PHYSICAL THERAPY - BDSRA

Exercises can strengthen muscles and improve a child’s range ofmovement. Exercise also helps some children improve their balance.Your child may perform exercises alone or with a Physical Therapist’shelp. Active therapy or therapeutic exercise includes stretchingand postural modification to strengthen the spine and minimize reinjury. A Physical Therapist may help your child stretch an arm or legto more functional limits. Passive modalities include heat/cold therapy,ultrasound, electrical stimulation, and joint mobilization. A PhysicalTherapist has several ways, other than exercise to treat children.The use of warm water whirlpool baths with swirling whirlpool currentsoften relax stiff and painful joints. Ice packs can reduce swelling andheating pads can ease pain. Massage is another modality that loosenstight muscles. Physical Therapist’s often help children heal, feelbetter, gain strength, and regain their use of body parts as much aspossible.So to sum up what Physical Therapy is – it provides treatment thathelp maximize function, improve mobility, relieve pain, and minimizephysical special needs of children suffering from illness or injuries.Physical Therapy is used to: ease the pain of sprains and strains andminimize further injuries, plan treatment programs for children whohave neurological, orthopedic, and other disorders, reduce pain andimprove motion, test for exercise stress, evaluate low back painand eliminate functional causes, and rebuild self-confidence andinterest in returning to an independent active life as much as possible.There are Physical Therapy Assistants that perform componentsof Physical Therapy procedures and related tasks selected by asupervising Physical Therapist.Also, Occupational Therapists can work with Physical Therapists on avery close level. Occupational Therapists help children improve theirability to perform tasks in their activities of daily living. OccupationalTherapists help children succeed in their “occupation” of learning,playing and growing. Occupational Therapy offers creative solutionsand resources for carrying out your child’s daily activities.Occupational Therapist’s may help children to increase their functionallevel, with improving hand function, strengthening hand, shoulder and10

torso, and eating skills. In schools, Occupational Therapists evaluatechildren’s abilities, recommend and provide therapy, modify classroomequipment, and in general, help children participate as fully as possiblein school programs and activities.Sometimes Speech-Language Pathologists are needed to assess,diagnose, and treat speech, language, cognitive, communication, voice,swallowing, fluency, and other related disorders. Audiologists identify,assess, and manage auditory, balance, and other neurological systems.B. What is the purpose of Physical Therapy?The purpose of Physical Therapy is to help your child return to activelife as quickly as possible and to the best your child can accomplish.Physical Therapy strives to reduce pain, increase flexibility, range ofmotion, and function, build strength, and correct posture.Child/Parent education is an important component in Physical Therapy.Parents/children learn how their spine works, proper body mechanics,common disorders and their causes, benefits of good posture,importance of physical fitness and its relationship to illness and injury,prevention and progress.C. Who are Physical Therapists?Physical Therapists are licensed health care professionals in the stateor states in which they practice. Prior to practicing, PhysicalTherapists must obtain either a Bachelor’s or Master’s Degree inPhysical Therapy and pass an examination to be licensed. PhysicalTherapists must develop an understanding of humanity’s spiritual andsocial needs as well as physical requirements. Physical Therapists mustlearn to think logically, to analyze, and to interpret. PhysicalTherapists must be able to establish good interpersonal relationships.D. What does the Physical Therapist do?The Physical Therapist talks to the child/parent and evaluates yourchild’s condition by testing joint motion, muscle strength,cardiovascular function, reflexes, and functional skills. If a Physicianrefers your child, the Physical Therapist will review the Doctor’sprescription along with your child’s records. After necessaryinformation has been gathered, the Physical Therapist designs a11

treatment plan to fit your child’s needs and goals. The PhysicalTherapist will work together as a team toward wellness or to the bestpossible solution to the therapy.Physical Therapists help bedridden children and children whose specialneeds have resulted from sickness and possibly injury to maximizephysical, emotional and spiritual health. Specifically, PhysicalTherapists offer treatment, by checking and evaluating the physicaland mental health of an individual child to determine appropriatetreatment methods and objectives.Physical Therapy attempts to help children develop their gross motorabilities, those that involve the large muscles of the body, such aswalking, running, crawling, and jumping. By keeping in close contactwith parents and teachers, the Physical Therapist can demonstrateand review methods used to encourage development of your child’sgross motor skills. Families are expected to continue working withtheir child on some of the exercises and activities at home as well.This is essential if improvements are to be made. Without carryoverof the program to home and school, where children spend most oftheir time, the effects of weekly or monthly Physical Therapysessions would be lost quickly. By working with the PhysicalTherapist, many parents have become excellent co-therapists fortheir children. The Physical Therapist also can be instrumental inhelping parents learn to use assistive technology and devices thathave been prescribed for their children.Exercise Therapy is intended to relieve pain and to improve motorskills for exercising and daily activities, by strengthening your child’smuscles, joints, and balance. Exercise Therapists help children withphysical special needs or diminished physical strength, maximize andmaintain health. Thus, Exercise Therapy means helping children torecover physical abilities to the extent possible through exercise.Physiotherapy is intended to relieve pain through thermal therapy,water therapy, light therapy, and electric therapy. It also helps toimprove circulation.12

Training for daily activities is where Physical Therapists train, advise,and instruct children/parents in order to help them act in their dailylives without any or the least amount of difficulty. They also giveadvice on how to refurbish homes to facilitate training at home.Physical Therapy provides services to children who have impairments,functional limitations, special needs, or changes in physical functionand health status resulting from illness, injury, or other causes.Impairment is defined as loss or abnormality of physiological,psychological, or anatomical structure or function; functionallimitation is defined as restriction of the ability to perform – at thelevel of the whole child – a physical action, activity, or task in anefficient, typically expected, or competent manner; and disability isdefined as the inability to engage in age-specific, gender-specificactivities in a particular social context and physical environment.Physical Therapy interacts and practices in collaboration with avariety of professionals, including Physicians, Dentists, Nurses,Educators, Social Workers, Occupational Therapists, SpeechLanguage Pathologists, and Audiologists. Physical Therapistsacknowledge the need to educate and inform other professionals,government agencies, third party payers, and health care consumersabout the cost-efficient and clinically effective services that PhysicalTherapists render. The rapid shift from the Physical Therapist’sresponsibility for the total care of your child to the current role ofadministrator and teacher has resulted from the population explosion,the increased public demands for better health care, and expandedPhysical Therapy treatments.Physical Therapists consult, educate, engage in critical inquiry, andadministrate. Physical Therapists direct and supervise PhysicalTherapy services, including support personnel.Perhaps the most important quality a Physical Therapist must possessis emotional stability. Physical Therapists must be able to thinkquickly with little or no time for mediation. Tact is an importantpersonality trait for the Physical Therapist to possess, because peopleare their business. Physical Therapists must be able to inspire13

confidence in children and build a solid working framework withchildren and their families. Moderate mechanical aptitude is helpfultoo. Knowing how to handle a screwdriver, hammer, and a wrench isuseful. Mechanical ingenuity, the ability to conceive and develop newdevices, is a great asset because many Physical Therapists are calledupon to improve and adapt self-help equipment. Some knowledge ofthe fundamentals of basic office procedures is also important,particularly of budgeting and accounting. Dealing with people demandsa good vocabulary and the ability to speak and write clearly. PhysicalTherapists direct children, teach families, instruct nursing schoolstudents, supervise Physical Therapy students, report on thechildren’s progress to Doctors and demonstrate Physical Therapyprocedures at medical staff conferences. Physical Therapists mustbe able to write effectively because they will be preparing clinicalnotes on their children, annual reports of the department’s activitiesto the hospital board of trustees, letters of medical necessity toDoctors and insurance companies, and letters to business leaders andprospective employers.People come in all sizes, shapes, colors, religions, ethnic backgrounds,social levels, and tax brackets. A Physical Therapist must be able todeal with people as they are, with love, understanding and totalacceptance, or Physical Therapy may not be the career for them. It isnecessary that a Physical Therapist be willing to have close bodilycontact with people, no matter how beautiful or ugly, brilliant orstupid, rich or poor they are. Physical Therapists must be able toshift their mental gears very quickly because they must adapt todifferent personalities in rapid succession. Physical Therapists mustbe innovative, looking constantly for improved methods ofperformance. Physical Therapists must be analytical in order tocompare the children’s performance from one day to the next, tocompare children with the same problems, and to determine how newapproaches to old problems can be tried.A Physical Therapist will need to be courageous. Sometimes it takescourage to convince a Doctor that a different approach to treatmentis worth trying. It will take even more courage to fight a legislativeassembly in the state capital, or in Washington, for the rights a14

Physical Therapist believes will benefit the children they treat.As clinicians involved in examination and in the evaluation, diagnosis,prognosis, intervention, and prevention of musculoskeletal andneuromuscular disorders, Physical Therapists are well positioned toprovide those services as members of primary care teams. On a dailybasis, Physical Therapists practicing with acute, chronic, Interventionor preventive stages of care, assist children in the following:restoring health; alleviating pain; and reducing the onset ofimpairments, functional limitations, other special needs, or changes inphysical function and health status resulting from illness, injury,and/or other causes. Prevention and wellness activities, includinghealth promotion, are a vital part of Physical Therapy. For acutemusculoskeletal and neuromuscular conditions, triage and initialexamination are appropriate Physical Therapists responsibilities.The primary care team may function more efficiently when it includesPhysical Therapists, who can recognize musculoskeletal andneuromuscular disorders. Physical Therapy Intervention may resultnot only in more efficient and effective child care, but also in moreappropriate utilization of other members of the primary care team.For certain chronic conditions, Physical Therapists should berecognized as the principal providers of care with in the collaborativeprimary care team. Physical Therapists are well prepared tocoordinate care related to loss of physical function as a result ofmusculoskeletal, neuromuscular, cardiopulmonary, or integumentary(skin) disorders. Through community based agencies, PhysicalTherapists coordinate and integrate provision of services to childrenwith chronic neuromuscular and musculoskeletal disorders.Physical Therapists are involved in wellness initiatives, including healthpromotion and education that stimulate the public to engage in healthybehaviors. Physical Therapists provide preventive care thatforestalls or minimizes functional decline and the need for moreintense care. Through timely and appropriate screening, examination,evaluation, and Intervention, Physical Therapists frequently reduceor eliminate the need for costlier forms of care, such as surgery, andalso may shorten or even eliminate hospital stays. PhysicalTherapists are involved in prevention and wellness activities,15

screening, and the promotion of positive health behavior. Theseinitiatives decrease costs by helping children: Achieve and restore optimal functional capacity Minimize impairments, functional limitations, and special needsrelated to congenital and acquired conditions Maintain health (thereby minimizing further deterioration orfuture illness) Create appropriate environmental adaptations to enhanceindependent functionBefore a Physical Therapist begins any test or treatment, your child’sconfidence must be won. In handling children, it is often necessary tospend as much time in the emotional preparation for treatment as inthe actual treatment.Physical Therapists are committed to providing necessary,appropriate, and high-quality health care services to both childrenand their parents. Children are individuals who are the recipients ofPhysical Therapy care and direct Intervention. Children areindividuals who are not necessarily sick or injured but who can benefitfrom a Physical Therapist’s consultation, professional advice, orprevention services.Physical Therapy, which is the care and services provided by andunder the direction and supervision of a Physical Therapist includes:1. ExaminationA. Examination of your child – for the Physical Therapist to gainmaximum information regarding your child, he/she should bepresent at the initial neurological examination and communicatewith the Doctor in charge. In this way he/she will gaininformation regarding:1. Your child’s illness or injury2. General condition3. The site and condition of the fracture, if any4. The presence of associated fractures or injuries, including anyskin lesions5. Condition of the chest including the vital capacity6. Motor function16

7.8.9.10.Sensory functionPresence or absence of reflexesSchoolingFamily historyB. Examination, evaluation, and establishment of a diagnosis and aprognosis are all part of the process that guides the PhysicalTherapist in determining the most appropriate Intervention.The five elements of child management are as follows:1. Examinationa. Historyb. Systems reviewc. Tests and measures2. Evaluation3. Diagnosis4. Prognosis5. Interventiona. Coordination, communication, and documentationb. Child related instructionc. Direct Interventionsd. Outcomese. Discharge Planningf. Other professional roles1. Examining school environments and recommendingchanges to improve accessibility for students withspecial needs2. Participating at the local, state, and federal levels inpolicymaking for Physical Therapy services3. Performing environmental assessments to minimize therisk of falls4. Providing peer review and utilization review services5. Responding to a request for a second opinion6. Serving as an expert witness in legal proceedingsg. Educationh. Critical inquiryi. Administration17

C. Examining (history, systems review, and tests and measures)children with impairment, functional limitation, and other healthrelated conditions and special needs in order to determine adiagnosis, prognosis, and Intervention; tests and measures mayinclude the following:1. Aerobic capacity and endurance2. Measuring functional capacities3. Arousal, mental, and cognition4. Assistive and adaptive devices5. Community and work (school/play) integration orreintegration6. Cranial nerve integrity7. Environmental, home, and work (school/play) barriers8. Ergonomics and body mechanics9. Gait locomotion, and balance10. Skin integrity11. Joint integrity and mobility12. Motor strength13. Muscle performance14. Neuromotor development and sensory integration15. Orthotic, protective, and supportive devices16. Pain17. Posture18. Range of motion19. Reflex integrity20. Self-care and home management21. Sensory integrity22. Ventilation, respiration, and circulation2. Alleviating impairment and functional limitation by designing,implementing, and modifying therapeutic Interventions that mayinclude, but not limited to:A. Coordination, communication, and documentationB. Child/parent related instructionC. Therapeutic exercise (including aerobic conditioning)D. Functional training in self-care and home management (includingactivities or reintegration activities, instrumental activitiesof daily living, work hardening, and work conditioning)18

E. Manual therapy techniques (including mobilization andmanipulation)F. Prescription application, and as appropriate for assistive,adaptive, orthotic, protective and supportive equipmentG. Airway clearance techniquesH. Wound managementI. Electrotherapeutic modalitiesJ. Physical agents and mechanical modalities3. Minimizing injury, impairment, functional limitation, and/or anyother special needs, including the promotion and maintenance offitness, health, and quality of life in all age populations.4. Steps of TreatmentA. Child evaluation – an assessment of your child’s abilities andlimitations. 4 types of diagnostic tests may be used:1. Electrical muscle testing – to determine whether thedamage is in the brain, the spinal cord, the nerves carryingthe impulse from the spinal cord to the muscle, or in themuscle itself2. Test of voluntary muscle power - CAT scans help todiagnose and treat children with pain and/or degenerativediseases that affect the joints3. Joint measurement – with use of a goniometry to measurehow many degrees a joint moves4. Functional activity tests – by assessing your child’s activitiesof daily living (ADL’s)a. Exercise programs – how to proceed with exercises, bypassive motion, passive assistive motion, active assistivemotion or your child moves without any assistance ormoves against resistanceb. Other treatments, which may include:1. Hydrotherapy – water treatments2. Paraffin baths - mixed with mineral oil can help relievepain3. Hot packs - to relieve pain4. Radiant heat –

8. Therapeutic massage Page 144 a. Massage therapy Page 144 b. Massage therapy Page 144 c. Medical conditions it can help Page 145 d. Physical benefits of massage Page 146 e. Massage therapy and well-being – mental benefits Page 146 VIII. Advocacy P