Child S is a delightful two year old little 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 of age and she was on a waiting list for further assessment by the Children’s Community Physiotherapy and Occupational Therapy Service but mum was keen to have some therapeutic support during the waiting period.
On assessment, a full medical history was provided by mum whilst S played. She was under the care of a hospital paediatrician, from birth for a left sided torticolis, central hypotonia and delayed gross motor skills and she was waiting to be picked up by a community paediatrician. Mum’s main concerns for S were her difficulties in sitting on the floor and in her high chair and that she was not crawling. Her torticolis was much improved and S was able to hold her head in midline, with no tilting.
The physio assessment looked at S in a variety of positions, observing which movements she could achieve by herself, which patterns of movement she used and how much effort she had to use. 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 was observing was a true reflection of S’s abilities.
Play, singing and musical toys were used to make the session enjoyable. Assessment findings were shared with mum, and explained, to ensure she understood what physiotherapy was aimed at helping S to achieve.
Main findings of assessment:
S had low muscle tone around her neck, shoulders and upper body which made it difficult for her to hold her head up when she was on her tummy, to roll from her back to her tummy and to sit up by herself. Her arms were weak and she was unable to push herself through her arms, to move about when she was on the floor. She was more comfortable if she was placed onto her tummy but she was stuck and soon got upset. She was easily frightened by noise and was 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, enabling S to hold her head with more control when on her tummy and in sitting.
- To strengthen shoulder girdle muscles and teach S how to pivot to either side.
- To strengthen arm muscles to enable S to push up on straight arms onto her hands.
- To develop sitting skills.
- To learn how to move into sitting from lying and back down to lying again.
- To introduce a variety of textures and noisy toys, with care, to broaden S’s experience and improve her tolerance.
S attended for weekly ½ hourly sessions with goals incorporated into play. Mum led all the activities with guidance from the physio, helping her to gain confidence in her own handling skills, making therapy a little easier at home.
Short term outcomes:
Treatment began in April 2013 and 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
Although her NHS appointment came through, S continues to attend Tiny Tim’s and is now able to crawl at speed, move into standing and to step when her hands are held. She is more tolerant of a variety of noises and enjoys touching most textures.