Physiotherapy / Neurodevelopmental therapy

Physiotherapy for Children

Our clinic offers specialized physiotherapy for children.

The problems which Children face in their bones, muscles, and spine are quite different from those in adults. Our therapists are highly skilled and specially trained in dealing with children and their problems. The physiotherapists at our clinic are specially trained in the following fields;

Physiotherapy for scoliosis- Schroth Therapy

At the Children’s Orthopaedic and Spine clinic, we have dedicated programmes to treat Scoliosis in Children and Adolescents. We have specially trained paediatric physiotherapists who run exercise programs called Schroth therapy.

Schroth therapy is a program that was initially developed in Germany by Katarina Schroth. This program has spread mainly in Europe and North America, and is slowly gaining recognition as a system of exercises which helps to control Scoliosis and even improve it. Recent high-class studies from the USA have shown effectiveness of Schroth therapy and bracing in children and adolescents. Since 2019, our clinic has starting offering this exercise system to our patients with Scoliosis.

Schroth therapy is a system of exercises which involve postural awareness and its adjustment, exercises that specifically target muscles to address the imbalance of the trunk, and breathing techniques to facilitate thoracic expansion (expansion of the rib cage) to facilitate a better alignment.

When our patients regularly carry out exercises as per the program given to them, and are meticulous in wearing the brace supplied, we have observed very good effects on the abnormal curvature. In almost all cases, curves have not worsened or have actually improved. In some children, the improvement has been significant enough to obviate the need for surgery.

Therapy for Patients with Torticollis (Wry neck)

Congenital muscular torticollis is a condition in which an infant develops a tightness in one of the major neck muscles. This tightness forces the head to be maintained rotated in one direction and does not allow the child to turn their face completely to the opposite side.

We offer early intervention for this condition.

We assess the child to confirm the diagnosis – and make sure that the wry neck is not caused by a problem with vision, or abnormal bone development, or infection in the neck.

We then determine the severity of the condition, and then set up therapy sessions to help reduce and resolve the condition.

When children come to us early – in the first 4 months of life, we are able to achieve excellent results in most patients.

When the condition is left untreated or treated late, the repercussions are serious. Children develop bony deformity of the neck, may develop a problem with their vision, and almost always develop a deformation of the face that cannot be reversed.

So it is very important to complete all treatment in the first 12 to 15 months of life in order to avoid serious consequences of this condition.

Therapy For children with Cerebral Palsy / Developmental delay

Neurodevelopmental therapy

This is a specialized form of physical therapy for children suffering from developmental delays (delayed milestones) or inability to sit, stand, walk, or perform activities of daily living in a timely manner. By timely manner, we mean activities that develop with various stages of growth ( for example – children learn to walk between ages 12 months and 18 months). A child who cannot stand by age 18 months has a delayed milestone.

Our NDT specialists work on the ‘feeling’ of movement, training the brain to control the muscles, through a system of sensory feedback. Our specialists offer training programs which are tailored to varying needs of children. They use functional play and activity therapies which makes it enjoyable for the child to participate.

In cerebral palsy kids, the brain needs to re-learn the activities of daily living. Neuro-developmental therapy (NDT) helps these children with posture control, posture re-learning, rising to stand, ability to walk. The therapy also helps in avoiding abnormal movement patterns.

The therapy is especially important in the first 5 years of life, and is continued till the child is 8 to 10 years of age. Maximum brain learning happens in the 1st 3 years of life, so the importance of early therapy cannot be over-emphasized.

For us, every child needs to reach his or her maximum possible level of functional activity so that their participation in their environment is maximized. We strive to work hard to achieve the best possible quality of life for the children who come to us for therapy.

Sensory Integration

In children who have cerebral palsy, autism, and many other neurological disorders, the sensory system is altered.

The common signs of a sensory problem is:

Child is very sensitive to touch, sudden movement, sounds or sight.
The child may react fearfully to touch, or to ordinary movements.
The child may be irritable, withdrawn, distracted.
The child may be under-reactive to sensations.
The child may seek out sensory experiences which are intense. He or she may be hyper-active, always running our, whirling, and bumping into things.
The child may have difficulty in balancing and coordination.
The child may seem to walk as if on a tightrope-high-above-the-ground.
The child may have a poor awareness of self, poor organization of behaviour, delayed motor milestones, delayed speech and academic activity.

Sensory integration helps children improve their sensory system, helps the brain to understand and improve the sensations (sensory input) from the environment. The sensations can be sound, light, touch, feel, sensations that help balance and position of the body.

Therapy for Spina bifida

Spina bifida occulta does not need any treatment.

Severe Spina bifida can be associated with a meningo-myelocoele. In these situations, a neurological deficit may occur. The deficit can cause a small degree of weakness of the leg, or can be more severe with significant involvement of both lower limbs and loss of control of urine and stools.

Therapy for Spina Bifida involves:

A comprehensive assessment
Setting up a tailor-made physical therapy program for rehabilitation. This can be an early intervention program when the baby is seen early.
Assess the need for Orthopaedic interventions, urology care, neurosurgery care and make appropriate timely referrals.
Assess for application of orthotic devices to help control the limb, help in standing, walking and prevent deformities. They also prescribe other mobility aids like walkers, crutches, rollators and train children to use these.
Various therapies like strength training, mobility training, balancing exercises are carried out. Therapy is prolonged and it is essential for the parents to regularly attend therapy sessions in order to get good results.
Home exercise programs are also prescribed so that children may attend school and yet benefit from physical therapy

There is a close coordination between the paediatrician, child physiotherapists, orthopaedic surgeons, urologists, neurologists, neurosurgeons, psychologists and orthotists in order to achieve a good result in these children.

Therapy for Obstetric Brachial Plexus Injury, Erb’s Palsy, Klumpke’s Palsy

This condition develops due to a difficult childbirth – the baby gets stuck in the birth canal and has to be pulled. This causes injury to the nerves in the neck region. These nerves supply sensations and movements to the upper limb.

When damage occurs, the arm on the affected side develops weakness, and problems in sensations. In most babies, there is variable recovery of the weakness. Function gradually returns. In some, the injury is severe, and the arm is left with weakness, difficulty in moving the arm or the hand, deformity and a significant loss of function.

Physiotherapy is essential to help with the recovery of this condition.

Our children’s physiotherapists start by making a full assessment. The evaluation includes assessing which muscle groups are affected, and the power in individual muscles. Sensory evaluation is made, and scoring of the injury is carried out. Scoring helps to develop an idea on how much recovery would occur, as well as the type of interventions to carry out.

The treatments which the therapists at the Children’s Orthopaedic and Spine clinic offer are;

Passive exercises and Stretching exercises to prevent contractures.
The baby is assessed periodically to check for recovery.
Active exercises
As the baby grows and improves, active movements are encouraged. Over a period of time, more exercises are added to the recovering muscles
Muscular re-education
The baby is encouraged to move the muscles, gradually building in correct movements and muscle coordination.
Functional training
As the child grows, he or she may have difficulty with some or other activity of daily living. Our therapists tailor individual programs to train the child carry out movements that are important for day-to-day activity.
Proprioceptive learning
Often children will not use the affected arm because the sensations to the hand are not good. Therapists use many strategies in trying to overcome these limitations such that the child can regain function of the hand and arm.

The therapists have an all-important role is regular monitoring of the patients and suggest interventions like Botox injections, surgery or other interventions.

The goal is to obtain maximum function possible, and allow the child to live a happy and functional life with minimum or no disability.

Therapy During Limb Lengthening

Limb lengthening in Children and Adults involves application of External Lengthening devices (Called an external fixator) and internal nails and plates. The bone is divided by a procedure called an Osteotomy, and then gradually lengthened to the target length. During the course of lengthening, the soft tissues also undergo a process of lengthening, just like the bone does. However, the patient and the therapist experience a few challenges.

Initially, there is pain of surgery. This causes inhibition of muscles such that these function in a feeble manner. The joints become stiff. The body does not allow the patient to take any weight on the operated limb.

The goals of therapy are :

Make the muscles contract

The muscles need to regain full strength. The therapist gently encourages strengthening of muscles so till muscles come back to normal strength.

GOAL 1

Make the joints move

This is often the most difficult part. Patients are taught to actively contract the muscles in order to move the joints. It is important to regain at least 70% joint movements by the end of lengthening and then 100 % movements in the 8 weeks after fixator removal.

GOAL 2

Make the patient bear weight

Weight bearing to tolerance is encouraged. Usually, patients use walkers and crutches to walk around and perform their daily tasks. The therapists train the patient to walk, negotiate obstacles and tight spaces, and to climb stairs.

GOAL 3

Our specially trained therapists guide and help the patient through the process of limb lengthening and are indispensable in achieving excellent results of limb lengthening at our clinic.