Orthoses(sometimes known as braces) are used by many children for the lower limbs at some stage in their development. These are custom made and individually fitted for each child from a combination of materials including high temperature plastics with velcro closures.
Upper limb splints are sometimes made by an occupational therapist to maintain range of movement, facilitate better grasp and improve overall function of the arm and hand. These splints, usually of plastic material, are individually made for each child. Over recent years, a technique of splinting with dynamic lycra splints has been developed. These splints are often called 'second skin'. 3. Plaster castsare sometimes applied to lower limbs to stretch the calf muscles, and to improve the position of the foot during walking. The casts are changed every one to two weeks, the child walks in the plasters, and generally the plasters remain in use for about six weeks. These plasters are sometimes called 'inhibitory casts'.
Botulinum toxin A('Botox') is used as a treatment for tight or spastic muscles, most commonly when tightness in the calf or hamstring muscles is interfering with progress in learning to move, although it is increasingly being used in other parts of the body including the upper limbs. A light anaesthetic is required for the injections. There may be some temporary mild pain at the injection site but other side effects are uncommon. Botox can reduce spasticity and provide a period of more normal muscle growth and development, which may be accompanied by progress in the child’s movement abilities. Disadvantages include the fact that the administration of Botox involves injections; the effects of the drug are not completely predictable and are of short duration; and the toxin is costly.
Oral medicationsfor spasticity include Diazepam, Dantrolene and Baclofen. These medications are often not effective or may cause too many unwanted effects. Hence they are prescribed relatively infrequently.
Diazepam ('Valium') is a good medication for spasticity, but may cause sedation. However it is useful following surgery, particularly orthopaedic procedures.
Dantrolene ('Dantrium') may be helpful, but can rarely cause liver problems. It may also cause drowsiness, dizziness and diarrhoea.
Baclofen ('Lioresal') is said to be more useful in spasticity due to spinal lesions than in spasticity due to cerebral lesions. However, it is often used in children with severe spasticity. Side effects are uncommon but may include nausea. It is reported to aggravate seizures though this is a rare problem.

Very occasionally, a pump is implanted under the skin. The pump is connected to a tube which delivers the drug into the space around the spinal cord. This type of treatment is only suitable for a small number of children with severe spasticity and is known as intrathecal baclofen therapy.

Orthopaedic surgery.Surgery is mainly undertaken on the lower limb, but occasionally in the upper limb. Some children require surgery for scoliosis. Physiotherapy is an essential part of post-operative management. Gait laboratories are useful in planning the surgical program for children who are able to walk independently or with sticks or walking frames.

Physiotherapy:

Therapy is often incorporated in an early intervention program which addresses not only the movement. problems but aims to optimise the child’s progress in all areas of development. The most commonly used approaches by therapists in Victoria are listed below.

Neuro-Developmental therapy(often abbreviated to 'NDT' and also known as Bobath therapy) is a therapeutic approach to the assessment and management of movement dysfunction in children with neurological dysfunction. The ultimate goal of treatment and management is to maximise the child’s functional ability. The therapy was first developed by Dr and Mrs Bobath in the 1940s and hence is sometimes known as 'Bobath therapy'. Following a thorough assessment, the treatment focuses on making desired movements more possible and preventing undesired movements. Family members and other caregivers receive education in NDT principles to maximise quality of movements and implementation of the program at home, preschool, school and in other community environments.
Programs based on the principles of Conductive Education.Conductive Education is a Hungarian system for educating children and adults with movement disorders. In 1940, Professor Andras Peto established the approach by recognising that such disorders are learning difficulties to be overcome rather than conditions to be treated. Conductive Education provides an integrated group program where children and their carers/parents learn to develop skills in all areas of life, for example, daily living, physical, social, emotional, cognitive and communication skills. There are some programs that apply the principles of Conductive Education in Victoria. The professionals involved in these programs include special education teachers, therapists and occasionally Hungarian 'conductors'.
Constraint induced movement therapy, often abbreviated to 'CIMT' is a therapy for children with hemiplegic cerebral palsy that aims to increase the child’s use of their hemiplegic arm and hand. This therapy approach has developed from studies of the effects of constraining the non-affected arm and hand of adults following stroke to 'force' the use of their hemiplegic arm and hand. CIMT involves constraining a child’s unaffected hand and/or arm for a period of time, usually in a modified glove or mitt, while they are encouraged to use their affected hand and arm in play activities.
Goal directed training involves the child and/or family identifying specific tasks that the child may need to, want to or have to do at home, school or in their leisure. The approach developed from our understanding of how children learn motor skills. The therapist works with the child and family to identify specific goals or tasks and to assess the child’s performance. The therapist may structure aspects of the task or environment to optimize the child’s performance. Skills required by the child are identified and developed. Repeated task practice is an important part of the approach and requiresthe child and family to be active partners in the therapy process.

CEREBRAL PALSY TREATMENT

Physiotherapy:

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