Dr.

Mohammed Alghamdi 1
§ The content is for educational purpose and not designed
for distribution by any mean given that materials used are
subjected to Copyrights from publishers. Materials have
been used according to “Fair Use Guidelines” but
permission to use has not been secured in writing.
§ Some slides are courtesy of Dr. Ehab Abdel-Kafy

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§ Pediatric Physical Therapy
§ Philosophy of Service Delivery in Pediatric Physical Therapy
§ Pediatric Physical Therapist: Roles and Responsibilities
§ Comprehensive Assessment and Evaluation
§ International Classification of Functioning, Disability, and Health
(ICF) in Pediatric Rehabilitation

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• Subspeciality in physical
therapy dedicated to infants,
children, and adolescents.
• Focus on the assessment,
diagnosis, and treatment of a
variety of health conditions
in a pediatric population.

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 Help children reach their maximal functional level of independence to
participate as fully as possible in their home, school, and community
environments

• Maximizing the child’s motor skill development

and functional abilities.
• Improving strength and endurance for better
overall health.
• Assisting in the management of pain or
discomfort.
• Facilitating rehabilitation from injuries or surgical
procedures.

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• Developmental Considerations: Treatment is tailored to the child’s specific
stage of growth and development.
• Play-Based Therapy: Play is utilized as a fundamental approach to treatment,
making it engaging and suitable for children.
• Family Involvement: Family members are integral to the therapeutic process
and play a crucial role in a child’s development and adherence to therapy.
• Holistic Approach: The therapy addresses not only physical needs but also
considers the emotional, social, and psychological aspects of the child's well-
being.
• Educational Component: Parents and caregivers are often educated about the
child’s condition and ways to support their development at home.
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§ Family-Centered Care (FCC)

§ Practice Setting

§ Early Intervention

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§ Improved family satisfaction, increased family involvement in care, and better outcomes for
children with disabilities. McManus et al 2021. 8
1. Shock and Denial: Initial difficulty accepting the diagnosis.
2. Emotional Turmoil: Anger, sadness, and confusion.
3. Information Seeking: Gathering details and support.
4. Financial and Practical: Managing costs and care.
5. Social Changes: Altered relationships and interactions.
6. Adaptation: Accepting and adjusting to the reality.
7. Resilience: Building coping strategies.
8. Family Impact: Strengthened bonds, sibling dynamics.
9. Advocacy: Fighting for the child's needs.
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 What is
the child’s n
atural e
nvironm
ent?

the following are all possible settings in which

Pediatric PT can be offered:
§ NICU
§ Rehabilitation Hospital (including sub-acute, and
day hospital units)
§ Home care
§ Inpatient
§ Outpatient
§ Early Intervention
§ School 10
§ Medical setting: episode of care in medical setting may have a focused reason
for care, i.e. pre-surgery breathing exercises, therapists in medical setting may
not have the opportunity or need to be as holistic in their care at all times.

§ School setting: school therapists may not be able to pursue strategies such as
electrical stimulation, or systematic strength training to focus on impairments
that may be hypothesized to influence the activity limitation.
§ Ott and Effgen (2000) examined the naturally occurring opportunities to
practice three types of gross motor behaviors (stability, mobility, and
transfers) among preschoolers. They found a high incidence of opportunities
for stability skills (sitting activities) but a low incidence for mobility and
transfers.
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Leisman, Gerry & Melillo, Robert. (2015). Infant and Childhood Frontal Lobe Development: Asymmetry and the Regulation
of Temperament and Affect. Functional Neurology Rehabilitation and Ergonomics. 5. 443-470. 12
§ Enhances Developmental Outcomes: Early intervention can significantly
improve developmental outcomes. When therapy is started early, it can
capitalize on the brain's neuroplasticity, especially in the first few years of
life when the brain is most adaptable.
§ Minimize Secondary Complications: Timely physical therapy can help
prevent or minimize secondary complications that might arise from the
primary condition. For example, in children with cerebral palsy, early
intervention can prevent muscle contractures and deformities.
§ Improves Motor Skills and Physical Abilities: Early physical therapy can aid
in the development of motor skills, strength, and coordination. This is
particularly important for children who might have delays in these areas due
to their health conditions.

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§ Facilitates Better Long-term Prognosis: Early intervention often leads to a
better long-term prognosis. Children who receive early therapy may achieve
developmental milestones more quickly and effectively than those who start
therapy later.
§ Supports Family and Caregivers: Early intervention programs often provide
support and education for families and caregivers, equipping them with
strategies to aid the child’s development at home.
§ Reduces Healthcare Costs Over Time: By addressing issues early on, long-
term healthcare costs can be reduced. Early intervention can decrease the
need for more intensive therapies or medical interventions later in life.

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§ Comprehensive Assessment and Evaluation

§ Designing Individualized Treatment Plans

§ Collaboration with Multidisciplinary Team

§ Advocacy and Education

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Comprehensive Assessment and Evaluation
Surveillance: The process of recognizing children who may be at risk of
developmental delays (Pediatricians)

Screening: The use of standardized tools to identify a child at risk of a

developmental delay or disorder (Pediatricians, Pediatric Nurses,
Pediatric PTs)

Clinical Evaluation: The complex process aimed at identifying specific

developmental disorders that are affecting a child (Every healthcare
provider)

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Comprehensive Assessment and Evaluation
• Developmental Screening: Essential for monitoring developmental milestones
and identifying potential delays or abnormalities. This can be conducted using
screening tools such as Ages and Stages Questionnaires (ASQ) and Denver-II
Developmental Screening Test

• Clinical Evaluation
• History Review
• Observation
• System examinations
• Standardized testing

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Clinical Evaluation: History Review
§ Birth History: Complications, birth
weight, gestational age.
§ Medical Diagnoses: Past and present
conditions.
§ Surgical History: Relevant surgeries,
especially orthopedic.
§ Medication Review: Current/past
medications and effects.
§ Hospitalizations: Past hospital stays
and medical interventions.
§ Family Medical History: Genetic
conditions or patterns.
§ Developmental Milestones: Age at
key milestones (crawling, walking,
speaking).
§ Previous Therapies: Past therapy
services and outcomes.
§ Functional Status: Daily activity
limitations and challenges.
§ Behavioral/Social History: Behavior
and social interactions.
§ Nutrition/Feeding: Dietary needs and
feeding issues.
§ Immunization/Illness History:
Vaccinations and major illnesses. 19
Clinical Evaluation: Observation
• Movement Analysis: Note • Social Interaction and Behavior: Pay
coordination and any asymmetries. attention to interactions, response to
instructions, and behavior.
• Posture Assessment: Examine resting
and active posture for deviations. • Reaction to Sensory Input: Note
responses to sensory stimuli and any
• Play Activity Observation: Assess
processing issues.
engagement, hand-eye coordination,
and motor skills during play. • Facial Expressions/Non-verbal Cues:
Observe for indications of discomfort,
• Interaction with Environment:
frustration, or enjoyment.
Observe navigation and adaptation to
surroundings.

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Clinical Evaluation: System Examination

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 Clinical Evaluation: Standardized Testing
Assessing specific outcomes using
standardized tests either clinical
(ROM, Berg Balance, etc) or
instrumental tests (Vicon Gait
Analysis)

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Important Consideration in Clinical
Evaluation
Performance:
1. Refers to how a child functions in their natural, day-to-day environment.
2. Indicates how external factors (like environment and social support) impact the child's
abilities.
3. Example: Observing how a child climbs stairs at home or interacts with peers on the
playground.
Capacity:
1. Refers to the child's potential abilities in a controlled, clinical setting.
2. Focuses on the child's inherent physical and cognitive abilities.
3. Example: Assessing how high a child can reach or how long they can balance in a
therapy session.

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Handling of the child during P.T
evaluation
Undressing:
Children less than 6 years of age dislike being undressed, and get tense, and
this may affect the reliability of examination.
To overcome this problem:
- Don't keep the young child undressed for long period.
- The mother should undress the child.
- The examiner help the child get dressed.

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Handling of the child during P.T
evaluation
The examination room:
It should be small, quiet, warm, lighted and restful.

The Therapist:
- Don’t approach the child directly.
- Avoid white coat if necessary.
- Examiner's hand should be warm.

Presence of the child’s caregiver (can be + or – depending on the child).

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Designing Individualized Treatment Plans

• Goal Setting: Specific, measurable, achievable, relevant, and time-

bound (SMART) goals are set in collaboration with the child and
family.
• Treatment Strategies: Various strategies such as strength training,
coordination exercises, balance activities, and functional skill
development are implemented.
• Adaptability: Treatment plans are continually adjusted based on
the child's progress and changing needs.

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Collaboration with Multidisciplinary Teams

• Interdisciplinary Approach: Involves collaboration with other

healthcare professionals like pediatricians, occupational therapists,
speech therapists, and educators for holistic care.
• Family Involvement: The family's role in therapy is critical,
including educating parents and caregivers on supporting the
child’s development at home.
• Coordination of Care: The therapist coordinates care across
different settings, such as clinics, homes, and schools.

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Advocacy and Education

• Advocating for the Child: Pediatric physical therapists advocate for

the child’s needs in various environments, including educational
settings and the community.
• Educational Role: An educational role is played in informing
families, teachers, and caregivers about the child’s needs and
facilitating their development and participation.

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What is ICF?
§ The International Classification of Functioning, Disability and Health (ICF) is a
framework for describing and organizing information on functioning and
disability. (ICF Manual, 2000)
§ It was created in early 2000 to substitute the disablement model (figure
below)

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The aims of the ICF (WHO 2001):
1. Provide a scientific basis for understanding and studying health and health-
related states, outcomes, determinants, and changes in health status and
functioning;
2. Establish a common language for describing health and health-related
states in order to improve communication between different users, such as
health care workers, researchers, policy-makers and the public, including
people with disabilities;
3. Permit comparison of data across countries, health care disciplines, services
and time; and
4. Provide a systematic coding scheme for health information systems.

(ICF Manual, 2000) 31

 The ICF is structured around three broad components (Fig. 1.1):

— body function (b) and body structure (s)

— activity and participation (d)
— environmental factors (e).

This synthesis of different health perspectives – biological, individual and social – enables a
person’s difficulties to be viewed as a whole and is called a biopsychosocial model.
Alterations of body function and/or body structure lead to activity limitation, which in turn
affects the participation of the individual in everyday life situations and in society. In the ICF
framework, functioning and disability are viewed as a complex interaction between the health
condition, environmental factors, as well as personal factors which influence the capacity of

What is the ICF Framework?

the individual. The scale is dynamic in nature to reflect the variability which can affect each
component.

Health condition

(Disorder or disease)

Body functions and

Activity Participation
structures

(Impairments) (Limitations) (Restrictions)

Contextual factors

Environmental
Personal factors
factors

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Figure 1.1 Framework of the International Classification of Functioning, Disability and
Health (WHO 2001).
Heather L. Atkinson, Kim Nixon-Cave (2011)

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 Check out this tool
§ ICF e-Learning Tool

§ http://icf.ideaday.de/en/index.html

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 Check out this tool
§ ICF Core sets
§ https://www.icf-core-sets.org

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§ Campbell’s Physical Therapy for Children
§ https://pediatricapta.org/fact-sheets/
§ ChatGPT was utilized to organize content and generate some
pictures.

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