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.

World Down Syndrome Day

World Down Syndrome Day: Managing Gross Motor Skills via Physical Therapy

Since the year 2012, March 21 has been officially observed by the United Nations as a global awareness day for Down syndrome. Down Syndrome (DS) is a genetic disorder that causes a global delay in development, including motor function, language, and cognition. It is a medical condition that makes the immune system weak and patients have about a 12-fold increased risk of infectious diseases. For COIVD-19 also, Down syndrome patients are considered to be at higher risk. An early intervention presents the most benefits, as neural plasticity is at its peak in the first months of life. One of the interventions used is Physiotherapy. Physiotherapy is offered from birth to stimulate the acquisition of motor skills. It helps to strengthen the muscles, enabling the children with Down syndrome to keep their body in proper alignment and therefore prevents future health problems. 

The physiotherapist uses the following techniques for giving treatment to the Down syndrome patient:

 Relaxation:

Relaxation decreases muscular tension, improves body control, and co-ordinated movements. The treatment may include breathing control, which focuses on relaxing your upper body and breathing from your tummy. This can be used in conjunction with deep breathing which helps the muscles relax when pain is restricting breathing. Progressive muscle relaxation is another technique, which involves slowly tensing and then releasing each muscle group individually, starting with the muscles in the toes and finishing with those in the head.

 Improve Co-ordination:

Coordination is the ability to execute smooth, accurate, controlled motor responses (optimal interaction of muscle function). It is the ability to select the right muscle at the right time with proper intensity to achieve proper action (which involves the co-ordinated action of various segments, as in cases of hand-eye coordination) and general co-ordination (which involves the entire body). The physiotherapist uses the activities like hitting a balloon, rolling balls, popping bubbles, throwing into a container, throw and catch, juggling, egg and spoon race etc, to improve the coordination of the patient.

 Improve Balance:

It is well known that persons with DS are often considered floppy, clumsy, uncoordinated, and have awkward movement patterns due to balance issues. These balance challenges often follow the child into the teen years and sometimes into adulthood. The physiotherapist may use equipment such as an exercise ball or bobath ball, to improve your child's ability to hold the head erect or to maintain a sitting position. Other skills such as jumping, skipping, and dribbling a ball may be incorporated into a fun physical therapy regimen. The development of balance happens progressively, starting from various postures (control of the head from prone positions, of the trunk in the seated position, etc.), and moving on to the more refined postures found in dynamic and in in-motion balance. 

 Improve Motor function:

The Down syndrome patient has hypotonic or low muscle tone. The physiotherapist teaches the patient to move the body in appropriate ways and improves muscle tone. The therapist works on the muscles and movements which help to reach some of the milestones and prevents the child from developing problems of bad posture. Physiotherapy can play a major role in the management of children with Down syndrome, through exercises, manual therapy, and education, physiotherapists can empower people to take charge of their health and participate in their treatment.

 Improving Strength:

If the muscles are not strengthened the child can end up having a postural, gait, and greater risk of joint problems later in life from using their muscles incorrectly. The physiotherapist can teach exercises to improve and increase muscle strength, this can include crawling, climbing, wheelbarrow, pushing up through their arms in tummy line, bridging, crab walking, roll-ups, planks, games, and fun tasks that are adjusted as the child grows. Also identifies new fitness activities to reduce the risk of obesity and improve and maintain heart health.

 Improve Developmental Skills:

Physical therapists can help your child to learn motor skills such as crawling, sitting to standing, standing to sitting, pulling, and walking. They can also give training for positioning, movement, feeding, and play, and suggest changes at home to encourage movement and communication development.

 The importance of early intervention should be emphasized. Physiotherapy treatment aims to assist people to live as independently as possible.