Interventions for Pediatric Special Populations
Autism Spectrum Disorder
Autism Spectrum Disorder is characterized by difficulties in social interactions, communication, and repetitive behaviors. The severity of the symptoms considerably varies between people, depending where they fall on the spectrum. Children often have poor motor control and planning, balance, and strength, although these are not part of the diagnostic criteria. In severe cases, they may be hypersensitive to large amounts of sensory input.
In the clinic, the PTA may work with younger children on improving gross motor skills such as sitting, standing, and walking. In these functional positions, they can also work on balance and coordination activities to work on neuromuscular component of movement, i.e. controlled lateral weight shifting to be able to walk normal. Functional strengthening and endurance activities, such as picking objects off of a floor and putting them on a shelf, can be used to build up their stamina.
It is important to make sure the environment is conducive to the child's individual needs, and this depends on where they are on the spectrum. For example, if a child is overwhelmed by bright lights and noises, a quieter environment may be a better option. In addition, children with autism can be extremely fussy about what they want to do. Allowing them to choose from a variety of activities increases their level of compliance and is more likely to produce positive outcomes. Also, it has been shown that children who focus on doing the task correctly rather than getting the task done become easily frustrated, which lowers compliance. In this population, it is important to tailor treatments to the child's needs and desires to attain success.
Underneath the IDEA, physical therapy is a covered service. Physical therapists in schools may provide many of the same services as in clinics, although they may attempt to integrate the child with their peers more. In physical education classes, some physical therapists may pull children out of the groups and work with them individually on activities such as a pedal bike or playing catch, as the environment may be overwhelming. The IDEA helps the students, teachers, and parents to work together to make the child's learning experience successful.
Ries E. Physical therapy for people with autism (2018).
Retrieved from PT in Motion: https://www.apta.org/PTinMotion/2018/7/Feature/Autism/
Cerebral Palsy
Cerebral Palsy is a disorder in which the infant brain becomes damaged due to brain hemorrhage, malformation of the central nervous system, or lack of oxygen to the brain (hypoxia). As a result, posture, balance, and mobility impairments occur. In addition to motor movement, emotional and behavioral issues may be present. The severity depends on how much brain damage is present and the location of it.
Interventions differ based on the age of the child. From birth until about 3 years, it is extremely important to get the parents involved in the child's treatment, as this promotes positive social interaction and builds the foundation for future relationships. With cerebral palsy, primitive reflexes may persist long after the age they normally disappear, so it's important to put the child in positions that facilitate proper muscle activation. For example, having the parent hold the child in prone promotes head orientation and symmetry of the midline. In this position, children can begin reaching for objects, which activates their extensor muscles and prepares them for walking. Using brightly colored objects helps to generate the child's interest. Parents can also incorporate range of motion exercises while changing diapers, clothing, or bathing their child.
As the child gets older, activities should become more functional as the reflexes disappear. Once the child is able to stand upright while holding on to something, functional activities such as squatting and crouching, standing and sitting, and stepping up and down with assistance can be incorporated into the treatment. During the preschool years, it becomes more important for the child to move around independently. PTAs can begin training children how to properly ambulate, challenging balance by giving gentle perturbations and teaching weight shifting activities. Orthotic devices, such as ankle foot orthoses (AFOs), may be needed for toe clearance during gait. The PTA can instruct the child in how take care of it, which gives a sense of responsibility. Assistive devices, such as a rolling reverse walker, can help establish a normalized gait. Sometimes, independent mobility is not always feasible depending on the amount of motor involvement. Children with quadriplegia are taught how to operate power wheelchair, in which no arm or leg strength is needed. Strengthening and endurance activities are also included, as they will need both to get through the day at school. While there, children can participate in activities such as soccer or playing tag, which helps build muscular endurance. In addition, the social interaction they have with other children can help facilitate friendships.
Once a child reaches adolescence, the goal becomes to maintain and increase independence gained thus far. At this age, children are much more likely to comply to therapy if the goal is directed towards their personal goals. Therapists allow children to choose from a pool of activities that accomplish the child's goals but also work toward achieving age appropriate developmental milestones. Isokinetic exercise has been shown to increase hamstring and plantar flexor strength, which has been demonstrated with climbing stairs, running, walking, and jumping. Social integration becomes much more important at this stage, as it helps increase motivation towards increasing function and fitness. Community programs, such as the YMCA, offer classes for swimming, basketball, soccer, and so many more. People can participate in these classes to enjoy the benefits of exercise and get to know others.
Kessler M, Martin T. Neurologic interventions for
physical therapy. 3rd edition (2016). Philadelphia,
PA: Elsevier; 2016
IDEA
The Individuals with Disabilities Education Act is a federal law that offers free education to qualifying children with special needs from ages 3-21. It also provides funding for services that allows these children to participate in the classrooms with their peers. This may include specialized equipment such as keyboards. An Individualized Education Program (IEP) is designed to meet the needs of each child and may include services such as occupational, speech, and physical therapy. Here are some links that provide additional information about the IDEA as well as how it governs physical therapy in schools: