Children's FAQ's

# 1. Scolioisis

What is Idiopathic Scoliosis?

Among other types of scoliosis, Idiopathic Scoliosis is the most commonly found spinal deformity. Scoliosis is a 3 dimensional bending of the spine. There is a side shift to the left or right and also a rotational element. Scoliosis may be mild i.e. less than 20 degrees or may be more severe. Physicians and Physiotherapists describe the curve based on location and direction.

There are three types of idiopathic scoliosis:

  • a) Infantile Scoliosis: birth to 3 years old
  • b) Juvenile Scoliosis: from 3 - 9 years old
  • c) Adolescent Idiopathic Scoliosis: from 10 - 18 years old.

Approximately 80% of cases are the last category. Especially in younger children, congenital spinal malformations need to be ruled out as a cause for progressing spinal deformity.

Scoliosis is diagnosed in the clinic and confirmed by an x-ray.

A comprehensive Scoliosis intervention programme includes regular follow ups with an Orthopaedic Surgeon, a Physiotherapist specialised and trained in scoliosis management and an Orthotist for TLSO bracing system. Braces are typically prescribed if the curve is greater than 20 degrees. Other factors that can affect scoliosis progression are age of diagnosis, skeletal maturity of bones, other underlying conditions and a family history of scoliosis. Children diagnosed with Adolescent Idiopathic Scoliosis should be monitored closely for progression as during this age, growth is the most rapid and there is a risk of scoliosis progression.

Physiotherapy Scoliosis Specific Exercises such as Schroth Therapy, SEAS and BSPTS have been shown to help prevent the progression of scoliosis, improve scoliosis, and prevent and/or delay surgery.

# 2. Toe walking

What is toe walking?

Toe walking is when a child/person walks on their toes with very little or no weight on any other part of the foot. Toe walking may be normal for toddlers but should not persist in a school age child and/or in adolescence.

Persistent toe walking may result in tight heel cord and calf muscles which may need further intervention such as:

  • a) Physiotherapy to stretch and strengthen the muscles involved;
  • b) Casting to provide a constant stretch to the muscle that is tight;
  • c) Orthotics/Braces to provide a heel to gait pattern;
  • d) Botox to relax the tight muscle and increase movement of the joint/muscle;
  • e) Sensory Integration Interventions.

The intervention chosen is typically related to the cause of toe walking, which may be one of many. Some of the typical causes are:

  • a) Idiopathic toe walking/ Habitual
  • b) Cerebral Palsy
  • c) Sensory Processing Disorders
  • d) Charcot Marie Tooth and other neurological conditions
  • e) Post-surgery

Toe walking can result in delays in achieving gross motor milestones, such as standing, walking, balance and jumping skills and therefore should not be ignored.

# 3. Plagiocephaly and torticollis

Plagiocephaly or, flat head syndrome” is characterized by the development of a flat spot on the back or side of the head. An infant’s skull is very soft and prolonged pressure can cause head deformity. Plagiocephaly does not have a significant effect on infant’s neurological development. However, if left untreated it may progress to noticeable facial asymmetry, jaw misalignment and a misshapen head into adulthood.

The cause of Plagiocephaly is certainly multifactorial including womb position, size of baby, possible breached orientation, limited space due to multiple births, prematurity, developmental delay, back sleeping without appropriate positioning or extensive use of carriers and bouncy seats. Most parents notice the appearance of plagiocephaly features between 6-8 weeks of child’s age.

One of the most common conditions associated with Plagiocephaly is Torticollis.

Congenital muscular torticollis is the most common form of pediatric torticollis. The sternocleidomastoid (SCM) muscle becomes shortened and contracted. SCM tightness on one side predominantly causes side preference which in many cases gradually leads to development of plagiocephaly. The most common reasons why the SCM muscle may have become contracted are damage to the muscle during birth and positioning of the baby in the womb. Occasionally a small pea-sized lump is found on the sternocleidomastoid (SCM) muscle, especially in the case of birth trauma. As a result, children may have limited range of motion in the neck and head tilt to one side while the child looks to the other side.

In addition, less common cases of congenital torticollis may be also seen as a symptom of other underlying conditions such as Dwarfism, Shortened neck, Achondroplasia, Klippel-Feil syndrome and others.

For the best outcomes of your child’ treatment it is important to start physiotherapy soon. In general, the majority of children with congenital muscular torticollis and plagiocephaly improve after a few months of physical therapy when started early. Physical therapists can use different techniques in treatment of plagiocephaly and torticollis including supervised tummy time, correct manual handling, repositioning techniques together with specific stretching and strengthening techniques. In more severe cases, a multidisciplinary team approach (Pediatric physiotherapist, Orthotist and Pediatric orthopaedic surgeon) will be necessary.

# 4. Special considerations for the premature infant

Special considerations for the premature infants – do they require physiotherapy?

If your baby had a difficult start, spent time in a neonatal intensive care unit (NICU) as a result of prematurity they will take longer to reach their developmental milestones.

You will need to look at the milestone guidelines a little differently when assessing your baby’s’ development. The age at which your baby is expected to reach various milestones is based on the due date. So use your baby's adjusted age when looking at the milestones. For example a baby born 2 months early and is aged 4 months old will not be doing the same as a 4 month old baby but as a 2 month old baby – this is the adjusted age. Even after adjusting for age, it’s important to remember that no two babies are the same.

It is important to seek advice from your pediatrician if you feel your baby is not reaching the correct milestones at their adjusted age. Your pediatrician may suggest for you to see a physiotherapist if they feel that your baby needs some help to catch up.

Physiotherapist will assess your child’s muscle tone, strength, movement patterns, reflexes and motor skills including a general assessment of vision, play skills, social interaction, communication and fine motor development. The physiotherapists will track the development of you babies’ gross motor skills using various outcome measures.

They may also use the General Movement Assessment.

The General Movements Assessment (GMA) is a non-invasive, observation-based and cost-effective way to identify neurological issues which may lead to Cerebral Palsy and other developmental disabilities.

All infants have typical and distinct spontaneous “general movements” from before birth right through to 20 weeks post term known as ,,writhing” and ,,fidgety” movements. Infants whose general movements are absent or abnormal are at higher risk of neurological conditions. GMA is used to identify pathologies in movement patterns and, depending on the type of abnormality, can be highly predictive of Cerebral Palsy by about 3 months of post term age.

The assessment can be completed from birth to approximately 5 months of age including necessary correction for children born before due date. GMA may give information on how your baby’s neurological system is developing especially if there were medical concerns at birth such as oxygen deprivation or prematurity. As a result, if an infant is diagnosed as at risk of cerebral palsy using GMA, the treatment intervention can start very early with potentially better outcomes.

It is important to seek attention as early as possible if you feel your premature baby isn’t moving correctly, acquiring motor skills in line with milestones, feels stiff / floppy in their muscles and lacks strength. Early intervention by a highly specialized pediatric physiotherapists is essential.

Physiotherapists use different techniques but essentially they aim to improve strength so that your baby begins to reach motor milestones. They often use a neurodevelopmental treatment approach (Bobath) through play using facilitation techniques.

Another treatment approach used in early intervention is Vojta therapy.

Vojta Therapy is a neurologically based treatment approach with aim to activate basic, pre-determined movement patterns in child’s brain. This leads to gradual improvement of coordination and movement performance in many areas including postural control, gait, grasp, breathing, speech, eye movements, the swallowing process, bladder and bowel function. Understandably, this type of treatment is the most efficient in early infancy as Central Nervous System is enormously adaptable and abnormal movement (substitutive) patterns have not been established yet. Therapy is carried out by stimulation of defined zones on the body in supine, prone or side position. Body musculature is activated on a subconscious level, thus eliciting two basic movement complexes- Rolling and Creeping. Therefore, child doesn’t practice single tasks such as reaching or sitting, but tends to activate the whole body as well- cooperating unit in order to achieve automatic regulation of posture, support function of the extremities and required movement precision.

The Vojta therapy is characteristic for its close cooperation between the therapist and parent/s as commitment to structured home exercise program is vital for treatment success. The therapist supports parents and regularly adjusts the treatment program based on child’s overall progress.

# 5. When should my child walk independently?

All children are different. As an early intervention physiotherapist I usually tell parents that children may walk independently anytime between 10 and 16 months.

Walking is one of the most anticipated developmental milestones where desire, motivation and a child’s temperament have at least the same impact as brain and physical development.

However I would like to check children when they are 9-10 months old and not yet able to do one of these- Roll, Sit Up or Move around using Crawling on tummy or knees.

# 6. What does an Occupational Therapist Do?

Paediatric Occupational Therapy encompasses working with children aged from 0 – 18, covering a wide range of conditions and problems to promote their function. Some of the conditions we work with include Autism Spectrum , Attention Deficit Hyper Activity Disorder, Dyspraxia and Cerebral Palsy, working to improve function in activities such as writing, dressing, fine motor and gross motor activities and self-care based activities.

Our aims are to enable your child to live as happy and independently as possible. We meet goals that YOU set through meaningful activities that children enjoy doing.

As children grow and develop they may encounter some development problems, both as a result of a diagnosed condition and environmental factors or biological influences. Children may be not meeting their developmental milestones at the right time, compared to other classmates, or be struggling in school with handwriting or in P.E, which can worry a parent. One of our highly trained and experienced therapists will help alleviate some of these concerns through assessment and a personalised treatment plan.

  • Fine motor skills: Coordinating the small muscles such as the hand (usually in co-ordination with the eyes), to enable your child to hold, explore and manipulate toys and tools such as a pencil or spoon. Fine motor skills are used in activities such as handwriting, dressing, feeding and using scissors.
  • Gross motor skills: Involve the large muscles of the body that are important for major body movement such as sitting, walking, jumping, and throwing a ball.
  • Tool Use: Involves utilising objects within the hand such as cutlery or pencils for play, self-care and handwriting skills.
  • Handwriting: A child must have sufficient manual dexterity, fine motor coordination and visual motor skills for handwriting. Areas such as letter formation, reversals, speed, legibility, pencil grip, reducing pain and/or fatigue may be addressed.
  • Table top and School Readiness: These activities are generally the expected requirements when starting kindergarten. For example: drawing, cutting, on-task classroom behaviour, task completion, following instructions and craft skills.
  • Self-care skills: Involve skills such as using a knife and fork, tying shoelaces, fastening buttons and dressing and toileting.
  • Play skills: Are those that are used in everyday play, such as threading and using puzzles as well as the imaginative, social and communication requirements.
  • Visual perception: Involves understanding what is being seen. Visual perception is highly important in completing many activities, such as reading a story, completing a puzzle, identifying letters and numbers, copying and writing.
  • Sensory processing: Involves the way the body processes and reacts to the information it receives from the surrounding environment. Children may demonstrate over or under sensitivity to certain sensations such as loud noises or certain items of clothing; sensation seeking behaviour, such as chewing on things or enjoying being spun repetitively; and difficulty maintaining a calm state.

Hand therapy

It is a service provided by either an Occupational Therapist or a Physiotherapist with a higher degree of training in the rehabilitation of hand and upper limb. It is a specialized service that often requires advanced certification or accreditation. Hand Therapy involves the use of physical modalities, therapeutic exercises and splinting in order to facilitate the reintegration of clients into their various roles.

  • Hand, Wrist and Elbow fractures/dislocation
  • Post-operative hand rehabilitation
  • Trauma and Crush Injuries of the Hand
  • Upper Extremity Splint prescription for correction/prevention of injury
  • Work Hardening & Manual Dexterity Skills Training/re-education
  • Activities of Daily Living Skills re-training
  • Hand & Upper Limb Sensory rehabilitation after nerve injury

Back to Top

The Children's Medical Centre

Address

1060 Al Wasl Road,
Umm Suqeim 2,
P.O. Box 215524,
Dubai, United Arab Emirates.