Physical Therapy

It used to be that the physician would evaluate and refer the child for physical therapy that would be indicated for the specific condition.Nowadays the physical therapist often participates in the multidisciplinary team that performs the evaluation.The therapist makes diagnostic decision related to impairment and functional limitation.After deciding that treatment is indicated the next desicion is to define the therapy and the duration.The justification for treatment is easier if there is an endpoint that can be reached.Unfortunately, many chronic conditions do not respond very well and so secondary effects, for example, the prevention of contractures, may be important.

TABLE 8-1. LIMITATION OF SPORTING ACTIVITIES FOR MEDICAL CONDITIONS

Contact or Collision                 Limited Contact                                      Non-contact

Basketball                               Baseball                                                  Archery

Boxing*                                   Bicycling                                                  Badminton

Diving                                      Cheerleading                                           Body building         

Field hockey                            Canoeing/kayaking(white water)           Bowling

Football                                   Fencing                                                   Canoeing/kayaking

Ice hockey                               Field                                                          (flat water)

Lacrosse                                    High jump                                             Crew/rowing

Martial arts                               Pole vault                                              Curling

Rodeo                                      Floor hockey                                            Dancing

Rugby                                      Gymnastics                                             Field

Ski jumping                             Handball                                                    Discus

Soccer                                     Horseback riding                                        Javelin

Team handball                        Racquetball                                                Shot put

Water polo                              Skating                                                    Golf

Wrestling                                   Ice                                                         Orienteering

                                                  Incline                                                   Powerlifting

                                                  Roller                                                    Race walking

                                                Skiing                                                      Riflery

                                                  Cross-country                                        Rope jumping

                                                  Downhill                                                Running

                                                  Water                                                    Sailing

                                                Softball                                                   Scuba diving

                                                Squash                                                    Strength training

                                                Ultimate Frisbee                                    Swimming

                                                Volleyball                                               Table tennis

                                                Winsurfing/surfing                                 Tennis

                                                                                                                Track

                                                                                                                Weightlifting

*Boxing not recommended for children

      Notes: (1) Contact or collision should be avoided with absence or persintent abnormality of eye, kidney, or testis. (2) Caution necessary for spinal cord injury, bleeding disorders, carditis, enlarged liver or spleen, poorly controlled convulsive disorder. (3) Other medical conditions should be evaluated in an individual basis.

                        Pediatric physical therapy is designed to achieve optimal motor function for mobility and to aid in the activities of daily living.Early identification of infants and children who will benefit from therapy is important.The objective is to reduce the effect of chronic illness upon developmental milestones.Screening of motor development milestones may not pick up mild abnormalities and careful history and physical examination is necessary for full evaluation.Parents notice movement of their children and may be able to find abnormalities if they are told what to watch for.

                Although physical therapists do not require a specific referral in most states it is usual for the physician to write orders for therapy.It is important for the therapist to be aware of other medical problems in designing a therapy.This includes seizures, cardiac or respiratory problems, and other conditions that may impact the therapy.

                Physical therapy has in the past used clinical experience to justify its usage.In the era of managed care, there needs to be scientific justification for recommendation of a particular therapy for a specific condition.The initial consultation results in the development of a treament plan which is individualized to manage the specific problems areas.For example, the plan might include what exercises are indicated and which appliances or devices may assist.Outcome measures should be defined and assessments made to evaluate success and cost effectiveness.

                Conditions that can be evaluated include loss of motion, weakness, and deformities.Treatment strategies can be devised based on the disability.Musculoskeletal impairment, which results in contractures, may respond to exercise and splinting.Weakness can be managed by strengthening exercises including weights or by exercising in apool using water as resistance.Treatment is focused on interventions that reduce impairments and optimize functional potential.Learning and re-learning motor tasks is a major part of rehabilitation of neurologic and orthopedic impairment.The acquisition of skills of motor perfomance is a complex process.