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