Pediatric Physical Therapy

Common Disorders in Children:
  • Down Syndrome: a genetic disorder characterized by impaired communication, excessive rigidity, and emotional detachment
  • Cerebral Palsy: a form of paralysis caused by a prenatal brain defect or brain injury during birth resulting in difficulty with certain motor skills and control of voluntary muscles
  • Autism: a developmental disorder characterized by mild to severe mental retardation, weak muscle tone, and a low nasal bridge

Types of Physical Therapy Used:
-Aquatic Physical Therapy: provides buoyancy and support for the body and resistance to help build strength and balance
-Electrical Stimulation: uses a current of electricity to force a certain muscle or group of muscles to contract and release to help increase muscle strength and stimulate blood flow to the affected area
-Sensory Integration: the ability to use a combination of our senses to put together a picture of our surroundings; children with disabilities need extra stimulation and repetition of colors and pictures to help them achieve this more easily
-Casting and Splinting: used to hold the body in place; to help the child stand or walk

Devices Used to Aid in Rehabilitation:
-Mobile Standers: help children stand and move, increase muscle activity, promotes bone density development
-Therasuit: new innovation for children with Cerebral Palsy and other neuro-developmental disorders
-Pushchairs: pivoting seat for proper alignment, supportive adjustable head rest, and ankle straps


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The connection between autism and child physical therapy

Professionals from the fields of psychology and physical therapy both work with children who have severe mental disorders and diseases. Their goals in life are to help these children live as "normal" of a life as possible


Autism- a developmental disorder characterized by impaired social interaction, communication, repetitive behaviors and restricted interests.

  • Autism was first described by Leo Kanner in the 1940s. His definition of autism was attributed to a group of 11 children who demonstrated similar behavioral characteristics some of which included communication difficulties, ritualistic behavior and extreme social isolation
  • The term autism was derived from early definitions of schizophrenia. This led to the idea that schizophrenia and autism were linked.

Myths About Autism

  • Parents Cause Autism- This is a false statement. This idea came about back when Leo Kanner first described autism. One of his early theories was that autism was developed from a 'refrigerator mother', a threatening or unloving parent. We now know this isn't the case.
  • Children with Autism are 'idiot savants'- Idiot savants refer to the conundrum of a person of low IQ displaying qualities of a person with a high IQ. The news and media perpetuate this thought in society's mind by creating movies such as the "Rainman" and showing like qualities on the news. Yet, this is only myth. Autistic children show a wide range of skills and the ability to memorize facts, but most do not show unusual splinter skills.
  • Children with Autistic Syndrome Disorder (ASD) come from higher economically situated families- In the past ten years this myth has been busted. The reason why this myth was around was because the specialists in autism charged a significant amount that only the relatively wealthy could afford
  • Autistic Children are in able to love- It is true that autism was first identified by "autistic aloneness", the inability to form close relationships. This notion persists in the idea that children will never be able to fully relate to others as 'normal' children can. Yet, evidence shows that children with autism can feel a personal sense of love, especially with their mother, father, or other primary caregiver.
  • Autistic children are incapable of communicating and thinking creatively- This is completely false because children with autism can problem solve and use ideas creatively and logically. The road isn't easy to being able to problem solve but if caregivers help the child build these skills other undesirable behaviors will lessen.
  • The value of repetitive exercises- When a child is making little headway into understanding a new skill, it is tempting for the parent and/or teacher to repeat the task. But studies show that as the focus on repetitive tasks increase, the child's interaction will decrease.

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Possible Causes of Autism
  • Theories of Viral illness and immunological deficiency that originated before birth or within the first two years of life
  • ‘Refrigerator mom’ theory is the idea that children become autistic from a frigid, non-nurturing parent
  • Research gradually focuses more on genes
  • No one theory addresses all of the questions associated with autism.

Possible explanations to the causes of signs and symptoms of autism
  • Failure to acquire and intuitive “theory of mind”- This is a neurologically based deficit that in order to be understood one must look at the origin of the specific social communication impairment. Sometimes referred to as mentalizing failure or mind blindness. These individuals have trouble understanding pretence, irony, deception and non-literal language.
  • Weak Central Coherence- There are two major cognitive theories that involve a weak central coherence. The first theory alludes to poor connectivity through the brain as a result of poor pruning. Pruning is the process in which the brain eliminates faulty connections in the neurons. The behaviors that coincide with weak central coherence are non-social features, such as repetitive and obsessive behavior. Autistic individuals can recall the exact words in a story but not the gist of it.
  • Executive dysfunction- An explicit link between the frontal lobe failure and neuropsychological patients that have damaged frontal lobes. Problems addressed by this theory are rigidity and perseveration. There is a strong linking of routine and repetitive behaviors like planning, impulse control, shifting set and the initiation and monitoring of actions.

Broader Phenotype of Autism
  • Phenotype- any observed quality of an organism
  • There is hope for autism in genetic studies. Studies have found that close relatives to an autistic individual show a few of the same characteristics, but milder, as the autistic individual.
  • Also, Baron-Cohen and Hammer reported that parents of autistic children show similar characteristics when it came to involved mentalizing. Thus, another psychologist, Hughes, concluded that children with autism and their parents both show poor planning skills.


Variations of Autistic Disorders

Asperger Disorder

  • Asperger Disorder- A type of autism where an individual is withdrawn from other children, has impaired social, communication, and motor skills but still has high intellectual functioning and specific interests.
  • More common in boys than girls
  • Research is limited

Rett’s Disorder
  • Rett’s Disorder- normal early development in females followed by loss of the use of hands, slowed brain and head growth, seizers, and mental retardation.
  • One of the leading causes of retardation in girls

High Functioning vs. Low Functioning Autism
  • Whether a child is deemed “high” or “low” functioning autism is usually related to
1) The presence or absence of mental retardation,
2) Whether or not the child is verbal
3) The degree to which challenging behaviors are present.
  • If a child has an IQ within average range, can speak short sentences, and is relatively cooperative, she may be described as “high functioning”

Common features of an ASD
  • Well developed motor and visual-motor integration skills- gross motor skills involve large body movements, fine motor skills require discrete movements (writing letters)
  • Mechanical skills
  • Special interests in Numbers or Letters
  • Mental Retardation- 70% , earn an IQ of below 70 must show significant deficits in his ability to perform activities of daily living and social skills
  • Odd Responses to sensory stimuli- can be oblivious to name calling but certain sounds can upset the child
  • Distractibility and High Activity Level
  • Mood Lability- describe a person when their mood is not influenced by environmental experiences. Moody, upset, irritable for no reason
  • Self Injurious behaviors- many have unusual high tolerance for pain
  • Insistence of sameness
  • Limited food preference
  • Sleep difficulties and disturbances- have trouble sleeping, need less sleep than average person
  • Lack of Danger Awareness
  • Depression
  • Seizures- likely to have at least one in their life time

Recommendations to Parents with Autistic Children as given by Demystifying Autism Spectrum Disorders
  • Develop a file that includes all evaluations, recommendations, handwritten notes, data etc. related to your child’s condition
  • Develop Realistic, but respectful goal for your child
  • The more you learn about ASDs, the better equipped and more assured you will be that your child is receiving the most effective treatment
  • Do your best to accept that there will be some “unknowns”, unanswered questions
  • Be vocal in describing the disorder and advocating for your child’s needs
  • Go back and review information in order to assure complete comprehension
  • Communicate and support members of the family
  • Hold two distinct meetings rather than complete both processes during one session- in the child’s education- 1 session in reviewing results of evaluation 2nd session IEP will be developed which includes the child's educational needs and recommendation for classroom placement
  • Balance everyone’s needs within the family (including your own) in order to decrease the possibility of parental burn-out and sibling resentment
  • Although having a child an autism spectrum disorder is not likely your choice for a life experience, it can nonetheless be a path full of insight and rewards
  • Remember that your child is a child first, and a child with ASD second
  • Allow yourself time to digest the fact that your child has an ASD.

The importance of early intervention
  • Research proves that treatment as early as possible improves the overall prognosis of the child
  • Time before age five the brain is rapidly growing
  • Healthy parts of the brain able to compensate
  • Studies show that children who are provided with intensive direct instruction eventually are able to be included in a typical classroom

Resources to find out more about autism:
  • Asperger Syndrome Coalition of the United States
    P.O. Box 351268
    Jacksonville, FL 32235-1268
  • Autism Society in Canada
    P.O. Box 638
    Fredrericton, New Brunswick
    Canada E3B 5B4
    www.autismsociety of
  • Autism Society of America
    7910 Woodmont Ave., Ste. 300
    Bethesda, MD 20841
    301-657-0881; 800-328-8476

Bruey, Carolyn Thornwarth. Demystifying Autism Spectrum Disorders.United States, Woodbine House, 2004.
Frith, Uta and Hill, Elisabeth L. Autism: Mind and Brain. New York, The Royal Society, 2003.
Greenspan, Stanley I and Wieder Serena.Engaging Autism.Cambridge, MA, Da Capo Press, 2006.