Paediatric Neuro

What is Paediatric Neuro Rehabilitation?

Paediatric Rehabilitation Centre provides comprehensive rehabilitation Care to children suffering from range of Neurological difficulties. The goal of Paediatric Rehabilitation is to limit the physiological and psychological effects of childhood illness, and to improve overall mobility and abilities to perform activities of daily living.

Why Progressive Care?

Progressive Care Paediatric Department is concerned about children with a variety of developmental conditions, how to identify children and families at risk based on their needs and how to best support these children over the life course. With a team of highly qualified Neuro and paediatric therapists who are determined and focussed on their work for wellbeing of the special child.

Progressive Care Paediatric Department is built on following 7 core functions:

  • To take a leadership role in solving child’s problems, by thorough assessments, framing goals, and implementing strategies in a child and family centered practice.
  • To be updated with high quality research which enables the physiotherapists to be right on top in their field.
  • Evidence based practice with gold standard outcome measures will be helpful for planning appropriate protocols according to the disability.
  • Sharing the knowledge gained while practicing/research among the unit members to develop the equality in thinking standards which enables kid to develop rapidly
  • Educating the family members about the assessments, recovery, reassessments, goals, strategies and care to be taken at home.
  • Providing an opportunity for fellow therapists, interns, PG’s to learn ethical practice in research point of view.
  • Organising regular CME’S and workshop’s to keep the therapists updated and highly skilful    

Our cutting edge research and active strategies for making findings easily accessible to a wide range of audience, make Progressive Care the premier source for childhood disability rehabilitation. We strive to generate innovative knowledge and translate our research in an accessible way that is relevant and meaningful to those who need it most.

Our training mainly focusses on International Classification of Functioning Disability and Health (ICF) framework where we focus on child’s abilities as well as disabilities and set goals which are child specific and apply latest treatment strategies to achieve the pre-set goals.

  • How the child is Functioning, our focus will be on improving functioning capacity of child.
  • How the Family is responding to child’s functional capacity.
  • Fitness’ of the child, evaluating the intensity and fatigue levels. We focus on promoting fitness.
  • We always rely on child’s active participation in the treatment with F
  • We assess how the child is accompanying with Friends and involving in play activities.
  • Our prognosis plan which is child specific will help us and parents about the Future of a child.(Rosenbaum P, 2012)

Who do we treat ?



Neuromotor Disorders

Overview:

Cerebral palsy describes a group of permanent disorders of the development of movement and posture, causing activity limitation, that are attributed to non-progressive disturbances that occurred in the developing fetal or infant brain.

According to a recent study worldwide incidence of CP is 2 to 2.5 per 1000 live births. Based on the extent of damage and its location in the brain, CP is classified as Spastic, Athetoid, Ataxic, Hypotonic and Mixed. Topographically it is classified as Monoplegia, Hemiplegia, Diplegia and Quadriplegia. Spastic CP is the most common form of CP and involvement of trunk is more in spastic quadriplegia making recovery little difficult

Prenatal causes such as maternal infections, ingestion of toxins, weight gain, gestational diabetes and hypertension. Natal causes such as obstructed labor, prolonged labor, placenta Previa, breech position etc. Post-natal causes such as infections, trauma, Seizures, shaken baby syndrome etc.

ypical impairments in Cerebral palsy:

Spasticity, Limited Range of motion, Stiff joints, Problem in grading of muscle forces, co-activation, Delay in development of Gross and Fine motor skills, Subluxations and dislocations, Limb length discrepancy, Oromotor impairments, decreased cardiovascular fitness, Postural abnormalities, balance and coordination issues, gait abnormalities.

Management:

Gross motor and Fine motor mobility training, Strength training, Self-care, Communication training, Body weight supported treadmill training (BWSTT), (Provost, 2007) Neuro Developmental Therapy (NDT), (Nikos Tsorlakis a1 c1, 2004) Task oriented approach, Constrained Induced Movement Therapy (CIMT), (Edward Taub, 2004) Play therapy, family centered treatment with parent education plays a very important role in the management of a CP child. (Damiano, 2006)

Overview:

Spina Bifida is one of the neural tube birth defect causing neuromuscular dysfunction. It is the second most common birth defect after Down’s syndrome, According to a recent study incidence is 1 in 1000 live births.

Deficiency of Folic acid is considered to be the primary cause of Spina bifida. Maternal use of valproic acid is also known to increase the risk of Spina Bifida. Hydrocephalus and Arnold Chiari Malformation are closely associated with Spina Bifida. Types are spina bifida Occulta, Meningocele, Myelomeningocele.

Typical Features:

Decreased strength, Bowel and bladder issues, Back pain, Orthopaedic Problems in trunk and lower extremities, Sensory problems, Developmental delay, Poor feeding Skills, Lethargy, increased spasticity.

Management:

Preventing fixed joint contractures, Sensory re-education, Correcting musculoskeletal deformities, preventing spinal malformations, Teaching precautions for shunt, Managing CNS abnormalities like Spasticity, Strengthening, Maintaining and improving Joint Range of motion, Orthotic prescription, bladder and bowel care. (Tappit-Emas, 2007)

Overview:

Traumatic brain injury is a frequent cause of morbidity and mortality in the paediatric population, occurs when an external mechanical force either accidentally or intentionally impacts the head. Falls, motor vehicle accidents, Gunshots wounds, Abuse/Assault, Sports/ Recreational activities are the causes of Traumatic brain injury. Concussion, contusion, skull fractures, intracranial haemorrhages and diffuse axonal injury are primarily the reasons for injury to brain.

Typical impairments:

Headaches, dizziness, hearing loss, sensory loss, Spasticity, ataxia, balance impairment, fatigue, seizure, cranial nerve injury, anxiety, depression, decreased arousal, inattention, agitation, memory loss, speech and language problems, limited bed mobility, balance impairment, feeding, fine motor and gait impairments.

Management:

Based on the evaluation and categorising the child according to Paediatric Rancho Scale treatment will be given as low, mid and high cognitive levels. Which includes coma stimulation program, managing confused and agitated child thus increasing the cognitive level thereby reintegrating the child to normal school. (A.Kerkering, 2006)

Overview:

Paralysis of one side of the body that may occur at birth as a result of cerebral haemorrhage in utero and as a result of lack of oxygen, or during a febrile illness in infancy. It is also called as stroke in children more common among boys. Cause may be ischaemic and haemorrhagic, head trauma, brain tumour, Brain abscess, congenital or perinatal injury.

Typical features:

Stiffness and weakness in muscles on one side of the body. Only using one hand during play or favouring one hand before the age of 3 years. Keeping one hand in a fist. Difficulty with walking and balance. Difficulty with fine motor tasks like writing or using scissors. Delay in reaching expected developmental milestones such as rolling over, sitting up, crawling, or smiling. Memory, behaviour, speech, communication and Seizure disorders.

Management:

Managing primary impairments such as spasticity and thereby preventing contractures, increasing Range of motion, Improving Gross and fine motor skills, Training Postural control, Balance, Co-ordination, Posture and Gait. (Andrew M. Gordon, 2006)

Overview:

Down’s syndrome is chromosomal disorder resulting in 47 Chromosomes, instead of 46 commonly, called trisomy 21 which leads to developmental delay. Older woman have more chances of having a child with Down’s syndrome.

Typical Features:

Decreased muscle tone, short neck, flattened facial profile and nose, upward slanting eyes, white spots on coloured part of eye, short hands and short fingers, single crease on the palm, larger first web space of the toes, short attention span, poor judgement, impulsive behaviour, slow learning, delayed speech and language development.

How to confirm:

Prenatal diagnosis can be done with blood test and ultrasonography from the mother, amniosynthesis.

Management:

Promoting development, Preventing subluxations, Preventing wasting and increasing strength, Preventing foot deformities and maintaining arches thereby encouraging symmetrical and uniformed weight bearing, Correct postural abnormalities, Improve balance, Improve coordination, Correct gait pattern, Learning disorders, Overall QOL. (Barbara H Connolly, 1993)

Overview:

Dandy walker syndrome (DWS) is congenital brain malformation involving the cerebellum and fluid filled spaces around it. It leads to delay in motor development. The malformations occur when openings that allow CSF to move into space surrounding the surface of the brain failed to open. Hydrocephalus is the most predominant feature. The term dandy walker syndrome is the co-existence of several abnormalities like DWS malformation, DWS mega cisterna magna and DWS variant.

Typical features:

Slow motor development, progressive enlargement of the skull, increased intra cranial pressure leads to irritability, vomiting and convulsions. Signs of cerebellar dysfunction such as unsteadiness, lack of muscle co-ordination and gait abnormalities (Waddling Gait). DWS frequently associates with absence of corpus collosum. (George A. Alexiou, 2010)

Diagnosis:

Ultrasound, MRI, CT confirms the diagnosis.

Management:

After reduction of intracranial pressure by surgery, Physiotherapy plays a major role in reducing the symptoms, balance retaining, management of gait abnormalities, increase in the rate of recovery, improvement of gross and fine motor skills, improving strength, recovery will be good when it doesn’t combine with other congenital defects.

Overview:

Hypoxic ischemic encephalopathy (HIE) is the brain injury caused by oxygen deprivation to the brain, also known as intrapartum asphyxia. The new born body can compensate for brief periods of depleted oxygen but if the asphyxia lasts too long the brain tissue is destroyed. Preeclampsia, maternal diabetes, congenital foetal infections, drug or alcohol abuse, umbilical cord occlusion, breech position, (Transient Ischaemic Attack) TIA attack after birth are the common causes for HIE.

Typical features:

Spasticity, decreased muscle strength, decreased range of motion, joint contractures, severe muscle wasting, decreased balance coordination, bowel and bladder issues, feeding and gait abnormalities.

Management:

Physiotherapy management will be based on extent of damage and clinical features. It includes maintenance of range of motion, improving strength, improving balance coordination, preventing contractures, decreasing spasticity, improving overall quality of life of child. (Rebecca L. Holt, 2011)

Neuro Muscular & Musculoskeletal Disorders

Overview:

Spinal muscular atrophy is a genetic disease affecting the anterior horns of spinal cord leading to muscle weakness. A defect in the SMN1 gene which encodes SMN protein which is responsible for survival of motor neurons, thereby affecting the muscles and leads to atrophy. There are four types of SMA, (1. Infantile, 2. Intermediate, 3. Juvenile, 4. Adult onset.)

Typical Features:

Areflexia, decreased muscle tone, muscle weakness, developmental delay, Frog legged position sitting, weak respiratory muscles, poor feeding skills, decreased weight, etc., Infantile SMA is the most severe type, otherwise called as floppy baby syndrome.

Management:

Maintenance of muscle tone, joint ROM, strength, prevention of spinal deformities, application of orthosis, breathing exercises, cough training, improving the mobility, thereby improving the overall quality of kid. (Stuberg, 2006)

Overview:

Muscular dystrophy is the group of diseases that causes progressive weakness and loss of muscle mass. Abnormal gene mutations interfere with production of proteins needed to form healthy muscle. Various types includes duchenne’s Beckers, Limb girdle, Congenital, Facioscapulo humeral, Myotonic, Emery-Dreifuss muscular dystrophy.

Typical features:

Progressive muscle weakness, frequent falls, difficulty in getting up from lying position, trouble running and jumping, waddling gait, walking on toes, large calf muscles, muscle pain and stiffness, learning disabilities.

Management:

Maintaining and improving muscle strength, joint range of motion, aerobic exercise training, preventing the joint contractures, prescribing orthosis if necessary, breathing and general relaxation training, Maintaining cardio pulmonary fitness, educating the child and the parents about the condition and effects of inactivity. (Stuberg, 2006)

Plexus Injuries

Overview:

Brachial plexus injuries are caused by injury to C5 to T1 nerves that innervate the muscles of upper limb. They are classified into traumatic and obstetric. Road traffic accidents, falls, penetrating injuries are common causes of traumatic injuries. Obstetric injuries arises because of trauma during child birth. Types are upper brachial plexus lesion, lower brachial plexus lesion, and whole brachial plexus.

Typical features:

Paralyzed arm, lack of muscle control in the arm, hand, or wrist, and lack of feeling or sensation in the arm or hand. Infants, in particular, may suffer brachial plexus injuries during delivery and these present with typical patterns of weakness, depending on which portion of the brachial plexus is involved. The most severe form of injury is nerve root avulsion, which results in complete weakness in corresponding muscles. Erb’s palsy and Klumpke’s palsy are most common disabilities.

Management:

Physiotherapy plays a major role in relieving pain, edema, improving sensory awareness, improving activities of upper limb, improving motor control, preventing deformities, post-operative care, positioning and handling techniques are taught to parents or caregivers. (Agnes F Hoeksma MD, 2007)

Behavioural, Sensory Processing and Learning disorders

Overview:

Autism is neurodevelopment disability with strong genetic basis, by inhibiting child’s ability to communicate and develop social relations accompanied with behavioural changes.

Lifelong development disorder occurs in first 3 years of life with no cause. Child looks like normal child but has difficulty in expressing himself and may not know how to mix with other people. No specific medical or genetic tests which leads to misdiagnose. Sensitive observation of child’s skills, Modified Checklist for Autistic Toddlers (M-CHAT), Diagnostic and Statistical Manual 4 (DSM 4) criteria for autism helps in diagnosis.

Typical features:

Impaired social interaction like no response to name call, avoids eye contact, inappropriate facial expressions, play alone, and avoids physical contact. Lack of communicative skills like delayed speech and language skills, no gestures, repetition of words, no pointing. Restricted and repetitive behaviours like rigid routine, unusual attachment to toys, unusual fears and interests, staring at space, rocking back and forth, hand flapping, lining up of toys, spinning objects. Hyperactivity, aggression, temper tantrums, self-injury.

Management:

Developing gross motor and fine motor skills, improving activities of daily living and sensory integration therapy for sensory issues along with behavioural issues. (Case-Smith & Arbesman, 2008)

Overview:

Attention deficit hyperactivity disorder (ADHD) is a common childhood disorder and continue through adolescence and adulthood with hyperactivity.

ADHD is a disorder with difficulty staying focused and paying attention, difficulty controlling behavior, and hyperactivity and generally with 3 subtypes – Predominantly hyperactive-impulsive, Predominantly inattentive, Combined hyperactive-impulsive and inattentive. No single test to diagnose often combines with learning disability, anxiety, bipolar disorder.

Typical features:

Easily distracted, difficulty in focusing, daydreaming, easily confused, dash around, constantly in motion, difficulty in sitting still, impatient, etc.,

Management:

Sensory integration helps in managing hyperactivity of child and helps in increasing sitting tolerance of child and helps in improving attention. (Ghanizadeh, 2011) Behaviour therapy also helps in controlling behaviour. (Andrea M. Chronis, 2004)

Overview:

Learning disabilities (LD) are neurologically-based processing problems. These processing problems can interfere with learning basic skills such as reading, writing and/or math. LD along with learning basic skills, can also interfere with higher level skills such as organization, time planning, abstract reasoning, long or short term memory and attention. Auditory Processing Disorder (APD), Dyscalculia, Dysgraphia, Dyslexia, Language Processing Disorder, Visual Perceptual/Visual Motor Deficit are few types of LD. IQ-Achievement Discrepancy, Response to Intervention (RTI), and assessment for evaluating skills.

Typical features:

Difficulty in reading which includes word recognition, fluency, and comprehension; difficulty in computation and problem solving and difficulty in written expression, including handwriting, spelling and composition.

Management:

Managing the motor skills helps in coping up of these difficulties. Few adjustments in their lifestyles, classrooms, planned lesson patterns, scripted lessons helps child to overcome with these difficulties.

Developmental Coordination Disorder

Overview:

Developmental Coordination Disorder (DCD) is a motor skills disorder that affects school-aged children resulting in inability to perform everyday tasks. According to a recent study it affects 5 to 6% of school aged children. It occurs because of problems in receiving in sensation from periphery, planning of action and executing the action. It is commonly associated with ADHD, Learning difficulties.

Typical Features:

Poor timing, Poor balance (sometimes even falling over in mid-step). Tripping over one’s own feet is also common, Difficulty combining movements into a controlled sequence, Difficulty remembering the next movement in a sequence, Problems with spatial awareness, or proprioception, some people with developmental coordination disorder have trouble picking up and holding onto simple objects such as pencils, owing to poor muscle tone and/or proprioception This disorder can cause an individual to be clumsy to the point of knocking things over and bumping into people accidentally Some people with developmental coordination disorder have difficulty in determining left from right, Cross-laterality, ambidexterity, and a shift in the preferred hand are also common in people with developmental coordination disorder, Problems with chewing foods. Problem in Prehensions and grip.

Management:

Task oriented approach in training balance and coordination, cognitive rehabilitation in decreasing symptoms of ADHD plays a very important role in managing of children with DCD. (Cheryl Missiuna, 2008)

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