PHYSIOTHERAPY FOR CHILDREN

1. PHYSIOTHERAPY FOR CHILDREN ASIMAYAN NANDI BPT(SRMC&RI,CHENNAI), NDT/BOBATH PAEDIATRICS(JOBURG,RSA) PAEDIATRIC NEURO DEVELOPMENTAL THERAPIST CHILD DEVELOPMENT CENTRE APOLLO GLENEAGLES HOSPITAL,KOLKATA

2. PWS or children with hypotonia usually in their early stage are tube fed, NG tube. Long NICU graduates Referred for chest physiotherapy by the community paediatrician

3. NEONATE CHEST PHYSIOTHERAPY • Place child in up right position . • Using cupped hand, percuss over the lung field . • After percussion is completed over each lober area, vibration is done.

4. NEONATE CHEST PHYSIOTHERAPY

6. Significant Gross Motor Developmental Measures • Lift head when on tummy……3m • Rolling………………………….4-6m • Sitting…………………………..6-8m • Crawling……………………….8-10m • Standing……………………….9-12m • Walking unsupported…………9-18m The baby develops dramatically in his/her gross motor skills in the first year of life

7. Development of dynamic balance and refinement of gross motor skills • Jumping from height safely….5yr • Running efficiently……………5yr • Stairs walking………………....adult form • Balance on 1leg………………5s for 5yr old • Development of balance and emerge of new skills • Squatting well…………..18m • Jumping on a spot ……..3yr • Running safely………….3yr

8. PWS • Lack of opportunity • Consistent to be put in certain position • Too much time in baby walker, means inadequate time for tummy play time • Floppy • Low muscle tone • Prefer to lay on their back • Dislike tummy time • Not eager to move around • Sit with a round back

9. Falling over on a flat surface • Poor balance, pigeon toed • Moving with awkward movements • Arms and legs looks awkward when the child is running or jumping • Poor balance/coordination • Having difficulty to stand up from floor • Weak trunk muscles • Falling over excessively(18 m) • poor balance, severe pigeon toed, perceptual issues injuries

10. What to encourage? Facilitate baby to look to both directions Provide plenty of tummy play time Perform arms and legs exercises after nappy change Facilitate crawling instead of bottom shuffling Encourage walking along furniture and negotiate obstacles Cross-legged sitting instead of ‘W’ sitting posture

11. Riding tricycle • Kicking and throwing balls • Using out-door equipment • Swings, slides, climbing frame, tunnel • Riding bicycle • Jumping on bouncy surface • hydrotherapy • Using out-door equipment • Swings, slides, climbing frame, tunnel • Walking on balance beam (20-30cm wide) • Chasing • Jumping in the sand-pit • Hippo therapy horse riding

12. Use of upper limb Self care skills – depending on their age can include being able to self feed, dress themselves, or be toilet trained. Children learn and develop most of their skills through play. Therefore for children work and play are the same thing

13. Fine motor skills This is using your hands and fingers. These skills allow you to open a jar, undo your shoe laces, do up a button and use a pencil, etc .

14. Visual perceptual (VP) and Visual motor integration (VMI) skills • Visual Perception is the brain interpreting what the eyes see. • Recognising own name • Judging the right way around to put clothes on • Knowing which way to hold a book (even if just looking at the pictures) • Visual Motor integration is doing something in response to what you see. • Draw a picture • Do a Puzzle

15. Play Skills • This includes a range of skills, from basic exploration of toys to more creative play: • Cause and effect • Teddy/doll play • Object Substitution • Role playing and story telling • Playing with peers

16. Sensory Processing There are the five typical senses There is also Proprioception (sense of body awareness) and Vestibular (sense of movement)

17. Self Care Skills • Feeding • Independent finger feeding • Use of cutlery • Drinking from a cup • Dressing

18. All children develop at their own pace and have their own activity preferences. When do you know a child is having a difficulty??

19. Fine motor problems • 6months • No hand or arm use at all. • A marked difference between the use of the left and right hands. • Not letting go of toys, even when finished playing with it. • 12 months • Still using whole hand to pick up objects, rather than attempting with fingers first. • Not using two hands together.

20. 3 to 4 years • Poor pencil skills (compared with other children the same age) • Refuses or avoids fine motor activities • Cannot use a fork • 4 years – not showing a hand preference (esp. if to start prep in the next year). • 18 months • Not stacking blocks • Cannot use a spoon for feeding 2 years • Not interested in pencils

21. VP and VMI problems • 6 months • not reaching for toys • 12 months • poor ability to self feed (hand to mouth feeding) • 18 months • unable to use simple insert puzzles or shape sorters

22. 2 years • Unable to copy horizontal or vertical lines (when first drawn by an adult) • 3 to 4 years • Not drawing simple pictures (may not look like anything but they should be able to tell you what they have drawn)

23. What to encourage Trunk needs to be in extension, gravity assisted ,over head activities