PHYSICAL THERAPY
by Margaret J. Barry, M.S.,P.T., P.C.S.
Physical
therapy
(PT)
does not cure
spasticity but can improve impairments and limitations. For
example, strengthening exercises reduce weakness in children
with spasticity. Functional limitations, such as poor ability to
sit, might also improve with therapy. If these changes happen
only in the therapy gym, the disability remains unchanged.
Therapy must improve abilities to perform meaningful tasks.
Changing the level of disability is the ultimate goal.
Medical treatments
Prior to
treatment, a child may have relied on spasticity in certain
muscles- spastic back muscles to sit or spastic thigh muscles to
keep knees straight for standing or walking. Following treatment
which decreases spasticity, specific therapies to strengthen
and/or develop more typical movement patterns are usually
needed.
Since selective dorsal rhizotomy (SDR)
eliminates spasticity at the time of the operation, intensive PT
following surgery builds strength and appropriate movement
patterns. Less intensive PT is needed with intrathecal baclofen
therapy because doses increase slowly, giving a child time to
get stronger and to learn to move with less spasticity.
Strengthening exercises and other therapy interventions are
often essential following orthopedic operations.
Infancy to adulthood
Intervention by physical therapists may begin in infancy.
Infants with severe spasticity need help to explore the world
around them and to learn like other infants. Physical
therapists, as part of an early intervention team, use a variety
of techniques to help infants and toddlers move and explore.
Adaptive equipment-wheelchairs, wheeled standers, etc. - can
provide more opportunities to move, keep up with and play with
friends, and even get into trouble. Communication devices are
also important in learning and development. Therapists can show
parents how to incorporate therapeutic activities into everyday
tasks such as stretching an infants legs while changing a
diaper.
As children with
spasticity grow, their muscles and joints tend to get tighter
and/or painful if not treated. At this point, therapists are
concerned about contractures in growing muscles, so they create
activities that stretch muscles and maintain the range of motion
of the joints. In addition, proper alignment of muscles and
bones with orthoses, serial casts and adaptive equipment can
protect joints, help prevent contractures and make movement more
efficient. Because children get heavier as they grow, an
important focus of therapy continues to be on successful
transfers, standing and walking.
Children's social and intellectual capabilities are significant
as their movement skills. Therefore, when scheduling sessions,
therapists must consider a child's need to develop social
community activates. Classroom activities may take precedence
over therapy.
While walking may be an appropriate goal for some children,
independent powered-wheelchair mobility may be of greater
overall benefit, especially if limited walking takes a lot of
energy. Long-term consequences of walking with crutches
(or walkers)
may need consideration. Looking to adulthood, opportunities for
independent living and employment also need to be considered as
intervention strategies evolve.
Children
approaching adolescence need enjoyable activities to keep them
fit and motivated. At this stage, the PT focus shifts to a
physical fitness perspective with activities such as swimming,
horseback riding and working out.
Treatment for adolescents center on personal independence.
teenagers are key players in developing their own goals. If
self-care is not possible, learning to direct personal care
attendants allows some independence. Mobility and communication
skills continue to be emphasized. When a teenager moves to a
larger high school setting requiring moving from classroom to
classroom, walking may be inefficient and exhausting.
Accordingly, a physical therapist can help an adolescent choose
the best means of mobility.
For the
adolescent who is not limited by significant impairment of
intelligence or memory, independent community mobility is an
appropriate goal. This can be accomplished by learning to drive
or using public transportation.
During
puberty, physical therapists may address issues regarding bodily
changes, sexuality and weight gain.
In the
past, children who needed it received therapy regularly, from
birth to adulthood. Currently, few insurance companies cover
therapy to that extent. Instead, brief, intense periods of
therapy are considered desirable, especially at times of
transition and growth. For example, when a child is considered
ready to learn a new skill, such as getting on and off the
toilet, she or he is likely to benefit from therapy two or three
times each week until this skill is mastered. In addition,
physical therapists can work with parents to devise home
exercise programs. In this way therapy can be ongoing.
Today,
therapists follow a family centered approach focusing on
lifetime needs especially for communication, mobility and
self-care. Improvement at the level of impairment may minimize
deformity and reduce pain. Successfully reducing limitations and
disabilities greatly improves quality of life.
credit for this article goes to Margaret
J. Barry,MS,PT, PCS and Exceptional Parent magazine.
Links
to physical therapy
http://www.pediatrictherapynetwork.org/
This
site above has some pretty awesome information on the therasuit
plus many other links!
http://physicaltherapist.com/
