THE ROLE OF

PHYSIOTHERAPY IN

THE DISABLED CHILD

Red Cross War Memorial

Children’s Hospital

Physiotherapy

Samantha van Deventer

Janine Victor

INTRODUCTIONThe Disabled Child

• WHO and The International Classification of Functioning,

Disability and Health (ICF)

Health Condition(disorder or disease)

Participation

Restriction

Activity

Limitation

Body Function &

Structure

Environmental

Factors

Contextual Factors

Personal

Factors

THE DISABLED CHILD

• Moderate to severe physical disability

• Spectrum of motor impairments

• Congenital or acquired

• Including but not limited to:

Cerebral Palsy

Traumatic Brain Injury

Spina Bifida

Spinal Cord Injury

Neuromuscular Disease

• The Global burden of Disease: ≈ 9.5 million children 0 -14 yrs with

disability of which 1.3 million are classified as severely disabled

ROLE OF PHYSIOTHERAPY

• Physiotherapists focus on gross motor skills and

functional mobility, including positioning, transitional

movements, use and issue of assistive devices

• Postural management programme

• Positioning

• Education, training and support

• Multi-disciplinary team involvement

• Physiotherapist’s role in palliation

PRINCIPLES OF MANAGEMENT

• Practice specific, relevant and functional skills

• Facilitation of normal movement patterns

• Work for better active participation

• Improve/maintain range of movement

• Improve/maintain muscle strength and control

• Improve/maintain postural alignment

• Parent participation and education

Patients should be assessed individually

and treated age appropriately.

APPROPRIATE MANAGEMENT

• Importance of early referral and intervention

• Anticipate progression/effects of condition

Initial / Evolving stage Plateau Stage Palliative Stage

POSTURAL MANAGEMENT

PROGRAMME• 24 hours

• Variation in environment, activity and intervention

• Positively impacting on posture and function

• Enhanced communication and participation

• Transitioning through stages of life

Positioner

Wedge

Standing frame

Wheelchair (seating system)

POSTURAL MANAGEMENT

PROGRAMMEo Immature skeletal and neuromuscular system

oBiomechanical alignment

oConsiderations should be given to:

Assistive device for play, feeding,

relaxing and independence

Stretching positions

Sleeping positions

SIDE LYING

WEDGE

STANDING

• Advantages

oBone densityDecreased incidence of fractures

Decreased incidence of hip dysplasia

Increased bone growth

oImproved passive range of movement

(maintaining neutral alignment)

oInfluences tone

oActivation of anti-gravity muscles

oImproved lung function

oImproved bladder and bowel function

oSocialisation and interaction

STANDING

THE WHEELCHAIR

THE WHEELCHAIR

• Extensive Research

• Major role under Physio- and Occupational Therapy

• Human Rights Framework – Ability rather than DISablility

• Full assessment of child considering:

Diagnosis

Age

Functional abilities

Postural deviations

Deformities

Environment

Function

THE WHEELCHAIR

THE WHEELCHAIR

Pressure Mapping

BEFORE AFTER

BUGGY

POSTURE CHAIR

WHEELCHAIR

Hybrid Dual Terrain Chair

WHEELCHAIR

Active Urban chair

MOTORISED WHEELCHAIR

Motorised Chair

EDUCATION AND TRAINING

• Caregiver’s acceptance and understanding of child’s

disability

• Child’s capabilities in optimum position

• Focus on abilities rather than disabilities

• Caregiver main role-player:

Therapy manager

Caregiver included in decisions re: therapy,

frequency and intensity

Goal setting

Therapy incorporated into daily routine

MULTIDISCIPLINARY COLLABORATION

• Ideally collaboration between role players across

disciplines to meet common goals

• Therapy and management of one role player directly

influences that of another

PHYSIOTHERAPY AND PALLIATIVE

CARE

Symptom control: • Suctioning

• Supportive chest physio

• Importance of movement

• Pain relief

Support for the patient & family• Positions of rest/comfort

• Back care

• Independence

• Distraction

• Enhanced QOL

THANK YOU

REFERENCES

• Armstrong, W., Borg, J., Krizack, M., Lindsley, A., Mines, K., Pearlman, J., Reisinger, K. &

Sheldon, S. (2008). Guidelines on the provision of Manual Wheelchairs in less resourced

settings. Publications of the World Health Organization. Geneva.

• Bax, M., Goldstein, M., Rosenbaum, P., Leviton, A. & Paneth. N. (2005). Proposed definition

and classification of cerebral palsy. Developmental Medicine and Child Neurology. 47: 571-

576.

• Big Shoes., Hospice Palliative Care Association of South Africa. (2012). Management of

Common Symptoms and Problems in Paediatric Palliative Care. Clinical Guidelines.

• Google Images

• Gough, M. (2009). Continuous postural management and the prevention of deformity in

children with cerebral palsy. Developmental Medicine & Child Neurology. 51: 105-110.

• Gunel, M.K. (2011) Physiotherapy for Children with Cerebral Palsy, Epilepsy in Children –

Clinical and Social Aspects, Dr. Zeljka Petelin Gadze (Ed.)

• http://www.who.int/mediacentre/factsheets/fs352/en/index.html

• http://www.who.int/topics/disabilities/en/

• Laakso, L. (2006). The role of physiotherapy in palliative care. Australian Family Physician.

35(10): 781.

REFERENCES• Michaud, L.J. et al (2004). Prescribing Therapy Services for Children with Motor Disabilities.

American Academy of Pediatrics. 113 (6) 1836 – 1838.

• Pin, T.W. (2007). Effectiveness of Static Weight-Bearing Exercises in Children with Cerebral Palsy. Pediatric Physical Therapy. 19: 62-73.

• Pineda, V. S. (2008). It’s About Ability. An explanation of the Convention of the Rights of Persons with Disabilities. United National Children’s Fund (UNICEF)

• Quin, S., Clarke, J. & Murphy-Lawless, J.(2005). Report on a Research Study of the Palliative Care Needs of Children in Ireland. Department of Health and Children, The Irish Hospice Foundation and the Faculty of Paediatrics.

• Rosenbaum, P. (2009). Cerebral Palsy in the 21st Century: Is There Anything Left to Say? Neuropediatrics. 40: 56-60.

• Saloojee, G.M., Rosenbaum, P.R. & Stewart, A.V. (2011). Using caregivers’ perception of rehabilitation services for children with Cerebral Palsy at public sector hospitals to identify the components of an appropriate service. South African Journal of Physiotherapy. 67(3).

• Scheffler, E. (2010). Basic wheelchair and seating training. Provincial Government of the Western Cape, Department of Health.

• Scheffler, E. (2012). Intermediate wheelchair and seating training. Disability and Rehabilitation Consultancy Services.

• Stewart, D. & Rosenbaum, P. (2003). The International Classification of Functioning, Disability, and Health (ICF) A Global Model to Guide Clinical thinking and Practice in Childhood Disability. CanChild Centre for Childhood Disability Research.