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Neuro Physiotherapy

Physiotherapy for children with developmental delays

Developmental delay occurs when children have not reached milestones by the expected time period.

Cerebral palsy

  • Cerebral palsy is a group of disorders that affect muscle movement and coordination. It results from abnormal development or damage to the parts of the brain that control movement, posture and coordination. The damage to the brain is permanent. It mostly occurs during pregnancy; however it may occur during birth or shortly after birth or during the first years of a child’s life, while the brain is still developing. It is the most common movement disorder in children. When the brain sustains damage, the victim can face difficulty ranging from walking to swallowing. In general, cerebral palsy causes impaired movement associated with abnormal reflexes, abnormal posture, involuntary movements, unsteady walking, and rigidity of the limbs. The disability associated with cerebral palsy may be limited primarily to one limb or one side of the body, or it may affect the whole body. Moreover, cerebral palsy is divided into several types, each of which can produce its own set of symptoms.

    Symptoms

Symptoms vary widely among children with cerebral palsy. Most often, the symptoms appear during infancy. Problems associated with cerebral palsy may include:

  • Lack of muscle coordination (Ataxia)
  • Difficulty in walking
  • Difficulty in speaking
  • Tremors or involuntary movements
  • Excessive drooling
  • Difficulty in swallowing
  • Seizures

Causes

  • Cerebral palsy is caused by an abnormality or disruption in brain development, usually before a child is born. The abnormal development or injury to the brain tissue disrupts the nerve signals to the muscles and therefore causes difficulty with movements, posture and co-ordination. In many cases, the exact cause isn’t known. CP related to genetics is not preventable. However, there are actions people can take before and during pregnancy, as well as after birth that might help reduce the risk of developmental problems, including CP.

Factors that may lead to problems with brain development include

  • Maternal infection
  • Jaundice
  • Premature birth
  • Multiple births

Physiotherapy for cerebral palsy in children:

Physical therapy is considered one of the most important aspects of treating children with Cerebral Palsy. In children, physiotherapy primarily aims to increase mobility and promote physical development such as sitting, crawling and walking. The therapy also helps strengthen muscles and joints, reinforcing a child’s stability and positioning. Additionally, a physical therapist provides positive reinforcement for a child by focusing on his or her capabilities. They encourage movement and balance using mobility aids such as wheelchair and walking aids. Physiotherapy uses physical approaches to promote, maintain and restore physical, psychological and social well-being within all environments of the child.

Treatment Approaches-

  • NDT
  • CIMT
  • Electrical Stimulation
  • Treadmill Training
  • Stretching

Bobath concept

Bobath concept aims to improve gross motor function and postural control by facilitating muscle activity through key points of control assisted by the therapist. In 1960, the name of the approach was changed to neurodevelopmental treatment (NDT).

NDT (Neurodevelopmental treatment)

  • NDT is one of the oldest and most popular intervention use to treat children with cerebral palsy. It is a hand on treatment approach. It involves task‐specific postures and movements. This therapy uses guided movements as a treatment strategy to ensure correlation of input from tactile, vestibular, and somatosensory receptors within the body. During NDT evaluation and treatment sessions, the therapist interacts with the child in a dynamic and reciprocal way. The approach is individualised and tailored to each child’s specific problems, aims and goals. This approach aims to facilitate typical motor development and function and to prevent development of secondary impairments due to muscle contractures, joint and limb deformities.

    CIMT (Constraint-induced Movement therapy)

Constraint-induced Movement Therapy (CIMT) is a specialized approach used to increase the use of a limb affected or weakened as the result of a brain injury. It is used predominantly in the individual with Hemiplegic Cerebral Palsy to improve the use of the affected upper limb. Children with hemiplegic CP often have an imbalance in brain activity between the left and right sides of the brain. In CIMT, a constraint is applied to the unimpaired (or less impaired) hand or wrist while the patient undergoes intensive training with the impaired limb. The goal is to improve activity level and usage of the impaired limb.

Electrical stimulation

Electrical stimulation is provided by TENS. TENS is a method of electrotherapy which aims to provide pain relief around injured tissue.

Benefits of physical therapy:

The goal of physical therapy is to develop coordination, improve balance, and build strength. It helps in:

  • Improving mobility
  • Increasing muscle strength
  • Reducing swelling and inflammation
  • Managing pain
  • Decreasing muscle spasm

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