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Cerebral Palsy

Cerebral palsy (CP) is a group of neurological disorders that affect movement and coordination. The condition is caused by brain damage or abnormalities in brain development before, during, or after birth.

Physiotherapy plays an important part of supporting people with CP and managing symptoms related to movement, posture, and balance. Physiotherapy can help improve the development of motor skills and prevent motor problems from worsening with time.

What are the goals of physiotherapy for CP patients?

The main goal of physiotherapy is to help children with CP achieve their potential of physical independence and improve their quality of life.

Treatment goals:

  • improve patients’ existing motor skills and help them develop new ones
  • teach postural and movement skills
  • provide support with sitting, movement, and mobility
  • help strengthen muscles
  • lessen pain
  • support participation in sports, recreation, and leisure activities

How do physiotherapists assess patients?

Each child with CP will have different needs, so the physiotherapist does a thorough assessment by examining the child’s medical history and conducting a series of observatory tests. These tests assess various aspects of the child’s condition, including physical strength, range of motion, endurance, joint integrity, breathing, posture, flexibility, and balance.

The physiotherapist may also use the International Classification of Functioning, disability, and health – Child and Youth version (ICF-CY) document, which is designed to assess issues including muscle tone and strength, motor control, daily activities, quality of life, and outside influences such as family interactions. A treatment plan is prepared based on the results, and goals for improvement are set.

What happens during a physiotherapy session?

Physiotherapists can provide exercises to improve muscle strength, manage spasticity, prevent muscle tightening, and improve posture. Physiotherapists can also offer infants specific exercises to help them achieve greater mobility. They may also prescribe exercises for balance and posture, as well as stretches that can be done at home.

A physiotherapist may recommend and use assistive equipment or mobility aids such as braces, casts, splints, and shoe inserts to help with therapy.

What is the role of parents in physiotherapy?

The child’s parents play a key role in ensuring that physiotherapy is successful. Family and friends offer an important support network. Physiotherapists work closely with parents and caregivers, and teach them ways of making sure the child is able to perform the prescribed exercises properly. Parents’ constant interaction with the child and positive feedback while performing daily activities and exercises are crucial.

Developmental Coordination Disorder

Dyspraxia or Developmental coordination disorder (DCD) is a diagnosis given to children who have significant impairments in motor coordination, which have significant impacts on their academic achievement and activities of daily living. DCD is not associated with any medical or mental problems.

Children may meet the diagnosis of DCD if they present with some of the following:

  • Performance in daily activities that require motor coordination is substantially below that expected, given the person’s chronological age and measured intelligence. This may be manifested by:
    • Marked delays in achieving motor milestones (e.g., walking, crawling, sitting)
    • Dropping things
    • Clumsiness
    • Poor performance in sports
    • Poor handwriting
  • When the disturbance significantly interferes with academic achievement or ADLs
  • If a learning disability is present, but the motor difficulties are in excess of those that are usually associated with it.

DCD can be diagnosed by referring a child to a paediatrician or neurologist; to rule out underlying neurological conditions, to determine the child has coordination difficulties compatible with DCD, in addition to referring to a physiotherapist if needed.

Causes

Motor control processes depend on the integrated functioning of the sensory, perceptual, cognitive and motor systems. Because of this, it is difficult to determine the location and nature of this deficiency. The evidence indicates a significantly higher risk in premature and low birth weight children, those with delayed walking after months, as well as children with abnormal neurotransmission.

How can physiotherapy help?

Physiotherapists help children with DCD improve their strength, coordination, and balance. Furthermore, they assist them with enhancing their quality of life and daily activities. Your child’s treatment plan may include:

  • increasing strength
  • improving balance
  • improving body awareness
  • improving skills through task-oriented and task-specific learning

Clubfoot

Clubfoot, or talipes equinovarus, affects roughly 150,000 to 200,000 children each year. Every year, almost 11,000 children are born with clubfoot in Southern Africa, around 2,000 in South Africa. Boys are twice as likely to develop it. Clubfoot is the most common musculoskeletal birth deformity.

It is a congenital condition, meaning that it is present at birth. It may affect one or both feet, and about 50 percent of cases are bilateral. In most cases, the cause of clubfoot is unknown (idiopathic), but there may be a genetic component since it can run in families.

Clubfoot causes the foot to turn inward and point downward. Shortened tendons and ligaments on the inside of the lower leg restrict outward movement and cause the foot to turn inward. A tight Achilles tendon causes the foot to point downward. Most children born with clubfoot do not have missing bones, muscles, or connective tissue. Babies with clubfoot aren’t usually in pain, but if not treated, clubfoot can become painful and make walking difficult.

Clubfoot can be easily identified at birth since the foot will be twisted inwards and rigid. In some cases, the diagnosis is made before birth during a routine ultrasound. If you suspect your child may suffer from clubfoot, talk to a doctor who is experienced in diagnosing this condition.

Clubfoot is usually treated within a week or two of your baby’s birth.  The Ponseti method is the main treatment for clubfoot.  This involves gently manipulating your baby’s foot into a better position, then putting it into a cast from the toes to the thigh, to hold the foot in position.  The process is repeated every week for about 5 to 8 weeks.  Casting and manipulation are done very gently, so your baby should not experience any pain.

Once the foot has been corrected, your baby must wear special boots attached to each other by a bar.  The boots should be worn for 23 hours a day for the first 3 months, then only during nap times and at night until the child is 4 or 5 years old. All other times, regular footwear may be worn.

How can physiotherapy help?

Paediatric physiotherapists have the expertise and clinical training to provide early treatment to children with symptoms of Clubfoot.  We will provide your child with a comprehensive assessment and the best possible level of care during the treatment process.

Our aim is to assist your child’s walking biomechanics in order to encourage your child to walk as efficiently as possible.  We aim to prevent pain in the future, maintain your child’s muscle and tissue flexibility, and prevent any weaknesses in the lower extremities and core developing.

Stretching exercises are designed to help maintain the length of the tissues in your child’s foot.

Low muscle tone (Hypotonia)

Muscle Tone is defined as a muscle’s potential ability to respond or counter an outside force, a stretch, or a change in direction. A child with proper muscle tone can respond quickly to an outside force, whether it is through balance responses, righting reactions, or protective reactions. In addition, it allows the muscles to relax quickly once the change is no longer perceived. In children with hypotonia, muscles are slow to contract against an outside force, and cannot sustain a prolonged contraction. Children with low tone might have difficulties performing age-appropriate tasks and may have poor postural control and endurance.

Signs and Symptoms of Hypotonia:

  • Delayed motor skill development or slow to attain motor milestones
  • Decreased strength
  • Hypermobile joints
  • Increased flexibility
  • Rounded shoulder posture
  • Difficulty sitting upright without significant lean or support
  • Poor attention and motivation
  • Decreased activity tolerance
  • Difficulty transitioning in and out of positions
  • Clumsy or inefficient movement patterns
  • Difficulty with hand eye coordination
  • Prefer to observe rather than participate

Even though strength and tone are different, if a muscle is not adequately prepared for a contraction, its strength will be impaired.

How can physiotherapy help?

A comprehensive assessment of the child’s muscle strength, flexibility, endurance, and coordination can provide clues as to what is causing the child’s postural and movement difficulties. Once the impairments are identified and the possible factors that have contributed to these impairments have been identified an effective treatment plan that addresses impairments, function and participation can be implemented.

Treatment goals:

  • Increase proximal strength and support in order to facilitate distal strength and function
  • Improve postural control
  • Facilitate motor development and foundations of motor planning
  • Improve postural responses and protective reactions
  • Address fluidity and efficiency of movements
  • Improve functional strength