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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
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
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
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
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.