It is our experience that children do not like new situations. Therefore prior to the appointment it is important that the parents explain to their child the reason for the visit and what a physiotherapist does. In simple terms the parents should explain that a physiotherapist looks at how strong people are and how they move. Sometimes when children are finding some activities difficult it may be due to poor muscle strength. The assessment will be fun and the child will not be asked to carry out any task that they find hard.
The child is asked to wear a T shirt and shorts to ensure that full observations can be made on how the child moves. The assessment takes approximately one hour and parents are asked to stay for the session so that any difficulties can be highlighted and explained at the time. A full explanation of the findings will be explained at the end of the session. Goals and aims of what the child should achieve by the end of treatment will be made. A full copy of the assessment will be forwarded to the parents within a couple of days and copies of the summary are sent to the G.P., school and any other relevant professionals.
Normally a child is seen on a weekly basis for 8 sessions and treatment is supplemented by a daily home programme. Each treatment sessions takes approximately one hour and parents are asked to stay during the session and join in with some of the activities. It is important that sessions are kept to time as there will be another patient following . For this reason, the session will conclude 5 minutes before the next appointment. It is advised that the child wears a T shirt and shorts for each session.
The sessions consists of carrying out exercises and activities to improve the muscle strength and skills. Initially, the child is asked to complete 10 repetitions and these are increased by 5 repetitions per week until 35 - 45 repetitions are achieved. Games and activities which can be purchased from retail shops are used to improve co-ordination, short term memory and planning skills.
The Home programme
An important part of the programme is that in order to assist the child to reach their maximum potential some daily activities must be carried out. There are two programmes taught, each one lasting 4 weeks. This is to ensure that the child does not become bored and keeps an interest in the treatment. On the first treatment the physiotherapist will demonstrate and Practice the exercises and activities that are to be continued with at home. Generally a child is asked to carry out 3 exercises for the hips and shoulders. There are many different muscles around the hip and shoulder joints all of which need to be strengthened and for this reason the child is asked to complete 3 shoulder and 3 hip exercises every day.
The home programme also consists of ball activities to Practice and these will be demonstrated to the parents and the child. These only need to be Practiced 10 times each day and take no longer than a few minutes to complete.
The physiotherapist will also lend games which may be taken home. The Practice asks that care is taken with the games and that no pieces are lost. If however, something is lost or unavoidably broken it is asked that the game is replaced.
The parents and child are asked to discuss when would be the best time to carry out the programme in their daily routine. Generally, the activities should take no longer than 20 minutes. The programme may be broken down so that some exercises are carried out in the morning and some in the afternoon. It is important to consider the family routine and those of the siblings.
Liaison with Schools
The Practice considers that liaison with schools is an important part of the overall management with these children. For this reason a copy of the summary is sent to the school via the parents, with a short leaflet on advice within the classroom and P.E. setting. In addition, there is a liaison diary which the class teacher, parent and physiotherapist use in order that there can be good communication between them. In addition, the school is also informed of the progress made at the review and reports are sent following annual reviews. The Practice is always happy to receive calls from teachers who require further assistance.
At The End of Treatment
During the last session , the Physiotherapist will discuss with the parents a programme of activities go continue with until the child is reviewed 3 months later. The amount of activities is not as intense as during the treatment but it is necessary as it assists with the long term maintenance of improvement. In addition, if some areas remain to have residual weakness, these can be improved upon. As it is obviously more difficult to carry out the activities when there is no regular input from the physiotherapist, the Practice has devised a chart for parents to use in order to assist with this. During this time, it is also more important that additional sports and activities are encouraged not only to maintain the improved muscle strength and skills but also to promote social skills and interests.
This takes place 3 months following the completion of treatment and the tasks and activities carried out in the original assessment are reviewed. This will ascertain the amount of improvement and from the scores taken a percentage of improvement can be calculated. A long term management programme is then devised. This involves a checklist which the family are asked to complete on a monthly basis to ensure that the scores in key areas are maintained at an age appropriate level. Further advice is also given for activities, games and strategies to assist the child in as many situations as possible. It should be remembered that during sudden growth spurts, difficulties may manifest themselves again and a further although often shorter course of treatment may be required.