Physical Therapy

Though the terms are often used interchangeably, physical therapy and physiotherapy are forms of rehabilitative health practiced in slightly different ways. They restore, maintain and promote optimal movement and physical function. They target activity limitations, participation restrictions, and environmental barriers experienced by individuals with motor impairment. Physical therapy uses functional training, manual therapy, assistive technologies, and electrotherapeutic modalities.

What is physical therapy?

Physical therapy (PT) is a branch of rehabilitative health that is considered one of the most important aspects of treating children with Cerebral Palsy. Those with Cerebral Palsy experience mobility, function, posture and balance challenges of varying degrees, and physical therapy – which focuses on basic mobility such as standing, walking, climbing stairs, reaching or operating a wheelchair – is a key element in the multidisciplinary approach to increasing a child’s mobility.

Physical therapy is the rehabilitation of physical impairments by training and strengthening a patient’s large muscles – those in the arms, legs, and abdomen. The goal of physical therapy is to maximize functional control of the body, or increase gross motor function.

The goal of physical therapy is to help individuals:

• develop coordination
• build strength
• improve balance
• maintain flexibility
• optimize physical functioning levels
• maximize independence

Trained and licensed physical therapists identify mobility issues and determine the unique physical abilities and limitations of children, taking into account their age and cognitive functioning, after a diagnosis of Cerebral Palsy is made by a physician.

The therapist will then develop a course of treatment that will include exercises, stretches, and possibly assistive and adaptive equipment designed to achieve mobility. The treatment may also employ the use of passive modalities involving hot and cold packs, ultrasound technology or other means in which the child does not take an active role.

All treatment is designed to meet a child’s individual needs in a way that emphasizes physical fitness, and minimizes injuries and pain.

Additionally, a physical therapist provides positive reinforcement for a child by focusing on his or her capabilities, not limitations. The therapist will set goals for young patients, and work with them to meet predetermined benchmarks with confidence in a safe, supportive environment.

Therapy aids overall treatment goals such as:

• Overcoming physical limitations
• Expanding range of joint motion
• Building and maintaining muscle tone
• Increasing recreational capabilities
• Identifying alternate ways to perform everyday tasks
• Fostering independence
• Decreasing the likelihood of contractures, bone deformity
• Educating children and parents about adaptive equipment
• Providing sensory stimulation
• Increasing fitness
• Increasing flexibility
• Improving posture
• Improving gait
• Minimizing pain and discomfort

Who benefits from physical therapy?

A child, and his or her parents or caregivers, benefit tremendously from physical therapy because it helps the child overcome physical limitations by increasing mobility, and identifies alternate methods of completing tasks.

The individual with Cerebral Palsy benefits

This is of benefit to the child because it makes possible something unaffected individuals take for granted: the ability to move from place to place and interact with other children or adults by playing or performing tasks. Therapy also increases overall health by strengthening the body in a way that makes functioning not only possible, but pain and stress-free.

This is achieved not only by developing strength and flexibility in the body, but also using adaptive techniques – or equipment that can be operated by the child – that will allow the patient an alternate path to perform tasks able-bodied children their age perform.

Depending on the nature of a child’s Cerebral Palsy, a child can live a near-normal life; persons with the condition have attended college, participated in sports and activities, excelled in their careers and have married.

Physical therapy empowers the child physically and emotionally, and sets the stage for entering adulthood as an independent individual.

Parents and caregivers benefit

Parents and caregivers benefit because as a patient progresses, raising a child with Cerebral Palsy becomes less labor intensive. Parents and caregivers are often overwhelmed and under an extreme level of stress. They have several responsibilities, including assisting their child with many physical tasks, providing love and emotional support, making sure the child is receiving adequate care in a medical setting and an education at school. The more physical challenges a child can overcome or adapt to, the less hands-on assistance is required of the parents.

Additionally, a successful physical therapy program allows a parent to see their child interacting with others in a healthy way, building relationships, using their body to the best of his or her ability, and potentially, living independently.

What are the benefits of physical therapy?

The benefit of physical therapy, for any patient that is experiencing physical limitations, is regaining – or developing – physical mobility.

By developing a comprehensive plan of treatment, a physical therapist can address limitations in a child’s mobility – and specifically address them. This is achieved through employing exercises that increase physical function, and using adaptive equipment such as wheelchairs, walkers, canes and orthotics to improve performance.

As a child’s physical abilities improve, the therapist can modify the equipment, or the overall course of therapy, to further advance a child’s treatment.

The largest benefit of therapy to the child with Cerebral Palsy is in treatment of problematic conditions when they occur, including:

• Muscle atrophy or tightening
• Loss in joint range of motion
• Muscle spasticity
• Pain in muscles and joints
• Joint inflammation
• Contractures (muscle rigidity)

The therapists focus on achieving optimal results and minimizing unforeseen complications.

When is therapy advised?

Physical therapy typically begins after a pediatrician or a family physician determines a child has Cerebral Palsy, and after it is determined the young person may need assistance with his or her gross motor functionality, pain, contracture or spasticity. A diagnosis is often made before a child is 18 months old.

Because limitations on motor skills vary significantly among children with Cerebral Palsy, it is possible that a child may not require physical therapy.

How is physical therapy performed?

Physical therapy is carried out by licensed physical therapists and physical therapy assistants, often by using means such as:

• soft tissue mobilization (kneading of the muscles)
• joint mobilization
• specialized exercises
• stretching
• endurance exercises designed to meet therapeutic goals

Physical therapy is hands-on: a therapist, or an assistant, will guide the child through exercises.

Exercises often include the use of equipment, such as:

• Weights
• Exercise machines
• Bands
• Rollers
• Balance balls
• Heat and cold packs
• Ultrasound technology

At some centers, sports or recreation like swimming, dancing and playing games such as throwing and catching a ball, may be used to help children develop muscles, balance, coordination and range of motion.

Swimming, because the child is almost entirely submerged in the water, will give children an opportunity to do exercises they cannot do otherwise; moving against the water, kicking and other beneficial exercises can be accomplished in a pool, sometimes in braces. These methods can provide children with an opportunity to play and have fun.

Adaptive equipment including braces, splints, walkers, orthotics, wheelchairs and even computers will be used in therapy; therapists will modify the equipment as needed. The therapist will also play an instructive role in this regard for children and parents, teaching them how to use the equipment.

Where does physical therapy occur?

Physical therapy takes place in several settings, including outpatient medical offices or clinics, inpatient rehabilitation centers, specialized physical therapy centers, skilled nursing centers, hospitals, special education classrooms, and in the home.

The number of physical therapy settings are dependent on several factors; the most important of these is prescribed treatment of the child. Additional considerations include what adaptive equipment is used in treatment, as well as the abilities of a caregiver to provide additional therapy at home. Insurance coverage can also dictate how often a child attends therapy in a clinical setting.

In many cases, a physical therapist will prescribe exercises to be completed at home. The physical therapist or an assistant will train the individual with Cerebral Palsy, the parent or caregiver and the primary caregivers on how to properly perform exercises at home.

What happens during physical therapy?

There is no therapeutic template for Cerebral Palsy since there are many forms of Cerebral Palsy which affect each individual differently.

All physical therapy begins with a diagnosis - the child’s primary doctor will then refer the child to a physical therapist while providing specific treatment goals to accomplish.

At the start of physical therapy, a comprehensive medical history for the child will be obtained. Additionally, the therapist will conduct a series of tests, observations and measurements to assess the child’s body mechanics and function.

The examination may assess:

• Gait
• Range of joint motion
• Physical strength
• Flexibility
• Balance
• Endurance
• Joint integrity
• Posture
• Neuromoter development
• Sensory integration
• Cognitive functioning
• Reflexes
• Breathing, respiration

The therapist then prepares a patient-centered plan of care that takes into account the child’s condition, and the child’s overall environment.

The physical therapist will also determine what orthotic equipment, adaptive equipment, or assistive technologies may be needed to help a child.

Orthotic equipment can include braces that stabilize the ankles, knees, legs, torso, upper arms, lower arms, elbows or hands. Adaptive equipment includes strollers, nets, walkers and wheelchairs. The therapist will teach the child – and his or her caregivers – how to operate the equipment, and will make modifications to accommodate a child’s condition.

Once the child’s plan of treatment is determined, therapists will set goals for a child’s progress, and work with the child to meet those benchmarks. This typically means the therapist and his or her assistants manipulate a child’s body while completing stretches, strength exercises or games with specific movements or purpose.

Often therapy includes instructions for exercises, stretches, posturing and balance to be performed while outside the therapy sessions; at home, school or work.

Who provides physical therapy?

Physical therapy is performed by licensed, accredited physical therapists, or physiotherapists. These professionals are often assisted by physical therapy assistants.

Practicing physical therapists may be doctors, some having earned a master’s degree in physical therapy or kineosiology.

The coursework a budding physical therapist must complete is extensive, and includes:

• biology
• physics
• chemistry
• anatomy
• physiology
• kinesiology
• human growth and development
• examination
• therapeutic practices

Physical therapy assistants – who worked under the supervision of a physical therapist –typically complete bachelor’s or associate degree programs focusing on the same topics as the physical therapist.

All states require licensure via state board examination to practice, though the requirements to take the exam vary from state to state. Most states require the therapist to successfully complete the National Physical Therapy Examination; however, others administer their own examination.

Most states require licensure for physical therapy assistants. Assistants work under the careful guidance of physical therapists. Assistants may also pursue additional certification in specific therapies, such as aquatics, through the American Physical Therapy Association.

More specific information is available at the various state medical board websites.

What is the difference between physical therapy and physiotherapy?

The job of the physical therapist and the physiotherapist is the same – to help a child develop muscular coordination, strength, flexibility and balance to support their mobility.

Even though the two terms have been used interchangeably, here are some differences between the two professions. A physical therapist is trained to work in private physician practices, specialized centers or clinics. Physiotherapists are found more often in hospitals.

There is also a slight difference in the approach to therapy; a physical therapist may concentrate solely on physical activities, while a physiotherapist may use ultrasounds or other electronic means to achieve goals.

Though there used to be several differences in training, most experts agree that requirements to work as a physical therapist or a physiotherapist are very similar.

Is there any risk or special consideration for physical therapy?

Although physical therapists and their assistants are trained to minimize unforeseen circumstances while carrying out treatment plans with patients, there is some risk associated with therapy. Physical therapy is meant to be restorative in nature – a therapist more often than not will not over-work a patient. However, this can occur.

If physical therapy is taken too far in a given session, this can cause injury or unnecessary pain, which is not the goal of therapy.

The key to minimizing risks and maximizing results is open communication between the child, his or her caregivers and physical therapists. Identify where your child’s physical and psychological limits are. Talk to your child regularly to discover difficult areas of therapy. Don’t be afraid to mention your concerns with the therapist.