Paediatric physiotherapy

A child’s development begins while it is still an embryo and does not end when the growth process ends. A child’s development is a continuous process. Theories on child development have been studied for a long time. However, several groups of researchers now suggest there are new factors that influence a child’s development as well as new theories on the subject.

Recent theories state that development involves much more than the disappearance of maturity-related reflexes of the central nervous system. The development of a child is a complex process where behaviour and competence result from the interaction of the child’s developing neural and musculoskeletal systems as well as the child’s environment.

The sequence of development is the same for all children, but the speed at which this occurs is not the same for each child. During a child’s development, a cephalocaudal sequence is evident: control of the head occurs before control of the upper limbs and the trunk, and only after this does the child begin to control the lower limbs. Control of the head, trunk and arms comes before control of hands and fingers.

The motor skills which the child acquires in the first year of life are relevant in the overall development prognosis of the child. The first three years of life are crucial in the growth of the child’s neuromotor development. It is during this period that a huge amount of skills are developed, such as crawling, unassisted walking, running up and down stairs, eye/hand coordination and handling objects of various shapes and sizes.

The physiotherapist should, therefore, always keep in mind the expected normal development of the child in order to properly identify abnormalities and the possible consequences that these alterations might play in the child’s future activities and social participation.

Knowledge of the various stages of development and parental counselling on various activities that may help promote the child’s acquired skills may avoid some of the problems related to environmental factors and mistakes in the child’s stimulation.

On the other hand, knowledge on motor development and consequently recognising pathological deviations at an early stage is also very important as it means that the child is referred to specialised medical care and earlier intervention.
There are multiple reasons for the intervention of physiotherapy in paediatrics.

The reason might be of limited duration and will improve in time, as is the case with a fracture, or it might be long term, permanent or incurable as in the case of cerebral palsy.

Parents are always the first allies of both the child and the physiotherapist. It is the parents who know their children best, know their behaviour, as well as the child’s likes and dislikes.

The collaboration of the parents is fundamental to the success of the physiotherapist’s intervention in paediatrics. The parents are the ones that will need to continue the exercises at home which were performed by the physiotherapist in the clinical environment.

The role of the family in the whole treatment process has also evolved with the passing of time. In the past, treatment was body-centred care only, taking into account almost exclusively curative measures.

In the meantime, child-centred care began to develop, based on respect and concern for the child’s recreation and play as well as school development, where parents began to be seen as necessary assistants in all the techniques.

Subsequently, care became family-centred, where the family and family’s needs were considered, as well as the whole relationship involving the child.

The parent/child bonding is fundamentally valued. It is not only about helping the child, but also helping parents in their needs and developing their necessary abilities.

The HPA Group has a multidisciplinary team of professionals in paediatric rehabilitation who specialise in different approaches and technical skills.

By Inês Ribeiro
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Inês Ribeiro is a physiotherapist and specialist in paediatric physiotherapy, and is part of the rehabilitation team at the Hospital Particular do Algarve.