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How Physical Therapists Help Children with Cerebral Palsy

August 22, 2023

Cerebral palsy (CP) is a group of neurological disorders. It is caused by damage to the immature, developing brain, usually before birth. CP can have a broad range of effects. People with CP may have trouble seeing, hearing, feeling, thinking, or communicating. Difficulties can range from mild to severe. CP also typically affects movement, muscle coordination, and balance. This can result in problems moving and walking, abnormal muscle tone, exaggerated reflexes, and involuntary movements. There is no cure for CP, but early treatment can help.

Physical therapy is one of the most important forms of treatment for children with CP. PT can help children improve their movement skills, stay active, and perform daily tasks. PT can also help prevent movement problems from getting worse over time and reduce physical discomfort. Let’s look at a few of the ways PT can be helpful:

Take Advantage of Neuroplasticity

Neuroplasticity is the ability of the neurons and neural networks in the brain to form new connections and change their behavior. This can help the brain to adapt or “train” other areas to take over the function that the damaged part was intended to do. Neuroplasticity is highest during the first few years of life, when the brain is still developing and forming new connections. This means that early intervention PT can have a greater impact on the brain’s ability to reorganize and learn new skills.

Early PT can help children with CP enhance neuroplasticity by providing exercises and activities that stimulate and challenge their brain and nervous system. This could involve playing with children in different positions that challenge their balance and stability, encouraging the use of affected limbs, or using different forms of sensory stimulation. 

Improve Motor Skills and Function

Children with CP often have difficulty with motor skills and function due to muscle spasticity, weakness, or stiffness.

PT helps children with CP improve their motor skills and function by providing exercises and activities that target the large muscles in the arms, legs, and abdomen. For example, a physical therapist may use strength training, stretching, or balance training to improve the child’s muscle tone, range of motion, and stability. For young children, a PT might also use functional training techniques like crawling, climbing, walking, or propelling a wheelchair to improve the child’s mobility and independence.

Prevent or Delay Secondary Complications

Secondary complications are problems caused or are worsened by the primary diagnosis of CP. These can include muscle atrophy, loss of range of motion, muscle spasticity, pain,  joint inflammation, and contractures. Secondary complications affect the child’s daily function, health status, and quality of life.

PT can help children with CP prevent or delay secondary complications by providing exercises and activities that maintain or improve their physical health and functioning. Examples include massage or stretching to relax and lengthen the muscles, positioning devices to improve posture, or braces, splints, or orthotics to support and align the affected joints.

Increase Quality of Life and Well-being

Movement limitations and environmental barriers can affect the self-esteem, confidence, and social relationships of children who have CP.

PT can improve the quality of life and well-being of children with CP by providing exercises and activities that are tailored to their individual needs and goals. Adaptive equipment such as wheelchairs, crutches, or bicycles can help the child access their community and enjoy recreational activities. A physical therapist will also work with the child’s family and other professionals to provide education and support for the child’s overall health and development.

Conclusion

Early physical therapy is a vital form of treatment for children with cerebral palsy. It can help them take advantage of neuroplasticity, improve motor skills and function, prevent or delay secondary complications, and increase their quality of life and well-being. PT can help kids with CP be as independent, comfortable, and healthy as possible. 

If you are looking for an early intervention physical therapist for your child with cerebral palsy, you can visit Choose PT to find one near you.

References 

1. Physical Therapy for Cerebral Palsy – Improving Mobility. (n.d.). Retrieved from https://www.cerebralpalsyguide.com/treatment/physical-therapy/
2. Physical Therapy for Children with CP. (n.d.). Retrieved from https://www.cerebralpalsy.org/about-cerebral-palsy/treatment/therapy/physical-therapy
3. Cerebral palsy – Diagnosis and treatment – Mayo Clinic. (n.d.). Retrieved from https://www.mayoclinic.org/diseases-conditions/cerebral-palsy/diagnosis-treatment/drc-20354005
4. Cerebral Palsy and Physical Therapy. (2022, April 28). Retrieved from https://www.cerebralpalsyguidance.com/cerebral-palsy/treatment/physical-therapy
5. Therapy has long-lasting benefits for children with cerebral palsy. (2021, November 9). Retrieved from https://www.nih.gov/news-events/nih-research-matters/therapy-has-long-lasting-benefits-children-cerebral-palsy
6. Early Intervention for Cerebral Palsy: Examples & What to Do. (n.d.). Retrieved from https://www.flintrehab.com/cerebral-palsy-early-intervention/
7. Morgan, C., Fetters, L., Adde, L., Badawi, N., Bancale, A., Boyd, R. N., Chorna, O., Cioni, G., Damiano, D. L., Darrah, J., de Vries, L. S., Dusing, S., Einspieler, C., Eliasson, A.-C., Ferriero, D., Fehlings, D., Forssberg, H., Gordon, A. M., Greaves, S., Guzzetta, A., … Novak, I. (2021). Early Intervention for Children Aged 0 to 2 Years With or at High Risk of Cerebral Palsy: International Clinical Practice Guideline Based on Systematic Reviews. JAMA Pediatrics, 175(8), 846–858. https://doi.org/10.1001/jamapediatrics.2021.0878
8. Therapy for Cerebral Palsy | Early Intervention | CerebralPalsy.org. (n.d.). Retrieved from https://www.cerebralpalsy.org/about-cerebral-palsy/treatment/therapy
9. Early Intervention and the Importance of Early Identification of Cerebral Palsy – Physiopedia. (n.d.). Retrieved from https://www.physio-pedia.com/Early_Intervention_and_the_Importance_of_Early_Identification_of_Cerebral_Palsy
10. Cerebral Palsy Early Intervention. (n.d.). Retrieved from https://cprn.org/cerebral-palsy-early-intervention/

Let’s Get Back Into A Routine!

August 15, 2023

As school is beginning to get started again for another year many of us are getting reminded of what is feels like to get back on schedule or to start a new routine. Our children are getting used to going to bed at a specific time and will soon be learning about their new routine for their school and class schedules. Even as parents we are getting used to being home more at night, ensuring our children (and ourselves) are getting the proper amount of sleep, and a new morning routine to try to get out of the house on time for school and work. Routines provide structure and promote physical and mental health benefits. While the word routine may bring on feelings of boredom, stress, or anxiety, it can be a very valuable tool in living our lives to their fullest.

We use the word routine a lot in therapy. It is one of the tools that we use to help a patient reach their fullest potential as quickly as possible. We try to develop a new routine for the patient that includes their home exercise plan, which is an integral part of an effective and efficient physical therapy plan of care. It is important that the therapist and the patient work together to develop a home exercise plan that they can complete and commit to. Making a plan with small changes and adjustments that are built around our current life and habits may make the routine easier to establish and follow.

Take some time as we work to get back into the school and fall season to begin to make a routine for you and your family to follow. Use the next few months of 2023 to try out this routine, make adjustments, and reflect on how it is working. This can allow for clearer resolutions for 2024 and catapult you into next year!

References

https://www.fortbehavioral.com/addiction-recovery-blog/the-importance-of-routines/#:~:text=Routines%20create%20structure%20and%20promote,common%20response%20to%20these%20feelings.

https://www.nm.org/healthbeat/healthy-tips/health-benefits-of-having-a-routine

Witte Physical Therapy Areas of Concentration – Orthopedics

August 8, 2023

Many people think of outpatient physical therapy and orthopedics as being the same thing. They feel that the main reason to go to a physical therapy clinic is because of pain or issues they are experiencing from an orthopedic issue. Orthopedic structures tend to fall into 3 categories: bone, muscle, and ligament. These tend to be the causes of back pain, shoulder, knee, or other joint pain, pulled muscles, joint replacements, worker’s compensation accidents, motor vehicle accidents, rotator cuff and other types of shoulder repairs, and the list goes on and on. For these issues physical therapy is a very common non-invasive, conservative treatment option that could save you from unnecessary medications, injections, and procedures.

At Witte Physical Therapy we have an Orthopedic Certified Specialist who can assist in the formation of our patient’s individualized plan of care and who regularly trains our therapists on how to treat and progress these issues as effectively and efficiently as possible. A therapist who has obtained an Orthopedic Certified Specialist certification has received extra training and successfully passed an additional federal board examination to be recognized as a specialist in the management and treatment of orthopedics. Witte Physical Therapy is fortunate to have one of the 5% of physical therapists who have achieved a specialist certification.

Treatment of any orthopedic condition can include a wide range of interventions using many different “tools from our toolbox”. While every treatment for every patient needs to be properly evaluated and assessed by a physical therapist to provide the best care for each individual patient, the list of interventions we can use is endless. Manual therapy can be used to improve soft tissue abnormalities and extensibility to improve motion and flexibility. Exercise can be used to improve strength and mobility. Other interventions can improve balance, stability, coordination, and function. Aquatic therapy, functional dry needling, IASTM, and many other tools can be used to improve all these areas. Witte Physical Therapy can address all these areas and use all of these tools to maximize your results!

How Physical Therapy Helps People with Parkinson’s Disease

August 1, 2023

Parkinson’s disease (PD) is a progressive neurological disorder that affects movement, balance, posture, and coordination. It can also cause non-motor symptoms such as pain, fatigue, mood changes and cognitive impairment. While there is no cure for PD, there are treatments that can help manage the symptoms and improve the quality of life of people living with PD.

Physical therapy is one of these treatments. PT can help restore or maintain physical function, mobility, and independence. Physical therapists are trained professionals who can assess, diagnose, and treat movement problems related to PD. They can also provide education, advice, and support to people with PD and their caregivers.

Benefits of Physical Therapy for People with PD

Physical therapy can help people with PD in many ways, such as:

Improving muscle strength and endurance. Both age and PD can weaken and decondition muscles. A physical therapist will prescribe exercises using light weights or resistance bands to improve strength. More strength helps with balance and mobility.

Enhancing amplitude of movement PD can cause people to reduce the size and speed of movements. This can affect walking, speech, facial expressions, and gestures. Physical therapy can help increase the amplitude of movement by teaching overexaggerated physical movements, such as high steps and arm swings. This is a way to retrain the muscles and brain to compensate for the reduced movement that Parkinson’s can cause. The LSVT BIG program is a specific set of exercises and activities that has been shown to improve mobility and quality of life.

Reinforcing reciprocal patterns. Reciprocal movements are side-to-side and left-to-right patterns, such as swinging your arms while taking steps as you walk. PD can affect these patterns, which makes walking slow and unstable. Physical therapy can help to reinforce reciprocal patterns by using machines like a recumbent bicycle or elliptical machine. Practicing walking with arm swings is another activity that can help restore reciprocal movements. This can improve coordination, rhythm, and fluidity of movement for people with Parkinson’s. Dance and tai chi are other activities that involve reciprocal patterns.

Improving balance and posture. PD commonly impairs balance. Your brain uses a complex mix of what you see, your inner ear and sensations from your feet and joints to maintain balance. Physical therapy can help to improve balance using exercises that challenge stability, such as standing on one leg or walking on uneven surfaces. PT will also focus on specific components of the balance system by doing things like having a person close their eyes to focus on the sensations from the feet and joints. Physical therapy can also improve posture by correcting any muscle tightness or weakness that may cause stooping or learning sideways.

Increasing flexibility and range of motion. PD also often causes muscle stiffness and rigidity. Physical therapy can help increase flexibility and range of motion with stretching exercises that target specific muscles. Common areas of issue are the hip flexors, hamstrings, and calves. Stretching regularly can also help to reduce pain and spasm.

Providing education and self-management advice. Physical therapy can help people learn more about PD and how it affects their movement. A physical therapist can provide tips on how to maintain safety when exercising, how to cope with fatigue or pain, how to use assistive devices if needed, and how to prevent or manage complications such as falls or freezing.

Sounds Great. Is There Proof?

Yes. Research backs up all these claims. One meta-study (a study that combines the results of many other studies) that covered 1827 participants found that when compared to no intervention, PT significantly improved:

• gait speed
• two- and six-minute walk test scores
• Freezing of Gait questionnaire
• the Timed Up & Go test
• Functional Reach Test
• and the Berg Balance Scale

These results indicate improvements in mobility, endurance, strength, and balance. Gait speed is an especially important measurement. Physical therapists often consider gait speed a “vital sign.” This is because low gait speed has been linked to:

• declines in functional mobility
• higher rates of hospitalization
• higher fall rates
• cognitive decline
• increased disability
• and higher risk of death

A larger meta study that included 191 studies with 7998 participants found that PT significantly improved motor symptoms, gait, and quality of life. Specifically:

• Resistance and treadmill training improved gait.
• Strategy training improved balance and gait.
• Dance, Nordic walking, balance and gait training, and martial arts improved motor symptoms, balance, and gait.

Conclusion

Physical therapy is a valuable treatment option for people with PD, as it can help to improve or maintain their physical function, mobility, and independence. Physical therapy can also enhance their quality of life, confidence, and well-being. If you have PD or know someone who does, consult with a physical therapist who specializes in PD to see how they can help you.

References

(1) Physical Therapy for Parkinson’s Disease – Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/physical-therapy-for-parkinsons-disease.

(2) Physical Therapy and PD | Parkinson’s Foundation. https://www.parkinson.org/library/fact-sheets/physical-therapy.

(3) Physical and Occupational Therapy for Parkinson’s: What to Expect. https://bing.com/search?q=physical+therapy+for+parkinson%27s+disease.

(4) Parkinson’s Disease Treatment Physical Therapy. https://www.parkinsonsdaily.com/parkinsons-disease-treatment-physical-therapy/.

(5) Physical, Occupational & Speech Therapies | Parkinson’s Foundation. https://www.parkinson.org/living-with-parkinsons/treatment/physical-occupational-speech-therapies.

(6) Physiotherapy in Parkinson’s Disease: A Meta-Analysis of Present Treatment Modalities – https://pubmed.ncbi.nlm.nih.gov/32917125/

(7) Physiotherapy versus placebo or no intervention in Parkinson’s disease – https://pubmed.ncbi.nlm.nih.gov/24018704/

Witte Physical Therapy Areas of Concentration – Pelvic Health

July 18, 2023

As a small community physical therapy company, we try to be as many things to as many people as we can. We try to serve our community both inside our clinic and outside.

Outside of our clinic we work to support many different groups and organizations to ensure they have the resources they need to continue to thrive in and serve their communities. We provide community service and work to be an advocate for our communities by being involved with different groups and boards.

Inside of our clinics we have worked to assemble a staff that puts patients first. They work to build an individualized plan for each patient so that not all patients who have had a total knee replacement get the same plan. We have also worked to get our staff extra training and experience in many different aspects of physical therapy. We have an orthopedic certified specialist on board. We have a therapist who has taken a special interest and more advanced training in vestibular and balance therapies. We have a therapist who has seen and worked with a variety of women’s health issues. And finally, we have a therapist who has an extensive background in pediatric therapy. These are just a few of the areas that we have tried to work with as many patients as possible for our therapists. Today, let’s focus on those patients who could benefit from pelvic health therapy.

Most of the time when we think of pelvic health we think of woman’s health and pelvic pain. This pain can be from childbirth, aging issues, or other causes. However, men can have pelvic issues leading to pain or incontinence. Physical therapy aims to help correct and treat these issues for all types of patients.

A physical therapy evaluation will be performed by our pelvic health physical therapist to determine the cause of your issues and to develop a plan of care based on those findings. Treatment could consist of a variety of techniques aimed at improving flexibility, strength of intrinsic and extrinsic musculature, and core stability to name a few. Your treatment plan will be specific to you and developed based on your symptoms and goals. Most of the time these treatments are performed in a private room to give you the privacy you need to be comfortable with what we are working on.

If you are having any pelvic issues give us a call and set up a time to talk to a therapist to develop a plan that will work best for you!

Witte Physical Therapy Areas of Concentration: Vestibular and Balance Therapy

July 11, 2023

As a small community physical therapy company, we try to be as many things to as many people as we can. We try to serve our community both inside our clinic and outside.

Outside of our clinic we work to support many different groups and organizations to ensure they have the resources they need to continue to thrive in and serve their communities. We provide community service and work to be an advocate for our communities by being involved with different groups and boards.

Inside of our clinics we have worked to assemble a staff that puts patients first. They work to build an individualized plan for each patient so that not all patients who have had a total knee replacement get the same plan. We have also worked to get our staff extra training and experience in many different aspects of physical therapy. We have an orthopedic certified specialist on board. We have a therapist who has taken a special interest and more advanced training in vestibular and balance therapies. We have a therapist who has seen and worked with a variety of women’s health issues. And finally, we have a therapist who has an extensive background in pediatric therapy. These are just a few of the areas that we have tried to work with as many patients as possible for our therapists. Today, let’s focus on those patients who could benefit from vestibular and balance therapies.

Vestibular therapy aims at improving balance and vertigo related symptoms associated with an inner ear dysfunction. It is important to note that not all balance issues are vestibular because our vestibular system is just one part of our overall balance. Three “systems” that make up our balance system are our eyes, our ears, and our musculoskeletal system. Vestibular deals with the ear and the mechanism that helps us feel where we are at in space. This system needs more specialized work than traditional physical therapy normally provides. We have a duct system in our inner ear that has a X, Y, and Z axis. This system houses tiny crystals that move in these canals as our bodies move in order to keep us upright and centered. Special evaluation techniques, interventions, and exercises are used to correct these crystals if they get stuck or travel down the wrong duct system. We have therapists who has taken extra training in working with and correcting these issues. 

Balance therapy can include vestibular components, but sometimes balance issues are related only to musculoskeletal deficits. When we start to use our balance we use three strategies to try to prevent a fall. Our ankle strategy focuses on quick and reflexive foot movements to correct a loss of balance episode. Our hip strategy takes over if we need more help to stop a fall. It involves try to shift our center of gravity over our current base of support. Finally our stepping strategy is engaged if we are unable to stop a fall without widening our base of support. Physical therapy can help make sure these strategies are all operating optimally and in the correct sequence. 

If you are having any balance issues give us a call and set up a time to talk to a therapist to develop a plan that will work best for you!

Sleeping Strategies with Shoulder Pain

June 27, 2023

If you are experiencing shoulder pain often it affects many aspects of your life. It can make reaching for objects, getting dressed, or trying to lift anything a pain. Many people do not realize that their shoulder pain can also cause great issues with sleeping. Laying on your back or on your side can be very uncomfortable. If you are a stomach sleeper often you put your arms above your head, this position can also cause a lot of discomfort. So how can you find a way to get some sleep?

One option that many try is to sleep in a recliner. Sleeping in a recliner allows you to adjust your head height. This adjustment can take pressure off of your shoulder and help to keep the joint better aligned which will decrease your pain and stress. 

Another option is to try to sleep on your back with pillows under your shoulder blade to help support your shoulder complex. This is often another technique that can help decrease your shoulder pain with sleep.

The position of your shoulder that often offers the most space and thus the least pain is the 30 30 position. This position puts your shoulder into 30 degrees of flexion and 30 degrees of abduction and provides a way to avoid any excessive compression. Positioning your shoulder with pillow propping into this position while laying on your back or side can often provide some shoulder relief.

Overall there is no one right answer to decrease your shoulder pain to help you sleep, but helping your body to get rest is pivotal in working on improving your recovery and decreasing your pain.

Dehydration

June 20, 2023

As we are in our hottest run of hot weather yet this summer the topic of dehydration has come up multiple times in the clinic. Keeping properly hydrated is important for our normal health, but becomes increasingly important as we are healing and as we are dealing with increased temperatures.

Dehydration is caused by losing more fluids than we take in. This can cause a host of issues in our bodies due to the imbalance of fluid and nutrients that it causes. Some early signs of dehydration are a dry mouth, feeling thirst, feeling tired, urinating less, or having urine that smells or looks differently. 

Dehydration can affect anyone, but being an athlete or active adult, having chronic medical conditions, or recovering from an illness or procedure can make you more susceptible to dehydration.

If you are experiencing any of these issues it is important to remember to try to drink more fluids. If doing this makes you feel sick, then you need to take more frequent smaller drinks. Try to avoid any flavored or carbonated beverages. Tea and coffee may also not be the best choice when trying to get rehydrated. 

Staying hydrated will keep your blood levels up and flowing through your body. This allows for the nutrients and oxygen that you need to feel you best and that your tissues need to heal. It is recommended adults should drink at least 64 ounces of fluid per day. If you are at risk for dehydration that amount should be increased. 

Perhaps a water bottle (Witte Physical Therapy has some!) should be just as important of an accessory to carry around with you as your phone is!

References:

https://www.nhsinform.scot/illnesses-and-conditions/nutritional/dehydration#:~:text=Dehydration%20is%20caused%20by%20not,of%20physical%20activity%20and%20diet.

https://extension.usu.edu/news_sections/home_family_and_food/summer-hydration

How to Travel After Surgery

June 13, 2023

It is summer! It is a great time of year to get out and enjoy the outdoors, catch a ball game, and take that family vacation. Unfortunately some of us need to have surgery in the summer. This could be elective or not our choice, but regardless of the reason surgery does not need to put a damper on your summer travel plans. Here are some tips to think about when you are preparing to travel after a surgery.

Travel with someone: After a procedure it is important to have a buddy when you travel. Whether you are driving a car or flying, traveling alone can contain some risks. These include faster fatigue, balance or gait issues, or some other rare side effects that your physician went over with you prior to traveling. Having a buddy with you ensures that there is an extra set of eyes to keep you safe.

Keep moving: After any procedure it is important not to sit too long. We want to get up and move every hour or two to keep our blood flowing. This also helps with trying to minimize blood clots, can work to improve swelling, and can keep fluid out of our lungs. 

Stay hydrated: This is a tip we all could probably do a better job of. Keeping our fluid intake up after a procedure if key in recovery. It is also another requirement in trying to avoid a blood clot.

Dress appropriately: We want to avoid wearing any restrictive clothing. As we travel and become active we may not be able to control or predict our swelling patterns. Restrictive clothing can be very uncomfortable and hinder blood circulation after surgery. Wear something loose and comfortable. 

Avoid stress: Traveling can be stressful, especially if you are on a schedule that you have to keep. Giving yourself extra time to get where you need to go can take some of the stress of traveling.

It is always important to talk to your surgeon about your travel plans to make sure that you know the risks and are aware of any precautions that you need to take. Having these conversations and proper planning can keep you safe and allow you to “let loose” this summer!

References:

https://newsnetwork.mayoclinic.org/discussion/when-your-summer-travel-includes-surgery-mayo-clinic-expert-offers-tips-for-a-safe-trip-2/