Children with motor disorders will benefit from assessment, treatment and/or consultation with a pediatric physiotherapist. Pediatric physiotherapists are specialized in the treatment of children. They have an in–depth understanding of what is supposed to be the normal development of the child, as well as the child’s anatomy, physiology and neurological framework, which they are often called upon to apply to pediatrics. They are therefore able to recognize motor difficulties at a very early age (as early as two to four months).

The physiotherapists assess children regarding their range of motion, muscle strength, gross motor function and quality of movement. Difficulty in any of these areas may be a result of a motor disorder, and this in turn, hinders the child’s ability to explore his/her environment. The ultimate goal of therapy is the facilitation of optimal, functional movement. With movement, the child can explore his/her immediate environment more easily and learn by it. It is important that all children who have a movement disorder, or are at a risk to develop such difficulties be screened as early as possible by a pediatric physiotherapist. Although intervention is available at any age, the earlier this begins, the better it is for the child, as then the child could begin to achieve optimal, functional movement and overcome any difficulties he/she may be faced with.

Physiotherapy Before & After Heart Surgery
Chest physiotherapy is an important part of recovery following surgery. Children who have had chest surgery often need physiotherapy to help prevent and decrease lung problems. The anesthetic and the operation itself sometimes results in more secretions than usual in the lungs and after the surgery your child will be less active than normal.

Before the operation
A physiotherapist may see your child before the operation to teach techniques such as deep breathing exercises, huffing and effective coughing. If the child is old enough then an “Incentive spirometer” is used. If needed, the physiotherapist may treat the child to remove secretions before the operation.

After the operation
A physiotherapist will come and see your child the day after the operation. Whether your child is still on the breathing machine (ventilator) or breathing by himself/herself, the physiotherapist will be checking that the lungs are clear of secretions and using techniques such as chest percussion and vibrations to help clear them. Suction may be used to remove the extra secretions from the lungs if they are unable to cough.

A physiotherapist will continue to see your child until physiotherapy is no longer needed. This is usually three to five days. If physiotherapy is still required when it is time for you to go home, the physiotherapist will teach you how to do the techniques before you go.

Physiotherapy in Muscular Dystrophy
Definition
The healthy baby, as it grows through infancy into childhood, gradually acquires the movement skills and muscle strength that it needs to perform complex tasks. In some areas he/she develops at the same pace as other children e.g. in social skills and intellectual achievement. However, the child will be slower to achieve skilled movement and some movements may never be possible. But development is taking place so it is important to encourage and improve upon what your child can do.

It is usually quite difficult to say, with certainty, during the first eighteen months, to what extent your child will be able to stand or achieve limited walking using orthoses (callipers, braces). This is because the condition affects the normal physical ‘Milestones’ by which development can usually be judged. A general approach is to recognize that some ‘Milestones’, e.g. crawling, may be missing from your child’s repertoire but the important thing is to work on what your child can do at present.

Aims of Physiotherapy
1. To improve, delay or help prevent contractures:
A contracture happens when weak muscles are unable to move a joint through its full range. This leads to tightness in the muscle itself and structures around the joint. Contractures occur in places where the muscles that bend the joint are stronger than the ones that straighten it e.g. in the ankles, hips, elbows and knees.
Contractures may:

• Make standing more difficult.
• Be uncomfortable and make management difficult.
• Affect spinal posture.
• Further disadvantage the weaker muscles.

2. To try and improve muscle strength and assist movement
Muscles become stronger with activity, ideally through working against resistance however small that may be. Exercises are the best way of gaining some improvement in muscle strength and your child will be able to exercise if you organize his/her play in a certain way. If parents know the aims of exercise, they can become very good at structuring the play to stimulate movement.

Exercises
When a young child is very weak, playing with him/her to encourage a physical muscle response can be part of the fun you will enjoy having with your baby. When he/she cannot make a movement you can show how to do it by moving the limbs or the trunk yourself in the desired direction and encourage your child to help you. The more a muscle is used, the stronger it becomes, although of course, this does not make the disorder go away. What does happen is that the remaining muscle fibers which are not affected can be encouraged to work and can be strengthened in partial compensation for the weakness of others. This type of active exercise and practice of movements is going to be important throughout your child’s life.

Passive Stretching
Passive stretching is where you are doing all the work. Ideally it is performed daily to all necessary joints through a full range. Use a firm surface such as a mat on the floor. It is also useful to do the exercises at the same time every day. Physiotherapy should start as soon as the child has been diagnosed, even with a very young baby.

Hips
The hip joint is controlled by some of the largest muscles in the body. The two groups that are most likely to become contracted are those that control the bending or forward lifting of the leg (the hip flexors) and those that move the leg out to the side (the hip abductors). There are three different ways in which these muscles can be stretched. When possible, all hip exercises should be repeated about 10 times on each side.

A. The child lies on one side with the top leg straight (the hip to be stretched) and the helper positioned behind. The bottom leg may be bent or straight. Place one hand firmly on top of the hip bone to steady it and slide the other hand under the thigh of the top leg, just above the knee. The leg is then drawn backwards towards you to stretch the hip flexors which lie across the front of the hip joint.

If you choose this method you must be sure that the pelvis is steady. You can put your knee against the child’s lower back so that your thigh acts as a cushion. Repeat the stretch on the other side.

B. The child lies face down. One hand is placed firmly on the buttocks on the same side as the hip to be stretched and the other hand is slipped under the thigh just above the knee. The thigh is then lifted and thus extended, stretching the front muscles of the hip and thigh. Repeat with the other leg.

C. The child lies on his/her back and the opposite leg (the one not being stretched) is bent up towards the chest and held in that position by you or the child, if he/she can manage it. Your hand is then placed just above the knee of the leg to be stretched and a downward pressure is exerted. Repeat with the other leg.