What is Therapy Stars?

Therapy Stars is an independent paediatric physiotherapy company (what a mouthful!). Essentially that means….we offer private physiotherapy to babies, children and young adults. That can be physiotherapy alongside any NHS therapy input, or instead…it’s up to you!

The Therapists at Therapy Stars are there to help you and your child decide the best way of delivering the therapy that you need. You will work as a team, so it is essential that you build a good relationship with your child’s therapist. That is why we try to offer flexible, prompt appointments at a location to suit you all. This may be at your child’s home, at their Grandparent’s house, at school or nursery, or even in a clinic setting. You and your therapist can discuss which combination works best for your child.

Treatment techniques, frequency and duration will also vary dependent on each child and what their needs are. This will be constantly monitored by your child’s physiotherapist and discussed with you from the first appointment, after a thorough assessment.

Therapy Stars covers a large area, as we are based near Shropshire, Cheshire, Staffordshire and Wrexham. The main towns that we cover are:

Wrexham, Mold, Oswestry, Whitchurch, Ellesmere, Shrewsbury, Market Drayton, Crewe, Nantwich, Winsford, Northwich, Welshpool, Chester, Ellesmere Port, Stoke and surrounding areas. If you live in or near these towns and would like more information about the services that we can offer you and your child, please contact info@therapystars.co.uk or ring Sian Boffey on 07813 764938

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Cerebral Palsy (CP)-what does it mean?

Cerebral Palsy (CP) is now a widely used diagnosis given to many children. It is a term that can cover a wide spectrum of varying degrees of disability-it may include a mild impairment that only minimally affects a child’s everyday function, or a child may present with full body involvement and use a wheelchair as their permanent mobility. Obviously a blog post couldn’t possibly cover such a complex subject, but I’ve written this basic guide as a start….:

So what does CP actually mean? It is widely accepted that CP refers to a non-progressive, neurological disorder that is caused by a brain injury or developmental malformation of the brain. It is primarily a motor function disorder that affects muscle movements, posture and co-ordination. This can obviously present in many different ways and each individual is unique.

So to simplify that further…CP affects the way an individual can move and control some of their muscles. This can be often due to fluctuations in the tone of their muscles. Tone (in a basic explanation) refers to the amount of resistance that occurs when you try to move a limb or muscle. For most people with normal muscle tone, when relaxed, someone could easily bend their elbow so that their hand is close to their shoulder. This is because in a relaxed state the main muscles around our joints are not rigid so can be passively moved (moved by someone else). For a child with CP this may be slightly different: they may have high tone (hypertonia or spasticity) which would mean there is excessive resistance to any movement of certain muscles. They could also have some muscles which are low tone (hypotonic) and appear more “floppy” than you would expect. This will then affect their ability to move and control any of these muscles groups.

Cerebral Palsy is often broken down and classified even further, depending on how or where a child is affected. For example, if CP only affects one side, it can be referred to as being hemiplegic CP. If only the lower limbs are affected, this is known as diplegic CP and if all 4 limbs are affected quadriplegic CP. These all involve some degree of high tone (spasticity). There are also children who have CP that have lots of unwanted movements. This can generally be classed as either athetoid CP, where the child has constant unwanted movements, even when trying to sit still, or ataxic CP, which involves poorly controlled and co-ordinated or awkward movements. However, like many disorders, it is not easily “labelled” and even within each classification, every child will present very differently.

From a physiotherapy perspective, a full assessment can provide us with vital information about which main muscle groups are most affected. Rigid, high tone muscles can often lead to joints becoming stiff and even having reduced range of movement, which then affects function further. Unwanted movements and/or low tone can make mobility and simple tasks such a sitting on a school chair very difficult. It is our job to try to help a child to fulfil their full potential and to minimise any limits to their everyday function. Plus the key is…to make therapy FUN for every child. That way they don’t even realise that they are working hard!

If you would like more information, or think that Therapy Stars can help your child, please contact me on info@therapystars.co.uk or 07813764938.

 

Baby walkers-why don’t physiotherapists like them?

Lots of parents choose to put their baby into a baby walker. These activity centre style walkers tend to be advertised as being for babies as young as 6 months old and are often marketed to parents as a way of encouraging a child’s mobility. So….why don’t paediatric physiotherapists recommend them?

A baby in a baby walker

An example of a baby walker activity centre.

 

There are 2 main reasons why we would not recommend a baby walker: The first is due to safety and the second because of development.

Safety: Any parent’s first priority is to keep their child safe. However every year there are many reports of babies being injured whilst in a baby walker. These accidents include trapping arms/legs, head injuries and burns/scalds. Some studies have shown that just under half of the babies that are put into a baby walker will experience some form of injury whilst using it. If you do use or decide to use a walker, never leave your child unattended.

Development: A baby will walk when a baby is developmentally ready. In order to get to the point of walking, a baby has to learn so many other things. The timescales for a baby to walk will also depend on their body shape, motivation, personality and many other factors.

Various studies carried out have shown that not only do baby walkers NOT encourage a child’s development but they can actually cause a delay in a baby’s motor development milestones. Spending lots of time in a walker limits the amount of time spent in other positions like lying on the floor. Here your baby will learn skills that are crucial to their motor development like rolling, sitting and using their arms and hands to lean on. Walkers also alter a baby’s ability to see their legs and feet. At such a young age babies are learning where their bodies parts are, relative to themselves and to their environment…again a skill that is essential for a developing baby. There is also evidence that suggests that the use of baby walkers can cause a child to walk on their toes. This may be because their muscles and joints are not ready to take their own body weight at such a young age. The toe walking may also continue once your child is walking independently.

It is for these reasons that baby walkers are not recommended. However if you do decide to use one with your baby, the APCP (Association of Paediatric Chartered Physiotherapists) have published a parent leaflet that advises that your child is ALWAYS under close supervision and that they use a walker for no longer than 20 minutes at a time. Also ensure your child’s feet are flat on the floor, not up on their toes. This can be found at http://apcp.csp.org.uk/publications/parent-leaflets

If you require any further advice or information about the use of baby walkers or your baby’s development, please contact Therapy Stars on 07813 764938 or info@therapystars.co.uk

 

Toe Walking-can physiotherapy help?

You may never have noticed, but some children tend to walk up on their toes, rather than keeping their heels down. This is referred to as “toe walking”. But why do they adopt this position?

 
In many cases, the reasons are never known why a child may start to walk on their tip toes. Some walk like that from very early on-as soon as they are on their feet. Others develop their walk in this position as they get older. Many children choose to walk on their toes for some of the time, as a game or to avoid a cold floor for example. But toe walking refers to children who walk up on tip toes for most of the time and often struggle to correct their position by keeping their heels down.

A child in a toe walking position.

A child in a toe walking position.

Toe walking can be very common and many toddlers grow out of it. However it can be associated with other conditions, such as cerebral palsy (CP). Children with CP may have tight Achilles Tendons due to spasticity (rigidity) in their muscles and this causes them to have to walk up on their toes. Some children who seek sensory feedback (for example children on the Autistic Spectrum) may adopt a toe walking position as a sensory strategy.

 
But for many there can be no definite reason for toe walking-this is known as idiopathic toe walking. Most children who are idiopathic toe walkers end up with some degree of tightness in their Achilles Tendon and calf. This is because the calf does not get a full stretch when in a pointed position, as it is when toe walking. But part of toe walking can also be attributed to habit…and this is often the hardest part to rectify. Therefore early intervention can be extremely beneficial.

 
For children who toe walk there are several methods of physiotherapy treatment that may help. Firstly a full physiotherapy assessment would be carried out. The Therapist would look at muscle length, particularly around the calf and Achilles Tendon. They would also assess muscle strength, especially the muscles of the lower limb and core (back, hips and abdominals). They would then provide an exercise programme that targets muscle lengthening and strengthening. For younger children this may involve parents being shown how to stretch certain muscle groups and encourage activities that help to strengthen particular muscles. For older children, it may be more appropriate for them to be taught how to stretch and strengthen themselves. They may also use a stretching wedge to specifically stretch the calf muscles.

 
Regular, daily stretching is important in order to gain some length in the muscles and therefore allow your child to be able to put their heels down more easily. However, for some children, stretching alone may not be enough. These children may require further intervention that can include serial casting (regular plaster casts being applied to the ankles over a period of 4-6 weeks to gain a consistent stretch), splints (made of plastic, they hold the ankle in a certain position, therefore preventing toe walking) or in very severe cases surgery.

 
If you have any concerns about your child toe walking or would like some advice, please contact Therapy Stars on info@therapystars.co.uk or 07813 764938.

 

Hypermobility and your child

Having recently been asked to assess and advise parents regarding their child with hypermobility, I thought it may be useful to look at hypermobility in general. Many parents are told that their child is hypermobile…but what does this mean for your child? Hypermobility is the term used when you have more than normal range of movement at some or all of your joints. Is if often referred to as being “double-jointed”. It is relatively common, particularly in children, as we get less mobile as we grow older. Like many conditions it encompasses a wide spectrum from mild to more severe symptoms.

A mild case of elbow hypermobility.

A mild case of elbow hypermobility.

In a lot of cases, being hypermobile may have absolutely no consequences for your child-they may just realise that they are slightly “bendier” or  more flexible than their friends. But for some children, where they have several hypermobile joints, it may first become noticeable when they aren’t quite as quick to reach their developmental milestones.

 
Delayed walking can sometimes be an indicator that a child may have hypermobility around their ankles. For these children, supportive, well fitting footwear is crucial. Shoes should have a good supportive heel and sturdy upper material to offer you child’s foot maximum support and stability. Occasionally a child may benefit from specialist orthopaedic boots which can be prescribed through a physiotherapist, orthotist or podiatrist (dependent on the service in your area).

 
Children with hypermobile joints may complain of tiredness and fatigue quicker than their friends or siblings. This is due to their muscles having to work harder to stabilise the joints and can also be due to muscle weakness. They may be more prone to injury as their joints allow the body to adopt positions with greater ranges than the norm, which can lead to the soft tissues becoming over stretched. In the most severe cases joints may even dislocate.

 
For some children though this can even become an advantage-gymnasts and dancers are well known for needing to be ultra flexible and many children with hypermobility will excel at these types of disciplines. However it is important for their coaches to always be aware of their hypermobility to minimise the risk of injury.

 
So…what do you suspect your child is hypermobile? Firstly be aware of which of your child’s joints seem to have excessive ranges of movement. This is so that you can monitor any injuries or aches and pains to see if they are related. Pain relief can be given as and when appropriate for your child. If there are ongoing problems with pain and/or injury, then trying to strengthen your child’s muscles can often help. Swimming is a great way of targeting lots of muscles, and children often find it less stressful on their joints because there is no impact. For younger children, soft play areas and using trikes can be good ways of trying to encourage muscle strengthening.

 
In a few cases, severe or widespread hypermobility or hypermobility alongside other specific symptoms, may be an indicator of another condition. If you have concerns that this may apply to your child, you should consult with your child’s GP. There is also lots of information and advice on the Hypermobility Syndrome Association website www.hypermobility.org There is also an information leaflet produced by the APCP (Association of Paediatric Chartered Physiotherapists) which can be found at www.apcp.csp.org.uk/publications/parent-leaflets

 
If your child has hypermobility and you would like an physiotherapy assessment and further advice, please contact Therapy Stars on info@therapystars.co.uk or 07813 764938.

Why is “Tummy Time” important?

Those of you who have recently had a baby or have young children have probably heard about “Tummy Time”. This is where you are told to encourage your baby to spend time playing or lying on their front. But why…?

Evidence has now shown that the safest position for our babies to sleep in is on their back. This is to reduce the risk of Sudden Infant Death Syndrome (SIDS) or cot death. However it is still vitally important for developing babies to spend quality time on their tummies. If a baby is always on their back, they not only miss out on a different perspective of the world, but they may develop flat spots or changes of head shape and/or poor development of their motor skills.

When a baby is positioned on their front, they are encouraged to lift their head and therefore strengthen their back and neck muscles. They also go on to learn to turn their heads from side to side in reaction to what is going on around them. As they get older and stronger, they then start to use their arms to lean on, and strengthen the muscles around their shoulders. This all helps as your baby continues to develop and learn new skills. These muscles are then used as your baby learns to roll, sit, crawl and walk.

You can start to position your baby on their front from birth, but many wait for the first few weeks due to the umbilical cord stump. But once this has come away, your baby needs to start to experience “Tummy Time”. The easiest way to start may be to position your baby tummy down but on your front. This way you can feel that you can monitor them closely. Many babies will find the position hard work, especially at first, so little and often is usually the key! There is no set time so do what works for your baby.

Please remember that the accepted advice is now that babies should only be place on their tummies when awake and supervised. It is not advised for your baby to sleep on their fronts.

If you have any concerns about your baby, or need any advice regarding “Tummy Time” please feel free to contact us on info@therapystars.co.uk or Sian on 07813 764938.

Prone

Muscular Dystrophy

Muscular Dystrophy (MD) is a term used to cover several conditions. Each can present with different severity and symptoms depending on an individual’s diagnosis. Probably the most well known and most common is Duchenne Muscular Dystrohpy (DMD).

DMD is a neuromuscular condition that causes progressive muscle weakness. This is due to a lack of protein called Dystrophin. DMD is a genetic condition linked to the X chromosome, and therefore affects males. Females can, however, be carriers of DMD. Approximately 100 boys are born in the UK with DMD every year.

Boys with DMD often first present with mobility problems at a very young age (around 2-4 years). They may seem clumsy, struggle to keep up with their friends and be unable to complete more difficult physical tasks such as climbing stairs and jumping. It is also very common for them to resort to walking on their toes (although there are many other reasons for toe-walking). They may have frequent falls and tire very easily. Diagnosis can be via a DNA test and/or muscle biopsies, but your first port of call if you have any concerns should be your own child’s GP.

There are several specialist centres for DMD, including 3 in the North-West (Alder Hey, Oswestry and Manchester). They all have their own teams which include Consultants and physiotherapists who review and assess the boys regularly and liaise with their local doctors and therapists.

There is currently no cure for DMD. Treatment consists of managing the symptoms of the condition, which can include maintaining mobility, medication and regular monitoring. There are several research projects and trials being held all over the world to try to find a cure or the best treatment for DMD.

Physiotherapy is key to maintaining muscle length and mobility for a child with DMD. Regular stretching, use of standing frames, hydrotherapy, orthotics and specialised seating all help to promote postural management and maintenance of function. Physiotherapists may also be involved in respiratory management-that is setting up and use of equipment to help the boys maintain their oxygen levels and clear their airways if required.

For specific information regarding Muscular Dystrophy, please look at the Muscular Dystrophy Campaign website at http://www.muscular-dystrophy.org/. The Muscular Dystrophy Campaign is the leading UK charity focusing on Muscular Dystrophy and related conditions. They have the most up to date information regarding treatment and research for MD. They have a fantastic network of families and fundraising across the country.

If you have any questions or concerns regarding your own child, please contact us at info@therapystars.co.uk to see if we can help.

 

 

What is Paediatric Physiotherapy?

Therapy-Stars-header-logoTherapy Stars offers Paediatric Physiotherapy…but what is it?

Paediatric physiotherapists are physiotherapists who have experience and training to specifically treat children and teenagers. All physiotherapists have general training during their degree, and can then specialise in different areas, dependent on their interests, experience and developing skills.

Physiotherapists who work with children can be found in hospitals, in the community and in private practice. They can help children with a variety of symptoms, injuries, conditions and illnesses.

Paediatric physiotherapists will have a solid understanding of child development and growth, as this is a major difference between treating adults and children. They will also have knowledge of treatment methods that aim to maximise a child’s function and potential, whilst appreciating that childhood is a time for fun and enjoyment.

If you are unsure if your child may benefit from paediatric physiotherapy, please contact us at info@therapystars.co.uk or Sian on 07813 764938.

News for April 2014

Please contact me for further information