Pediatric Physical Therapy

Pediatric Physical Therapy

Pediatric physical therapists provide support and services for children (birth to 21 years) with developmental disabilities, and their families, aimed at developing, restoring and improving mobility to improve quality of life. These services are provided in homes, schools, and community settings, as well as in hospitals and clinics.

Pediatric physical therapy benefits children and their families/caregivers by promoting activity and participation in everyday routines, increasing functional independence, enhancing learning opportunities, improving strength and endurance, facilitating motor development and mobility, and easing the challenges of daily caregiving.
In addition to direct intervention and consultation, pediatric physical therapists promote health and fitness for children with all levels of ability and provide information to and collaborate with families and other medical, developmental, and educational specialists.

Symptoms & Conditions

Physical therapists treat and manage numerous conditions affecting youths, including:

Autism Spectrum Disorder
Blount's Disease
Cerebral Palsy
Concussion
Container Baby Syndrome
Developmental Coordination Disorder
Developmental Delay
Diabetes
Down Syndrome
Female Athlete Triad 
Infantile Brachial Plexus
Infant Prematurity
Muscular Dystrophy 
Osgood-Schlatter Disease
Plagiocephaly (Flat Head Syndrome)
Scoliosis
Spina Bifida
Spinal Muscular Atrophy
 

 

Children with autism spectrum disorder (ASD) experience delays in the development of basic skills in specific areas. They have difficulty interacting and communicating socially, and they show limited and repetitive patterns of behavior. Children with ASD may rely on routines, such as putting on their clothes in the same order every day, and may be very sensitive to changes in routines or the environment.

They are often delayed in acquiring motor (movement) skills and may have difficulty with motor coordination, postural control, and imitating the movements of other people. Symptoms of ASD begin in late infancy or early childhood; however, they may not be recognized until the child is older. Symptoms in individuals vary from mild to severe.

About 1 in 68 children in the United States has been identified with ASD, and the disorder is almost 5 times more common in boys than girls.

What is Autism Spectrum Disorder? Autism spectrum disorder (ASD) is a developmental disability resulting in social, communication, and behavioral challenges. Symptoms begin in early childhood and continue throughout the lifespan. While many terms previously were used related to autism, in 2013 all autism disorders were merged into 1 umbrella diagnosis of ASD.

This change conforms to the May 2013 release of the American Psychiatric Association’s new edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The DSM-5 is used by many organizations, individuals, and governments to classify diagnoses, including ASD.

The use of the term "spectrum" allows for the variations in symptoms and behaviors identified among children with this diagnosis.

All of the causes of ASD are not yet known, but specific environmental, genetic, and biological factors may predispose a person to develop ASD. The number of children being diagnosed with ASD is increasing, and may be related to better efforts at diagnosis or to an increase in causes of ASD not yet understood.

Motor (movement) skills are impaired in individuals with ASD. Research has shown that motor coordination, postural control, and learning of skills through imitation of the movements of other persons may be limited, and planning and completing new motor tasks are challenges for many children with ASD. Early motor delays in children with ASD may contribute to difficulty acquiring social skills.

Research also shows that early intervention services can help children with ASD learn important skills and improve development. Early diagnosis can help a child with ASD achieve full potential. Physical therapists are members of teams that provide services to children with ASD and their families from early childhood, through the school years, and into adulthood.

How Can a Physical Therapist Help?

Physical therapists can work with your child, family, and educational team to help your child: Improve participation in daily routines at home and school

Acquire new motor skills
Develop better coordination and a more stable posture

Improve reciprocal play skills, such as throwing and catching a ball with another person Develop motor imitation skills (seeing another person perform an action and then copying that action) Increase fitness and stamina

A physical therapist will conduct a thorough evaluation of your child that will typically include a health and developmental history and assessment of:

Postural strength and control
Functional mobility (eg, walking and running)
Body and safety awareness
Coordination
Play skills
Interests and motivators

Ability to change between different activities Strengths and challenges in making large body movements, such as jumping, hopping, pedaling a tricycle or bicycle, and skipping Participation in daily routines in the home, community, and school

Your physical therapist will work with you to develop goals to help your child participate as fully as possible in daily routines at home, in the community, and at school. Your physical therapist will then develop a comprehensive plan to meet your child's, and your whole family's needs. No "standard" treatment exists for children with ASD.

Each child's challenges and goals are different. Your physical therapist will design an individual program to meet the strengths and needs of your child. The therapist will work with you to monitor how your child progresses, and collect data to make sure that the treatment plan is leading to positive outcomes for your child.

Physical Therapy in the Early Years: Birth to Age 3 Physical therapists work with families and caregivers to increase a child's participation in routines of daily life that are challenging. They promote opportunities during free play and structured play to develop and practice the movement skills common to your child's age group.

Physical therapists work on increasing strength and coordination, and walking safely and efficiently in all needed environments, such as negotiating stairs. Priorities may include developing imitation skills (eg, performing actions to songs like “Head, Shoulders, Knees, and Toes”) and indoor and outdoor play skills. Guidance is provided to include structure, routines, and physical boundaries to daily activities to promote positive behaviors.

Physical Therapy in the School Years (Including Preschool): Ages 3 to 18
Physical therapists work with parents and teachers to increase awareness about the impact of ASD on school functioning.

They use the latest, most effective treatments based on medical evidence to minimize each child's challenges and help make the school experience a positive one. Physical therapists recommend modifications and accommodations to support learning. Examples include using ball chairs to reduce "out-of-seat behaviors," and using hula hoops, carpet squares, or specially placed seating to identify personal space. They provide whole-class movement breaks, and use strategies like "motor learning" to teach the movement skills needed to participate in social games and peer interactions.

Physical therapists provide direct help when needed to improve a child's ability to negotiate challenges, such as school bus steps, crowded hallways, cafeterias, and playgrounds. They work together with school teams to promote skills like self-regulation, listening, and taking turns.

Strategies are provided to teach the child how to imitate the movement activities of other children, develop directional concepts, body and spatial awareness, and coordination as well as to promote success in physical education and fitness activities. Physical Therapy During Adulthood: Age 18+

Physical therapists work with adults with ASD to promote success in daily life. They recommend community resources to increase movement opportunities. They develop individualized exercise routines to promote body coordination and walking skills.

They work with each individual to help improve movement, function, and fitness so the individual can hold a job, function at home, and enjoy leisure activities.

 

Cerebral Palsy (CP) is a general term used to describe a group of disorders that affect the normal development of movement and posture. CP is caused by an injury to the brain—such as infection, stroke, trauma, or the loss of oxygen to the brain—that occur before, during, or after birth or within the first 2 years of life. The injury to the brain is "nonprogressive," meaning that it does not get worse after the initial injury. However, the day-to-day activities that can be affected by the injury during an individual's childhood can worsen throughout the individual's life.

Difficulties from CP can range from mild to severe. Individuals with CP may have trouble seeing, hearing, feeling touch, thinking, or communicating. They may also experience seizures.

CP affects approximately 3.6 infants per each 1,000 born in the United States. The number of children diagnosed with CP has grown in recent years as a result of the increased survival rates of premature babies and those born with low birth weights. The average life expectancy of adults with CP has increased as well. People with CP can benefit from physical therapy throughout all the stages of their lives.

Physical therapists are experts in helping people with CP improve their physical functions. They can help them stay active, and healthy, and perform day-to-day tasks such as walking, operating a wheelchair, and getting in or out of a wheelchair to and from a bathtub, bed, or car

What is Cerebral Palsy?

Cerebral palsy is a broad term used to describe the effects on the development of motor skills caused by nonprogressive injuries to the developing brain. Types of CP are given different names based on the type of movement problem and the areas of the body affected:

Spastic involves increasing spasm of the muscles as the person moves faster.

Ataxic involves decreased coordination and unsteadiness throughout the body.

Dyskinetic involves unpredictable changes in muscle tone and movement that create unstable posture.

Mixed describes a combination of the movement problems noted above (spastic, dyskinetic, or ataxic).

Quadriplegia describes CP that affects both arms and legs, the neck, and the trunk.

Diplegia affects either both legs (the most common form of the disorder) and both arms (less common). Hemiplegia affects just one side of the body.

How Can a Physical Therapist Help?

A physical therapist is an important partner in health care and fitness for anyone diagnosed with CP. Therapists help people with CP gain strength and movement to function at their best throughout all the stages of life.

The physical therapist will provide care at different stages in the individual's development, depending on his or her unique needs. Therapy may be provided in your home or at another location such as a community center, school, or a physical therapy outpatient clinic. The physical therapist will work with other health care professionals, such as speech/language pathologists or occupational therapists, to address all the individual's needs as treatment priorities shift.

Physical Therapy in the Early Years: Birth to Age 4

Physical therapists can help caregivers support their child's movement development by providing hands-on training for positioning, movement, feeding, play, and self-calming. Your therapist will also suggest changes at home to encourage movement development, as well as communication, hearing, vision, and play skills. It is important to remember that it is through play that young children learn many skills. Your therapist will develop an individual program of play activities that match your child's specific needs—to improve strength, movement, and function. At this age, physical therapy is generally provided at home, in a daycare center, or in an outpatient clinic.

Physical Therapy in the School Years:  Ages 5 to 12

Physical therapists train caregivers to help the child with CP accomplish functional goals and promote the highest quality of life through all stages of development. The treatment plan and goals will change as your child ages.

Pre-school and school bring challenges for your child to navigate new environments each year. At this age, children also experience growth spurts, requiring adjustments to therapy and equipment used to help the child. Care priorities can focus on walking, transfers, personal hygiene, play, socialization, and adaptive equipment needs to meet the social and physical changes that occur during this time period. Physical therapy may be provided in outpatient and/or school settings. School-based therapy focuses on accommodations and modifications to ensure your child has the best possible learning environment.

Physical therapy benefits the adolescent with CP by focusing on prevention of posture problems and joint limitations. This is done by encouraging mobility and fitness, managing muscle and/or joint pain, and recommending braces and other helpful equipment to maintain health and function. The physical therapist will educate parents about self-care, maintaining daily routines, socialization, physical activity, and plans for the child's schooling and future careers.

It is important to note that lifelong health habits are formed at this age—and developing an individual fitness program can improve the person’s health and function for the remainder of his or her life. Children with CP are at a greater risk than the general youth population of not exercising enough and becoming sedentary, which can lead to weight issues and medical complications.

These issues progress gradually but can have a significant impact on the quality of life of the child and of the caregivers. Physical therapists are skilled in developing individual exercise programs that use each child's strengths and abilities. For instance, a therapist might recommend adaptive sports such as bowling, swimming, cycling, volleyball, tennis, and basketball to promote physical fitness and socialization with peers.

 

The brachial plexus is a network (bundle) of nerves in the shoulder and under the arm. The network is composed of the nerves that carry signals from the spinal cord to the shoulder, arm, hand, and fingers. These signals transmit information between the brain, the spinal cord, and the arm and hand and are required for typical movement and feeling (sensation). If nerves in the upper part of the brachial plexus bundle are damaged, the injury is called Erb’s (or Erb-Duchenne) Palsy. If the nerves in the lower part of the brachial plexus are damaged, the injury is called Klumpke’s (or Dejerine-Klumpke) Palsy. In some instances, all the nerves may be damaged, resulting in "global" palsy.

Injuries to the brachial plexus result in movement and sensation difficulties in the arm, which may be mild or severe, and temporary or prolonged. Brachial plexus injury occurs in approximately 1.5 of every 1,000 infants born; the rate of injury is lower in smaller infants (under 6 pounds) and increases as the size of the infant increases, especially in babies who weigh 9 pounds or more.

What is a Brachial Plexus Injury?

The brachial plexus is a bundle of nerves that runs from the neck through the shoulder to the arm. Although injury can happen anytime, most brachial plexus injuries occur during birth when the infant's shoulder becomes wedged in the birth canal. This event, called shoulder dystocia, can stretch the brachial plexus, damaging the nerves. The delivery becomes an emergency situation, and additional maneuvers are required to deliver the infant. Injury also may occur without shoulder dystocia if the labor is long, the infant is large, the mother develops gestational diabetes, the delivery requires external assistance (such as forceps), or if a breech birth (buttocks- or feet-first rather than head-first) occurs.

Possible Causes

Erb's or Klumpke's Palsies result from 4 types of brachial plexus injuries:

Neuropraxia occurs when 1 or more of the nerves are stretched and damaged, but not torn. It is the most common type of injury to the nerves of the brachial plexus, and may heal spontaneously.

Neuroma results from a torn nerve that heals, but scar tissue develops. The scar tissue puts pressure on the injured nerve and prevents signals from being transmitted between nerves and muscles. Neuroma injuries require treatment to heal.

Rupture describes a torn nerve, but the tear is not at the site where the nerve attaches to the spine. Surgery will be required, and the muscles may continue to weaken if physical therapy treatment does not occur following surgery.

Avulsion is the most severe type of injury, in which the nerve is torn from the spine. The size and growth of the arm or hand may be affected, and damage may be present for life.

How Can a Physical Therapist Help?

A physical therapist is an important family treatment partner for any child diagnosed with a brachial plexus injury. Physical therapy should begin as soon as possible after diagnosis or surgery, and before joint or muscle tightness has developed. Physical therapists will:

Identify muscle weakness and work with each child to keep muscles flexible and strong. Help reduce or prevent muscle or joint contractures (tightening) and deformities.

Encourage movement and function.

Even when surgery is not required, therapy may need to continue for weeks and months as the nerves grow again or recover from damage. Children with Erb's Palsy will usually recover by 6 months of age, but other palsies may require longer treatment. Each treatment plan is designed to meet the child's needs using a family-centered approach to care.

Evaluation. Your child's physical therapist will perform an evaluation that includes a detailed birth and developmental history. Your child’s physical therapist will perform specific tests to determine arm function, such as getting the child to bring the hands together, grasp a toy, or use the arm for support or for crawling. The physical therapist will test arm sensation to determine whether some or all feeling has been lost, and educate the family about protecting the child from injuries when the child may not be able to feel pain. Physical therapists know the importance of addressing the child’s needs with a team approach, review all health care assessments, and send the child for further evaluation, if needed.

Treatment. Physical therapists work with children with brachial plexus injury to prevent or reduce joint contractures, maintain or improve muscle strength, adapt toys or activities to promote movement and play, and increase daily activities to encourage participation—first in the family, and later, in the community. Treatments may include:

Education on holding, carrying, and playing with the baby. Your physical therapist will make suggestions for positioning, so that your baby's arm will not be left hanging when the baby is being held or carried. Your physical therapist will provide ideas for positioning the baby on the back or stomach for play without injury to the arm.

Prevention of injury. Your physical therapist will explain the possible injuries that could occur without the baby crying, since the baby cannot perceive pain if sensation is limited in the arm.

Passive and active stretching. Your physical therapist will assist you and your child in performing gentle stretches to increase joint flexibility (range of motion), and prevent or delay contractures (tightening) in the arm.

Improving strength. Your physical therapist will teach you and your child exercises and play activities to maintain or increase arm strength. Your physical therapist will identify games and fun tasks that promote strength without asking the baby to work too hard. As your child improves and grows, your physical therapist will identify new games and activities that will continue to strengthen the arm and hand.

Use of modalities. Your physical therapist might use a variety of intervention techniques (modalities) to improve muscle function and movement. Electrical stimulation can be applied to gently simulate the nerve signal to the muscle and keep the muscle tissue functional.

Flexible tape can be applied over specific muscle areas to ease muscle contraction. Constraint-induced movement therapy (CIMT) may be applied to the nonaffected arm to encourage use of the affected arm. Repetitive training of the affected arm is encouraged, using age-appropriate tasks, such as finger painting, building a tower, or picking up and eating small bites of food. Your physical therapist will collaborate with other health professionals to recommend the best treatment techniques for your child.

Improving developmental skills. Your physical therapist will help your child learn to master motor skills, like putting the child’s weight on the injured arm, sitting up with arm support, and crawling. Your physical therapist will provide an individualized plan of care that is appropriate based on your child’s needs.

Fostering physical fitness. Your physical therapist will help you determine the exercises, diet, and community involvement that will promote good health throughout childhood. Your physical therapist will continue to work with you and your child to determine any adaptations that may be needed, so that your child can participate fully in family life and in society.

Therapy may be provided in the home or at another location, such as a hospital, community center, school, or a physical therapy outpatient clinic. Depending upon the severity of the brachial plexus injury, the child's needs may continue and vary greatly as the child ages. Your physical therapist will work with other health care professionals, eg, occupational therapists and physicians, to address all your child's needs as treatment priorities shift.  

Can this Injury or Condition be Prevented?

All pregnant women should seek good prenatal care, including a test for gestational diabetes. Mothers with gestational diabetes tend to have larger babies. The larger the baby, the higher chance of brachial plexus injury during delivery. Attentive care during labor and delivery is extremely important. Specific positioning of the mother during the delivery may improve the infant's movements through the birth process, and the delivery health care provider may be able to suggest the most helpful positions. The use of equipment to assist in delivery also has been associated with brachial plexus injury.

 

Scoliosis is a condition that affects the normal shape of the spine, altering a person's overall trunk alignment and posture. Scoliosis causes the spine to move to the side and turn. This condition can occur at any time during the lifespan, but is more commonly detected during adolescence. Scoliosis affects 2% to 3% of the general population, and is more common in females than males. Scoliosis ranges from mild to severe cases, requiring a variety of treatments. The more severe cases may require surgery. Scoliosis is best managed with a team approach that includes the family, orthopedic physician or surgeon, orthotist, and physical therapist.

What is Scoliosis?

The Scoliosis Research Society defines scoliosis as a curvature of the spine to the side that also includes rotation. As previously mentioned, scoliosis causes postural and trunk alignment changes that cannot be corrected by “standing up straight. On an x-ray, the spine may appear to have an "s" or "c" shape. The severity of scoliosis is determined by measuring the angle of the curvature, also called a Cobb angle. A minimum of "10° of Cobb" needs to be present for a diagnosis of scoliosis.

Adolescent idiopathic scoliosis (AIS), the most common type of scoliosis, is diagnosed in children aged 10-18 years. Idiopathic means no identifiable cause is known, but 30% of children with AIS have some family history of the condition.

Other types of scoliosis include congenital, neuromuscular, and early onset (infantile and juvenile). Congenital scoliosis is caused by a deformity in the bones of the spine that occurs during a baby's early development in the womb.

Neuromuscular scoliosis is caused by a medical condition of the nervous system, such as cerebral palsy or muscular dystrophy, which triggers weakening of the muscles that support the spine. The cause of early onset scoliosis is not known. Early onset scoliosis includes infantile scoliosis diagnosed from birth to 3 years of age, and juvenile scoliosis diagnosed before the age of 10.

How Does it Feel?

Scoliosis is usually a pain-free condition, but pain may occur as the spine curves abnormally and affects the surrounding muscles and joints. These changes may alter a person's alignment, posture, and movement patterns, causing irritation and pain. Muscles that usually support the spine may become imbalanced in scoliosis, leading to a loss of strength and flexibility. A person with scoliosis may note: Uneven shoulder height.

Uneven hip height.

An uneven waistline.

A general sense that the 2 sides of the body don't line up.

Pain in the areas surrounding the spine, including the shoulder, pelvis, and hip.

Pain with specific movement or activity.

A primary goal of physical therapy is to identify conditions, such as scoliosis, help the individual restore and maintain mobility so they can function at their personal best, and improve their quality of life.

How Can a Physical Therapist Help?

The variety of treatment options for scoliosis includes physical therapy, bracing, and surgery. Determining the best course of treatment is based on the type and severity of the scoliosis, the patient’s age, and the guidelines established by the Scoliosis Research Society.

Physical therapists can provide care during any of the phases of scoliosis treatment, including bracing or postsurgery. They will evaluate and assess the posture and movement patterns of the whole body, noting any limitations caused by changes in the spine, and address other symptoms, such as pain and muscle imbalances.

Your physical therapist will work with you and your child to develop an individualized plan tailored to the type and severity of the scoliosis as well as patient goals. Your physician will continue to closely monitor progress throughout the course of rehabilitation.

Physical therapy treatments may include:

Range-of-Motion Exercises. Your physical therapist will design a gentle range of motion treatment program to prevent limitations or to increase the body's range of motion, if movement limitations are present.

Strength Training. Your physical therapist will design a treatment program to strengthen any muscles surrounding the spine or in other parts of the body that have been weakened by the change in the spine’s position, such as the hips, shoulders, or even the head and feet.

Manual Therapy. Physical therapists are trained to gently restore motion to joints and muscle tissue that may have become restricted due to scoliosis. They may use their hands to help guide and retrain movement patterns.

Modalities. Several additional treatments, such as ice, heat, electrical stimulation or ultrasound may aid in achieving physical therapy goals. Your physical therapist will choose the most appropriate modalities for your particular case.

Functional Training. Physical therapists are trained to be experts in assessing movement patterns, providing education on proper movement patterns, and retraining the body for optimal movement. Education. Your physical therapist will provide information about scoliosis and the effects on the body and movement.

Can this Injury or Condition be Prevented?

Scoliosis cannot be prevented. Research is ongoing regarding treatments to stop the progression of scoliosis, such as bracing. A recent study has demonstrated that bracing is effective at limiting the progression of spinal curves. The primary goals of physical therapy are to manage symptoms and maximize each individual's functional capacity. A team approach to treating scoliosis works best.

 

 

Spina bifida is a birth defect that develops when an infant's spinal cord does not completely close during the early stages of the mother's pregnancy. Spina bifida is diagnosed in approximately 1,500 babies born in the United States each year. The birth defect may cause both physical and intellectual disabilities.

What is Spina Bifida?

Spina bifida is a birth defect involving the spine that occurs when a baby's "neural tube," or fetal spinal cord, does not completely close in the early stages of development during the first month of a mother's pregnancy. When the neural t'ube does not close, the bones of the spine that protect the spinal cord do not form as they should. Spina bifida can occur anywhere along the spine, and often results in damage to the spinal cord and surrounding nerves.

Signs and Symptoms

Spina bifida may cause both physical and intellectual disabilities that range from mild to severe. The severity of disability depends on the size and location of the opening in the spine, and the extent to which the spinal cord and nerves are affected. Babies born with spina bifida often cannot move their legs due to weakness or paralysis resulting from spinal cord and nerve damage.

People with spina bifida may have problems controlling their bowel and bladder, skin problems, orthopedic concerns, learning disabilities, problems with attention, or other neurological complications.

How Can a Physical Therapist Help?

The physical therapist is an important partner in health care and fitness for anyone diagnosed with spina bifida. Physical therapists help children and adults with spina bifida gain and maintain mobility, and function at their best throughout all stages of life. The physical therapist will also work with other health care professionals, such as orthopedists and occupational therapists, to address each individual's needs as treatment priorities shift. Your child's physical therapist will perform an evaluation that includes:

Birth and developmental history. The physical therapist will ask questions about the child's birth and developmental stages (the age your child held the head upright, rolled over, sat up, crawled, walked, etc).

General health questions. The physical therapist may ask some of the following questions: Has your child been sick or hospitalized? When did your child last visit a physician or health care provider? Were any health concerns shared with you during that visit?

Parental concerns. The physical therapist will ask about your chief concerns. What are you worried about? What do you hope to accomplish first in therapy?

Physical examination. The physical exam may include measuring the child's height and weight; observing movement patterns; making a hands-on assessment of muscle strength, tone, and flexibility; and testing the child's balance and coordination.

Motor development tests. The physical therapist will perform specific tests to determine the child's motor development, such as sitting, crawling, pulling up to standing, and walking. The physical therapist also may screen the child's hand use, vision, language skills, intellect, and other areas of development.

Physical therapy may be provided in a variety of locations, including the hospital, home, school, or outpatient clinics. 

Physical therapists in the intensive care unit address infant positioning needs and provide parent and family education.

Early-intervention physical therapists can provide physical therapy in the home or other community-based locations to help encourage the child's development of strength, movement, and balance skills by teaching parents specific play-based exercises.

School-based physical therapists often consult with other educational team members to help students with spina bifida participate in curricular activities, and develop independence within the school setting. They may recommend special equipment for the student to use during the school day.

Physical therapists also recommend appropriate equipment, such as braces, walkers, and wheelchairs to help people with spina bifida increase their functional mobility. 

Physical therapy is also important for the prevention of other possible problems, such as obesity, by identifying activities that encourage continued participation in sports or other fitness-based activities that promote lifelong health and wellness.

 

Spinal muscular atrophy (SMA) is a common, inherited neuromuscular disease that causes low muscle tone (hypotonia) and progressive muscle weakness and wasting (atrophy). All motor skills can be affected by the disease, including walking, eating, and breathing. SMA is a leading cause of death in infants.

It affects approximately 1 in 10,000 babies born in the United States, of any race or gender. Approximately 1 in every 50 Americans is a genetic carrier of SMA. Physical therapists help children with SMA develop muscle strength and movement abilities to function at the highest level possible.

What is Spinal Muscular Atrophy?

Spinal muscular atrophy (SMA) is a genetic (inherited) neuromuscular disease. The large motor nerves of the spinal cord are abnormal in people with SMA because a gene (the Survival Motor Neuron-1 or SMN1 gene) is missing or altered. Without the gene, or with a damaged gene, the nerves do not have a specific protein that allows them to control muscles. The decrease of the SMN1 protein results in improper functioning, and eventually death of the motor nerve cells in the spinal cord. The severity of SMA is related to the amount of the SMN1 protein that is absent in the motor nerve cells (more protein allows for more function). Severity of the disease ranges from mild muscle weakness, to total paralysis and the need for support to breathe.

How Can a Physical Therapist Help?

Evaluation is important for guiding the treatment of a child with SMA. Your physical therapist will conduct a thorough evaluation that includes taking the child’s health history and examining the child’s posture, muscle strength, motor activities that include walking, joint motion, respiratory function, participation with family and friends, and quality of life.

Treatment is important to allow children with SMA to achieve the highest level of independent living and mobility possible, and to prevent or delay the development of complications. Physical therapists work closely with the child and family to develop the most appropriate goals for each child based on functional levels and interests.

Your child's treatment may include:

Therapeutic Exercises and Strength Training. Physical therapists use different therapeutic exercises to help children with SMA improve and maintain mobility, and prevent or slow the progression of contractures and respiratory failure. Therapeutic exercises may include strengthening and aerobic at levels appropriate for the specific child.

Strengthening Exercises. Your physical therapist can help your child slow any deterioration in muscle strength and prolong your child’s ability to walk. Physical therapists design strengthening exercises to keep children with SMA active and moving. They identify games and fun tasks that can be used during therapy or taught to the family to maintain strength.

Improving Developmental Skills. Your physical therapist will develop strategies to help your child learn developmental skills that will improve:

Head and trunk control

Floor mobility, such as rolling and crawling

Changing positions, such as pulling up to stand Learning upright positions and skills, such as sitting, standing, and walking

Aquatic Therapy or Hydrotherapy. Some physical therapists specialize in aquatic therapy and use the physical properties of water to provide strength training, walking and balance exercises, and aerobic training, without the risk of fatigue or overworked muscles.

Standing Programs. Standing programs for children who can't walk are used to maintain muscle flexibility and length, prevent contractures, promote musculoskeletal development, and prevent bone-mineral density loss. Your physical therapist can design standing programs to be used at home or at school, as appropriate.

Management of Respiratory Complications. Physical therapists teach parents and caregivers how to perform chest drainage techniques, and help with coughing and breathing techniques to keep children with SMA breathing well. Your physical therapist will provide chest physical therapy as appropriate, and teach the family some blowing games (like bubbles) to improve breathing.

Management of Contractures. Physical therapists help prevent joint tightness (contractures) and increase flexibility in children with SMA by designing specific programs in range-of-motion exercises, positioning, and regular stretching. Your physical therapist may recommend the use of splints, braces, or standing devices, as appropriate.

Feeding. Physical therapists work closely with speech or occupational therapists to promote healthy feeding in children with SMA. They will help position the child in appropriate head and body postures to allow the most effective feeding. 

Management of Scoliosis and Skeletal Deformities. Physical therapists can assist in the prevention or reduction of scoliosis and skeletal deformities by designing specific programs to improve movement, and maintain healthy positioning at all times.

They will recommend wheelchair modifications and the use of braces to ensure the safety and health of each individual child, as needed. If a child requires surgery for scoliosis or other joint deformities, intensive preoperative and postoperative physical therapy can help prevent respiratory complications and loss of strength or function.

Assistive Devices. Many children with SMA require adaptive or assistive devices to help them maintain function at some point during the course of the disease, and especially following surgery. Physical therapists work with other rehabilitation specialists to select and modify assistive devices to meet each individual child's specific needs. Types of assistive devices range from those that position a child for feeding or playing, to motorized wheelchairs.