Physiotherapy for Child's Developmental Delay | Its Role and Importance

Do you suspect that your toddler is not developing on schedule and has a developmental delay? If yes, then you need to be vigilant and request a developmental screening test for your child. Developmental delay is diagnosed when a child does not reach the developmental milestone and can lead to a minor or major problem. You will be surprised at the number of resources and interventions available for the treatment of developmental delays. Physiotherapy is one of them. As the child's brain can adapt easily and respond well in the early years, therefore, the treatment for delayed milestones should be started as early as possible. Physiotherapy treatment aims to promote the ability to reach physical milestones and promote independence. Today, through this blog we can help you to understand about the developmental delay and the role of physiotherapy in it.

 

Developmental Delay

Developmental delay, also known as Delayed milestone, is when the development of the child is delayed as compared to other children. There can be many different causes for developmental delay such as problems during birth like occlusion of the internal carotid or mid cerebral artery during birth, asphyxia can occur by accidents which could be as a result of the knotted umbilical cord, cord around the neck, or prolapsed cord, problems during early infancy, genetic problem, infection, head injury, neonatal meningitis, etc.

The child feels gross motor skills or movement delay, fine motor developmental delay, speech and language delay, cognitive/intellectual developmental delay, social and emotional developmental delay thus causing problems in the child's ability to interact with others.

 

Benefits of Physiotherapy

Delayed milestone is the way a child grows and matures from birth to adulthood, mostly developmental delays can be corrected themselves if not then physiotherapy treatment can help:

• To achieve physical milestones such as crawling, sitting, and standing,
• Improve posture, muscle strength, motor control, balance, and coordination,
• Improve independence in activities of daily living,
• Improve confidence.

 

Treatment Techniques:

Treatment is specified to the child's needs, age and abilities. The physiotherapist often uses exercises and activities to help promote normal development.  Effective short and long-term rehabilitation goals are developed so that milestones are reached and improve their quality of life. The rehabilitation plan is set up after taking a thorough assessment of the areas concerned with the child's development to give them the best chance possible to achieve their physical milestones.

 

Neurodevelopmental Techniques:

Neurodevelopmental techniques are used to improve head and trunk control. For example, supporting the child in sitting to develop weight shifting, rotation, coordination, and balance. This technique session is given for the facilitation of head holding on a wedge or Swiss ball, neck extension on the Swiss ball prone with scapular retraction, prone on elbows and a hands-on Swiss ball, rolling with a weight shift to the rib cage, intercostal muscle stretch to sit on the mat, sitting on tilt board with weight shifts, side-sitting one hand weight-bearing, and sitting 90-90 upright on the small stool.

 

Oromotor Stimulation:

Oromotor stimulation devices used are finger brush with soft bristles, vibrating brush and nuke brush, the position of the head in midline, slightly flexed with the propped up position. The techniques used are stimulation by deep pressure on gums with a gloved finger, stroking over cheeks to improve sucking rate, intraoral stimulation with artificial nipples, and rooting reflex facilitation. For fine and coarse stimulation. The sequential introduction of different tastes like breast milk, sugar, honey, jaggery is also given.

 

Sensory Integration:

Sensory stimulation is followed by palm strokes with different soft and hard textures. The vestibular system stimulation includes head turns with 20 repetitions, head nod with 20 repetitions, swing on the horizontal plane in the supine position in forward, backward and lateral direction, cribbing in the vertical plane in supine, and rolling on the Swiss ball, bouncing on the Swiss ball in a sitting position and sitting on a rotatory swing. The proprioceptive system stimulation includes techniques like compression of the joints by concentrating on the extremities, tightly and firmly rolling into the blanket, and vibrations using a tuning fork or brush. Further progressed to firm deep pressure using the large ball. For proprioception, mirror imaging can also be used to increase the awareness of where the limbs are in space.

 

Passive stretching with the Myofascial release:    

Muscle stretching is done to lengthen the muscles, which in turn increases the range of motion and prevents muscles and joints from becoming stiff. The passive stretching follows the stabilization of the upper part of the thorax with one hand, laterally flexing the head of the child to the left side holding for 10 seconds and then laterally rotating the head to the right side holding for 10 sec and stretching the sternocleidomastoid.

 

Hydrotherapy:

Hydrotherapy treatment helps relax stiff joints and muscles, thus maximizing mobility in water and helping develop independence with the daily activities of daily living (ADL).

 

Assistive devices:

The physiotherapist recommends a supportive device such as orthotic devices, using a wheelchair, or other adaptive equipment (in case required).

 

The physiotherapist designs a treatment plan, which is developed to incorporate parents, caretakers, and teachers so that it helps them to understand the child's needs, promote future independence and develop independence with everyday tasks.

 

Prevention and Management of Bowel Dysfunction by Physiotherapy

Do you or anyone dear to you suffer from bowel incontinence? Is it due to intake of different kinds of medications or after having undergone a certain surgery? Then a proper assessment followed by the treatment is necessary to relieve the condition. Physiotherapy can be one of the interventions. A physiotherapist will help you to retrain your pelvic floor muscles and thus regain normal function.  In this blog, we will spread some light on the physiotherapy techniques used for bowel dysfunction.

 

Bowel Dysfunction

Bowel dysfunction or bowel incontinence is the loss of bowel control. The pelvic floor muscles play a significant role in bowel function. These muscles prevent stool leakage and gas by voluntarily controlling the anal sphincter. Constipation can be induced by different kinds of medications, including oral contraceptives, iron supplements, NSAIDs, antihistamines, and antidepressants. Dehydration can lead to firmer stools, which are more difficult to pass and cause more straining, which can lead to bowel dysfunction. Gastrointestinal distress can affect the pelvic muscles. The absence of voiding regularly can lead the bowel wall to become over distended, which can reduce its ability to contract effectively to propel stool out, resulting in bowel dysfunction.

Certain surgeries can also be a cause for pelvic floor dysfunction, such as surgery for rectum or anus cancer, hemorrhoids, or abscesses. Childbirth procedures like forceps or vacuum delivery, episiotomy, tear in the perineum while giving birth can also be a reason for bowel dysfunction. Injury to the nerves that control the pelvic floor muscles, bowel, or bladder can also cause dysfunction. Brain injuries, spinal cord injuries, multiple sclerosis, spina bifida, and neurogenic bowel or bladder and hormonal changes can also be one of the reasons.

Patients experience the following symptoms:

 

• Pain with bowel movements
• Bleeding
• Straining with defecation
• Fecal  incontinence
• Abdominal bloating
• Fecal urgency and frequency
• Irritation around the anus
• Burping, reflux, difficulty swallowing
• The emotional state of fear, embarrassment, anger, or depression

 

How does physiotherapy for bowel dysfunction help?

Physiotherapy helps to keep the pelvic floor muscles working in shape. The physiotherapist works in coordination with the other specialists to provide the best treatment program. As many contributing factors can cause bowel dysfunction, therefore there can be many different kinds of treatment that can be helpful. The patient first undergoes an evaluation with the physiotherapists for the most effective and individualized program.

 

Diaphragmatic Breathing

The diaphragm and pelvic floor muscles are linked like a piston.  The patient is asked to hold his breath, this stops the diaphragm from moving and hence stops pelvic floor muscles from relaxing, allowing to poop. The therapist teaches how to breathe effectively to poop in the right way.

 

Pelvic Floor Muscle Exercises

Pelvic floor strengthening exercises for the muscles are done to support the rectum. This group of muscles is called the sphincters and they control bowel continence. Weak pelvic floor muscles can cause incontinence. Doing strengthening exercises can lead to control of bowel movements. This is done by tightening the sphincter muscles as if one is stopping a bowel movement. While squeezing tightly, hold for a count of 10 and then relax for a count of 10. This constitutes a step. Repeat this exercise 10 times and do 10 sets per day.

 

Motor Control Training

Motor control training helps to effectively engage and relax the pelvic floor muscles. Effective use of pelvic floor muscles helps to control the bowels. Contract to hold in a bowel movement, and relax to void without straining. The physiotherapist will work by using different techniques to effectively contract and relax the pelvic floor muscles. Biofeedback is a safe and effective tool to manage mild-to-moderate bowel incontinence associated with traumatic sphincter injury.

 

Balloon Training

Balloon inserted into the rectum can be a common tool to assist training for bowel dysfunction. The balloon is inflated to simulate the pressure of an impending bowel movement. The patient is taught to contract the pelvic floor muscles by holding the balloon and relaxing to void the balloon out. In patients with reduced rectal sensation physiotherapy improves rectal sensation and may enhance coordination between perception improving an appropriate urge and holding that urge in patients with reduced rectal sensation.

 

Myofascial and Abdominal massage

Patients with chronic constipation are found to have more trigger points. Restrictions of muscles throughout the pelvic girdle can influence bowel function. The rectum should be able to expand to accommodate stool. When there is damage to these tissues by bowel surgeries, radiation for the treatment of cancer, Crohn's disease, the rectum can lose some of the flexibility. Manual therapy can be used to release the restricted rectal tissues.

 

Stress Management

Increased stress causes increased cortisol levels, which has a negative influence on bowel and pelvic floor function. Relaxation and breathing exercises can help improve the body's homeostasis and keep everything functioning well.

 

Urge Retraining

Due to repeated pushing ineffectively over time, the body can lose sensitivity to urge. Ignoring the urge to poop regularly, can lead to chronic constipation. Repeatedly ignoring the urge to poop, causes the body's intrinsic poop triggers not to get triggered easily because the rectum becomes less sensitive to the incoming signals

 

Physiotherapy interventions used for bowel syndrome, focus on alleviating its symptoms, by maintaining the exercise program designed to reduce anxiety and stress and thus should be followed by the patient on regular basis.

 Top 10 Exercises for relieving Hip Arthritis Pain

Hips hurt for a variety of reasons, arthritis can be one of them. Hip Arthritis causes pain and mobility problems making it difficult for the individual to do everyday activities, but if treated early, quality of life can be preserved. Though there is no cure for arthritis, but there are many treatment options to reduce its symptoms. One of the treatment options is physiotherapy. The physiotherapist uses a range of interventions to treat this condition and also guides in recommending the activities which are to be avoided thus enabling early treatment and preventing severe damage to the joint. In this blog, we will provide you with a quick guide that will help you know hip arthritis better and will also provide the exercises which you can do to improve your functionality.

 

Arthritis

The hip is a ball-and-socket joint that is covered by articular cartilage. Cartilage is a spongy tissue that cushions the joints, deterioration of this tissue causes bones to rub against each other. Pain usually occurs in the groin, but you can also feel pain in the hip region.

Types of arthritis that affect the hip joint the most:

•  Osteoarthritis,

•  Inflammatory arthritis and

•  Psoriatic arthritis.

 

Osteoarthritis

Osteoarthritis is the most common type of arthritis, caused by wear and tear in the hip joint. This causes cartilage damage at the end of the bones over time. It occurs in people age 50 or older due to trauma, hip dysplasia, femoroacetabular impingement, or obesity.

 

Inflammatory arthritis

Inflammatory arthritis, in this type there is inflammation of the joints and the surrounding tissues. It can occur in people of all ages but occurs mainly in early childhood. Types of inflammatory hip arthritis include ankylosing spondylitis, rheumatoid arthritis, systemic lupus erythematosus (SLE).

 

Psoriatic arthritis

This form of arthritis affects the skin. The main symptoms are joint pain, swelling, and stiffness in the affected joint, which can be the hip joint.

 

Benefits of Exercises

Exercises are done in a way that can make the patient feel better and also

•   Relieve pain

•   Decrease stiffness

•   Improve flexibility

•   Increase strength

 

Exercises

The physiotherapist initially recommends rest and ice therapy to relieve swelling and pain, activity modifications are done and walking aids like crutches and canes are provided for mobility.

 

Isometric hip flexion

•    Lie on the bed with legs extended straight.

•    Tighten or squeeze each of the buttocks and then release the tension.

•    Do 5-10 reps.

 

Hip circles

•    Stand by holding a chair for balance.

•    Make first small, gentle and then large circles as large as is comfortable.

•    Do for 20-30 seconds on each side and reverse the direction.

•    Each day do 2-3 times as long as it feels good.

 

Hip swings

•    Sit on the chair with legs hanging.

•    Start with small swings then slowly increase the distance.

•    Do 20-30 seconds on each side.

•    Repeat 2-3 times.

 

Lateral kicks

•    Stand in front of the wall.

•    Raise one leg by the side as far as it is comfortable.

•    Do 10-30 reps on each side.

•    Repeat 2-3 times each day.

 

Squat

•    Stand in front of the wall with back towards the wall.

•    Go down by bending the knees and sliding the back on the wall.

•    Go down till it is comfortable then raise back to the starting position.

•    Do 8-12 squats for 2-3 sets.

 

Hip bridge

•    Lie on the bed

•    Lift the hips as high as possible.

•    Push down through the heels.

•    Do 8-15 repetitions, hold for 10 secs.

 

Calf raises

•    Stand and hold onto a chair for support.

•    Raise the heels as high as possible till it's comfortable.

•    Do 20 reps.

 

Single leg deadlift

•    Stand with feet apart, knees slightly bent, raise one leg off the floor.

•    Flex the knee on the standing/support

•    Keep the back straight and lower the torso till it's parallel to the floor.

•    Squeeze glutes thrust the hips forward, and raise the torso back to the starting position.

•    Do 10-15 reps.

 

Wall sit and press

•    Stand in front of the wall

•    Keep the back in contact with the wall, bend the knees, and slide down the wall to move the arms.

•    Keep the core stable without arching the back move the arms overhead. 

•    DO 10-20 reps and 2-3 sets.

 

Balance pass

•    Stand on one leg and the other leg in kickstand position.

•    Pass the weight or dumbbell back and forth for30 seconds.

•    Do 2-3 times on each side.

 

Pain might be triggered by more no of repetitions and thus the patient may experience more pain therefore patient must add variety and take breaks in between the exercises sessions.