FINGER- NOSE TEST

HOLD YOUR FINGER ABOUT AN ARM'S  LENGTH FROM THE PATIENT. ASK THE PATIENT TO TOUCH YOUR FINGER WITH THEIR INDEX FINGER & THEN TOUCH THEIR NOSE, REPEATING THE MOVEMENTS BACK & FORTH. PATIENTS MAY DEMONSTRATE PAST POINTING (MISSING YOUR FINGER) OR INTENTION TREMOR.

LOW BACKACHE FLEX ION EXERCISES

FLEXION EXERCISES

Flexion exercises are advocated the following goals:

1.  To open the inter vertebral foraminae.
2. To unlock the facet joints.
3. To stretch the hip flexors.
4. To mobilise the posterior fixation of the lumbosacral articulation.
5. To strengthen the abdominal muscles.
6. To stretch the back extensors.
7. To increase the intra-abdominal pressure by contracting the internal& external oblique abdominal muscles.       

Indication of flexion exercises.See below.

 Indication Flexion exercises Extension exercises

• Pain relief on Sitting Lying

Forward bending walking

Lumber lordosis Repeated back bending

Fixed lumber lordosis Decreased lumber lordosis

with bending

• Pain increased on Sitting

                                          Standing                             Driving                      

                                     Sustained forward                   Arising from chain          

                                        bending                                                                            

                                    Repeated backward                 Stooping                              

                                        bending                               Bending                                    

                                        Extreme range of                  Forward bending                

                                      backward bending                                                                

                                                                                    Repeated forward bending                                           

                                    

LOW BACKACHE EXTENSION EXERCISES

TREATMENT  OF LOW BACKACHE DUE TO LUMBAR DISC DISEASE:MUSCLE STRAIN, & LIGAMENT SPRAIN (Common LBA)

The principles of treating common low backache are explained by three R's.

• Relieve pain in acute cases.
• Restore normal movements in chronic cases.
• Recurrence is to be prevented.

The following are the treatment exercises

in low backache.

Extension Exercises

These exercise aim to achieve the following goals:

1. They maintain the normal lumber lordosis
2. They improve the strength of the extensor  muscles of back & hip.
3. In patients with posterior or posterolateral disc prolapse it relieves the pressure on the disc.
4. The improve the mobility of the spine.

Type of Extension Exercises 

1. Extension to neutral
2. Hyper extension exercises

 Contraindication

1. Acute disc prolapse
2. Multiple back operations.
3. Spinal stenosis
4. Spondylolisthesis

Rotational Exercise

1. These exercises provide overall relaxation of the spinal muscles.
2. The external & internal oblique abdominal muscles help in the development of intra-abdominal pressure & help in the maintenance of anterior & posterior trunk balance.

They also provide anterior stability to the spine.

Exercises for Stretching the Side Muscles

Patient lies on the back, keeping the backflat & feet together, the knees are rotated on either side for a count of ten.

Other Forms of Exercises

• Mobility exercises 

1. Pelvic rotation
2. Chest roll on either side in sitting or supine.

• Stretching exercises
• Aerobics 

 

WHAT IS AUTISM?

  Autism Spectrum Disorder (ASD) & autism are both general terms for a group of complex disorders of brain development. These disorders are characterized in varying degrees, by difficulties in social interaction, verbal & nonverbal communication & repetitive behaviours.They include autistic disorder, Rett syndrome, childhood dis-integrative disorder, pervasive developmental disorder -not otherwhttp://drchetanparasar.blogspot.com/2012/09/what-is-autism.htmlAUSTIMise specified (PDD-NOS) & Asperger   syndrome.

ASD can be associated with intellectual disability, difficulties in motor co-ordination & attention & physical health issues such as sleep & gastrointestinal disturbances, some persons with ASD excel in visual skills, music, math & art.http://drchetanparasar.blogspot.com/2012/09/what-is-autism.html Done

Autism appears to have its roots in very early brain development.

However the most obvious signs of autism & symptoms of autism tend to emerge between 2 & 3 years of age. Autism speaks continues to fund research on effective methods for earlier diagnosis as early intervention with proven behavioral therapies can improve outcomes.

Increasing autism awareness is a a key aspect of this work & our families & volunteers play an invaluable role.     

    

  

WHAT ARE THE SYMPTOMS OF AUTISM?

WHAT ARE THE SIGN AND SYMPTOMS OF AUTISM?

http://drchetanparasar.blogspot.com/2012/09/what-are-symptoms-of-autism.html

1. 

AUTISM SPECTRUM DISORDERS(ASD) are characterized by social interaction difficulties, communication challenges and a tendency to engage in repetitive behaviors.However,symptoms& their severity vary widely across these three core areas.Take together,they may result in relatively mild challenges for someone on the high functioning end of the autism spectrum.For others, symptoms may be more severe as when repetitive behaviour s &lack of spoken language interfere with everyday life.

1. Social Communication Deficits
2. Repetitive Behaviours 
3. Language Disability
4. Associated medical conditions

• Genetic Disorders
• Seizure Disorders
• Sleep Dysfunction
• Sensory processing problems
• Pica (tendency to eat things that aren't food) 

WHAT DOES A PHYSICAL THERAPIST DO FOR PEOPLE WITH AUTISM?

Physical therapists may work with very young children on basic motor skills such as sitting, rolling, standing & playing. They may also work with parents to teach them some techniques for helping their child build muscles strength, co-ordination & skills.

As children grow older, physical therapists are more likely to come to a child's preschool or school.

There they may work on more sophisticated skills such as skipping, kicking throwing & catching.

http://drchetanparasar.blogspot.com/2012/09/what-does-physical-therapist-do-for.htmlIn school setting, physical therapist may pull children out to work with them one-on-one or "push in" to typical school setting such as gym-class to support children in real life situations. It isn't unusual for a physical therapist to create groups including typical & autism-tic children to work on the social aspects of physical skills.These skills aren't only important for physical development, but also for social engagement in sports recess & general play.

Physical therapist may also work with special education teachers & aides, gym teachers & parents to provide tools for building social / physical skills.

WHAT EXACTLY IS A PHYSICAL THERAPIST?

Physical therapist (often called "PTs") are trained to work with people to build or rebuild strength, mobility & motor skills.

Most physical therapist work in clinical settings who are recovering from injuries. Many also work with people recovering from stroke.

 A subset of physical therapists work with children & adults who are coping with lifelong disabilities such as cerebral palsy, spina bifida, or related neurological disabilities.

Dance & movement therapy hippo therapy ( therapeutic horseback riding) aquatic therapy (therapeutic swimming) recreational therapy & even play therapy may also be offered by people with a background in physical therapy.  

   

HOW THE PHYSICAL THERAPY HELP THE CHILDREN SUFFERING FROM AUTISM?

WHY WOULD A PERSON WITH AUTISM NEED TO SEE A PHYSICAL  THERAPIST?

Autism is a pervasive developmental disorder. This means that most people on the autism spectrum have delays, differences or disorder in many areas including gross & fine motor skills.

Children on the spectrum may have low muscle tone, or have a tough time with co-ordination & sports. These issues can interfere with basic day- to-day functioning & they are almost certain to interfere with social & physical development. 

Children with autism would rarely be termed physically disabled (though there are some autistic children with very low muscle tone, which may make it difficult to sit or walk for long periods) most children with autism do, however have physical imitations.

FAQ

         DIFFERENCE BETWEEN PHYSICAL THERAPY & OCCUPATIONAL THERAPY AS RELATED SERVICES IN EDUCATION 

One common question asked by parents is what is the difference between physical therapy & occupational therapy services

provided through schools as a related special education service?

Both therapies are related services to special education & are provided only if the child needs therapy to function in the educational setting.

The role of  physical therapist & an occupational therapist is to facilitate a student's independent functioning & decrease the effects of a disability on his/her ability to participate in the educational setting & process.

The following is a general response to the difference between the two.

Physical Therapy (PT): emphasizes the acquisition of basic motor skills necessary for functional mobility about the school environment as well as the physical capability for participating with peers during education & recess.Areas of focus for the school physical therapist include:

• Gross motor skills: activities that use large muscles

• Mobility skills: moving safely throughout the school environment, including entering & exiting the school bus

• Postural control & alignment needed to perform school activities & for increasing independence in life skills

Occupational therapy (OT):emphasizes the acquisition of or compensation for functional performance skills needed by students during their educational experience:

• Fine motor skills: small, finely coordinated hand movements
• Visual  perceptual skills: the ability to understand & interpret what is seen.
• Visual motor skills: the ability to coordinate visual skills & motor skills 
• Self care skills: feeding, dressing, hygiene,& toileting skills for increasing independence in necessary life skills

Both physical & occupational therapist may address the following areas:

• Strength & endurance
• Body awareness
• Classroom positioning & adaptions 
• Sensory motor skills necessary for participation in an educational program

Physical therapists & occupational therapist have similar training. Occupational therapists receive more training in oral & hand skill interventions & physical therapists receive more training gross motor & postural development. 

ADHD

     WHAT IS ADHD?

                                      Attention deficit hyperactivity disorder(ADHD) is a developmental disorder.It is characterised primarily by"the co-existence of attentional  problems and hyperactivity,with each behaviour occuring infrequently alone"and symptoms starting before seven years of age.              

WHAT ARE THE SIGNS & SYMPTOMS OF ADHD?

Inattention, hyperactivity & impulsivity are the key behaviors of ADHD. The symptoms of ADHD are especially to define because it is hard to draw the line at where normal levels of inattention, hyperactivity & impulsivity end & clinically significant levels requiring intervention begin.

    Predominantly inattentive type symptoms may include:

• Be easily distracted, miss details, forget things, & frequently switch from one activity to another.
• Have difficulty maintaining focus on one tasks.
• Become bored with a task after only a few minutes, unless doing something enjoyable.
• Have difficulty focussing attention on organizing & completing or turning in homework assignments, often losing things (e.g -pencils, toys, assignments) needed to complete tasks or   activities.
• Not seem to listen when spoken to.
• Daydream, become easily confused & move slowly.
• Have difficulty processing information as quickly & accurately  as others.
• Struggle to follow instructions.

         Predominantly hyperactive impulsive type symptoms may include:

• Fidget & squirm in their seats.
• Talk non stop.
• Dash around, touching or playing with  anything & every thing in sight.
• Have trouble sitting still during dinner, school & story time.
• Have difficulty doing quiet tasks or activities.
• Be very impatient.
•  Blurt out inappropriate comments, slow their emotions without regard for consequences.
• Have difficulty waiting their for things they want or waiting their turns in games.

                   COMORBID  DISORDERS       

Inattention & "hyperactive behavior aren't  necessarily the only problems in child with ADHD.

ADHD exists alone in only 1/3 of the children diagnosed with it.

The combination of ADHD with other conditions can greatly complicate diagnosis & treatment. Many co-existing  condition require other courses of treatment & should be diagnosed separately instead of being grouped in the ADHD diagnosis.

 Some of the associated conditions are:

• Oppositional  defiant disorder.
• Conduct disorder.
• Temper tantrums.
• Antisocial personality disorder.
• Borderline personality disorder.
• Vigilance.
• Mood disorders.
• Bipolar disorder.
• Anxiety disorder.
• Obsessive-compulsive disorder. 

HOW THE PHYSIOTHERAPY HELP THE CHILDREN WITH ADHD?

        ADHD & MOTOR SKILLS COMPLICATIONS:  

                                                    HOW TO REDUCE ANXIETY IN YOUR CHILD 

                        For adults who suffer from anxiety, there is significant connection between this mental health complication & the poorly managed symptoms of attention deficit hyper activity disorder, ADHD.

 If you are an adult with anxiety, & if you find that your child has symptoms of ADHD, it is important to treat those symptoms appropriately.

                         Without treatment, your own child may grow to develop anxiety as well.

For  children with ADHD  there is a risk for complications associated with poor motor skills & this  often manifests in what some parents refer to as a general clumsiness in their child.

       Because  ADHD   plays a role  in adversely affecting your child's gross & fine motor  skills, it is not uncommon  for your child to develop an anxiety complication they begin to recognize they are physically & functionally different from other children.

         To avoid this risk in your child, it is important to take a two-step approach to treatment. First you will want to be sure that your child is adequately treated for symptoms of disorder & second, you will want to ensure that your child receive adequate. Physiotherapy with a combination of physiotherapy, to improve motor skills & use of medication, to control  ADHD   symptoms your child will gain a greater confidence in their functional ability. With this increase in confidence, the risk for developing an anxiety disorder will dissipate.

For many children, the complication of  ADHD  lead to variety of health complications, both in chilhood as well as in adulthood.

While as a parent, you can't prevent every symptom of  ADHD  from arising, you can be prepared for the adverser complications & then seek out the necessary treatment to control those complications.

                    Sources: Child & Adolescent Mental Health May 2010, vol15 Issue 2, p.85-89

WHAT IS PERTHES DISEASE?

                 PERTHES DISEASE :

Perthes disease is a disorder in children affecting the hip joint, where the blood supply to the head of femur become inadequate. As a result the bone begins to soften & break down (known as necrosis). There is no identifiable cause for perthes diseases. Over time the body will begin to heal it self laying  down new blood vessels & bone over several months & years to produce a new femoral head.

  

WHAT ARE THE SYMPTOMS OF PERTHES DISEASE?

Pain usually affects the groin hip area & may cause the child to limp when walking.The leg may appear shorter with  muscle wasting in the thigh & restricted range of movement. Diaagnosis is usually confirmed with X-RAY or bone scans.

HOW CAN PHYSIOTHERAPY HELP PERTHES DISEASE?

THE AIM OF PHYSIOTHERAPY FOR PERTHES DISEASE ARE TO RESTORE FUNCTION AND INDEPENDENCE TO MAXIMISE QUALITY OF LIFE. TREATMENT BY OUR SPECIALIST PHYSIOTHERAPIST MAY INCLUDE:  

• Advice regarding appropriate walking aids to maximise independence during initial stages e.g-crutches.

• Exerciseses to maintain & restore range of movement & muscle stregth .

• Gait re-education to improve mobilty.

• Exercise to improve balance & co-ordination.

• Provision of a home exercise programme.

• Advice on appropriate activitivies & which activities to avoid  e.g- high impact activities .

• Hydrotherapy.

                                  Recovery from perthes disease may take up to two years & althrough most children recover fully some may be left with permanent problems with their walking & therefore may require additional therapy at a later stage.

WHAT IS DEVELOPMENTAL DEPMENTAL DEALY?

             DEVELOPMENTAL DELAY  

                                                                                               Dvelopmental dealy is when a child does not progress as expected in achievement of specific milestones such as learning to sit, crawl, walk or talk.

WHAT CAUSES DEVELOPMENTAL DELAY?

  There can be many different causes of developmental delay such as genetic problems, problems during pregnancy or birth, & problems during early infancy or childhood such as infectin or head injury often there is no identifiable casues.

WHAT ARE THE SIGNS OF DEVELOPMENTAL DELAY?

DEVELOPMENTAL DELAY CAN AFFECT BEHAVOUR, PHYSICAL ABILITIES, VISION, SPEECH & HEARING.

                                  SOME COMMON SIGNS INCLUDE:

• Problems with concentration reduced eye contact and easily frustrated.

• Slow to achieve milestones floppy or stiff limbs, clumsiness.

• Difficulty following moving objects, focussing eyes crossed or turned eyes.

• Small or deformed ears, does not startle to lovd noise or respondwhen called.

• Softly spoken or very loud voice, unable to pronounce words appropriate to their age.

WHAT ARE THE BENEFITS OF PHYSIOTHERAPY FOR DEVELOPMENTAL DEALY?

          BENEFITS  OF PHYSIOTHERAPY FOR DEVELOPMENTAL DELAY:

• Achievement of physical milestones such as sitting crawling & standing.

• Improved posture, muscle strength, balance & co-ordination.

• Improve confidence.

HOW CAN PYSIOTHERAPY HELP DEVELOPMENTAL DEALY?

Physiotherapy treatment aims to promote a child's independence & ability to reach physical  milestones.

Treatment  will be specific to a child's needs, age & abilities & our team of specialist physiotherapist will often use fun games & activities to help promote normal development. We liaise closely with parents, carers & teachers to help them understand the child's needs & how they can help promte future independence.

WHAT ARE THE EFFECTS OF HYPERMOBILITY SYNDROME?

For some children the exercessive laxity in joints &soft tissues presents with no problems, however in other cases it may lead to

• Painful joints & muscles which may be acute or chronic.

• Difficulty with prolonged exercise.

• Swollen joints.

• Disturbed sleep.

• More prone to injury.

HYPERMOBILITY SYNDROME

WHAT IS HYPERMOBILITY SYNDROME?                                     

Hypermobility syndrome is a term used to describe overly mobile joints which occurs as a result of the protein collagen benig more flexible than usual due to a genetic abnormality. It is an inherited condition which varies on a spectrum of diffrent severities, some with serious complications (e.g -marfan syndrome) which can affect internal organs. The other end of the spectrum has milder consequences which are not life threatening such as benign hypermobility syndrome.

HOW CAN PHYSIOTHERAPY HELP HYPER MOBILITY SYNDROME?

Some children with hyper mobility syndrome will eventually grow out of the associated problems as the supporting ligaments get stronger over time.Other children may have persiststent  problems and our team of special paediatric physiotherapist can help to reduce the effects of hyper mobility syndrome by:

• Providing an exercise programme  to strengthen muscles & support the joints.

• Provide advice on types of appropriate exercise & sports.

• Advising on appropriate pain management technique such as use of heat or ice.

• Reducing risk of injury & persistent pain into adult hood.

• Providing advice on reducing factors which may worsen symptoms such as excessive weight.

INJURIES OF THE KNEE JOINTS

1. COLLATERAL LIGAMENT INJURY

• Medial collateral ligament injury.

• Lateral collateral ligament injury.     

    2.CRUCIATE LIGAMENT INJURIES

•  Anterior cruciate ligament.

• Posterior cruciate ligament.

    3.MENISCUS INJURY                                 

• Medial meniscus injury.

• Lateral meniscus injury.

WHAT IS JOINT PAIN?

Many children experience joint pain at sometimes in their childhood which may be due to a number of different factors common causes of joint pain include:       

•  Trauma as a result of actual injury e.g muscle strain.

•  Overuse injury

• Pain due to hypermobility or laxity of joints.

• Pain secondary to poor posture.

          Less commonly joint pain may be an indicator of infection or inflammatory condition such as juvenile arthritis or even an indicator of serious illness such as neoplasm.It is therefore important that the symptoms of joint pain are investigated especially if there is no obvious cause to the parent or child.                                         

HOW CAN PHYSIOTHERAPY HELP JOINT PAIN?

                                     JOINT PAIN                                                                

                                                                                                                      

Our team of specialist pediatric physiotherapist can       provide a through assessment of a child's symptoms     in order to establish the potential reason or cause of    the pain.In cases where the casues is musculoskeletal in origin treatment will atm to address the underlying                        cause of the joint pain such as weak or tight muscles poor posture.The physiotherapist may provided            advice on pain management techniques, provides                           exercise to strengthen muscles & give advice injury      prevention.If the causes of the pain is not identifiable         or appears to be systemic in nature (e.g several joints affected) the                       physiotherapist may recommend referral back to a doctor in order in order to      confirm a diagnosis or rule out serious illness before offering treatment                                                               

   

WHAT IS BRAIN INJURY?

                                  BRAIN INJURY                                                         

Brain injury in a general term used to describe damage to the brain which may be used by of a number of factors. It may be cause hereditary, congenital or degenerative conditions. Injury to the brain is often acquired brain injury (ABI) or traumatic brain injury (TBI)  ABI is the leading cause of acquired disability in children & young adualts.

WHAT ARE EFFECTS OF BRAIN INJURY?

The effects of brain injury in children vary enormously according to the type size, severity & location of the area of damage. It may affect physical & cognitive abilities as well as speech hearing, vision, behavior & learning skills. Some problems will be immediately obvious whilst other do not become apparent until the child is order. Some common effects of brain injury include:

                                                         

• Physical problems including impaired movement abnormal muscle tone poor balance fatigue & mobility problems

• Cognitive problems such as poor memory concentration & organisational skills

• Behavioral problems such as aggression, imtabilty, impulsivity & inappropriate behavior

• Epilepsy headaches & depression.

   

HOW THE PHYSIOTHERAPY HELP THE CHILD SUFFERING FROM BRAIN INJURY

 HOW CAN PHYSIOTHERAPY HELP AFTER BRAIN INJURY?

The effect of brain injury can result insignificant disability, however as the brain is adaptable improvements are possible with regular physiotherapy input to maximise function & independence both immediately following the injury & longer term. The type of physiotherapy treatment will depend on the child's need  & abilities & can help to:  

•  Improve function abilities such as roling                               standing&walking                                                   

• Retrain normal patterns of movements                                  

• Improve balance & condition                                

• Improve muscle strength & range of movements                                        

• Improve posture                                                                                                    

• Improve positioning & alligement                                                  

• Improve independence & confidence                                                             

•  Reduce muscles spasm stiffness                                                    

Physiotherapy treatment can be provides regardless of the severity of the injury                              we can liaise with parents carers & teachers regarding the best way to manage  a child's physical need in order to maxmise their independence we can provide    advice on equipment & positioning to make care for child easier as well as          appropriate home exercise programmes to continue therapy between                           physiotherapy session.                                                                                                 

INDEPENDENCE OF THE SPECIAL CHILD

            KEEP  YOUR  CHILD HAPPY   DYSLEXIA AND                                           DYSPRAXIA SUPPORT

                       

WHAT IS DYSPRAXIA?

    INTRODUCTION            

                                 TO                      

                                       DYSPRAXIA           

Dyspraxia also known as developmental co-ordination disorder is impairment in the planning organisational & execution of movement due to poor processing of information in the brain which affects a child's ability to perform the normal range of physical activities expected for their age range.

Dyspraxia has two elements including:  

• Ideational Dyspraxia difficulty planning the sequence of coordinated movements.
• Idea motor dyspraxia difficulty carrying out the movement even though the sequence is known

It is thought that dyspraxia affects about 5-10% of the population & increasing numbers of children are being identified as having the condition-

Early recognition of dyspraxia will enable children to reach their potential through early intervention.

WHAT ARE THE SYMPTOMS OF DYSPRAXIA?

 WHAT ARE THE SYMPTOMS OF DYSPRAXIA?

DYSPRAXIA can affect different areas of development, below is a list of common symptoms that may be apparent in children with dyspraxia.

Speech & Language Skills.

• Difficulty making sounds, sequencing sounds & forming words in sentences
• Slower development of language
• Problems with feeding, messy eating                                                                

Fine Motor Skills

• Difficulty developing hand writing skills (learning the basic patterns of movement, speed of writing & establishing correct pencil grip)
• Difficulty with tasks requiring dexterity &fine co-ordination e.g-tying shoe laces, brushing teeth.

Gross Motor Skills

• Development of gross motor skills include the acquisition of major milestones such as walking running &jumping which may be affected in children with dyspraxia .

Problems May Include:

• Slower acquisition of development milestones e.g- learning to sit, crawl walk
•   Poor balance & timing, tripping over easily
• Poor co-ordination & sequencing of movements
• Clumsiness & poor spatial awareness
• Problems picking up simple objects
• problems learning left from right
• slower development of liberality i.e right or left handedness other symptoms
• Poor short term memory
• Poor concentration easily distracted
• Difficulty following instructions 
• Poor ability to organised time
• Increased likelihood of losing things
• Sensory integration dysfunction leading to over sensitivity to stimuli such as light, sound touch temperature
• Poor perception of distance difficulty crossing roads
• High levels of motor activity difficulty sitting still
• Limited creative & imaginative play
• Isolation with peer group difficulty forming friendships
• Slower completion of class work at school problem finishing tasks
• Easily distressed & emotional increased irritability

Children with dyspraxia may have problems in other areas that are not caused by dyslexia and behavioral difficulties which vary greatly between children. 

HOW WE GET TO KNOW THE CHILD IS SUFFERING FROM DYSPRAXIA OR NOT?

                HOW IS DYSPRAXIA DIAGNOSED?

If a child is showing problems in the planning and organisation of movement further investigation is necessary to allow prompt recognition and early intervention  in dyspraxia problems may be identified by a child's parents helath visitor or teacher.

Appropriate referral to pediatrician or child development until may be made. Assessment for dyspraxia  typically include establishing a history of developmental,milestones,motor skills screening activities and a comparison to normal rates of  development to establish areas of difficulty.

HOW THE PHYSIOTHERAPY HELP THE CHILD SUFFERING FROM DYSPRAXIA?

PHYSIOTHERAPY TREATMENT FOR DYSPRAXIA

 There is no cure for dyspraxia,however symptoms may improve with growing maturity and can lesson with appropriated advice and treatment research has shown that physiotherapy treatment has a positive effect on gross motor skills,fine motor skills and dexterity,activities of daily living & self confidence.

Prior to treatment an initial assessment will be carried out to determine the child's skills and whether they are performing with the expected quality for their age range specific tests will be used to assess the child's motor sensory and perceptual abilities.

Once the assessment has been completed problems areas will be identified and a  treatment plan will be devised in discuss with the child and their parents.Treatment will focus  on improving the child's motor abilities which will in turn lead to improvements in self- es-team and confidence.

Treatment may include:

• Practising gross motor skills such as walking ,running,hopping,
• Balance activities
• Co-ordination skills e.g throwing and catching ball
• strengthening activities to improve movement control
• Activities to improve postural control
• Advice and education to parents and teacher on management of dyspraxia
• Referral with other health professionals such as occupational therapist and speech and language therapists
•  Advice on appropriate equipment to improve abilities.

Treatment will be supplemented by a home exercise programme which is an essentials aspect of treatment in order to make lasting significant improvements.A school visit may be arranged to assess the child in the class room , provide advice on the environment,and make recommendations regarding aids that may be required to maximise the child's potential.

HOW THE PHYSIOTHERAPY HELP THE CHILD SUFFERING FROM DYSPRAXIA?

    BENEFITS OF PHYSIOTHERAPY FOR DYSPRAXIA INCLUDE:

• Improved gross motor skills
• Improved fine motor skills &manual dexterity
• Improved balance and postural control 
• Improved strength
• Improved posture
• Improved coordination of movement
• Improved confidence and self esteam
• Improved spatial awareness
• Improved participation in school activities

FLAT FEET

                WHAT ARE FLAT FEET? 

 Flat feet(also known as pes planus or fallen arches) is a condition where the arches of the foot either falls to develop or collapse.This means that the sole of the foot is in contact with the floor when standing.                                              

WHAT CAUSES FLAT FEET?

                      WHAT CAUSES FLAT FEET?

The arch in the foot normally develops by age 5 or 6 as the fat pad babies is gradually absorbed and balance improves as skilled movements are acquired.In some children however,the arch  fails develop which may be result of tightness in the calf muscles laxity in the achille's tendon or poor core stability in other areas such as around the hips.

WHAT ARE THE EFFECTS OF FLAT FEET?

         WHAT ARE THE EFFECTS OF FLAT FEET?

Initially a child may note complain of any problems associated with their flat feet however over time it may lead to an altered walking pattern clumsiness limping after long walks and pain in the foot kness or hips.It is there fore important that appropriate treatment commences as early as possible.

HOW CAN PHYSIOTHERAPIST HELP THE CHILD SUFFERING FROM FLAT FEET?

                HOW CAN PHYSIOTHERAPY HELP FLAT FEET?     

Physiotherapy can help to reduce the problems associated with flat feet by:

• Providing advice on exercise to help stretch tight muscles and strengthen weak areas to aid development of correct foot posture.
• Providing advice on appropriate footwear.
• Advising on appropriate insoles to improve foot position and referral to a specialist orthotist if necessary.
• providing advice on pain management.

INDEPENDENCE OF THE SPECIAL CHILD

CEREBRAL PALSY.

SPINA BIFIDA

Spina bifida is the term used to describe a series of birth defects in babies affecting the development of the spine and neural systems.The severity of the neural defect can vary and spina bifida is classified in to three types.

SPINA BIFIDA OCCULT

The most common & least serious form that usually does not require treatment.In this type there is only a tiny gap between the vertebrae.

SPINA BIFIDA MENINGOCELE

The rarest type where the bones of the vertebrae develop normally,however the protective membranes of the spinal cord are pushed out,this can be removed surgically and no further treatment is usually required.

MYLOMENINGOCELE

This is the most serious form where the spinal coloumn remains open causing the membranes and spinalcord to push out creating a sac that may or may not be covered by skin, in this case there may be extensive damage to the nervous system.

WHAT ARE THE EFFECTS OF SPINA BIFIDA?

The effect of spina bifida will vary according to the type, location & amount of nerve damage in the spinal cord in mylomeningocele there may be:                                                                                                

1. Partial or complete paralysis of the parts of the body below the spinal level affected which impacts on development of gross motor skills such as sitting standing &walking.
2. Altered sensation.
3. Altered bladder &bowel control.
4. hydrocephalus.
5. secondary effects of altered muscle control impact on musculoskeletal system.

HOW CAN PHYSIOTHERAPY HELP SPINA BIFIDA?

The effects of spina bifida can impact enormously on a child's function &physiotherapy should commence as soon as possible in order to maximise a child's potential and quality  of life. treatment will vary according to the severity of the condition our specialist physiotherapist can provide treatment which may include:     

• Maximising independence  in functional activities such as standing transferring& walking.                                                                                                      

• Provision of mobility aids & equipment to increase independence                            Exercise to maintain or improve muscle strength & length.

• Anticipating,preventing & minimising  secondary effects such as development of contractunes.

•   Positioning & postural advice.      

•  Teaching wheelchair skills to maximise independence.     

•  Provision of appropriate orthotics.       

•    Exercise to improve balance & co-ordination to prevent risk of falls.

WHAT IS DOWN"S SYNDROME?

Down"s syndrome is a chromosomal disorder caused by an additional 21st chromosome which causes abnormalities in physical and cognitive development.

WHAT ARE THE SYMPTOMS OF DOWN"S SYNDROME?

The presence of the additional chromosome causes characteristic features of down"s syndrome which may include.,Low set,upward sloping eyes and small low set ears.,Small mouth with large protruding tongue.,flattened nose,broad hands,low birth weight and small stature.,Additional complications may arise as a result of the chromosomal abnormality including heart abnormalities,sight and hearing problems,thyroid problems,poor immunity digestive problems and dementia. most people with down"s syndrome have learning difficulties and can be slower in their development although the severity varies.

HOW CAN PHYSIOTHERAPY HELP CHILDREN WITH DOWN"S SYNDROME?

Early physiotherapy for children with down"s syndrome can help address developmental problems and muscle weakness to maximise function and quality of life.our team of specialist physiotherapist can help.,Promote achievement of gross motor skills such as sitting,crawling,standing.,improve independence in functional activities.,improve muscle strength posture and balance.,Improve quality of life and confidence.,Reduce the risk of secondary joint problems in later life as a result of lax ligaments and muscle weakness.

MUSCULAR DYSTROPHY

Muscular dystrophy refers to a group of inherited muscle disorders characterized by progressive muscle weakness. It is caused by a genetic abnormality which affects the muscle structure and function which over time leads to increasing disability.Although there are over one hundred types of muscular dystrophy the most common types that usually present in childhood are:- Duchenne muscular dystrophy affects mainly boys and is the most severe and common form of muscular dystrophy.symptoms are usually apparent by age three..,Becker muscular dystrophy:-milder and less common than duchenne"s  .  symptoms may not present until age ten or eleven.

WHAT ARE THE SYMPTOMS OF MUSCULAR DYSTROPHY?

As there are many types of muscular dystrophies there is a wide variations in symptoms,however some of the likely symptoms are:- Progressive muscle weakness and wasting usually in the lower limbs first causing problems with standing,walking,climbing stairs and participating in sports etc., muscle cramps and spasm.,poor balance,frequent falls.,altered walking pattern., behavioral difficulties.,respiratory problems.,

HOW CAN PHYSIOTHERAPY HELP THE CHILDEREN SUFFERING FROM MUSCULAR DYSTROPHY

Physiotherapy for muscular dystrophy aims to maximise a person"s quality of life and independence for as long as possible and may include., exercise to maintain joint range of movement and soft tissue length.,strengthen exercise to maintain muscle strength for as long as possible.,Advice regarding appropriate mobility aids and equipment to maintain independence.,Anticipating and minimizing secondary complications that may occur.,Providing support with respiratory problems to maintain a clear chest., Referral to other health professionals such as occupational therapists if needed.

PHYSIOTHERAPY TREATMENT FOR HYDROCEPHALUS

Excessive pressure on the brain can result in physical problems in babies or children which may affect their physical development,achievement of milestones,balance,co-ordination or mobility.our team of specialist paediatric physiotherapist can provide treatment of a child"s physical problems in order to maximise their potential and quality of life.aims of treatment will vary according to the child"s needs and age may include-promoting achievement of physical milestones such as sitting,standing,crawling.,maximising independence in mobility.,exercise to improve balance and co-ordination.,exercise to stretch or strengthen tight or weak muscles.,improving confidence and quality of life.,improving tolerance and stamina.

HYDROCEPHALUS

Hydrocephalus-It is also known as "water in the brain" is a medical condition in which there is an abnormal accumulation of cerebrospinal fluid in the ventricles,or cavities,of the brain.This may cause increased intracranial pressure inside the skull and progressive enlargement of the head,convulsion, tunnel,vision,and mental disability.Hydrocephalus can also cause death.The name derives from the Greek word uopo-[hydro] "water" and kephalos-head.

PHYSIOTHERAPY TREATMENT FOR CEREBRAL PALSY

• Phelps Technique
• Massage
• Passive movement
• Active assisted movements,
• Proprioceptive neuromuscular facilitation
•  Brunstrom"s approach
• Roods approach
• Vojta"s technique for trigger points were used to reflexly stimulated creeping
• Rolling or crawling activities.collis technique for dressing
• Feeding,toileting and washing
• Conductive education
•  Bobath approach;integrated approach for cerebral palsy                                                             Developing rapport with parents and patients,
• Normalizing tone of muscles,stretching and mobility
• Developing postural reaction,
• Sensory integration,
• Oromotor control training,nutitional counseling
•  Biofeedback.