Physiotherapy with Children

1. Physiotherapy with Children

2. Movement is important for children’s development and learning

3. Physiotherapy with Children • Significant Gross Motor Development Milestones (GMDM) • Red Flags • What to encourage?

4. Physiotherapy=‘physical’ + ‘treatment’ Physiotherapy with Children Assessment Formulate problem list Block of therapy Refer to other services Review and home program Discharge as appropriate

5. Areas that Physiotherapist work on with children • Gross motor development • Movement patterns • Postures

6. The baby develops dramatically in his/her gross motor skills in the first year of life

7. Significant GMDM (6wk-18m) • Lift head when on tummy……3m • Rolling………………………….4-6m • Sitting…………………………..6-8m • Crawling……………………….8-10m • Standing……………………….9-12m • Walking unsupported…………9-18m

8. Tummy play time • Start as early as possible, soon after birth • Best before feed, after bath or when well alert • A few times a day

9. Rolling (4-6m) • First exciting mobility on the floor

10. Sitting (6-8m) • Sit up to see the world

11. Crawling (8-10m) • Set the foundation for coordination tasks

12. Standing and walking (9- 18m) • Feel tall and big

13. Red flag when babies are • looking to one direction most of the time • Habit • Muscle tightness at the neck • Flattened on one side of the back of head Further flattening of head which lead to asymmetrical head shape (positional plagiocephaly)

14. Born pre-mature • Born equal or less than 34weeks • Eg. Baby born at 32wks, when they are 8m, we should expect that the GM dev. will be around 6m • Stiff • High muscle tone, tight muscles • Arching of the body, hard to bend the arms and legs • Difficulty in dressing, changing nappies, sitting up

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

16. ‘W’ sitting • sit between feet with knees bent develop pigeon toe walking pattern • Constantly stand or walk on tip toes • tight calves, high calf muscle tone, habit delay in walking, shortening of calves

17. 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

18. Significant GMDM (18m-3yr) • Development of balance and emerge of new skills • Squatting well…………..18m • Jumping on a spot ……..3yr • Running safely………….3yr

19. Red Flag when children are • Falling over excessively • poor balance, severe pigeon toed, perceptual issues injuries • Walking on tip-toes (80-90% of the time) • tight calves, high calf muscle tone, habit sore calves, decrease walking tolerance, shortening of calves

20. What to encourage? • Using out-door equipment • Swings, slides, climbing frame, tunnel • Walking on balance beam (20-30cm wide) • Chasing • Jumping in the sand-pit

21. Riding tricycle • Kicking and throwing balls

22. Significant GMDM (3-5yr) • 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

23. Red Flag when children are • 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

24. Avoiding physical activities • Low muscle tone, vestibular dysfunction, perceptual issues • Tiring quickly • Low muscle tone

25. What to encourage? • Walking on narrow beam (10-15cm wide) • Kicking and throwing balls to target • Simon says • Run and freeze game

26. Using out-door equipment • Swings, slides, climbing frame, tunnel • Riding bicycle • Jumping on bouncy surface

27. Any doubts?? • Refer to the Queensland Health Developmental check list www.health.qld.gov.au/child&youth/factsheets

28. Physiotherapy services • Contact your local community health centre, developmental assessment team or hospital • Private Paediatric Physiotherapy services can be obtained through • Australian Physiotherapy Association www.physiotherapy.asn.au Queensland branch office (07) 3423 1553 • Yellow page

29. Occupational Therapy with Children

30. What is Occupational Therapy?? • Common belief that OTs help people return to work following injury or illness. • This is only part of the picture. • “Occupation” actually refers to any activity that you do during the day • Self care activities • Work and productive activities (paid/unpaid) • Leisure activities

31. Occupation for children • 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

32. Skills OTs typically work on with children • Fine motor skills • Visual perceptual and visual motor skills • Play skills • Sensory processing • Self care skills

33. 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 etc.

34. 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

35. 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

36. Sensory Processing • There are the five typical senses • There is also Proprioception (sense of body awareness) and Vestibular (sense of movement) • OTs tend to look more at how sensory input impacts on the child as a whole.

37. Self Care Skills • Feeding • Independent finger feeding • Use of cutlery • Drinking from a cup • Dressing • Toileting (note: issues withpersistent bed wetting or soiling tend to be managed by OTs in hospital settings).

38. RED FLAGS • All children develop at their own pace and have their own activity preferences. • When do you know a child is having a difficulty?? • See website at end of presentation for checklists.

39. Fine motor red flags • 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.

40. Fine motor red flags cont… • 18 months • Not stacking blocks • Cannot use a spoon for feeding • 2 years • Not interested in pencils

41. Fine motor red flags cont… • 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).

42. VP and VMI red flags • 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

43. VP and VMI red flags cont… • 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)

44. Play red flags • 6 months • Does not enjoy sensory play (toys with noise, lights and/or texture) • 12 months • Does not engage in container play • 18 months • Does not understand simple cause and effect play

45. Play red flags cont… • 2 years • No imaginary play (pretend play with dolls/teddy or imitating adults) • 3 to 4 years • No imaginary play or very immature play • No cooperative play with peers

46. Sensory Processing • All children need more sensory input than adults, therefore they seem to be constantly seeking input. • Sensory processing issues are only a problem if they impact negatively on the activities children either need, or want, to do.

47. Sensory Processing red flags • When a little feels like a lot (over-responsive) • Want to wash hands +++ or avoids messy play. • Does not like ++ noise • Avoids rough and tumble play • Does not tolerate other children coming too close. • Poor eating – limited range of foods • Tends to be very easily upset and over-reacts to situations

48. Sensory Processing red flags cont… • When a lot feels like a little (under-responsive • Constantly “on the go” • Seeks messy, noisy and/or rough and tumble play. • Alternatively may need a lot of input to get going and may appear quite passive. • Can be intrusive into others personal space • Can have poor attention

49. Self Care red flags • 12 months • Not self feeding • 2 years • Not using cutlery; Not drinking from a cup • 3 to 4 years • Not able to manage clothes for toileting • Not dry by day (by 4 years)

50. OT services • QLD Health OT services vary from district to district. Contact your local community health centre or hospital for details on services • It is important to know the eligibility criteria – some services need GP or Paediatrician referrals, while others take self referral.