The goals of physical therapy for torticollis are to improve the child’s ability to turn his or her head from the right to left side, improve ability to bring chin to chest, and improve ability to orient his or head to midline against gravity.

For children with low muscle tone, also known as hypotonia, our physical therapists address proximal strength and support in order to improve postural control, facilitate motor development, improve postural responses, address fluidity and efficiency of movements, and improve functional strength.

Our physical therapists work with children to help improve certain skills such as organization, ability to complete everyday tasks quickly and well, and control their hyperactivity.

It is common for children with Autism Spectrum Disorder (ASD) to struggle with coordination and posture control. Our physical therapists help children with ASD develop their gross motor skills and basic movement skills. These skills help children with ASD play games, sports, and more.

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Our physical therapists work with children with Down’s Syndrome to improve muscle strength, balance, coordination, and movement skills to improve independence with daily activities and quality of life. Early intervention by a physical therapist can help a child with Down’s Syndrome develop to their maximum potential.

For children with Cerebral Palsy, physical therapy can help improve motor skills and can help to slow down the progression of movement problems over time through implementing strength and flexibility exercises that ultimately help provide the child with more independence.

Our physical therapists will first evaluate the child to determine the child’s specific strengths and weaknesses and then a personal treatment plan aimed at building motor skills one step at a time to reach established goals will be created.

Plagiocephaly is a result of deforming forces from constant contact of the head with a resting surface. This is secondary to no variation in the position of the head. Risk factors of plagiocephaly include uterine malformations, postnatal positioning, male gender, and muscular torticollis.

Interventions for this are similar to interventions used for torticollis, encouraging range of potion, strength, postural control, positioning and caregiver instruction. Other interventions can include splinting, taping, and cranial helmets.

Juvenile Idiopathic Arthritis (JIA) is an autoimmune disease where white blood cells lose their ability to tell the difference between the body’s healthy cells and harmful invaders. The immune system releases chemicals that damage healthy cells and cause inflammation and pain. There are 5 subtypes of JIA: polyarticular arthritis, oligoarticular JIA, systemic JIA, psoriatic JIA and enthesitis.

• Polyarticular Arthritis affects large and small joints and is found in large and small joints. The cervical spine and TMJ may be involved and the person may also have a low grade fever.
• Oligoarticular JIA is the most common subtype and affects girls more than boys. This type of JIA affects less than 4 joints. Symptoms of this subtype of JIA include pain, stiffness and swelling of joints, most commonly the knee, ankle, and elbows. Inflammation of the iris may also occur.
• Systemic JIA is the least common subtype and boys and girls are affected equally. The person may have a spiking fever 1-2 times daily for 2 weeks, may have a rash on the trunk, limbs, face, palms, and soles of feet. The spleen and lymph nodes may enlarge and many joints are affected by swelling, pain and stiffness.

Idiopathic Toe Walking has no known neurologic or sensory cause. It cannot be explained by any other diagnosis and may be intermittent or consistent. Idiopathic toe walking increases fall risk, shortens stride length, limits gastroc soleus strength and ROM and decreases stability.

Most children with idiopathic toe walking can correct this pattern when asked.

Physical therapy can help with idiopathic toe walking by helping to increase foot range of motion, increase strength of foot, and helping to sensitize the bottom of the feet to normalize walking.

Childhood obesity is a major public health problem that can be addressed by physical therapy. Today, children are 4x less active than their grandparents were. Obesity is strongly associated with insulin resistance which when coupled with insulin deficiency.

Kids with Type II Diabetes Mellitus are at risk for developing vascular complications earlier.

Physical therapists can examine these patients for possible orthopedic conditions, perform strength and balance tests, and assess any pain. PT can also help make exercise programs and recommendations.

Spinal Muscular Atrophy is a disease of the anterior horn cells of the spinal cord that leads to progressive motor weakness. Children with SMA present with weakness that is symmetrical and more proximal than distal, meaning that the weakness in the lower extremities is greater than in the upper extremities. Children may have limb and trunk weakness, contractures, hip subluxation and spinal deformities.

Physical therapy is used to address SMA through prevention of contractures and deformities, positioning for comfort and posture, range of motion and strengthening, bracing, adaptive equipment and providing opportunities to strengthen respiratory muscles.

Arthrogryposis Multiplex Congenita is a non-progressive disorder that is present at birth. Children are born with severe joint contractures, muscle weakness and fibrosis. The upper extremities and lower extremities are affected. Children with this may also have hips that dislocate at birth, facial deformities, and scoliosis.

Osteogenesis Imperfecta (OI) affects the production of collagen in bone and other tissues but it is not caused by poor nutrition. The primary concerns of OI include laxity of joints, weak muscles, challenges with collagen production and frequent fractures.

Physical therapy is used to address safe handling/movement, protective positioning, energy conservation, splinting, bracing, strengthening and prevention of deformities or fracture.

Muscular Dystrophy is a progressive loss of muscle contractility caused by the destruction of myofibrils. Dystrophin is a protein in the scaroleminal membrane that helps to keep the muscle fibers healthy. This loss of dystrophin causes the fibers to breakdown, which results in weakness and loss of function. Weakness presents in the neck flexors, pelvic girdle, quadriceps, hip extensors and hip abductors. Weakness will also present in the shoulder girdle. As time goes on, weakness will progress from proximal to distal muscle. These children will have a wide base of support in walking, lordosis, knee hyperextension, retracted shoulders, ankle plantarflexion, iliotibial band contractures, hip flexion contractures, toe walking and frequent falling.

Physical therapy can be used to improve range of motion, increase strength, splint/brace, and maintain strength and endurance without overworking. Physical therapists assist patients with muscular dystrophy by improving functional mobility, respiration and possible post operative care.

Spina Bifida is termed a defect in the formation of the spinal cord. There are three types of Spina Bifida: Spina Bifida Occulta, Meningocele, and Myelomeningocele. Spina Bifida Occulta is a hidden lesion and is the mildest form.

Meningocele is the type that contains only the membranes that end in the sac wall. There is no nerve damage with this type. Myelomeningocele is an open spinal cord defect. Skin does not cover this lesion and it is associated with paralysis. This is the most severe form of spina bifida.

Children with spina bifida may have upper extremity weakness and they are defined as the level that is the lowest intact. These children may have upper limb discoordination, cranial nerve palsies, spasticity, progressive neurological dysfunction, skin breakdown and obesity. Spinal deformities associated with spina bifida include scoliosis, kyphosis, hyperlordosis and other muscular imbalances.

Physical therapy is used to address these impairments through strengthening, stretching, positioning, splinting, standing, posture, maintaining range of motion, and addressing gross motor goals.

Clubfoot is the most common deformity in newborns caused by a defect in early gestation. The calcaneus, talus and navicular bones of the foot are often involved. It results in shortened achilles and ligaments on the inside of the foot, making the infant’s foot appear to be curved inward.

Physical therapy can address this birth defect with casting, stretching, and strengthening early after birth. The goal of physical therapy is to stretch the medial structures, maintain alignment, proper positioning and mobility and developmental activities.

The brachial plexus is a network of nerves that sends signals from the spinal cord to the shoulder, arm and hand. An injury to the brachial plexus occurs when these nerves are stretched or compressed. Newborns can sustain brachial plexus injuries, especially after a difficult birth. Erb’s palsy is a type of brachial plexus injury that causes a child to have weakness or stiffness in an arm.

Physical therapy for brachial plexus injuries uses a combination of gentle and mild exercises, which includes massage, strength exercises, gentle stretching, and range of motion movements in order to speed up the healing of the damaged nerves and optimize the affected arm’s strength.

Scoliosis is a sideways curvature of the spine that most commonly occurs during a child’s growth spurt just before puberty.

The purpose of physical therapy treatment for scoliosis is to help the curved spine return to a more natural position, with the ultimate goal of improving posture, improving core stability and strength, alleviating pain associated with the condition, and improving movement.

Hip dysplasia is when a hip socket doesn’t completely cover the ball portion of the upper thighbone, resulting in the hip joint becoming either partially or completely dislocated. DDH tends to run in families and can be present in either hip. However, it usually affects the left hip and tends to be predominant in:

• Girls
• Firstborn children
• Babies born in the breech position (especially with feet up by the shoulders)

W-sitting is when a child is sitting on their bottom with both knees bent and their legs turned out away from their body, forming a “W” shape with their knees and legs. Some of the negative implications associated with W-sitting include:

• Promotes bad posture
• Leads to deficits in balance
• Can lead to hamstring tightness or hip dislocation

Physical therapy can help a child cease sitting in this position.