National Collaborating Centre for Women's and Children's Health

4 Physical therapy
(physiotherapy and/or
occupational therapy)
Introduction
Children with developmental and physical problems due to an upper motor neurone lesion (UMNL)
usually receive physical therapy (that is, physiotherapy and/or occupational therapy). Physical therapy
typically starts when developmental concerns first arise or at the time of injury, and it continues
throughout childhood and into adult life. Physical therapists use a proactive and preventative
approach centred on understanding the causes of the child or young person’s current functional
problems and how these impact upon their ability to develop and maintain skills and participate in
home and school life, and in the wider community. As well as managing functional problems, physical
therapists have a large educational and advisory role, helping children and young people and their
families or carers understand their conditions and prognoses.
Spasticity usually forms one physical feature in a complex movement disorder caused as a result of a
UMNL. Advances in the understanding of motor learning, neurodevelopment and how the child or
young person responds to different situations and environmental changes support a functional
approach to therapy, giving greater priority to maximising activity and participation in line with the
domains of the World Health Organization’s (WHO’s) International Classification of Functioning,
Disability and Health (ICF) Framework. The ICF Framework includes a version that is specific to
children and young people (ICF children and youth version). The link between these domains is not
clearly defined but it is recognised that negative and compensatory phenomena resulting from a
UMNL (for example neurological weakness, poor movement control, abnormal sensation, health
issues and reduced fitness and body condition) may have a more significant impact on a child or
young person’s ability to participate in everyday life than spasticity alone.
A child or young person’s physical therapy needs, which are usually assessed on an individual basis,
may be complex and multifaceted, changing throughout their lifetime as they develop physically and
cognitively. The severity of the neurological damage, age demands and resulting functional problems
determine physical therapy goals and interventions. Physical therapists recognise that a child or
young person’s cognitive ability, personality, health and fitness, family situation, comorbidities,
environment and social context have a significant impact on activity and participation. Many physical
therapy interventions have a wider impact and require responsibility to be shared between different
types of healthcare professionals, the child or young person’s family or carers, and social care and
education services.
Physical therapists recognise that movement difficulties in children and young people are complicated
by growth and the effects of gravity, which can cause increasing secondary compensation effects of
muscle and bony deformity. These can result in pain and limitation of activity causing reduced quality
of life and increased family stress, emotional difficulties and care needs. Physical therapists are vital
in recognising and managing these limitations, referring on to professional colleagues for advice and
further management where necessary. Physical therapy is used in conjunction with other
interventions, such as oral drugs, botulinum toxin type A (BoNT-A), continuous pump-administered
intrathecal baclofen (CITB), orthopaedic surgery and selective dorsal rhizotomy (SDR), to improve
effectiveness and aid rehabilitation.
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