Physical Therapy
Pediatric physical therapy helps children develop or regain the skills they need to move their bodies in order to meet every day challenges. This can include helping babies to crawl in order to retrieve their favorite toy that’s not in arm’s reach or retraining a child to negotiate stairs following a fractured femur from a fall.
Regardless if your child has not met their developmental milestones, has an orthopedic impairment, or has a change in health status, our physical therapists use a multi-faceted individualized approach to therapy that is focused on the child's ability to move through his or her environment. PT goals include improving balance, strength, coordination, endurance, flexibility, and family training so the child can safely participate in activities at home, school, and the community - like running and climbing at the playground.
Physical therapists work with children who have a variety of diagnoses including developmental delay, neurological impairments including cerebral palsy, and musculoskeletal disorders. Our comprehensive physical therapy evaluations are based on parent interview, clinical evaluations, and assessments tools (as indicated) including BOT-2, PDMS-2, GMFM, AIMS, and TGMD.
Our Physical Therapists are experienced and highly trained, including knowledge in traditional and leading-edge therapeutic approaches described on this page.
Assessments
Normal development of walking in the developing child is varied, however follows a typical pattern:
- 9 months: Stands holding on
- 10 months: Pulls to standing
- 12 months: Walks with assistance. Concern if not walking by 18 months.
- 15 months: Walks unaided.
- 18 months: Runs.
- 2 years: Goes up and down stairs without assistance.
- 2.5 years: Jumps. Walks on tip toes. Concern if cannot jump by school age.
- 3 years: Stands on one foot (few seconds). Goes up stairs 1 foot per step, comes down 2 feet per step.
- 4 years: Hops. Goes up and down stairs like an adult. Heel and tiptoe walk.
- 5 years: Skips.
- 7 years: Balance on one foot for 20 seconds.
When babies first learn to walk they walk with legs far apart and arms up in the air. As they continue to practice their legs comes closer together and their arms come down. Babies fall many, many times when first learning to walk and they also walk a lot. Typical 12- to 19-month-olds averaged 2368 steps and fell 17 times/hour.
Children sometimes walk with toes turned in or out and may trip and fall often. There are many reasons as to why this is happening from muscle weakness to a torsion/twist of the bone or just part of normal gait development.
A thorough knowledge of typical and atypical gait patterns is needed to assess a child’s gait and any potential for red flags. We perform Gait Assessments for children with neuromuscular impairments such as Cerebral Palsy. We use videotaping of the child walking with and without orthotics and walking aides. Then we analyze their gait pattern frame by frame. Measurements are taken and a plan of action recommended. Making adjustments to the orthotics and shoes have a tremendous impact to how the child walks.
For additional information, please visit: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3591461/
Many parents express concerns regarding their child’s feet and the way they walk or run. Some pediatricians say that the child will grow out it, however many do not. Developmental flat foot is one of the most common conditions seen. Recognizing and addressing this early in life may prevent joint and muscle problems in the future. Children ages 1-4 normally have a flat foot. We look at how much the heel turns out and if they are walking with feet turned out. Many of these children have poor core strength, balance and coordination issues. Children ages 4-10 do not have flat feet, and if they do then an orthotic is indicated. Just like the younger children, pain is not usually an issue. However even by age 4 you will see these children avoid running activities.
Our Orthotic Assessment Program will assess your child’s feet, legs and core alignment and strength. We will also do a gait assessment too see how the feet are affecting the way your child walks. If indicated we will recommend an orthotic. If it is a mild case, we have the orthotics in stock. If it is a more complicated situation your child may need to see an Orthotist to have custom made orthotics. We collaborate with many excellent orthotics locally to refer you to. If you presently have orthotics and would like us to assess them, we would be happy.
Call our office and set up an Orthotic Assessment if you have concerns.
The effects of torticollis can affect posture and freedom of head movement during maturing developmental skills resulting in abnormal movement patterns and developmental delays. It is imperative that the baby is diagnosed and treated at the youngest age possible. It is never too early to begin therapy for torticollis.
Our therapists will initially do an assessment which includes:
- A thorough birth history
- Evaluating the muscle length and range of motion in the neck
- Assess muscle strength in the neck and body
- Check for asymmetries throughout the body
- Check for ‘other’ orthopedic concerns such as hip dysplasia
- Assess gross motor skills
- Assess head/skull/face for asymmetries or plagiocephaly
Treatment recommendations may include:
- Physical therapy
- Occupational therapy
- Referral to a pediatric orthopedist
- Referral to an orthotist if helmet is needed for plagiocephaly.
- Parent education in positioning and exercises
Why it is important to have torticollis treated:
- Prevent a permanent shortening of the tight neck muscles
- Avoid the need for surgery
- Reduce the risk of development delays
- With therapy at an early age, the majority of children recover with no long term issues
Why PPOT?
- Our therapists have completed special training in the evaluation and treatment of torticollis
- Our therapists work closely with the physician to develop a comprehensive treatment plan
- We work very closely with several orthotists to develop the correct helmet, if needed
- No waiting lists, treatment available quickly
- One on one treatment for you and your child
- Patient/family centered approach
Torticollis can be quite distressing to the parents and baby. Our physical therapists can provide a thorough assessment and treatment plan to reduce the effects of torticollis and developmental delays as quickly as possible.
For more information on torticollis, please follow this link.
Treatment Techniques
Functional electrical stimulation (FES) uses small electrical signals to stimulate the nerves, causing the muscles to contract and produce a movement. FES can improve muscle mass and strength, spasticity, passive range of motion, upper and lower extremity function, and standing/walking abilities. When placed on multiple muscles that work together in function, the child will motor learn this movement when practiced over time.
For additional information please visit:
https://www.cerebralpalsyguidance.com/cerebral-palsy/treatment/functional-electrical-stimulation/
his program provides intensive physical and/or occupational therapy consisting of therapy 3 hours a day, 5 days a week for 3 weeks. This provides your child with the opportunity to achieve his/or goals sooner than traditional therapy of twice weekly for 30 minutes.
Research has shown that intensive therapy sessions are more effective at helping the child achieve their same goals as compared to traditional non-intensive therapy (see "additional information" links below).
Our program is individualized to the child and the goals are discussed and determined with the parents and the child.
- Cerebral Palsy
- Developmental Delays
- Post Stroke
The 3-week intensive therapy program allows us ample time to use many of the treatments we are trained in including Theratogs, FES, Kinesiotaping, NDT, Myofascial Release, Whole Body Vibration, Partial Weight Bearing Treadmill Training and sensory integration. However, two components are invaluable to the improvement in function in children with neuromuscular impairments. These components include:
1. The strengthening component. Improving muscle strength and endurance results in improvements in functional skills. Children with neuromuscular disorders have significantly reduced muscle strength. We use the Universal Exercise Unit, which is a system of pulleys and weights supported by a steel frame. Using this unit, specific muscles are isolated, with gravity eliminated, to facilitate even the weakest muscles to contract. The Whole Body Vibration unit and Functional Electric Stimulation also helps strengthen these weak muscles.
2. Functional training component. Children with neuromuscular disorders need to practice a skill or movements many times to learn it. Using the steel frame (spider suspension system), the child can be partially or fully suspended with a system of belts and bungee cords in an upright or seated position. Here, with the impact of gravity decreased, the child can practice many motor skills that they were not able to achieve due to the effects of gravity. In this supported position, the child experiences normalized movements. FES is another way to help train the muscles and the body to learn new tasks.
The family will be provided with a home exercise program, including pictures and/or video of their child performing them. To discuss this program and whether this would benefit your child please call us for an evaluation.
For additional information, please visit:
http://www.rehabpub.com/2013/09/pediatric-intensive-physical-therapy-an-emerging-model
https://www.ncbi.nlm.nih.gov/pubmed/27612885
https://cerebralpalsynewstoday.com/2016/07/18/intensive-physical-therapy-improves-gross-motor-function-children-cerebral-palsy
Kinesio Taping is a therapy technique that helps to provide support and stability for muscles and joints without preventing them from moving. It helps to prolong the benefits of a therapy session. It can be worn for several days and is safe and non-invasive. Kinesio tape can help to relieve pain, decrease inflammation, re-educate the neuromuscular system, and promote circulation and healing. The tape is applied specifically for each client based on what their therapy needs are.
Myofascial release is a hands-on technique that requires gentle pressure through the myofascial system to restore motion and decrease pain. Fascia is a specialized system in the body that surrounds and attaches to all structures. It is like a sweater that is woven throughout the body. Any trauma or inflammation can cause this supple fascia to tighten, causing pain and decreasing range of motion. (John Barnes) We use this technique to improve range of motion of the joints as well as to improve postural alignment. Children with cerebral palsy with high muscle tone and/or spasticity who have tightness throughout the body may benefit from this approach. MFR can help improve range of motion of the legs, arms, neck and back and may help avoid surgical intervention.
Neurodevelopmental Treatment (NDT) is a hands-on treatment approach to treat neuromotor deficits, postural disorders and movement disorders. NDT is used by physical therapists, occupational therapists and speech-language pathologists. Through the hands on approach the child is gently guided through a motion, or inhibited to move in an atypical way. The therapist is able to feel the movements the child is demonstrating and then respond to it and facilitate a better way of moving. The movements are continually being assessed and responded to allowing the child to learn the movement with good postural control.
For more information, please visit: https://cerebralpalsynewstoday.com/2017/03/31/cp-kinds-developmental-delay-get-intensive-neurodevelopmental-treatment/
Pediatric Physical & Occupational Therapy, PLLC, uses the WalkAble from Litegait for our partial weight bearing treadmill training program.
This is a device that through a harness, positions the child in partial weight bearing either over a treadmill or over the ground. This decrease in weight bearing decreases the demands on the muscles and thereby allowing more effective and efficient gait. It provides proper posture and eliminates the fear/concerns of falling and allows free movement of the arms and legs. It allows for progression of weight bearing from minimal weight bearing to maximum. Walking over a treadmill at constant rate provides rhythmic input which reinforces a reciprocal pattern of movement. The therapist’s hands are free so they can facilitate appropriate leg placement during walking on the treadmill.
Typically treatments are twice weekly for one half hour to one full hour. The program can run for 8 to 12 weeks. As soon as the goals are achieved gait should then be practiced over ground.
For more information about on the topic please view this brochure from the American Physical Therapy Association and for more information on the WalkAble please visit LiteGait.
Spider therapy is physical therapy using a piece of equipment called the spider “cage”. It involves attaching several bungee cords from a belt on the child to different levels on the cage. With proper positioning, the child will be suspended and weight bearing will be determined as to where the bungee cords are attached.
This suspension and partial weight bearing allows the child to move independently, strengthen their body as well as learn a variety of movements.
Gravity has a huge effect on children with neuromuscular conditions. It makes it difficult for them to move, resulting in abnormal movement patterns and postures. While suspended in the spider cage, gravity is reduced and movement becomes easier.
The positions the child is placed in while in the cage is based upon the goals to be achieved. They can stand, weight shift, kick a ball, put one foot on bench, practice sit to stand and even jump. Lower level activities such as tall kneel, half kneel, hands and knees can also be accomplished in the cage.
Spider therapy can:
- Improve postural responses through stimulation of proprioceptors and spatial awareness
- Improve strength and stability
- Improve balance and coordination
- Improve vestibular system
- Be FUN!!!!
....and much more
The therapists at Pediatric Physical and Occupational Therapy of Hudson Valley, PLLC (PPOT) are all trained with using the spider cage. It is frequently used as part of a 3 week intensive program; however we use it every day, all day. It has become as common place to us as using a therapeutic ball.
Please feel free to visit the office and see the Spider Cage.
TheraTogs™ are a “Velcro-sensitive garment” that applies prolonged, gentle forces to the child’s body to bring about changes in the way that they move. The garment allows the therapist or caregiver to attach straps that “work like external muscles” to improve the child’s posture and alignment of their limbs.
They can be used with a variety of diagnosis such as hypotonia, cerebral palsy, scissoring gait, knee hyperextension, ataxia, sensory disorders, flexible spinal kyphosis.
TheraTogs™ are a great adjunct to a therapy session. The garment can be worn under the child’s clothes throughout the day to help provide muscle or joint stability or sensory input to their whole body.
Our therapists are Certified TheraTogs™ Fitters and can assess your child and fit them with the TheraTogs™ system that will produce the best alignment.
For more information on TheraTogs, please visit TheraTogs website.
(picture courtesy of TheraTogs™)
We are pleased to offer whole body vibration using the Galileo. The Galileo is a machine you stand (or sit, or kneel, etc.) on and its board vibrates side to side at set frequencies
The lower frequencies help with:
- Tension relief / muscle relaxation, “Cool-Down”
- Improvement of proprioception / balance
Middle frequencies help with:
- Improvement of muscle function and coordination
- Muscle relaxation
- Stretching of muscles and tendons
Fastest frequencies help with:
- Improvement of muscle tone
- Increase of muscle power and muscle force
- Re-establishment of muscle force
There is a tremendous amount of research using the Galileo. Most impressive is the research with children with cerebral palsy.
For further information, please visit:
http://stimdesigns.com/concept
http://stimdesigns.com/testimonials/SusanHastings.pdf