Physical Therapy

Article excerpt

Physical theraphy (PT) does not cure spasticity but can improve impairments and limitations. For example, strengthening exercises reduce weakness in children with spasticity. Functional limitations, such as poor ability to sit, might also improve with therapy. If these changes happen only in the therapy gym, the disability remains unchanged. Therapy must improve abilities to perform meaningful tasks. Changing the level of disability is the ultimate goal.

Medical treatments

Prior to treatment, a child may have relied on spasticity in certain muscles -- spastic back muscles to sit or spastic thigh muscles to keep knees straight for standing or walking. Following treatment which decreases spasticity, specific therapies to strengthen and/or develop more typical movement patterns are usually needed.

Since selective dorsal rhizotomy (SDR) eliminates spasticity at the time of the operation, intensive PT following surgery builds strength and appropriate movement patterns. Less intensive PT is needed with intrathecal baclofen therapy because doses increase slowly, giving a child time to get stronger and to learn to move with less spasticity. Strengthening exercises and other therapy interventions are often essential following othopedic operations.

Infancy to adulthood

Intervention by physical therapists may begin infancy. Infants with severe spasticity need help to explore the world around them and to learn like other infants. Physical therapists, as part of an early intervention team, use a variety of techniques to help infants and toddlers move and explore. Adaptive equipment -- wheelchairs, wheeled standers, etc. -- can provide more opportunities to move, keep up with and play with friends, and even get into trouble. Communication devices are also important in learning and development. Therapists can show parents how to incorporate therapeutic activities into everyday tasks such as stretching an infant's legs while changing a diaper.

As children with spasticity grow, their muscles and joints tend to get tighter and/or painful if not treated. At this point, therapists are concerned about contractures in growing muscles, so they create activities that stretch muscles and maintain the range of motion of the joints. In addition, proper alignment of muscles and bones with orthoses, serial casts and adaptive equipment can protect joints, help prevent contractures and make movement more efficient. Because children get heavier as they grow, an important focus of therapy continues to be on successful transfers, standing and walking.

Children's social and intellectual capabilities are as significant as their movement skills. …