Pediatric Conditions

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Acute Trauma

Autism

Brain Injury

Cerebral Palsy

Developmental Delay

Down Syndrome

Juvenile Rheumatoid Arthritis

Mobility, Balance and Gait Problems

Muscular Dystrophy

Neuromuscular Disorders

Osteogenesis Imperfecta

Scoliosis

Spina Bifida

Spinal Muscle Atrophy

Torticollis

Acute Trauma

Any accident or injury that requires immediate medical attention for a child or adolescent is considered acute trauma.

Symptoms

Symptoms vary depending on the injury.

What you can expect from therapy

Therapy will address and focus on your child’s specific accident or injury. The treatment plan will be individualized to meet the physical needs of your child related to his or her injury. A home exercise or education program will be an important part of intervention for your child.

Autism 

Autism is a developmental disorder that appears in the first 3 years of life, and affects the brain's normal development of social and communication skills.

Symptoms

Most parents of autistic children suspect that something is different by the time the child is 18 months to 2 years old. Some children may lose the ability to speak, or avoid contact with parents/other children – this is known as regressive autism. Symptoms will vary, and severity will range from mild through severe.

Children with autism typically have difficulties in:

• Pretend play
• Social interactions
• Verbal and nonverbal communication
• Coordinated movement

People with autism may:

• Have increased sensitivity in sight, hearing, touch, smell, or taste (for example, they may refuse to wear "itchy" clothes and become distressed if they are forced to wear the clothes)
• Have unusual distress when routines are changed
• Perform repeated body movements
• Show unusual attachments to objects

Communication difficulties may include:

• Cannot start or maintain a social conversation
• Communicates with gestures instead of words
• Develops language slowly or not at all
• Does not adjust gaze to look at objects that others are looking at
• Does not refer to self correctly (for example, says "you want water" when the child means "I want water")
• Does not point to direct others' attention to objects (occurs in the first 14 months of life)
• Repeats words or memorized passages, such as commercials
• Uses nonsense rhyming

Social interaction:

• Difficulty making friends
• Does not play interactive games
• Is withdrawn
• May not respond to eye contact or smiles, or may avoid eye contact
• May treat others as if they are objects
• Prefers to spend time alone, rather than with others
• Shows a lack of empathy

Response to sensory information:

• Does not startle at loud noises
• Has heightened or low senses of sight, hearing, touch, smell, or taste
• May find noises painful and hold hands over ears
• May withdraw from physical contact because it is overstimulating or overwhelming
• Rubs surfaces, mouths or licks objects
• Seems to have a heightened or low response to pain

Play: 

• Doesn't imitate the actions of others
• Prefers solitary or ritualistic play
• Shows little pretend or imaginative play

Behaviors:

• "Acts up" with intense tantrums
• Gets stuck on a single topic or task (perseveration)
• Has a short attention span
• Has very narrow interests 
• Is overactive or very passive
• Shows aggression to others or self
• Shows a strong need for sameness
• Uses repetitive body movements

What you can expect from therapy

 An early, intensive, appropriate treatment program will greatly improve the outlook for most young children with autism. Treatment will build on the interests of the child and the functional/play skills that are successful for the child. Use of visual aids and collaboration between disciplines (PT, OT, SLP, ABA teachers, etc) is recommended. Treatment is most successful when it is geared toward the child's particular needs.

Brain Injury

Traumatic brain injury (TBI) is a complex injury with a broad spectrum of symptoms and disabilities.

Symptoms

A traumatic brain injury (TBI) can be classified from mild to severe. Symptoms are as follows:

Cognitive deficits including difficulties with:

• Attention
• Concentration
• Distractibility
• Memory
• Speed of processing
• Confusion
• Perseveration
• Impulsiveness
• Language processing
• "Executive functions" 

Speech and Language 

• Not understanding the spoken word (receptive aphasia)
• Difficulty speaking and being understood (expressive aphasia)
• Slurred speech
• Speaking very fast or very slowly
• Problems reading
• Problems writing

Sensory 

Difficulties with interpretation of touch, temperature, movement, limb position and fine discrimination

Perceptual

The integration or patterning of sensory impressions into psychologically meaningful data

Vision 

• Partial or total loss of vision
• Weakness of eye muscles and double vision (diplopia)
• Blurred vision
• Problems judging distance
• Involuntary eye movements (nystagmus)
• Intolerance of light (photophobia)

Hearing 

• Decrease or loss of hearing
• Ringing in the ears (tinnitus)
• Increased sensitivity to sounds

Smell

Loss or diminished sense of smell (anosmia)

Taste

Loss or diminished sense of taste

Seizures

The convulsions associated with epilepsy that can be several types and can involve disruption in  consciousness, sensory perception, or motor movements

Physical Changes

• Physical paralysis/spasticity
• Chronic pain
• Control of bowel and bladder
• Sleep disorders
• Loss of stamina
• Appetite changes
• Regulation of body temperature
• Menstrual difficulties

Social-Emotional 

• Dependent behaviors
• Emotional ability
• Lack of motivation
• Irritability
• Aggression
• Depression
• Disinhibition
• Denial/lack of awareness

What you can expect from therapy

Therapy will focus on two essential processes: restoration of functions lost that can be restored and learning how to do things differently for those functions that cannot be restored. Therapy will be individualized to your child’s needs.

Cerebral Palsy

Cerebral palsy is a non-progressive disorder from a neurologic injury at or right around birth. There are several different types of cerebral palsy, including spastic, dystonic, hemiplegic, diplegic, dyskinetic, ataxic, hypotonic, and mixed.

Symptoms

Symptoms may be noted at birth and can vary from mild to severe. Parents may notice that their child is delayed in reaching, use of hands/arms, eating, speaking, sitting, rolling, crawling, or walking. Symptoms may involve only one side of the body, or both sides. They can be more pronounced in either the arms or legs, or involve both the arms and legs.

The following symptoms may include:

• Atypical movements (twisting, jerking, or writhing) of the hands, feet, arms, or legs while awake, which gets worse during periods of stress
• Tremors
• Floppy muscles, especially at rest, and joints that move around too much
• Muscles that are very tight and do not stretch; they may tighten up even more over time
• Muscle weakness or loss of movement in a group of muscles (paralysis)
• Joints are tight and do not open up all the way (called joint contracture)
• Unsteady walk (gait): arms tucked in toward the sides, knees crossed or touching, legs make "scissors" movements, walk on toes
• Poor coordination for functional tasks/play skills

Other brain and nervous system symptoms:

• Decreased intelligence or learning disabilities are common, but intelligence can be normal
• Speech problems (dysarthria)
• Hearing or vision problems
• Seizures
• Pain, especially in adults (can be difficult to manage)
• Eating and digestive symptoms
• Difficulty sucking or feeding in infants, or chewing and swallowing in older children and adults
• Problems swallowing (at all ages)
• Vomiting or constipation

What you can expect from therapy

There is no cure for cerebral palsy. The goal of treatment is to help the person be as independent as possible and to prevent secondary complications.  It is important to have an interdisciplinary approach and collaboration between all professionals involved in the person’s care, including:

• Primary care doctor
• Dentist (dental check-ups are recommended around every 6 months)
• Social worker
• Nurses
• Occupational, physical, and speech therapists
• Other specialists, including a neurologist, rehabilitation physician, pulmonologist, and gastroenterologist 

Developmental Delay

Any significant impairment in a child’s physical (gross and fine motor), cognitive, communication (speech and language), behavioral, emotional, or social development that causes that child to lag behind their peers could be considered developmental delay.

Symptoms

• Gross motor delay: delayed in sitting, crawling, walking
• Fine motor delay: delayed in holding, grasping, manipulating
• Speech delay: delayed in speech sound production skills
• Language delay: delayed in receptive and expressive language skills

What you can expect from therapy

Therapy will focus on your child’s area of need to help your child achieve age level developmental skills. Parent carryover and follow through are an important part therapy and your child’s success.

Down Syndrome

Down syndrome is a genetic condition in which a person has 47 chromosomes instead of the usual 46 (an abnormal division of chromosome 21).

Symptoms

Down syndrome symptoms vary from mild to severe. However, children with Down syndrome have a widely recognized appearance. The head may be smaller and atypically shaped. The inner corner of the eyes may be rounded instead of pointed.

Common physical signs include:

• Decreased muscle tone at birth
• Excess skin at the nape of the neck
• Flattened nose
• Separated joints between the bones of the skull (sutures)
• Single crease in the palm of the hand
• Small ears
• Small mouth
• Upward slanting eyes
• Wide, short hands with short fingers
• White spots on the colored part of the eye (Brushfield spots)

Physical development is often delayed. Children may also have delayed cognitive and social development.

Common difficultiies may include: 

• Impulsive behavior
• Poor judgment
• Short attention span
• Slow learning

As children with Down syndrome grow and become aware of their limitations, they may also feel frustration and anger. Many different medical conditions are seen in people with Down syndrome, including: 

• Birth defects involving the heart, such as an atrial septal defect or ventricular septal defect
• Visual dysfunction, such as cataracts (most children with Down syndrome need glasses)
• Early and massive vomiting, which may be a sign of a gastrointestinal blockage, such as esophageal atresia and duodenal atresia
• Hearing dysfunction
• Hip joint difficulties with risk of dislocation
• Long-term (chronic) constipation problems
• Sleep apnea (because the mouth, throat, and airway are narrowed in children with Down syndrome)
• Teeth that appear later and in a location that may cause difficulties with chewing
• Under-active thyroid (hypothyroidism)

What you can expect from therapy

There is no specific treatment for Down syndrome. Cardiac, gastrointestinal and orthopedic physicians may be required after birth to rule out difficulties in these areas. Therapies should focus on gaining independence in functional activities and encourage participation in group and social activities.

Juvenile Rheumatoid Arthritis

Juvenile rheumatoid arthritis (JRA) is a term used to describe a common type of arthritis in children. It is a long-term (chronic) disease resulting in joint pain and swelling.

Symptoms

Symptoms of JRA may begin with a swollen joint, limping, a spiking fever, or a new rash.

Symptoms may include: 

• Joint stiffness and pain
• Limited range of motion
• Warm, swollen, or red joints 
• A child may stop using an affected limb or may limp 
• Fever, usually high fevers every day
• Rash (trunk and extremities) that comes and goes with the fever
• Pale skin
• Swollen lymph nodes (glands)
• Eye pain, which may get worse when looking at light (photophobia)
• Vision changes

What you can expect from therapy

When only a small number of joints are involved, non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen may be enough to control symptoms. Corticosteroids may be used for more severe flare-ups to help control symptoms.

Children who have arthritis in many joints, or who have fever, rash, and swollen glands may need other medicines. Those medicines are called disease-modifying anti-rheumatic drugs (DMARDs). They can decrease or prevent swelling in the joints or body.

It is important for children with JRA to stay active and keep their muscles strong. Walking, bicycling, and swimming may be good activities. Encouraging a warm up before exercising is recommended.

Muscular Dystrophy

Muscular dystrophy is a group of inherited disorders that involve muscle weakness and loss of muscle tissue, which get worse over time.

Symptoms

Symptoms vary with the different types of muscular dystrophy. All of the muscles may be affected. Or, only specific groups of muscles may be affected, such as those around the pelvis, shoulder, or face.  Muscular dystrophy can affect adults, but the more severe forms tend to occur in early childhood.

Symptoms include:

• Cognitive Delay
• Muscle weakness that slowly gets worse
• Delayed development of motor skills
• Difficulty using one or more muscle groups
• Drooling 
• Eyelid drooping (ptosis)
• Frequent falls
• Loss of strength in a muscle or group of muscles as an adult
• Loss in muscle size
• Difficulties walking (delayed walking)

What you can expect from therapy

There are no known cures for the various muscular dystrophies. The goal of treatment is to manage symptoms. Physical therapy may help patients maintain muscle strength and function. Orthopedic appliances such as braces and wheelchairs can improve mobility and self-care abilities. In some cases, surgery on the spine or legs may help improve function. Corticosteroids taken by mouth are sometimes prescribed to children to keep them walking for as along as possible. The person should be as active as possible. Complete inactivity (such as bedrest) can make the disease worse.

Neuromuscular Disorders

Neuromuscular disorders affect the nerves that control your voluntary muscles. Voluntary muscles are the ones you can control, like in your arms and legs. Your nerve cells, also called neurons, send the messages that control those muscles. When the neurons become unhealthy or die, communication between your nervous system and muscles breaks down. As a result, your muscles weaken and waste away. The weakness can lead to twitching, cramps, aches and pains, and joint and movement problems. Sometimes it also affects heart function and your ability to breathe.  Many neuromuscular diseases are genetic, which means they run in families or there is a mutation in your genes. Sometimes, an immune system disorder can cause them. Most of them have no cure. The goal of treatment is to improve symptoms, increase mobility and lengthen life.

Examples of neuromuscular disorders include:

• Amyotrophic lateral sclerosis
• Multiple sclerosis
• Muscular dystrophy
• Myasthenia gravis
• Spinal muscular atrophy

Osteogenesis Imperfecta

Osteogenesis imperfecta is a condition causing extremely fragile bones. 

Symptoms

• Weak bones, which makes them susceptible to fractures below average height
• Multiple bone fractures
• Hypermobility of joints
• Hyperpronation
• Bowed legs and arms
• Kyphosis/scoliosis

What you can expect from therapy

Treatments for osteogenesis imperfecta focus on minimizing fractures,  maximizing mobility, maximizing independent function and general health. 

Treatments include:

• Physical therapy and safe exercise including swimming
• Casts, splints or wraps for broken bones
• Braces to support legs, ankles, knees and wrists as needed
• Orthopedic surgery, often including implanting rods to support the long bones in arms or legs
• Medications to strengthen bones
• Mobility aids such as canes, walkers, or wheelchairs and other equipment or aids for independence may be needed to compensate for weakness or short stature.

Scoliosis

Scoliosis is a curving of the spine. The spine curves away from the middle or sideways.

Symptoms

A doctor may suspect scoliosis if one shoulder appears to be higher than the other, or the pelvis appears to be tilted. Untrained observers often do not notice the curving in the earlier stages.

Other symptoms can include:

• Backache or low-back pain
• Fatigue
• Shoulders or hips appear uneven
• Spine curves abnormally to the side (laterally)
• There may be fatigue in the spine after prolonged sitting or standing. Pain will become persistent if there is irritation to the soft tissue and wear and tear of the spine bones.

What to expect from therapy

Treatment depends on the cause of the scoliosis, the size and location of the curve, and how much more growing the patient is expected to do. Most cases of adolescent idiopathic scoliosis (less than 20 degrees) require no treatment, but should be checked often, about every 6 months. As curves get worse (above 25 to 30 degrees in a child who is still growing), bracing is usually recommended to help slow the progression of the curve.

Additionally, physical therapy may help to encourage mobility of the rib cage, pelvis and spine.  As well as to improve the flexibility and strength of the muscles around the spine.

There are many different kinds of braces used. The Boston Brace, Wilmington Brace, Milwaukee Brace, and Charleston Brace are named for the centers where they were developed. Each brace looks different. There are different ways of using each type properly.  The selection of a brace and the manner in which it is used depends on many factors, including the specific characteristics of the curve. The exact brace will be decided on by the patient and health care provider. A back brace does not reverse the curve. Instead, it uses pressure to help straighten the spine. The brace can be adjusted with growth. Bracing does not work in congenital or neuromuscular scoliosis, and is less effective in infantile and juvenile idiopathic scoliosis.

The choice of when to have surgery will vary. After the bones of the skeleton stop growing, the curve should not get much worse. Because of this, the surgeon may want to wait until your child’s bones stop growing. But your child may need surgery before that if the curve in his or her spine is severe or is getting worse quickly. Curves of 40 degrees or greater usually require surgery. Surgery involves correcting the curve (although not all the way) and fusing the bones in the curve together with the use of rods and/or screws Sometimes surgery is done through a cut in the back, on the abdomen, or beneath the ribs.

A brace may be required to stabilize the spine after surgery. The limitations imposed by the treatments are often emotionally difficult and may threaten self-image, especially of teenagers. Emotional support is important. Physical therapists and orthotists (orthopedic appliance specialists) can help explain the treatments and make sure the brace fits comfortably.

Spina Bifida

Spina bifida is any birth defect involving incomplete closure of the spine.

Symptoms

A newborn may have a sac sticking out of the mid to lower back. The doctor cannot see through the sac when shining a light behind it. Symptoms include:

• Loss of bladder or bowel control
• Partial or complete lack of sensation
• Partial or complete paralysis of the legs
• Weakness of the hips, legs, or feet 
• Atypical alignment of feet or legs, such as clubfoot
• Build up of fluid inside the skull (hydrocephalus)
• Hair at the back part of the pelvis called the sacral area
• Dimpling of the sacral area

What you can expect from therapy

After birth, surgery to repair the defect is usually recommended at an early age. Before surgery, the infant must be handled carefully to reduce damage to the exposed spinal cord. That may include special care and positioning, protective devices, and changes in the methods of handling, feeding, and bathing. Physical therapy may be needed to treat musculoskeletal symptoms. Braces may be needed for muscle and joint problems.

Neurological losses are treated according to the type and severity of function loss. Follow-up examinations generally continue throughout the child's life. Those are done to check the child's functional skills and to treat any cognitive, neurological, or physical difficulties.

Spinal Muscle Atrophy

Spinal muscular atrophy is a group of inherited diseases that cause progressive muscle degeneration and weakness, eventually leading to death.

Symptoms

Infants with SMA type I are born with very little muscle tone, weak muscles, feeding and breathing difficulties. With SMA type III, symptoms may not appear until the second year of life. Often, weakness is first noted in the shoulder muscles and proximal leg muscles. Weakness gets worse over time and will eventually become severe.

Symptoms in an infant:

• Breathing difficulty
• Feeding difficulty
• Floppy infant (poor muscle tone)
• Lack of head control
• Little spontaneous movement
• Progressive weakness (older infant to toddler) 
• Frequent, increasingly severe respiratory infections
• Nasal speech
• Worsening posture

What you can expect from therapy

There is no treatment for the progressive weakness caused by the disease. Supportive care is important. Attention must be paid to the respiratory system because affected people have difficulty protecting themselves from choking or aspirating. Breathing complications are common. Physical therapy is important to prevent contractions of muscles and tendons and abnormal curvature of the spine (scoliosis). Bracing may be necessary.

Torticiollis

Torticollis is a tightening of a child's neck muscles, which causes the head to tilt to one side and turn to the opposite side.

Symptoms

Torticollis may make it difficult for children to turn their heads for visual tracking, hold their heads in an upright position and perform appropriate upper extremity movements necessary for feeding and play. It can also affect flattening of the child's head (plagiocephaly or brachycephaly) and create asymmetries in the face and ears.

What you can expect from therapy

The physical therapist will perform an evaluation to assess the child's passive range of motion, active range of motion, muscle tightness, muscle strength and gross motor skills. The physical therapist also checks for other conditions that can occur with children who present with torticollis such as plagiocephaly/brachycephaly, hip dysplasia (misalignment of the hip joint), and spinal alignment. The therapist then discusses those results with the family and makes appropriate recommendations for physical therapy treatment, if indicated.  An individualized program may include positioning, play activities, massage, soft tissue elongation, and gentle range of motion may be provided.