Pediatric physical therapy is a separate area of physical therapy. 

During the evaluation and therapy processes, children should not be compared to adults. Children are new, live organisms that develop very quickly and this is the main factor that 
sets and directs the way of physical therapy intervention. Therefore, it is evident that a program of intervention for children with motor dysfunctions is very complicated. In order to design a program of intervention, the physical therapist must take into account the interaction of biological, environmental and developmental factors that affect each child.

The aim of pediatric physical therapy is to train children with cerebral palsy, muscular dystrophy and other motor disabilities to gain maximum movement and functional ability. This process is achieved through the containment of pathological motor patterns while simultaneously facilitating normal motor patterns. The stages of human development (table 1)  provide guidance to the physical therapist for the achievement of his goal and the efficient execution of the program. The physical therapist aims to make the child understand the nature of normal movements and to improve the child’s functionality. After all, the aim of physical therapy is to make the child as functional as their disability permits in order to integrate him/herself better in their social environment.

The physical therapist knows that each child is an active member of a family. Therefore, it is imperative to cooperate with the family, especially with those who are actively involved with the child, in order to train them on the physical therapy program, in order to achieve better results and to instill responsibility, self-respect and independence to the child with disabilities. The family must provide the child with constant and steady support in order for the child to grow, mature and gain independence within the safe environment that only the family can provide.

The parents and especially the mother must involve themselves as much as possible in the setting of new goals and in the expectations that the physical therapist has from their child as well as in the program itself, since it must be repeated in the house in order for the intervention to b continuous and successful. This involvement helps the parents to be more realistic regarding their expectations from their child. Usually, they expect more than the child can give them and forget to reward the child for everything s/he has achieved. At other times, they expect too little and do not encourage their child to function within the level that s/he has already achieved.

Any good physical therapy program guides and supports the parents in their attempt to repeat the exercises at home and helps them to overcome difficulties that may encounter such as feeding, sleeping habits, stress, dressing and undressing etc. in order to improve the results of their intervention.

The parents must learn:

  1. The natural positions and movements in order to encourage their child to adopt them.
  2. To identify and discourage undesired motor skill patterns.
  3. To identify the best communication positions.
  4. How to communicate with their child and how o encourage speech.
  5. Which sensory and attention experience they need to encourage.
  6. How to choose the appropriate equipment in order to facilitate movement.
  7. How to hold and carry their child.
  8. What toys they must use in order to achieve all of the above.
 

LYING

SITTING

WALKING

MANIPULATIONS

PERCEPTION

SOCIAL BEHAVIOUR

SPEECH

NEWBORN

(Prone)

The limbs are bent

Reflective movements

Unable to sit

Head on the side when lying on his back

Automatic walking movements

(1)

Grasp reflex

Reacts to light and sound stimuli

Snuggle reflex

Through their skin, they make their first contact with the environment

Loud screams

1st MONTH

(Prone)

Lift their head momentarily (3″)

Head moves from one side to the other

The head hangs at the back during lifting attempts

Lifts the head momentarily up front

Support reflex

(2)

Grasp reflex

Fists closed

Underdeveloped manipulation

Watch

Breast feeding

Quiets when cuddled

Crying

2nd MONTH

(Prone)

Lift their head (10″)

Minimum 45 degrees

Hold their head for approx. 5″

Transitional stage. (1) and (2) are exhibited less often

The hands start to open

Stops at the sound of the bell

First smile

Vowel sounds

3rd MONTH

(Prone)

Hold their head for 1 minute

90-degree angle

Lift their head when held.


Head held straight for approx. 30 seconds

Bend their legs when lifted

(1) and (2) disappear

Shakes the rattle with clumsy and nervous movements

Follows the rattle from one corner to the other

Social smile

Repeated “r” sounds

4th MONTH

“Swim”

Hold their head when lifted

Head held straight when leaned to the sides

No significant changes

Legs slightly bent

Play with their hands

Hands brought to the middle line

Hands and toy brought to the mouth

Loud laughter

Happy sounds

5th MONTH

Turn passively from prone to supine

Bend the legs, arms and head when lifted to be placed to the sitting position

Hold momentarily (1″) their body weight

When in supine, they reach for their toys, they touch them but fail to grasp them

Perceive moving objects and fine sound stimuli

Differentiate between strict and gentle tones

Some infants learn nothing, others make sound combinations

6th MONTH

Support their body with their arms 

Hand open or half-open

Perfect control of the positioning of the head

Holds his body weight for longer

Grasps the toys with their hands

Move the toys between their hands

Fine listening and observation skills 

Turn the heads towards the source of sounds (i.e. paper wrinkling)

Distinguishes between familiar persons and strangers

Rhythmical repetition of sound chains

7th MONTH

Turn from prone to supine (energetic turning)

Grasp and play with their feet when in supine

Dance

Grasp with both hands

Turn the toys with their hands

Look for fallen objects

First social game (“peek-a-boo”)

“Talk” by changing voice volume and tone

8th MONTH

Try to change positions by moving around their body axis

Pull to sit

Sit unsupported for a few seconds

Support themselves to the sides

No new skills

Perfection of skills already acquired

More attentive and focused

Recognize unknown persons

Watch others
Take interest in their reflection

Murmur

9th ΜΟΝΤΗ

Crawl voluntarily

Sit unsupported for one minute
Support body weight when arms are placed at the back

Stand holding objects

Drop objects

Interest low sounds

Differentiate between spatial relationships (front, back)

Play «peek-a-boo»

Double syllables

10th ΜΟΝΤΗ

Rock back and forth while on heads and knees.

Prepare to crawl

Able to turn to the sitting position

Sit with stretched legs and straight back

Stand holding furniture

Hold while standing

Apposition of thumb and fore-finger

Hand cooperation

Violent dropping of objects

Interested in detail

Imitate movements

Happy when praised

Conversation

Looks for objects and persons when asked

11th MONTH

Crawls

Sits unaided, good balance

Moves sideways around furniture


Moves forward when held

Thumb and index fingers bent for grabbing

Pulls a toy by its spring

Perception of item relations

Eats unaided using his hands

Drinks from a cup

First meaningful syllables


Understands restrictions

12th MONTH

Perfection of skills from the lying position

No changes

Walks when held from one hand

Gives items

Passes small items in small openings 

Eye-hand coordination

Plays “tag”

First meaningful baby words

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