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Dr. Mohammed Alghamdi 1 § Some slides are courtesy of Dr. Ehab Abdel-Kafy
§ Pediatric Physical Therapy • Subspeciality in physical
§ Philosophy of Service Delivery in Pediatric Physical Therapy therapy dedicated to infants,
§ Pediatric Physical Therapist: Roles and Responsibilities children, and adolescents.
§ Comprehensive Assessment and Evaluation • Focus on the assessment,
§ International Classification of Functioning, Disability, and Health diagnosis, and treatment of a
(ICF) in Pediatric Rehabilitation variety of health conditions
in a pediatric population.
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Help children reach their maximal functional level of independence to
participate as fully as possible in their home, school, and community • Developmental Considerations: Treatment is tailored to the child’s specific
environments stage of growth and development.
• Play-Based Therapy: Play is utilized as a fundamental approach to treatment,
making it engaging and suitable for children.
• Maximizing the child’s motor skill development
and functional abilities. • Family Involvement: Family members are integral to the therapeutic process
• Improving strength and endurance for better and play a crucial role in a child’s development and adherence to therapy.
overall health. • Holistic Approach: The therapy addresses not only physical needs but also
• Assisting in the management of pain or considers the emotional, social, and psychological aspects of the child's well-
discomfort. being.
• Facilitating rehabilitation from injuries or surgical
procedures. • Educational Component: Parents and caregivers are often educated about the
child’s condition and ways to support their development at home.
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§ Family-Centered Care (FCC)
§ Practice Setting
§ Early Intervention
§ Improved family satisfaction, increased family involvement in care, and better outcomes for
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children with disabilities. McManus et al 2021. 8
What is
the child’s n
atural e
nvironm
ent?
1. Shock and Denial: Initial difficulty accepting the diagnosis. the following are all possible settings in which
2. Emotional Turmoil: Anger, sadness, and confusion. Pediatric PT can be offered:
3. Information Seeking: Gathering details and support. § NICU
4. Financial and Practical: Managing costs and care. § Rehabilitation Hospital (including sub-acute, and
5. Social Changes: Altered relationships and interactions. day hospital units)
6. Adaptation: Accepting and adjusting to the reality. § Home care
7. Resilience: Building coping strategies. § Inpatient
8. Family Impact: Strengthened bonds, sibling dynamics. § Outpatient
9. Advocacy: Fighting for the child's needs. § Early Intervention
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§ School 10
§ Medical setting: episode of care in medical setting may have a focused reason
for care, i.e. pre-surgery breathing exercises, therapists in medical setting may
not have the opportunity or need to be as holistic in their care at all times.
§ School setting: school therapists may not be able to pursue strategies such as
electrical stimulation, or systematic strength training to focus on impairments
that may be hypothesized to influence the activity limitation.
§ Ott and Effgen (2000) examined the naturally occurring opportunities to
practice three types of gross motor behaviors (stability, mobility, and
transfers) among preschoolers. They found a high incidence of opportunities
for stability skills (sitting activities) but a low incidence for mobility and
transfers.
Leisman, Gerry & Melillo, Robert. (2015). Infant and Childhood Frontal Lobe Development: Asymmetry and the Regulation
11 of Temperament and Affect. Functional Neurology Rehabilitation and Ergonomics. 5. 443-470. 12
§ Enhances Developmental Outcomes: Early intervention can significantly § Facilitates Better Long-term Prognosis: Early intervention often leads to a
improve developmental outcomes. When therapy is started early, it can better long-term prognosis. Children who receive early therapy may achieve
capitalize on the brain's neuroplasticity, especially in the first few years of developmental milestones more quickly and effectively than those who start
life when the brain is most adaptable. therapy later.
§ Minimize Secondary Complications: Timely physical therapy can help
prevent or minimize secondary complications that might arise from the § Supports Family and Caregivers: Early intervention programs often provide
primary condition. For example, in children with cerebral palsy, early support and education for families and caregivers, equipping them with
intervention can prevent muscle contractures and deformities. strategies to aid the child’s development at home.
§ Improves Motor Skills and Physical Abilities: Early physical therapy can aid § Reduces Healthcare Costs Over Time: By addressing issues early on, long-
in the development of motor skills, strength, and coordination. This is term healthcare costs can be reduced. Early intervention can decrease the
particularly important for children who might have delays in these areas due need for more intensive therapies or medical interventions later in life.
to their health conditions.
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Comprehensive Assessment and Evaluation
Surveillance: The process of recognizing children who may be at risk of
§ Comprehensive Assessment and Evaluation developmental delays (Pediatricians)
§ Designing Individualized Treatment Plans Screening: The use of standardized tools to identify a child at risk of a
developmental delay or disorder (Pediatricians, Pediatric Nurses,
§ Collaboration with Multidisciplinary Team Pediatric PTs)
§ Advocacy and Education Clinical Evaluation: The complex process aimed at identifying specific
developmental disorders that are affecting a child (Every healthcare
provider)
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Comprehensive Assessment and Evaluation
• Developmental Screening: Essential for monitoring developmental milestones
and identifying potential delays or abnormalities. This can be conducted using
screening tools such as Ages and Stages Questionnaires (ASQ) and Denver-II
Developmental Screening Test
• Clinical Evaluation
• History Review
• Observation
• System examinations
• Standardized testing
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Clinical Evaluation: History Review Clinical Evaluation: Observation
§ Birth History: Complications, birth § Developmental Milestones: Age at
weight, gestational age. key milestones (crawling, walking, • Movement Analysis: Note • Social Interaction and Behavior: Pay
speaking). coordination and any asymmetries. attention to interactions, response to
§ Medical Diagnoses: Past and present
conditions. § Previous Therapies: Past therapy instructions, and behavior.
• Posture Assessment: Examine resting
§ Surgical History: Relevant surgeries,
services and outcomes. and active posture for deviations. • Reaction to Sensory Input: Note
especially orthopedic. § Functional Status: Daily activity responses to sensory stimuli and any
• Play Activity Observation: Assess
limitations and challenges. processing issues.
§ Medication Review: Current/past engagement, hand-eye coordination,
medications and effects. § Behavioral/Social History: Behavior and motor skills during play. • Facial Expressions/Non-verbal Cues:
§ Hospitalizations: Past hospital stays and social interactions. Observe for indications of discomfort,
• Interaction with Environment:
and medical interventions. frustration, or enjoyment.
§ Nutrition/Feeding: Dietary needs and Observe navigation and adaptation to
§ Family Medical History: Genetic feeding issues. surroundings.
conditions or patterns.
§ Immunization/Illness History:
Vaccinations and major illnesses. 19 20
Clinical Evaluation: System Examination Clinical Evaluation: Standardized Testing
Assessing specific outcomes using
standardized tests either clinical
(ROM, Berg Balance, etc) or
instrumental tests (Vicon Gait
Analysis)
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Important Consideration in Clinical Handling of the child during P.T
Evaluation evaluation
Performance: Undressing:
1. Refers to how a child functions in their natural, day-to-day environment.
Children less than 6 years of age dislike being undressed, and get tense, and
2. Indicates how external factors (like environment and social support) impact the child's
abilities.
this may affect the reliability of examination.
3. Example: Observing how a child climbs stairs at home or interacts with peers on the To overcome this problem:
playground.
- Don't keep the young child undressed for long period.
Capacity:
- The mother should undress the child.
1. Refers to the child's potential abilities in a controlled, clinical setting.
2. Focuses on the child's inherent physical and cognitive abilities. - The examiner help the child get dressed.
3. Example: Assessing how high a child can reach or how long they can balance in a
therapy session.
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Handling of the child during P.T Designing Individualized Treatment Plans
evaluation
The examination room: • Goal Setting: Specific, measurable, achievable, relevant, and time-
It should be small, quiet, warm, lighted and restful. bound (SMART) goals are set in collaboration with the child and
family.
The Therapist: • Treatment Strategies: Various strategies such as strength training,
- Don’t approach the child directly. coordination exercises, balance activities, and functional skill
- Avoid white coat if necessary. development are implemented.
- Examiner's hand should be warm. • Adaptability: Treatment plans are continually adjusted based on
the child's progress and changing needs.
Presence of the child’s caregiver (can be + or – depending on the child).
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Collaboration with Multidisciplinary Teams Advocacy and Education
• Interdisciplinary Approach: Involves collaboration with other • Advocating for the Child: Pediatric physical therapists advocate for
healthcare professionals like pediatricians, occupational therapists, the child’s needs in various environments, including educational
speech therapists, and educators for holistic care. settings and the community.
• Family Involvement: The family's role in therapy is critical, • Educational Role: An educational role is played in informing
including educating parents and caregivers on supporting the families, teachers, and caregivers about the child’s needs and
child’s development at home. facilitating their development and participation.
• Coordination of Care: The therapist coordinates care across
different settings, such as clinics, homes, and schools.
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What is ICF?
§ The International Classification of Functioning, Disability and Health (ICF) is a
framework for describing and organizing information on functioning and
29 disability. (ICF Manual, 2000)
§ It was created in early 2000 to substitute the disablement model (figure
below)
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The aims of the ICF (WHO 2001): What is the ICF Framework?
Health condition
1. Provide a scientific basis for understanding and studying health and health- (Disorder or disease)
related states, outcomes, determinants, and changes in health status and
functioning;
2. Establish a common language for describing health and health-related Body functions and
structures
Activity Participation
states in order to improve communication between different users, such as (Impairments) (Limitations) (Restrictions)
health care workers, researchers, policy-makers and the public, including
people with disabilities;
Contextual factors
3. Permit comparison of data across countries, health care disciplines, services
and time; and
4. Provide a systematic coding scheme for health information systems. Environmental
Personal factors
factors
(ICF Manual, 2000) 31 32
Heather L. Atkinson, Kim Nixon-Cave (2011)
Check out this tool
§ ICF e-Learning Tool
§ http://icf.ideaday.de/en/index.html
33 34
Check out this tool
§ ICF Core sets § Campbell’s Physical Therapy for Children
§ https://www.icf-core-sets.org § https://pediatricapta.org/fact-sheets/
§ ChatGPT was utilized to organize content and generate some
pictures.
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