Pediatric Aquatic Therapy

Aquatic Therapy or pool therapy, as it's often called, consists of an exercise program done in the water.

The buoyancy of the water supports the weight of the child and allows him/her to move in ways that would be impossible on land. Physical Therapists insist the pool relaxes muscles and reduces the force of stress placed on the joints . This, in turn, makes it easier to work and strengthen muscles.

In this exclusive segment produced by CP Discovery, Physical Therapist, Susan Cook demonstrates how aquatic therapy works and discusses it's benefits.

Aquatic Therapy may be used in conjunction with other therapies for children with Cerebral Palsy, Muscular Dystrophy, Down's Syndrome and a number of other childhood diagnosis.

Children with fevers, infections, or bowel/bladder problems may not be able to participate in Aquatic Therapy.

BONES,JOINTS AND MUSCLES

BONES,JOINTS AND MUSCLES

Conditions affecting bones, joints and the tissues around them are described as ‘musculo-skeletal’ or ‘orthopaedic’.

Because there are many physiological and anatomical differences between children and adults, children require a specialised approach to their orthopaedic management. The physiotherapists at KidsPhysio always consider these differences when assessing and treating children.

Some of the more common musculo-skeletal problems that affect children and teenagers include:

Trauma injuries: For example fractures, sprains or strains resulting from sports, falls, car accidents and other injuries.

• When children’s bones break they look similar to a broken green branch from a tree, hence the name "greenstick fractures". Adults bones tend to have a well-defined break. The bones of children and young adolescents contain "growing zones" called growth plates or epiphyses. Special care needs to be taken if the fracture site is near to one of these growth plates. Children often need physiotherapy after breaking a bone to help to restore mobility and strength to the affected limb.
• Strains occur when a muscle is over-stretched, often following inadequate warming up before sport or if the muscle is not used to a particular activity.
• Sprains are an overstretching or a partial tear of the ligaments or tendons, and are usually the result of an injury, such as twisting an ankle or knee.

Gait problems: When children first start walking they will often walk on their toes or with their feet turned in. This is quite normal, but usually improves by the time they are 6 or 7. Sometimes, as children grow, they develop an uneven walking pattern which can be improved with physiotherapy.

Flat Feet are feet with a flattened arch. Flat feet can contribute to other problems such as knee and hip pain and balance difficulties.

Scoliosis is a name given to an abnormal ‘s’ shaped curve of the spine.

Talipes is also called ‘club foot’. The ligaments and tendons around the foot and ankle are tight when the baby is born, making the foot stiff to move. Physiotherapy stretches can help to restore the movement in the foot.

Erbs Palsy is also known as Brachial Plexus Paralysis. The primary nerves, that supply the movement and sensation to the arm, are partially or completely paralysed causing weakness and limitation in movement. Physiotherapy helps to maximise the range of movement, strength and function of the affected arm.

Torticollis or ‘Wry Neck’, describes a condition where a tight sterno-mastoid muscle in one side of the neck limits a child’s neck movements. Positioning and physiotherapy stretches can help to gain full neck movements.

Hypermobility describes when a child has an increased range of movement in joints.

Arthritis is a disease involving the immune system. It causes inflammation of joints, causing weakness and stiffness.

Knee Problems are common in adolescents. Osgood-Schlatter disease is an inflammation of the bone, cartilage, and/or tendon at the top of the shinbone. Chondromalacia Patella is characterised by pain under the knee cap.

Growing Pains are pains, generally in children’s or adolescent’s legs, often attributed to rapid growth.

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DEVELOPMENTAL DISORDERS

DEVELOPMENTAL DISORDERS

Developmental paediatrics (child development) is concerned with the way children mature, from birth until adulthood.

Physiotherapists are mainly concerned with the development of body postures and large movements (gross motor skills). However, they need to understand the way children develop all their skills, including hearing, speech, vision, fine movements, social behaviour and play, in order to assess or treat a child with suspected developmental problems.

Health visitors screen children for developmental problems at the 6-8 week, 8 month, 18-24 month, and 3 year checkups. If there are any concerns regarding a child’s development, if there were difficulties at birth or if a baby is premature, they may be referred to a paediatrician (a specialist children’s consultant) at a hospital or child development centre.

If there are concerns regarding a baby’s or toddler’s gross motor development, they will generally be referred for physiotherapy. Ideally, a child should start physiotherapy as early as possible. Physiotherapy can help babies develop from a very early age, by placing them in beneficial positions and helping them to move.

BRAIN AND NERVOUS SYSTEM

BRAIN & NERVOUS SYSTEM

The nervous system is extremely complicated. The brain has often been likened to a central computer within a vast, complicated network of wiring (the nervous system). The brain works at lightening speed making infinite decisions that affect the outcome of everything we do. It allows us to breathe, feel, talk, learn and remember, and enables us to move our bones and muscles in complicated yet coordinated ways. The brain allows us to perform all of these things and more, often without any conscious effort on our part, and even while we are asleep.

Unfortunately, such an amazing and complex system can go wrong. Damage can happen to the brain and nervous system before, during and after birth. Physiotherapy can help when damage occurs by helping the brain learn or relearn patterns of movement. Some of the children’s conditions treated by physiotherapists include:

CEREBRAL PALSY(CP) is a condition primarily affecting a child’s motor development. It is caused by damage to the brain before, during or shortly after birth.

Meningitis and Encephalitis are inflammatory conditions affecting the brain and spinal cord, usually caused by bacteria or viruses. Meningitis is the inflammation of the coverings (‘meninges’) of the brain and spinal cord. Encephalitis is an inflammation of the brain tissue itself. Both conditions can result in permanent damage to the brain.

Spinal Cord Injury is caused by damage to the spinal cord. It can be caused from a direct injury to the cord itself or from an indirect injury from damage to the bones, soft tissues, and blood vessels surrounding the spinal cord. Only about 5% of spinal cord injuries occur in children. Symptoms of a spinal cord injury vary depending on the location and severity of the injury. The main problem is weakness of muscles and loss of sensation at and below the level of the injury.

Spina bifida is a congenital disorder affecting the formation of the spine. About 75% of cases are called ‘Myelomeningocele’. The backbone and spinal canal do not completely form before birth causing a decrease or lack of function of the parts of the body controlled from or below the defect. Most defects occur in the lower lumbar or sacral areas of the back (the lowest areas of the spine) because this area is normally the last part of the spine to close during inter-utero development.

HEAD INJURIES are injuries to the brain caused by the head being hit by something or shaken violently. Head injuries are also called traumatic head or brain injury (TBI) and acquired brain injury (ABI). They can change how the person acts, moves and thinks. The signs of head injury can be very different depending on which part of the brain has been injured and how severely.

Microcephaly is a neurological disorder where the baby’s head is much smaller than normal for an infant of the same age and sex. It may be associated with other conditions or syndromes. Children with microcephaly may have learning difficulties and delayed development.

SYSTEM & LUNG:

Conditions that affect the whole body are called ‘systemic conditions’. Examples include chronic fatigue syndrome, lupus and systemic juvenile arthritis. Specific and graded exercise programmes have been shown to help the recovery of such problemsRespiratory conditions effect the lungs and air passages. Physiotherapist offers assessment, treatment and advice on respiratory conditions including asthma and cystic fibrosis.

RESPIRATION:

ASTHMA

Asthma is a common problem for infants and children. It is also called ‘Reactive Airway Disease’. People with asthma have sensitive airways, which become inflamed and swollen and produce more mucus. The muscles surrounding the airways (bronchial tubes) contract more than they should, narrowing the air passages (bronchoconstriction).

Common symptoms of asthma include:

• recurrent episodes of coughing
• wheezing
• difficulty breathing
• shortness of breath
• rapid and/or noisy breathing

Asthma symptoms tend to worsen at night or after with exposure to certain triggers, such as smoke, dust, pet hairs, weather changes, exercise, and colds and flu.

Whilst there is no cure for asthma, with the right management, most children's asthma can be kept under control. They will be able to participate in physical activities and sports and keep up with the other children. Many health authorities have dedicated asthma clinics, where your child can see a doctor, nurse and physiotherapist regularly for check-ups and to offer advice on keeping your child’s asthma under control.

Physiotherapist will assess:

· Child’s medication

· Child’s peak flow rate

· The warning signs for when your child is likely to have an asthma attack .

· Child’s exercise tolerance . We will advise you and your child on any specific exercises or activities to help build up strength and offer general advice on sports.

· Child’s breathing technique and their ability to clear secretions. Your physiotherapist will advise on breathing games for younger children and specific breathing techniques for older children. These may include the active cycle of breathing technique and autogenic drainage.

· Physiotherapist will discuss what to do if the child has an asthma attack, including breathing control, relaxation, and positions that can help during an attack.

CYSTIC FIBROSIS

Cystic Fibrosis (CF) is a condition where the glands in the body produce abnormally thick, sticky mucus and the sweat glands produce excess salt. The two main areas of the body involved are the lungs and the pancreas. This increased production of mucus causes most of the problems seen in cystic fibrosis.

The lung problems of cystic fibrosis are caused by the thick sticky mucus, which makes them susceptible to infection and damage. The thick mucus collects in the lungs blocking some airways and resulting in damage caused by the infection. Much of this damage can be prevented through adequate treatment of infections.

Physiotherapy and medication help to keep the lungs clear of the mucus.

CONDITIONS

Childhood Conditions:

The list is endless but can be divided into:

• System & Lungs
• Brain & Nervous System
• Development Disorders
• Bones, Joints and Muscles

Sports or traumatic injuries on a child are managed differently to similar injuries seen on an adult. Healing times and mechanical forces vary throughout each stage of a child's development.

Similarly, developmental problems and conditions such as cerebral palsy, spina bifida, muscular dystrophy, scoliosis and cystic fibrosis amongst others, call for particular care, sometimes with intensive treatment, at various stages of the child's life.

INTRODUCTION

Introduction:

Pediatric physical therapy assists in early detection of health problems and uses a wide variety of modalities to treat disorders in the pediatric population.

Children are not just miniature adults. Throughout development from babies to teenagers, children are constantly growing and developing, physically, and psychologically. Only a highly experienced clinician is sufficiently qualified to care competently and compassionately for children.

Pediatric Physical therapists are specialized in the diagnosis, treatment, and management of infants, children, and adolescents with a variety of congenital, developmental, neuromuscular, skeletal, or acquired disorders/diseases.

Treatments focus on improving gross and fine motor skills, balance and coordination, strength and endurance as well as cognitive and sensory processing/integration. Children with developmental delays, cerebral palsy, spina bifida, and torticollis are a few of the patients treated by pediatric physical therapists.

Pediatric Physical Therapists provide treatment for children who have delayed gross motor skills and/or lack flexibility, strength or endurance.Physical therapy program is on a one-on-one basis with a licensed physical therapist. Each session is individualized to meet both the child and parent's needs. Treatments may include exercises and or therapeutic activities that are specifically geared toward improving strength, balance, coordination,and endurance. Therapy goals are established with the parents to focus on helping children improve their function, mobility, relieve pain and prevent or limit permanent physical disabilities.

Therapists teach parents and children to use adaptive equipment, such as crutches, walkers and wheelchairs and also evaluate and make recommendations for orthotics.