Neurological conditions are conditions that affect the brain, nerves and muscles. In children, they cover a wide range of diseases and disorders affecting the developing brain of the unborn or newborn child, traumatic and acquired brain injury in children and adolescents, and degenerative disorders that become apparent in childhood when gross motor milestones are not met or there is regression in already developed skills. Some of these conditions are relatively common, others are very rare. Some more commonly known conditions include cerebral palsy (CP); neuromuscular conditions, such as Duchenne muscular dystrophy (DMD) and spinal muscular atrophy (SMA); developmental coordination disorder (DCD), and acquired brain injury (ABI).
--How do I know if my child has neurological condition?
Neonatal period
Brain development is rapid in the unborn and newborn baby. The developing brain is sensitive to injury. Lack of growth or development of the brain, premature birth, infection or a lack of oxygen to the brain during this time puts the infant at risk of brain damage. Cerebral palsy (CP) is the term used to describe damage to or lack of development in the brain of newborns up to two years of age.
It is a permanent condition that affects muscles and movement control. One in 500 children is affected by CP, and it is the most common physical disability in childhood, ranging from mild to severe problems of movement, coordination, weakness and stiffness of the muscles.
Babies and toddlers
The first two years of life is a time of rapid growth and development. The newborn, unable to lift their head or roll over, grows into a toddler learning to stand and walk. The range of normal motor development is wide, but failing to meet motor milestones is a sign that there may be a problem.
Maternal and child health nurses regularly see babies and toddlers through this period and are checking to ensure that the growing baby is meeting these motor milestones. A weak and floppy baby, a baby with a persistent head lag, a baby not learning to roll or sit up, or an older baby not learning to move about on the floor and move into and out of sitting and standing, are all reasons to be concerned about your child’s gross motor development.
Pre-school
Problems with walking, not learning to run or jump, frequent falling (more than other children their age), uncoordinated or awkward movement, or a loss of physical skills, are all reasons to be concerned about your pre-school child’s gross motor development.
School-aged
Not keeping up with the other kids in the playground, being the last in every running race, falling over frequently, increasing fatigue for no particular reason, or appearing clumsy, uncoordinated or awkward when moving about, are some of the reasons to be concerned about your school-aged child’s gross motor development.
Acquired or traumatic brain injury (ABI/TBI)
At any stage in childhood or adolescence, a child may fall ill or sustain an injury that affects their brain; for example, stroke, infection or a head injury.
The severity of an ABI/TBI ranges from mild concussion sustained on the sporting field to a traffic accident and a severe head injury where the child is unconscious or unable to respond or follow commands. At any age, if a child has sustained a blow to the head or has fallen from a height, has lost consciousness, or, after hitting their head, develops nausea or sleepiness, or complains of dizziness, call 0-0-0 and seek urgent medical attention.
--What is developmental coordination disorder (DCD)?
A diagnosis of DCD can be made if performance in everyday activities that require motor coordination is significantly below what would be expected from that child’s age and intelligence level. DCD is prevalent in 5–6 per cent of school aged children who display difficulties which may include being unable to master age-appropriate tasks (eg, tying shoe laces, poor handwriting, poor performance in sport and clumsiness). Difficulties can occur in fine and gross motor development, speech and language development, body awareness and coordination of movement; some or all of which are below expected level for their age and are not due to any other neurological condition.
Motor coordination difficulties may impact on academic skills, and social and emotional development. Children with DCD will often have normal intelligence and may not have experienced a delay in their early motor milestones. DCD is commonly, but not always, associated with other developmental disorders, such as ADHD, learning difficulties and speech and language disorders. The cause is unknown but may be linked to the part of the brain that coordinates movement (the cerebellum).
--What are the signs or symptoms of paediatric neurological conditions?
Possible signs and symptoms of a neurological condition in children are: loss of previously present motor skills; failure to meet developmental milestones; history of headaches, blurred vision, eye pain; weakness or floppiness in arms and/or legs; stiffness in arms and/or legs; clumsy, unco-ordinated or awkward movement; unusual walking pattern (wide-based, persistent toe walking, markedly uncoordinated); obvious difference (asymmetry) in strength or coordination between the left and right side of body in arms and/or legs; frequent falls (more so than other children the same age), and increasing fatigue.
Paediatric physiotherapists can assess your child’s gross motor development and determine if there is a problem. Referral to a medical practitioner, such as a paediatrician or paediatric neurologist, may be necessary to determine if there is a neurological or medical reason for the presenting signs and symptoms.
--Should I be worried about gross motor milestones?
Most gross motor developmental milestones occur in a predictable order, but this is not always the case. There is a wide age range for ‘normal’ gross motor development. For example, the age range at which typically developing children start to walk varies from 9 to 18 months of age, with the average age being about 14 months. If you are concerned that your baby or toddler is not meeting their gross motor milestones, a paediatric physiotherapist can assess their development. There a number of standardised and valid assessment tools that can be used to determine if your child is developing at the expected level for their age.
--How can physiotherapy help with paediatric neurological conditions?
Paediatric physiotherapists are trained to engage with children to assess their skills and help them learn to move and participate in activities in their everyday environments. This may be in the home, at childcare, kindergarten or school. Physiotherapy assessment should involve validated or reproducible outcome measures which help to determine treatment-effect and goal-attainment.
Physiotherapy treatment will depend on what the problem is and what the child and their family feel is important to them. Many different types of treatment can be used in paediatric neurological conditions. These may include developmental care, strengthening, stretching, neurodevelopmental (Bobath) therapy, motor learning, fitness training, and early intervention.
The choice of treatment will depend on the child’s age and the nature of their condition.
Physiotherapy treatment for children is fun, motivating and often play-based, appropriate to the child’s age. It encourages active participation by the child. Treatment includes the child’s family and carers who are the people that are with the child most of the time. All treatments should be family-centred and goal-directed.
--How effective is physiotherapy for treating paediatric neurological conditions?
There is limited evidence available supporting the effects of physiotherapy intervention due primarily to the lack of research. The effects of interventions will also be influenced by the nature of the neurological condition itself.
In the area of cerebral palsy (CP) there has been several published reviews of the level of evidence relating to interventions or treatments. These include fitness training, goal-directed/functional training, strength training, hydrotherapy, home-based program of goal based tasks in the child’s own environment, and early intervention.
--What can we do at home?
Families and carers are the people who are with the child most of the time, and it is part of the physiotherapist’s role to teach them how to help their child in their everyday environments such as home, childcare, kindergarten or school. For example, this may be through setting up play situations in the child’s own environment to encourage and facilitate the child to learn to crawl or stand, assisting the child to walk, or assisting with prescribed activities and exercises.
--Can I access funding with the National Disability Insurance Scheme?
Funding through the NDIA is based on its access checklist.
