Cerebral Palsy is a clinical diagnosis that incorporates a “group of permanent disorders of the development of movement and posture, causing activity limitation, that are attributed to non-progressive disturbances that occurred in the developing fetal or infant brain”, according to a review report in 2017. It is a diagnosis that must be made based on both clinical and neurological signs. Cerebral palsy is one of the most common physical disabilities found in childhood, though the complete causal path is unclear in approximately 80% of cases. In children under 2 years of age, motor severity is difficult to predict accurately as their motor skills are still developing and changes in spasticity and tone are unknown. However, there is ongoing strong evidence in the importance of early clinical diagnosis and early intervention to prevent secondary complications and optimise opportunities of neuroplasticity and functional motor outcomes. Paediatric physiotherapy can help in screening children on their motor outcomes, liaising and referring to relevant intervening therapists and recommendations and guidance for parents and caregivers. Early and ongoing physiotherapy treatment for children with CP has been shown to improve cerebral palsy-specific functional outcomes that are task-specific.
Novak I, Morgan C, Adde L, Blackman J, Boyd RN, Brunstrom-Hernandez J, Cioni G, Damiano D, Darrah J, Eliasson AC, de Vries LS, Einspieler C, Fahey M, Fehlings D, Ferriero DM, Fetters L, Fiori S, Forssberg H, Gordon AM, Greaves S, Guzzetta A, Hadders-Algra M, Harbourne R, Kakooza-Mwesige A, Karlsson P, Krumlinde-Sundholm L, Latal B, Loughran-Fowlds A, Maitre N, McIntyre S, Noritz G, Pennington L, Romeo DM, Shepherd R, Spittle AJ, Thornton M, Valentine J, Walker K, White R, Badawi N. Early, Accurate Diagnosis and Early Intervention in Cerebral Palsy: Advances in Diagnosis and Treatment. JAMA Pediatr. 2017 Sep 1;171(9):897-907. doi: 10.1001/jamapediatrics.2017.1689. Erratum in: JAMA Pediatr. 2017 Sep 1;171(9):919. PMID: 28715518; PMCID: PMC9641643.
Muscular dystrophies are a group of uncommon, genetically determined myopathies characterised by progressive muscle wasting. There are different types of muscular dystrophies, which each have different clinical features. The most common is Duchenne muscular dystrophy or DMD, which is caused by absence or impaired dystrophin (gene in the X-chromosome). The role of the physiotherapist is to screen children with functional outcomes that may be deteriorating, as well as management of children with or adolescents with dystrophies for mobility concern, spine management and family support.
Brachial Plexus Palsy
Perinatal brachial plexus palsy is an injury that occur during birth, with nerves of the brachial plexus often damaged when under tension. These injuries are defined as a flaccid paresis of the arm at birth, that passively shows a larger range than active range of motion. There are subtypes of brachial plexus palsy, classified as upper, middle, lower or complete – these different types of palsy identify different cranial nerves that are impacted, resulting in different presentations. One of the most common subtypes of brachial plexus palsy is Erb Palsy, which affects C5 and C6 cranial nerves, affecting shoulder external rotation, abduction of the arm and elbow flexion/supination movements. The progression and outcome of children with brachial plexus injuries vary, depending on the level and the severity of the nerve injury. The role of paediatric physiotherapists are to rate your child’s progress and provide guidance through the rehabilitation to regain strength and function of the arm. It is vital that physiotherapy is started early in the newborn to ensure there are as little problems with joint stiffness, function and muscle imbalances as the child is still growing and advancing through their early life