PEDIATRIC PHYSICAL THERAPY

WHAT IS PEDIATRIC PHYSICAL

THERAPY?
• Pediatric physical therapists are physical therapists that
specialize in treating and caring for patients who are
toddlers, babies, children, teenagers and young adults.
They treat conditions related to genetic, neurological
and orthopedic disorders.
• Pediatric physical therapists treat and examine children
from birth to age 18, who have problems moving and
performing other physical activities. Pediatric physical
therapists help treat problems like injuries, pre-existing
conditions and problems caused by illnesses or
diseases.
 SERVICES THEY PROVIDE
• Developmental activities
• Movement and mobility
• Strengthening
• Motor learning
• Balance and coordination
• Recreation, play, and leisure
• Adaptation of daily care activities and routines
• Equipment design, fabrication ,and fitting
• Tone management
• Use of assistive technology
• Posture, positioning, and lifting
• Orthotics and prosthetics
• Burn and wound care
• Cardiopulmonary endurance
• Safety, health promotion, and prevention programs
NORMAL DEVELOPMENT
BASIC CONCEPTS IN NORMAL
DEVELOPMENTS
 POSTURAL BEHAVIOR
• Total postural behavior of an
individual is the result of the
interaction of all reflexes
• Postural reflexes interaction &
integration form background for
movements and skills
• Initially when a child born this
integrations is not present
• With maturation and integration
of lower centers contribute to the
development of higher center
• With inhibitory control from
higher centers the movements
are integrated
 POSTURAL BEHAVIOR
• At birth body is under the
unopposed control of lower center
of CNS which generate involuntary
reflex movement and posture
• Baby is influenced by neonatal
reflexes, body responds
mechanically and automatically
• This affects muscle tone and
posture or then movements
• The baby at birth is at a primitive,
crude level, a reflex level
• His movements are automatic no
component of voluntary control
 summary
Primitive postural reflexes
At about 15 months of age motor system
Involve changes in tone and matures and progresses to a level of
distribution proficiency in the basic motor functions
so that a child is able to accomplish a
Affects posture and number of skills
movements Development of these early function is
basis of further sensorimotor
Maturation of higher cns development
centers

Integration of reflex activity

Voluntary movements

High level skills

 BASIC COMPONENT OF MOTOR
DEVELOPMENT
• There are four basic component

Head control

Increased extensor control

Developing rotatory components

Equilibrium reactions
 HIGHER LEVEL MOVEMENTS
• Postural reflexes Primitive Postural reflexes
supply the basic reflexes
balance of tone
• First 5-6 month integrations
movements are in
pattern of total flexion Righting Equilibrium
and extension against reaction reactions
gravity
• Rightening reactions
• Equilibrium reactions
• Finally high level skills High level skills
 HIGHER LEVEL MOVEMENTS
• As the head rights extensor tone develops in
upper limb and child assumes the prone-on-
elbow---to extend elbows---quadruped and
finally reciprocal creeping
• Both flexor and extensor tone is developed to
produce coordinated movements
Extensor tone and landau reaction
• As heads uprights into extension
• Extensor tone starts developing down to neck
and trunk
• Thus initiating landau reaction

• Baby is born with minimal righting reaction

which act as protective response when prone
 ATNR & SIDELYING
• As the ATNR integrated ,
neck righting become
more mobile so that by
four to five months of age
the baby is turning from
side lying to prone
• Body righting on body and
rotatory component,, leads
to quadruped and sitting
• Body righting on
head…head assumes
vertical in the side lying
position
ROTATION IN BODY
• Using neck righting and body
righting, complete rotation of
the body is used to turn to
prone to supine
• by 18-24 month, righting
reaction and postural reflexes
are well integrated and child
use partial rotation to get
sitting, then turns to the
quadruped position and up to
standing
• By 4-51/2 adult method of
symmetrical sitting is used to
assume sitting and standing
position
 DEVELOPMENT OF EQUILIBERIUM
REACTIONS
• The development of equilibrium
reactions overlaps with that of
Rightening reactions and responsible for
modification and transformation of
righting reactions
• Equilibrium reaction develops as child
needed stability in balance and
independent function
• If postural reflexes and tone is dominant
then righting and equilibrium reaction
are compromised
• This further delays or prevent normal
sensorimotor development
• Vestibule apparatus and cerebellum are
involved in maintain of equilibrium
DEVELOPMENT AND DISTERIBUTION
OF BASIC TONE
 HOW MUSCLE TONE DEVELOP?
• At birth-dominated by flexor tone
• 10-12 month-extensor tone developed,
flexor tone strengthened, balance and
coordinated patterns of movements
from gross to skills
• Rotatory components for more skills
develop
• Primitive and postural reflexes play a
dominant role in regulation, balance,
and distribution of muscle tone
• Which further determine posture and
movements
• Automatic and voluntary movements
are difficult in hyper tonus
• Each reflex produce specific posture
• Total postural behavior is the result of
interaction of all the reflexes
CONTRIBUTION OF REFLEXES
Rooting reflexes—one example
• Stroking the newborn, s cheek/or palm, the
infant, s mouth will root, the arm will flex and
the hand will come up to his open mouth
• Prime important is its functional role for
survival
• Best seen during breast feeding
• Develops opening the mouth
NORMAL DEVELOPMENT
 NEONATE-ONE MONTH
• Momentary neck extension
• Reflexive flexion posture
• No functional muscle has developed
• Hip are flexed with weight bearing on head and upper limb
• Symmetrical in supine
• Limbs retracted assuming position of abduction and flexion
• Pronounced head lag, rounding of back, no extensor tone
• No rotation except for neck righting, rooting reflex
stimulates rotations
• Hands fisted mostly, grasp reflex
• Eye able to focus with in a limit range
 TWO MONTH
Prone:
• Neck extension develop to 45
degree
• Extension developing down
trunk
• STN(tension in down trunk and
upper limb) appear upper limb
• Still no scapular stabilization
• Back less rounded in sitting due
to extensor tone developing
 TWO MONTH
Supine:
• lack of flexor control
• ASTN(pattern of flexion and extension with
neck rotation) appears
Rotation:
• Lateral flexion and initial rotation influenced by
galant and rooting reflex
Hands:
• Reflexive grasp, hands maintain flexed position
• Involuntary release
Eyes:
• Focusing improved
• Coordination of hearing and vision
• Follows moving object to midline,
disassociation of head from trunk
FOCUSING TWO MONTH
 THREE MONTH
Prone:
• Neck extension
• Chin tucked
• Increased extension in back
and upper limb
• Upper limb move forward
and bear weight
• Scapular stabilization
• Less flexion at hips but no full
weight bearing yet
 THREE MONTH
Flexion:
• Increased flexion control
• Improved balance between
flexors and extensor
• Head has more midline
orientation
• Hands coming together to
midline especial when holding a
toy
• Eye focus in midline
• Head in alignment with trunk
 THREE MONTH
Rotation:
• Weight bearing on
forearm
• Head turning creates
weight shift
• Sensation of rotation
beginning
• If unable to shift
weight, rotation may
not develop
THREE MONTH
Hands:
• Reaches out with both upper limbs
• Lunges at object and can make
contact, may or may not able to
grasp
• Brings hand together and looks at
them
• Might suck fingers or fists
• Beginning to pull at clothing
• Continue to scratch surface
• Retains object using an ulnar grasp
as opposed to the palmar reflex
grasp
 THREE MONTH
Eye:
• Follow slow moving
object through 180
degree
• May see head rotating
with eyes
• Reaches with eyes when
held in sitting position
 FOUR MONTH
Prone:
• Increased extension at trunk LANDAU
REACTION
• Neck and limb extended
• Hands to midline, increased adduction,
elbow in line with shoulder
• Able to arch back in supine this give pelvic
stability and mobility, weight bearing on
heel
• Disassociation b/w UL & LL increased
• Pelvis rotation yet not present it need AP
stability of pelvis
FOUR MONTH
Supine:
• Increased flexor control
• Head in midline
• LL continue to be abducted
• Hands and upper limb more in
midline
• Scapular stability increased
• Increased weight shift bilaterally
• Gross grasp continuing on ulnar
side
• Eyes follow object smoothly
FIVE MONTH
Extension:
• Sitting less support
• Increased extension and scapular
stability
• Limbs reaching forward
• Shifting weight on forearm
• Reaching with hand open(ulnar
release)
• Less flexion on hip
• Neck stable
• Equilibrium reaction begin in prone
• Foot to mouth causes elongation of
lower spine and neck,
 FIVE MONTH
FLEXION
• Pull to sit with no head and neck lagging
• Starts to lift and flex lower limbs
• Abdominal control developing with pelvic stability
• Weight shift side lying
• Rotation in upper trunk
• Stability and mobility in shoulder girdle
• In side lying shoulder retract
• Can roll back to supine,
• Rolling prone to supine by neck extension and flexion,
roll like a log
• Grasps object in front of face
• Use palmar grasp with increased use of radial digit
• Can lift a cube, slap, pat, raking movements with
fingers
• Bilateral hand approach due to ulnar and radial
release
• Maintain fixation on self
SIX MONTH
• Sit with back straight
• Strong landau
• Balance tone in flexors and extensor
• Stands weight bearing positive
supporting
• Pull to sit: active flexion of neck,
abdominal control with raise lower
limb
• Good balance between flexion and
extension
• Righting reaction starts
• Equilibrium reaction in supine
• Weight shift to extended upper limb,
more control in shoulder and scapulae
 SIX MONTH- ROLLING
Roll from supine to prone:
• Body righting on body
• Need increased neck flexion
• Upper limb reaches out and
cross midline of body
• If initiate roll with lower
limb needs increased flexion
to past the mid line,
asymmetrical movement of
lower limb crossed
extension
 SIX MONTH -HANDS
• Radial palmar grasp
• If drops object may rescue it
• Transfer objects from hand to other
• Reaches out with one hand while holding
object other
• Pats image in mirror
 EIGHT MONTH
• Pivot-prone-type position- hyperextension in
lower back
• Stability in pelvis, weight bearing
 EIGHT MONTH-QAUDRUPED
• Able to push backward in
quadruped
• Increased stability and mobility in
hip
• Need neck and back extension, anti
gravity posture
• Controlled extension in UL
• Begins to rock back and
forward(weight shifting and
proprioceptive stimulation,
balanced hip flexion and extension)
EIGHT MONTH- sitting
• Sit with balance
• Able to push back into sitting, first
symmetrically, then develops
asymmetrically side sitting position
using pelvis rotation and stability in
shoulder
• In sitting lower extremities have
more extension to recover balance
• All component of extension are
available
• Able to pull stand with minimal
abduction for standing
 EIGHT MONTH-kneeling
• Able to kneel, with back and hip extension and
knee flexion (disassociation)
• Protective extension fully develop
 EIGHT MONTH-rotation
• Pushes back into quadruped position, rotates
pelvis into side sitting
• Begins lower extremities out in front for long
sit position
• Righting reaction, equilibrium reaction and
disassociation of body parts are in voluntary
control
 EIGHT MONTH- crawling on stomach
• Crowing on stomach reacquire
• a) weight on one side of pelvis, shifting weight
to other side
• b) proprioceptive in put into the pelvis and
shoulder
 EIGHT MONTH- creeping forward
• Has sufficient trunk, shoulder, and pelvic
girdle stability
• Reciprocal movements
• Half kneels using rotation
 EIGHT MONTH-standing
• Stand with feet flat(positive supporting
integrated)
 EIGHT MONTH- hands
• Pincer grip
• Increased maturity of neutral to supination
but not complete
• Crude voluntary release of objects
 EIGHT MONTH- hands
• Fore finger isolation, begining to isolate
fingers
• Pick up small objects with pincer grip
• More advance use of hands combine with
wrist extension and supination
 TEN MONTH
• Independence in sitting
• Grasp and release function
• Pincer position (finger and thumb) is
available voluntary
• Can twist, turn, pivot and regain sitting
balance
• may be able to Bear walks on the hand
• Control cruising sideways
• Walks both hand held, LL in abd &ext
rot
• Initial standing (high guard upper
extremities, abd & ext rotation lower
extremities)
 12-15 month
• Independent in standing, walking, and hand
use
summary