Click here to return to the Main / Home page

Physiotherapy and Special Needs

Use these links to find the section you are most
interested in or just scroll down the article.

Introducton	Signs to watch for	Special needs
Conditions Treated	Early Intervention	Physical Difficulties
What can parents do?	How can a physiotherapist help?

We have come a long way from using terms such as crippled, handicapped, disabled or mentally subnormal. The term special needs really comes from 'special educational needs'. The British 1993 Educational Act states that a child has special educational needs (SEN) if she or he has learning difficulties and needs special help. The code of practice thus issued gives guidance on how to identify and assess special educational needs. In other words, such a child finds it much harder to learn than most children of the same age, or the child has a disability which makes the normal educational facilities in the area unsuitable to meet the child's needs.

To return to the top click here 

Special needs

Special needs covers a huge area of different conditions which may be caused by physical and/or disability, visual, hearing or speech/language problems, a medical or health problem, emotional or behavioural problems,

A child with special needs can be a child, for instance, with mild cerebral palsy but normal intelligence attending a mainstream school. Or it can be a child with attention deficit disorder also attending a mainstream school but requiring a learning support assistant or a learning support teacher to help with the specific learning difficulties the child is experiencing. The educational need of some children with learning difficulties can not be met by a normal state school and these children , upon a careful educational assessment, will then attend a school for moderate (MLD) or severe learning difficulties (SLD). .

Some children present with problems in more than one area and hence professionals from different disciplines become involved with the child in a multidisciplinary approach.

To return to the top click here

Physical Difficulties

The paediatric physiotherapist is primarily involved with children who have physical difficulties. Some children present with problems in more than one area and hence professionals from different disciplines become involved in the care of the child. The physiotherapist will then be part of the multidisciplinary team involved in helping the child.

The physiotherapist can become involved in the care of the child at any stage during the child's development depending on when problems are identified and when the appropriate referral to physiotherapy is made. As part of the multidisciplinary team the physiotherapist is also asked to write a report as part of the statutory assessment which then will be used to draw up the child's Statement of Special Educational Needs if the child has any physical problems which need attention once the child enters school. The child will then continue to receive physiotherapy once attending school.

To return to the top click here

Conditions Treated

Amongst other, the paediatric physiotherapist has a very active role to play in helping the child with special needs. Typical conditions with a physical disability element seen by the physiotherapist are children who have dyspraxia ('clumsiness'), are blind or have cerebral palsy, hydrocephalus, congenital syndromes, such as Downs Syndrome, global developmental delay, spinabifida, congenital limb deficiencies and progressive neuromuscular conditions.

In unfortunate cases when the child is born with severe brain damage or with a syndrome such as Down's it is usually clear that the child will have special needs. And in such situations the baby or child will fairly quickly be channelled/referred to the local child developmental centre where a multidisciplinary team will be set up to help the child with his or her various needs. For instance, in a child with Down's Syndrome the local multidisciplinary team will consist of the following professionals: the G.P., health visitor, the hospital and community paediatrician, the portage worker (from the education department), the paediatric physiotherapist, the speech and language therapist and most likely also the occupational therapist.

The majority of children, however, who will be classed as having special needs are identified at some stage during the first 12 months (regular developmental check at your GP or health visitor or your own worry will bring the problem to attention), or often even later i.e. when the child is expected to walk at his or her first birthday, expected to say a few words, understand when you are talking to him or her , or even later when the child attends nursery school and starts to falls behind his peers in his or her learning abilities.

Unfortunately, problems are often identified only at a later stage during the child's development. This is partially related to the fact that more skills are expected of the child with increasing age and some problems such as reading or writing difficulties are only noticed once the child is expected to be able to read and write.

As a parent when do you know that your child has special needs? Parents often wonder whether their child is normal, are there any problems, what to do if there are problems, where to go for help etc.

To return to the top click here

Early Intervention

Early intervention is vital! From a physiotherapists point of view, I cannot emphasise this strongly enough. Babies and children love movement and through movement they learn about themselves and their environment. The numerous childhood conditions which can affect the child's physical abilities, therefore, can reduce a child's ability to move freely and well. Poor movement may lead to poor physical development, impaired learning and a lack of self-confidence. If you are worried about your child's development seek help and advice early!

So are there any early signs during the child's first 12 months which could indicate there may be some problems with the child's physical development.

To return to the top click here

Some of the signs and behaviours that prompt parents to bring their children for a "physio check".

1. Your baby performed poorly at the regular developmental checks with the health visitor.
2. Your baby may have feeding or swallowing difficulties.
3. Your baby does not react well when you talk to him or her, or to loud noises, banging doors etc.
4. Your baby may be very irritable , restless and has an irregular sleeping pattern.
5. Your baby may have poor head control.
6. You notice floppiness in his trunk or limbs.
7. You may notice stiffness in the legs, typically noticed during nappy changing, or your child may like to be held up in standing just too much.
8. Your baby may appear to use one hand better than the other, or she or he may always prefer to look to one side.
9. Your baby was born very prematurely, there were some complications at birth. It was weeks before you could take your baby home. At the follow-up appointment your doctor may say your baby is behind in his/her development but should eventually 'catch up'.
10. Your baby has inturning feet (positional talipes) and you may have been shown some stretches by the hospital physio whom you saw in the maternity ward. But now you are not sure whether your baby's feet are okay.
11. Your baby is 5 months old but makes no attempt at sitting up. You have also noticed that your child is slightly floppy. Your baby dislikes being placed on his/her tummy and does not appear to push up with the arms as your other children did at this age.
12. Your child engages in a lot of repetitive movements with little ot the variety you expect.

1. Your child has had his/her 1st birthday. He /she has never crawled but shuffles on his/her bottom. Your child is not motivated to stand or walk. You worry - "Is my child a late walker?"
2. Your child appears "delayed" in more than two areas.
3. Your child is uncoordinated and much more clumsy than other children you know
4. Your child has been walking for two years already but is very pigeon toed and tends to fall over his feet. Because of this, it appears, he can't run as fast as the others.
5. Your child is four years old and cannot yet ride a tricycle. He / she dislikes long walks, often falls when running around and his/her general movements appear uncoordinated. Is my child clumsy?
6. You suffer from back ache and have noticed your five year old slumped in front of the TV and think to yourself: I hope he won't get a bad back like mine!

Please remember that the above are only examples and if your baby or child does present with any one item mentioned it does not necessarily mean that your child is going to have a problem.

It is always better to seek early advice from a physiotherapist.

Frequently a little help from a physiotherapist - a "physio check" (developmental assessment) for your baby or child may simply help to put your mind at rest. Don't worry - help and advice are available!

To return to the top click here

What can a you do if you are concerned ?

• Trust your own instinct!
• If you think there may be something not quite right with your baby or child seek advice early!
• Contact your health visitor or go and see your GP. In some boroughs you can self-refer yourself to the physiotherapy department are your local child development centre.
• If you decide to go for private healthcare, you can contact a physiotherapist directly.
• Better act than wait even if you are told to 'wait and see'!

To return to the top click here

What can a paediatric physiotherapist do for your child?

• The therapist will assess your child holistically - that means looking at the "whole child" - and will identify the areas of physical concern. Together with the parent an appropriate treatment programme will be drawn up
• Give support and advice
• Offer your child therapy which may consist of massage, therapeutic exercises, neuro-developmental therapy, mobilisation, stretching and strengthening, posture education, sensory-integrative therapy and hydrotherapy
• Give you a home exercise programme and show you how to integrate therapy techniques, i.e. such as correct handling and positioning of the child into daily life
  • physically stimulate the child and help with play activities.
  • help to 'fill in the gap's' in your child's development.
  • Work/liaise with other professionals involved in the care of your child

To return to the top click here

References
'Special Educational Needs' a guide for parents, published by the British Department of Education, 1994

Swing by Kiki's Children's Clinic