Queen West Physiotherapy - Life Long Good Health!

Paediatric Physiotherapy

We have a well established PAEDIATRIC physiotherapy program for children (birth-21y.o.) with any condition, providing a service that supports children who have a condition that affects the development of their gross motor skills. We offer physiotherapy to children at two clinic locations - Queen West Physiotherapy in Brampton and at Albion Hills Physiotherapy in Bolton. We can also provide our services in the comfort of your own home.

Conditions which we often treat, include:

Developmental delay

a lag in development in which a child exhibits a functional level below the norm for his or her age. A child may have an across-the-board developmental delay or a delay in specific areas. It is possible that a child with a developmental delay who receives services, will not develop a disability; whereas if the same child is not treated professionally, the delay may become a disability. Development delay is measured by appropriate diagnostic instruments and procedures in one or more of the following areas: cognitive development, physical development, language and speech development, psychosocial development, and self-help skills.

Cerebral palsy

a genetic disorder that can affect the ability of an afflicted child to move his or her body in a usual manner.  As with the vast majority of genetic disorders, cerebral palsy is not curable, however there are treatment options available to improve the quality of life for those individuals who have been inflicted by this disorder.  The three most common forms of the disorder are spastic cerebral palsy, athetotic cerebral palsy and ataxic cerebral palsy.  In the first one stiff muscles affect the movement of the legs or as much as the entire body. In the second one, the entire body is affected by slow uncontrollable movements. The third type of cerebral palsy is the least common of the three and generally affects balance and coordination in the afflicted individual.  Some people have a combination of a few types of cerebral palsy and their symptoms can include a lack of coordination, known as ataxia, a stiffness of the muscles and poor reflexes, difficulty walking, variable muscle tone, and a tendency to drool and have difficulty speaking or swallowing.

Hypotonia

"low tone" - a physiological state in which a muscle has decreased tone, or tension. A muscle's tone is a measure of its ability to resist passive elongation or stretching. It is most often seen in newborns (congenital) and infants, but it may persist through adolescence into adulthood. Another name for infantile hypotonia is "floppy baby syndrome." This refers to the tendency of a hypotonic infant's arms, legs,and head to "flop," or dangle loosely,when they are picked up or moved. CNS trauma and infection are perhaps the most common cause of hypotonia, both in infants and in children. Insult to the brain may occur prenatally (before birth), perinatally (around the time of birth), or postnatally (after birth).

In addition to low muscle tone, infants with hypotonia may also exhibit excessive flexibility of the joints (hypermobility), decreased deep tendon reflexes (e.g., tapping the knee joint produces little or no muscle jerk), and difficulties with sucking and swallowing. Children in whom hypotonia persists often show delays in gross motor skills such as sitting up, crawling, and walking. They may also have difficulties with coordination and exhibit speech delays. In some cases, symptoms may persist into adulthood.

Hypertonia

a condition marked by an abnormal increase in muscle tension and a reduced ability of a muscle to stretch. It is caused by injury to motor pathways in the central nervous system, which carry information from the central nervous system to the muscles to control posture, muscle tone, and reflexes. When the injury occurs in children under the age of 2, the term cerebral palsy is often used. Hypertonia can be so severe that joint movement is not possible. Untreated hypertonia can lead to loss of function and deformity.

Spastic hypertonia

involves uncontrollable muscle spasms, stiffening or straightening out of muscles, shock-like contractions of all or part of a group of muscles, and abnormal muscle tone. Itis seen in disorders such as cerebral palsy, stroke, and spinal cord injury.

Dystonic hypertonia

refers to muscle resistance to passive stretching (in which a therapist gently stretches the inactive contracted muscle to a comfortable length at very low speeds of movement) and a tendency of a limb to return to a fixed involuntary (and sometimes abnormal) posture following movement. It is seen is the different forms of dystonia and sometimes in Parkinsonism. Rigidity is an involuntary stiffening or straightening out of muscles, accompanied by abnormally increased muscle tone and the reduced ability of a muscle to stretch. This type of hypertonia is most common in Parkinsonism.

Hypertonia is often treated by drugs such as baclofen, diazepam, and dantrolene which help to reduce spasticity. Injections of botulinum toxin are a recent treatment for chronic hypertonia in cerebral palsy, spasticity, and other disorders. Rehabilitative treatment may involve range of motion exercises, and active stretching exercises. Dystonic hypertonia and rigidity can be treated with therapies directed to the underlying disorders.

Developmental Coordination Disorder(DCD)

a condition where children do not develop normal motor coordination (coordination of movements involving the voluntary muscles).

Developmental coordination disorder has also been called clumsy child syndrome, clumsiness, developmental disorder of motor function, and congenital maladroitness. It is usually first recognized when a child fails to reach such normal developmental milestones as walking or beginning to dress him or herself.

Children with developmental coordination disorder often have difficulty performing tasks that involve both large and small muscles, including forming letters when they write, throwing or catching balls, and buttoning buttons. Children who have developmental coordination disorder have often developed normally in all other ways. The disorder can, however, lead to social or academic problems for children. Because of their underdeveloped coordination, they may choose not to participate in activities on the playground. This avoidance can lead to conflicts with or rejection by their peers. Also, children who have problems forming letters when they write by hand, or drawing pictures, may become discouraged and give up academic or artistic pursuits even though they have normal intelligence.

There are six general groups of symptoms. These include:

  • general unsteadiness and slight shaking
  • an at-rest muscle tone that is below normal
  • muscle tone that is consistently above normal
  • inability to move smoothly because of problems putting together the subunits of the whole movement
  • inability to produce written symbols
  • visual perception problems related to development of the eye muscles

Children can have one or more of these types of motor difficulties.

Developmental coordination disorder usually becomes apparent when children fail to meet normal developmental milestones. Some children with developmental coordination disorder do not learn large motor skills such as walking, running, and climbing until a much later point in time than their peers. Others have problems with such small muscle skills as learning to fasten buttons, close or open zippers, or tie shoes. Some children have problems learning how to handle silverware properly. In others, the disorder does not appear until they are expected to learn how to write in school. Some children just look clumsy and often walk into objects or drop things.

Gross Motor Concerns

The term gross motor skills refers to the abilities usually acquired during infancy and early childhood as part of a child's motor development. By the time they reach two years of age, almost all children are able to stand up, walk and run, walk up stairs, etc. These skills are built upon, improved and better controlled throughout early childhood, and continue in refinement throughout most of the individual's years of development into adulthood. These gross movements come from large muscle groups and whole body movement.

Important aspects of gross motor control include development of posture, learning to stand and walk, learning to go up and down stairs, hopping, jumping and running. Working with a child how has limited gross motor skills in any of the areas mentioned, can help them with their coordination, as well as some social aspects of their life.

What Our Experienced Paediatric Physiotherapist, Wendy Fowles, Can Offer

MEDEK

a treatment approach used to develop gross motor skills in infants and children with motor delay. Children with any of the following conditions, may benefit from MEDEK: Down Syndrome, cerebral palsy, hypotonia, global developmental delay or have an acquired brain injury.

The goal of this type of therapy is to develop functional motor control in order to achieve the maximum level of independence in sitting, standing, and walking. The therapist will use the most distal point of contact on the child’s body thatis tolerated at each moment. This exposes the body segments to the influence of gravity and the brain’s automatic responses are stimulated in order to produce the desired reaction.

In order to increase the frequency of intervention, a home program is taught to the child’s parents/caregiver. This home program consists of 6 to 8 exercises specifically chosen by the treating therapist to meet the needs of the child. Families are instructed to complete the home program on a daily basis. The acquisition and integration of a new skill requires practice, therefore repetition of the exercises is an important aspect of treatment. As the child progresses, the therapist will modify the treatment plan and teach new exercises to the family on an ongoing basis. We ensure that the purpose of each exercise is discussed in relation to the therapeutic goals for the child.

Neurological Conditions

Neurological disorders are those affecting the brain, spinal cord and nerves; such as stroke, MS and Parkinson's disease.

When the nervous system is damaged, muscles may feel weak and floppy or very tight with spasms or tremor and movement may be uncoordinated. Along with movement disorders, there may also be altered sensation.

Physiotherapy goals will be set at the initial assessment between the child, parent and therapist before treatment is started.

Treatment is specific to each patient, and involves methods to overcome your physical problems such as stretching, strengthening, balance and walking practice (if appropriate), postural awareness and control, respiratory assessment and education. Advice and recommendations will also be given on suitable walking aids and home adaptations / equipment. The majority of patients are seen once or twice a week and complete a home exercise program between treatment sessions.

Sometimes, early treatment can prevent the progression of a condition and prevent secondary complications. In some cases, although conditions may progress over time, there can still be gains by having physiotherapy to improve quality of life and promote independence.

Core Stability

Strengthening in children with cerebral palsy and other neuromuscular disorders can be beneficial for long-term functional gains, improved movement patterns, and optimal posture. Children with neuromotor impairments have decreased muscle strength, work capacity, peak muscle power, and muscle endurance; and an increased energy cost of movement.

During typical development, a child begins to build core strength through continuous practice of active movements and movements against gravity. A child will practice small components of a movement pattern before using the pattern functionally. Children with atypical motor development have a limited repertoire of movement patterns. Compensatory movement strategies learned in early development lead to decreased strength and endurance of key muscle groups later in life.

Due to atypical motor development in infancy, children with neuromotor dysfunction often have common muscle weaknesses. The typical weaknesses are described below with some basic exercises and progressions to work each area, as well as fun exercise ideas. Many functional movements and activities are wonderful because they can be used to strengthen more than one area.

Spinal extensors, especially thoracic extensors, are generally weak. This weakness presents as difficulty moving against gravity and maintaining optimal posture and alignment. There is often an overuse of flexors, such as pectorals, that limit activation of the antagonist extensors.

Abdominal weakness presents with shallow breathing, a flared rib cage, and difficulty maintaining optimal posture and alignment with movement. Children often have a poor connection between their upper and lower body, and have difficulty flexing against gravity.  Abdominals are composed of the rectus and transverse abdominis, and the internal and external obliques. Core exercises that engage all the abdominal muscles are key. Sit-ups are the most-often-thought-about abdominal exercise.

Challenging a child's trunk control can be done with numerous exercises besides the typical sit-up or curl-up. One example is rotation exercises in sitting, in which the child rotates his or her trunk while holding a ball or bar with both hands.

In many children with neuromotor dysfunction the scapular stabilizers are generally weak and present with significant scapular winging during arm movements. The scapular stabilizers are weak because of tightness and overactivity in the pectorals and the latissimus dorsi. This weakness limits weight-bearing on extended arms and efficient upper-extremity tasks.

The best exercises to work scapular stabilization are in weight-bearing on upper extremities. When the child is exercising, it is important to encourage or look for improvements in how the scapula moves smoothly along the thoracic wall. Often, the scapula will follow arm movements with a poor stable connection to the trunk. One example of an exercise is wheelbarrow walking, in which the therapist holds the child's feet and the child walks on their arms, is a great exercise.

Strengthening can be a very rewarding and beneficial aspect to most children's physical therapy plans. Simple strengthening exercises can make very effective home programs. And when strengthening activities are incorporated into play and functional activities, strengthening can offer benefits to all age ranges.

Thera Togs

Thera-Togs are an orthotic undergarment. They consist of a soft vest and shorts with a variety of elastic straps that can be used for positioning and body alignment. They provide dynamic support and facilitate neuro-muscular re-education. Thera Togs are typically used for children with motor impairments such as cerebral palsy, spina bifida or gait deviations.

To determine whether Thera Togs can be useful for a child, a thorough evaluation is required including musculo-skeletal, neurodevelopmental and functional motor assessments.

  • Wendy is experienced using Thera-Togs to maintain improved posture and musculo-skeletal alignment of the trunk and limbs throughout the day. These undergarments can be used to position muscles and joints at a biomechanical advantage. 
  • Thera-Togs can be used to help a child sit straighter, walk without crossing legs, walk with legs tracking at appropriate angles, etc.
  • When used on a daily basis, Thera-Togs can help to promote strengthening of weakened muscles and development of more functional motor patterns. They provide a long-term carry-over of therapeutic intervention outside of the direct therapy session.

Orthotics

Children with neuromuscular deficits frequently have difficulty performing motor tasks due to poor postural stability, poor muscular strength, ataxia, spasticity, etc. Orthotics can provide the stability needed in the lower extremities for the development of  functional mobility skills. They can also be used to prevent the development of muscle contracture and joint deformity.

Our pediatric physiotherapist, Wendy, determines the need for specific types of lower extremity orthotics in the following ways:

  • Performs musculo-skeletal evaluations, gait evaluations, and functional mobility assessments
  • Provides consultation with physicians and orthotists regarding splinting and bracing needs
  • Ongoing follow-up and monitoring of fit, comfort and effectiveness of orthotics

Pediatric Walkers

- aids for walking. They are height adjustable and can be either pulled from behind or pushed in from depending on their style and the child's abilities. They can have no wheels, two wheels or four wheels. The more wheels on a walker, the less stable it is however the more wheels the easier it will be to move. Some types of walker wheels will swivel which eases turning but reduces the stability of the walker. The rear wheels, when four wheels are used, in some cases can have drag brakes which slow the rotation of the rear wheels to make the walker more controllable and stable for the child.

 

Children's walkers can also have forearm attachments which allow the child's weight to be transmitted down through the elbows and forearms to the walker. These attachments are helpful for kids who cannot grip the walker with their hands or support their weight through their hands. Wendy can help choose and fit the appropriate walker for your child.

Pediatric Standers

commonly used by children who cannot stand on their own or for children who is suffering from different kinds of ailments in spine and limbs. It helps mothers to properly give the child proper posture in standing and sitting. Wendy knows the importance of proper positioning and so she always strives to secure your child into a better posture in standing and in sitting. The pediatric standers give aid to all mothers for properly maintaining the right positioning of the child.

Pediatric standers is used kids from 28''-40'' (71-101 cm) and up to 45 lbs (20 kg.), kids with Cerebral Palsy, Spinal Bifida, and Muscular Dystrophy. This is an early intervention standing system for preschool kids. A variety of support and mobility options accommodate children with different levels of disability.

It is used at home and daycare, early intervention centers, schools, and children's hospitals. It is used only when it's developmentally appropriate to stand, in school, when other kids are standing at home, and when doing activities with family.

It works easily. You transfer the child into the pediatric stander in seated position, secure positioning strap, lift the seat to desired position and tighten adjustment knob, and then move table to desired position.

Assistive Devices Program (ADP)

Wendy is an ADP authorizer. The Assistive Devices Program (ADP) financially helps Ontario residents with long-term physical disabilities to obtain basic, competitively priced, personalized assistive devices appropriate for the individual’s needs and essential for independent living. Assistive devices are also known as assistive technology, assistive-technology products, assistive-living products and adaptive technology.

To Obtain an Application Form: Call ADP at 1-800-268-6021
Call the INFOline at the Ministry 1-800-268-1154
Health and Long-Term Care 1-800-387-5559 TTD/TTY
Write to: info@moh.gov.on.ca
Or to: Assistive Devices Program
Ministry of Health and Long-Term Care
5700 Yonge St, 7th Floor
North York,ON M2M 4K5

You are eligible if you:

  • are an Ontario resident
  • have a valid Ontario Health Card
  • have a physical disability for 6 months or longer

Note: Specific eligibility criteria applies to each device and you are eligible for ADP whatever your income.

To Access ADP

  • A medical specialist or general practitioner provides you with a diagnosis
  • Based on the diagnosis, we assess whether you meet ADP funding criteria and prescribe the appropriate equipment or supplies
    • Wendy is a qualified healthcare professional registered with ADP who works in a hospital, home care agency or private practice
    • Wendy can complete a section of your application form, which you can then take to a vendor
  • A vendor is registered with ADP and sells equipment or supplies
    • ADP covers most devices only if they are bought from a registered vendor
    • the registered vendor bills ADP directory for ADP's portion of the approved cost

Equipment is not covered by ADP if…

  • it is intended exclusively for sports, work or school
  • your primary diagnosis is a learning disability or a mental disability
  • if you are on Worker’s Compensation
  • if you are a Group A veteran with a pensioned condition

Financial Assistance

ADP pays up to 75% of the cost for certain equipment and a fixed amount towards the cost of other equipment. In most cases, you pay your share of the cost at time of purchase, and the vendor bills ADP for the balance.

Possible sources of funding for your share of the cost include:

  • other provincial government programs, such as the Ontario Disability Support Program
  • some municipal social-service departments
  • charitable organizations, such as the Ontario March of Dimes
  • service clubs, such as Kiwanis
  • insurance companies
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