Physiotherapy case

Child S is a delightful two year old girl with delayed development. Her mum contacted Tiny Tim’s when S was one year old, following a recommendation from her Health Visitor.

S had attended NHS physio led “Tummy Time” sessions at nine months. She was on a waiting list for further assessment by the Children’s Community Physiotherapy and Occupational Therapy Service. Mum was keen to have some therapeutic support while she waited.

On assessment mum gave a full medical history while S played. S had been under the care of a hospital paediatrician from birth for a left sided torticollis, central hypotonia and delayed gross motor skills. She was waiting to be seen by a community paediatrician. Mum’s main concerns were S’s difficulty sitting on the floor and in her high chair and that she was not crawling. Her torticollis was much improved and S could hold her head in midline with no tilting.

The physio assessed S in a variety of positions. She observed which movements S could do by herself, which patterns of movement she used and how much effort they took. S’s posture was observed when she was moving and when she was still. Her balance, strength, movement and co-ordination were checked. The physio explained what she was looking for and checked that what she saw was a true reflection of S’s abilities.

Play, singing and musical toys made the session enjoyable. The findings were shared with mum and explained so she understood what physiotherapy aimed to help S achieve.

Main findings of assessment

S had low muscle tone around her neck, shoulders and upper body. This made it hard for her to hold her head up on her tummy, to roll from her back to her tummy and to sit up by herself. Her arms were weak and she couldn’t push through them to move about on the floor. She was more comfortable placed on her tummy but she got stuck and soon became upset. She was easily frightened by noise and very sensitive to different textures, which she avoided touching. S often rocked her head from side to side.

Initial physiotherapy goals

• To strengthen neck muscles so S can hold her head with more control on her tummy and in sitting.
• To strengthen shoulder girdle muscles and teach S how to pivot to either side.
• To strengthen arm muscles so S can push up on straight arms onto her hands.
• To develop sitting skills.
• To learn how to move into sitting from lying and back down again.
• To introduce a variety of textures and noisy toys with care. This broadens S’s experience and improves her tolerance.

S attended weekly half hour sessions with the goals built into play. Mum led all the activities with guidance from the physio. This helped her gain confidence in her own handling skills and made therapy a little easier at home.

Short term outcomes

Treatment began in April 2013. Within 6 weeks S had:

• Developed head control in prone
• 50% improvement in pivoting
• Able to push up onto hands when lying on tummy
• Able to maintain sitting on mat whilst pushing on right hand

Her NHS appointment came through but S continues to attend Tiny Tim’s. She can now crawl at speed, move into standing and step when her hands are held. She is more tolerant of a variety of noises and enjoys touching most textures.